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By
Sert, B (Sert, Batuhan) ; Oral, MA (Oral, Meltem Ayhan) ; Turan, O (Turan, Ozgur) ; Uyar, I (Uyar, Ilker)
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AESTHETIC PLASTIC SURGERY
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BackgroundProtruding ears are the most common auricular abnormalities seen in children (1). Protruding ears are a condition that has social and psychological consequences due to its physical appearance and one of the main causes of peer bullying at young ages (2). While various surgical methods exist to address prominent ears, the options for correcting the lobule are relatively scarce. In this study, we are aimed to present the modified fish-tail technique that we have developed and to compare it with other techniques in the literature.MethodsThe patients were selected from the cases that underwent otoplasty for prominent ear correction in our clinic between 2020 and 2022. A total of 21 cases that required protruded lobule correction during otoplasty were included in our study. Keloid and hypertrophic scar formation, wound dehiscence, hematoma, infection and recurrence in the lobule were evaluated. The patients were followed up for at least 1 year for early and late complications.ResultsEach patient in the study underwent bilateral prominent ear correction, including bilateral modified fish-tail technique. All cases were followed for at least 12 months. There was no wound dehiscence, infection, recurrence in lobule prominence or hematoma during the follow-up period. No hypertrophic scar or keloid was observed in any case.ConclusionsOur method stands out for its ability to achieve both adjustable vertical height and effective lobule correction with a reduced need for skin excision. We recommend the modified fish-tail technique as an alternative technique for prominent lobule surgery.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of contents or the online Instructions to Authors www.springer.com/00266.
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Author Keywords
Lobuloplasty Protruded lobule Otoplasty Modified fish tail
Flap viability in venous insufficiency models: an experimental study
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Çatalkaya, MB (Catalkaya, Musa Burak) ; Aksam, E (Aksam, Ersin) ; Basol, TB (Basol, Tunahan Berk) ; Uyar, I (Uyar, Ilker) ; Akkalp, AK (Kahraman Akkalp, Asli)
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EUROPEAN JOURNAL OF PLASTIC SURGERY
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Background Viability of fasciocutaneous flaps in distal lower extremity is affected by chronic venous insufficiency. The aim of this experimental study was to investigate how fasciocutaneous flaps in distal lower extremity were affected by the etiology and the level of chronic venous insufficiency. Methods 24 rats were divided into three groups of eight rats each. In the first group, a fasciocutaneous flap was performed on the left hind extremity without creating venous insufficiency. In the second group, the same flap performed three weeks after chronic venous insufficiency was created by ligation. In the third group, the same flap performed three weeks after the creation of an arteriovenous fistula between the femoral artery and vein. One week after flap elevation, the flaps were photographed and the rats were sacrificed and specimens were taken. Results Chronic venous insufficiency caused a statistically significant increase in flap necrosis rates (p < 0.05). While the rate of flap necrosis was 64.1% in the ligation group, the rate of flap necrosis was 53.49% in the fistula group. In the control group, this rate was 39.09%. Conclusions The presence of venous insufficiency in patients planned for lower extremity reconstruction may adversely affect the operation plan. In the rat model, it was thought that the anatomical level of venous pathology in chronic venous insufficiency may have a greater effect on fasciocutaneous flap viability than the effect of increased intravenous pressure. Level of Evidence: Not gradable.
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Fasciocutaneous flap Fistula Flap viability Ligation Venous insufficiency
A Different Method to Increase Breast Projection-Tunnelized Glandular Flap
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AESTHETIC PLASTIC SURGERY
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Background Breast ptosis may occur with increasing age, after pregnancy, after breastfeeding, or after weight loss. Understanding the vascular structure of the breast and nipple-areolar complex has guided the reshaping of the breast and thus paved the way for the emergence of different techniques. This study aimed to evaluate the results of tunneled glandular flaps used to increase projection in patients undergoing breast lift surgery.Methods Patients who underwent breast lift and breast reduction between January 2020 and January 2022 were examined through their files and included in the study. Deepithelialization of the superomedial pedicle was performed. A tunnel was created under the pedicle. A medial or lateral based glandular flap was prepared from the inferir. The prepared glandular flap was passed through the tunnel and fixed to the pectoral muscle.Results A total of 32 patients were included in the study. The average age of the patients was 44.31. Thirteen patients were smokers. Diabetes mellitus was present in 5 patients. To increase projection, medial glandular flap was used in 20 patients and lateral glandular flap was used in 12 patients. The average amount of tissue excised from the patients was 785.31 g. The average follow-up period was 14 months.Conclusions Tunneled glandular flaps prepared on a lateral or medial basis will be useful in increasing the projection in breast lift surgery.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Author Keywords
Breast lift Glandular flap Projection
Reconstruction option in complex lower extremity defects where microsurgical repair is not possible: Randomized bipedicled flaps
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ULUSAL TRAVMA VE ACIL CERRAHI DERGISI-TURKISH JOURNAL OF TRAUMA & EMERGENCY SURGERY
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BACKGROUND: Lower extremity defects may occur due to many etiological causes such as trauma, peripheral arterial disease, diabetic foot infections, tumor resection, gunshot injuries, and burns. Lower extremity defects show a wide clinical presentation ac-cording to the affected anatomical localization, amount of tissue, and tissue content. In this study, it is aimed to present the use of bipedicled flaps as a simple and reliable salvage method in cases where microsurgical repairs such as free flaps are not possible.METHODS: Patients with soft-tissue defect in their lower extremities between March 2018 and September 2021 were scanned retrospectively over the file. Among these patients, patients who were repaired with a bipedicle flap were included in the study. The patients were followed up regularly for at least 12 months. During the follow-ups, the patients were photographed, a physical examina-tion was performed in terms of flap viability, wound dehiscence, and soft-tissue infection, and the data were recorded.RESULTS: In this study, 23 patients with a defect in the lower extremity who were repaired with randomized bipedicled flap were retrospectively analyzed. In four patients, the location of the defect was located in the middle 1/3 of the leg, while in 19 patients, it was located in the distal 1/3 of the leg. The flap design was done vertically in 22 patients, and the flap design was done transversely in one patient. One bipedicled flap was used for defect repair in 14 patients, and two bipedicled flaps were used for defect repair in nine patients. While skin grafts were used for donor site repairs in 16 patients, the donor site was primarily repaired in seven patients. In the post-operative period, local soft-tissue infection was detected in five patients and dehiscence at the wound site in three patients, and uneventful healing was achieved with antibiotic therapy, resuturation, and appropriate wound care. No major complications such as flap or graft loss were experienced in any of the patients. CONCLUSION: Randomized bipediculated flaps are a very reliable option for the reconstruction of middle and distal lower extrem-ity defects. We think that it is a reconstruction option that can be safely applied in small and medium-sized defects of the lower ex-tremity, since it can be used even in patients with comorbidities such as diabetes mellitus and peripheral arterial disease that adversely affect wound healing.
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Author Keywords
Bipedicled flap lower extremity nonmicrosurgical
Comparative analysis of bipedicled fasciocutaneous flaps in meningomyelocele repair: influence of perforator preservation on postoperative outcomes and hospitalization duration
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Kendir, MS (Kendir, Munur Selcuk) ; Dadaci, M (Dadaci, Mehmet) ; Erdi, MF (Erdi, Mehmet Fatih) ; Uyar, I (Uyar, Ilker) ; Baycar, Z (Baycar, Zikrullah) ; Ince, B (Ince, Bilsev)
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CHILDS NERVOUS SYSTEM
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Purpose Meningomyelocele (MMC), a severe congenital defect of the central nervous system, is commonly associated with high morbidity and mortality. Surgical closure of MMC is essential to prevent infection, cerebrospinal fluid leakage, and nerve damage. In cases with large defects, flap surgery is required. This study examines whether preserving musculocutaneous perforators which enters to the flap itself during the repair with bipedicle fasciocutaneous flaps improves outcomes compared to flaps without perforator preservation. Methods We retrospectively analyzed 79 MMC patients who underwent repair with bipedicle fasciocutaneous flaps from January 2013 to December 2022. Patients were divided into two groups: Group 1 (perforators not preserved) and Group 2 (perforators preserved). We evaluated flap perfusion, complications, operation time, hospital stay, and discharge readiness. Results Results showed that Group 2 had a lower incidence of early postoperative venous insufficiency (15.2% vs. 34.29%, p < 0.05), partial flap necrosis (4.55% vs. 11.43%, p < 0.05), wound dehiscence (6.82% vs. 22.86%, p < 0.05), and secondary surgeries (13.64% vs. 25.71%, p < 0.05). Group 2 patients were ready for discharge significantly sooner (6.93 days vs. 9.26 days, p < 0.05). No significant differences were observed in operation time or blood loss between the groups. Conclusion Preserving perforators in bipedicle fasciocutaneous flaps enhances flap viability, reduces complication rates, and shortens hospital stays. This technique should be adopted for MMC repairs to improve clinical outcomes.
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Meningomyelocele (MMC ) Bipedicle fasciocutaneous flaps Musculocutaneous perforators Surgical repairFlap complications Neonatal surgery
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CLOSURE DEFECTS RECONSTRUCTION OPTION
Nasal Sill Flap for Lip Lifting
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FACIAL PLASTIC SURGERY
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Backgrounds Over the years, different techniques have been developed to reduce the number of incisions and scars in subnasal lip lifting and to increase the amount of lifting. The aim of this study was to present a new technique to hide the scars at the nasal base in subnasal lip lifting procedures and to review the literature.
Methods The file of patients who underwent subnasal lip lifting between January 2019 and January 2021 were examined. In all patients, the nasal sill flap that was designed was elevated, and the nasal sill flap that was prepared was adapted to its new location when the excision had been completed. Two different plastic surgeons evaluated the patients in the postoperative 12-month follow-ups. The scars were evaluated for vascularity, pigmentation, elasticity, thickness, and height.
Results The study included 26 patients. While 21 patients had no histories of lip lifting, five patients had had previous lip lifting history. The mean operation time was 37.11 minutes. Patients' skin types were determined as Type 3 in 18 patients and Type 4 in eight patients according to the Fitzpatrick classification. The mean follow-up period of the patients was 13.11 months. At the end of the 12-month period, the mean scar score of the patients was calculated as 11.15. The mean scar score of primary cases was 11.14, and the mean scar score of secondary cases was 11.20 (p = 0.983). There was no statistically significant difference in terms of complications among smokers (p = 0.356). The mean scar score was calculated as 12.17 in patients who had Type 3 skin and 8.88 in patients with Type 4 skin (p = 0.075).
Conclusions This technique is beneficial for patients because the scars are discrete and easier for patients to accept.
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Author Keywords
lip lift nasal sill subnasal lip lifting
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FACIAL FEMINIZATION SURGERY ESTROGEN SKIN
The effect of botulinum neurotoxin A on soft-tissue complications in intraoral reconstructions
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JOURNAL OF PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY
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Background: Intraoral reconstruction has become more common in recent years. Patients may suffer from complications because of hypersalivation. This issue can be overcome with an aid aimed at reducing saliva production.In this study, patients who underwent flap reconstruction were examined. The aim was to compare the complication rates between those who were administered with botulinum neu- rotoxin type A (BTXA) to the salivary glands before the reconstruction and those who were not.Methods: Patients who underwent flap reconstruction between January 2015 and January 2021 were included in the study. The patients were divided into 2 groups. BTXA was applied to the parotid and submandibular glands in the 1st group at least 8 days before the operation to reduce the salivary secretion. BTXA application was not applied to the patients in the 2nd group before the operation. Results: A total of 35 patients were included in the study. There were 19 patients in group 1 and 16 patients in group 2. The tumor type in both groups was squamous cell carcinoma. For patients in the 1st group, salivary secretion decreased in an average of 3.84 days.In the statistical analysis, no significant difference was found between the groups in terms of age, comorbidity, smoking-complication development, and comorbidity-complication devel- opment. When infection was excluded, there was a significant difference in the development of complications between the groups.Conclusions: BTXA application before the operation is beneficial to minimize complications in patients who plan to undergo elective intraoral reconstruction.(c) 2023 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
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Botulinum toxin Intraoral Reconstruction Salivation
A new method for second toe flap revascularization in plantar dominant artery pattern- dorsal metatarsal artery interpositional graft
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TURKISH JOURNAL OF MEDICAL SCIENCES
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Background/aim: Toe transfer to hand is a viable option for patients, which can provide functionally useful digits. Harvesting of the second toe is still accepted as a demanding surgical procedure. The major questions before this transfer are the location and the dominance of the arterial anatomy of the second toe. The authors present the incidence of patients with a dominant plantar artery system and a description of a versatile technique that can be used for toe transfers in these patients.Materials and methods: The study was designed retrospectively. Toe to hand transfers performed between 2010 and 2018 were reviewed. The patients with a dominant plantar arterial system were included in this study. The dorsalis pedis arterial graft technique described by the authors was used in all cases with a dominant plantar system. All of transfers were done by the senior author. All cases followed up at least one year post-operatively. The survival of the transferred finger was examined in the follow-ups.Results: Eleven toe to hand transplantation cases in nine traumatic patients were included in this series. The reason for the operation was trauma in all patients. Second toe transfer was performed in all of the cases. Plantar dominant arterial system was seen in 3 of the 9 patients. Dorsal arterial system was dominant in the remaining six patients. Dorsalis pedis arterial graft technique was used in these four cases. All of the toes survived, and reexploration was needed in 2 cases because of venous insufficiency. Mean follow-up time was 16.4 months.Conclusion: This is the first study to recommend the use of dorsalis pedis as an arterial graft instead of vein grafts. This surgical method described will make these rarely performed transfers easier and affect the success rates positively.
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Arterial graft dominant arterial system dorsalis pedistoe to hand transfer
Emergency approach in a rare congenital coexistence-ichthyosis and amniotic band syndrome
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ULUSAL TRAVMA VE ACIL CERRAHI DERGISI-TURKISH JOURNAL OF TRAUMA & EMERGENCY SURGERY
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Ichthyosis is caused by Mendelian cornification disorders. Hereditary ichthyoses are divided into non-syndromic and syndromic ichthyoses. Amniotic band syndrome involves congenital anomalies that most frequently cause hand and leg rings. The bands can wrap around the developing body parts. In this study, it is aimed to present an emergency approach to amniotic band syndrome accompanying a case of congenital ichthyosis. We were asked by the neonatal intensive care unit to consult on the case of a 1-day-old baby boy. On physical examination, congenital bands were found to be present on both hands, the toes were rudimentary, skin scaling was present on the entire body, and the consistency of the skin was stiff. The right testicle was not in the scrotum. Other system examinations were normal. However, the blood circulation in the fingers in the distal of the band had become critical. With the help of sedation, the bands on the fingers were excised, and after the procedure, it was observed that the circulation in the fingers was more relaxed than it had been before the procedure. Coexistence of congenital ichthyosis and amniotic band is very rare. Emergency approach to these patients is very important in terms of saving the limb and preventing growth retardation in the limb. As further developments take place in terms of prenatal diagnoses, these cases will be able to be prevented through the early diagnosis and treatment.
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Amniotic band ichthyosis
The effects of a combination treatment with mesenchymal stem cell and platelet-rich plasma on tendon healing: an experimental study
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Uyar, I (Uyar, Ilker) ; Altuntas, Z (Altuntas, Zeynep) ; Findik, S (Findik, Siddika) ; Yildirim, MEC (Yildirim, Mehmet Emin Cem) ; Yarar, S (Yarar, Serhat) ; Aktan, M (Aktan, Murat) ; Avci, A (Avci, Alunet)
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TURKISH JOURNAL OF MEDICAL SCIENCES
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Background/Aim: The objective of this study was to investigate the effects that the application of mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP) following tendon repair have on the strength and healing of the tendon and also to examine the possible mechanisms of action that take place. Materials and methods: The Achilles tendons of 80 rats were repaired and divided into eight groups. Following the repairs, MSCs obtained from humans were injected into the rat tendons in groups 1 and 2, a combination of MSCs from humans and PRP from rats was injected into the tendons in groups 3 and 4, and PRP from rats was injected into the tendons in groups 5 and 6. These procedures all took place simultaneously. Groups 7 and 8 did not receive any injections following the repairs. The rats were sacrificed at the end of the first and second months following the procedures, and biomechanical and histopathological analyses were performed. Results: Inflammatory cell density increased most significantly in the combined group when compared to the first and second months. The fibroblast density on the tendon repair region was significantly lower in the second-months groups of each intervention compared to their first-month groups (p = 0.001). For the analysis of the maximum tensile breaking force, the behaviors of the groups over time were significant when compared to the control groups (p = 0.0015). Also, the mean maximum breaking force in the combined group was statistically significantly higher at the end of the second month than at the end of the first month (p = 0.0008). Conclusion: The combination therapy increased tendon strength force. This combination therapy can make a positive contribution to the healing of tendons after surgery.
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Author Keywords
Experimental study mesenchymal stem cell platelet-rich plasma tendon healing
Comparison of Transcutaneous Fixation-Assisted Method with Classical Needle-Assisted Method in Prominent Ear Surgery
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AESTHETIC PLASTIC SURGERY
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Background Prominent ear deformity is an autosomal dominant inherited deformity. Surgery is the most effective treatment method for prominent ear patients. Different prominent ear operations have been described in the literature.
In this study, it is aimed to compare the transcutaneous fixation-assisted method that we described in prominent ear repair with the classical needle-assisted method.
Methods Patients who were operated for bilateral prominent ear deformity between January 2017 and January 2020 were included in the study. Two different approaches were used in the operations. In the first group, conventional needles were used to adjust the position of the conchascaphal sutures. In the second group, transcutaneous suturing was used to adjust the position of the conchascaphal sutures. The duration of the operation was recorded. Patients were called for controls in 1-3-6 and 12th months; photographs were taken. Measurements were made in the preoperative period, in the intraoperative and at the postoperative 12th month. SPSS program was used for statistical analysis.
Results A total of 52 patients were included in the study. There were 27 patients in Group land 25 patients in Group 2. There was no significant difference between the groups in terms of demographic characteristics (p>0.05).
While the average operation time was 80.37 minutes in Group 1, the average operation time was 60.40 minutes in Group 2. The operative times between the groups were statistically significant (p<0.05).
There was no statistically significant difference between the groups in preoperative, intraoperative and postoperative measurements (p>0.05).
Conclusions As a result, transcutaneous fixation-assisted method is performed faster than the classical needle-assisted method and the results are understood right at the beginning of the operation.
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Ear correction Fixation Otoplasty Prominent ear
Acquired Constriction Band Syndrome Affecting Multiple Digits - A Case Report
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Kendir, MS (Kendir, Munur Selcuk) ; Dadaci, M (Dadaci, Mehmet) ; Uyar, I (Uyar, Ilker) ; Yildirim, MEC (Yildirim, Mehmet Emin Cem)
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JOURNAL OF HAND SURGERY-ASIAN-PACIFIC VOLUME
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Rubber band syndrome is a condition that usually affects children because of wearing a rubber band on the wrist or the ankle. Depending on the degree of pressure caused by the band, patients may present acutely with ischemia and necrosis of the tissues distal to the bands or chronically with change in shape, oedema, loss of function, sensation and rarely amputation. This condition is very rare in adults and most reports in literature are in patients with cognitive impairment or psychiatric illness. We report 62-year-old lady with a background of a psychiatric illness who presented with an acquired constriction band syndrome affecting multiple digits of both hands.
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Author Keywords
Acquired hand diseases Constriction band syndrome Rubber band syndrome Self-mutilationFinger tying
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RUBBER BAND
Evaluation of the Effect of Subciliary Approaches on Lower Eyelid Position in Infraorbital Rim Fractures
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FACIAL PLASTIC SURGERY
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Background Periorbital fractures are a condition encountered after high-energy trauma in the face region. In the follow-ups after surgical repair, some changes may occur in the lower eyelid. Scleral show, ectropion, entropion, and canthal malposition are the most common complications. In this study, the effect of subciliary soft tissue approaches on lower eyelid position in patients with infraorbital rim fracture was investigated.Methods Patients admitted with orbital lower rim fracture between January 2017 and January 2021 were included in the study. A total of 90 patients, 15 patients in each group, were followed up for 6 months. Before the operation, the patients were randomly assigned to the groups by an impartial observer and the surgeons who would perform the operation were informed about the method. The patients were divided into six groups according to the type of soft tissue approach for fracture repair. Results There were 6 groups in total and each group included 15 patients. The mean age was 41.4 in group 1, 50.6 in group 2, 38.2 in group 3, 36.4 in group 4,38 in group 5, and 39.9 in group 6. There was no statistically significant difference between the groups in terms of age (p = 0.090), gender distribution (p = 0.835), and smoking (p = 0.685). Ectropion was observed in 14 of 73 male patients and 5 of 17 female patients. Ectropion was observed in 9 of 38 smokers and 10 of 52 nonsmokers. When all groups were evaluated together, the scleral show measurement was 0.072 on the operated side and 0.034 on the healthy side. This measurement was statistically significant (p = 0.000).Conclusion Subciliary skin-only or step incision approaches can be used safely in the exposure of infraorbital rim fractures, but both approaches must be supported by canthopexy.
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eyelid malposition lower eyelid surgery periorbital fractures cleral show
Reconstruction of Axillary Defects With Propeller Parascapular Flap After Resection in Patients With Advanced Hidradenitis Suppurativa
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Yildirim, MEC (Yildirim, Mehmet Emin Cem) ; Dadaci, M (Dadaci, Mehmet) ; Uyar, I (Uyar, Ilker) ; Ince, B (Ince, Bilsev) ; Uyanik, O (Uyanik, Orkun)
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WOUNDS-A COMPENDIUM OF CLINICAL RESEARCH AND PRACTICE
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Introduction. Wide excision of affected skin tissue and the apocrine glandular region is the standard treatment for advanced HS. Various flap types have been used for coverage. Objective. This study was conducted to assess the use and outcomes of propeller parascapular flaps for unilateral or bilateral axillary defects after excision in patients with advanced axillary HS. Materials and Methods. This retrospective case series reports on 11 patients with unilateral (7 patients) or bilateral (4 patients) advanced HS treated with propeller parascapular flap surgery between July 1, 2016, and December 31, 2018. Flap dimensions were measured. Patients were evaluated in terms of 2 main postoperative complications: postoperative recurrence and flap viability. In addition, other complications such as bleeding, infection, dehiscence, contracture, and hypertrophic scarring were noted. Results. The average flap area was 160 cm(2). One flap dehisced; no infection, partial necrosis, or total flap loss occurred, and no recurrence was observed. The mean follow-up period was 18 months. At final follow-up, no patient had contractures that caused restricted movement of the shoulder joint. Conclusion. Parascapular flaps should be the first choice in patients with advanced HS owing to low donor area morbidity, low recurrence rate, wide rotation arc, and sufficient flap size.
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axillary defect hidradenitis suppurativa propeller parascapular flap
Effect of Vitamin D Deficiency on Hypertrophic Scarring
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DERMATOLOGIC SURGERY
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BACKGROUND Although many different diseases have been reported with vitamin D deficiency, the authors failed to find any studies on the association of hypertrophic scarring (HS) in the literature.
OBJECTIVE The authors aimed to determine the relationship between vitamin D deficiency and HS and investigate the effect of replacement therapy on HS development in patients with vitamin D deficiency.
PATIENTS AND METHODS Patients who presented to the authors' outpatient clinic with HS between 2013 and 2016 were included in the study. In the first stage, all the patients with HS complaints were assessed for vitamin D levels. In the second stage, 50 patients with a vitamin D level less than 25 ng/mL and a linear scar after at least 1 year of trauma were randomly divided into 3 groups. Group 1: patients who did not accept any medical or surgical treatment; Group 2: patients who were subjected to vitamin D replacement only; Group 3: patients who underwent surgical excision and suturation after vitamin D replacement.
RESULTS A statistically significant correlation was found between HS and vitamin D levels (p < .05). A statistically significant decrease in scar width was observed in Group 3 (p < .05).
CONCLUSION Increasing vitamin D levels to above 25 ng/mL before scar revision and vitamin D deficiency in patients with HS may help reduce scar width.
Keywords Plus
DISEASE SKIN KELOIDS RISK
The effects of breast reduction operation on patients' mood and sexual life
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ARCHIVES OF PSYCHIATRY AND PSYCHOTHERAPY
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Aim. Breast hypertrophy is a condition that can negatively affect the quality of life of women in physical, psychological and sexual aspects. In this study, the effects of breast reduction operation on the psychological and sexual life of the patients in the postoperative period were investigated.
Material and Methods. 31 patients who underwent breast reduction surgery were included in the study. The patients were evaluated preoperatively and 6 months after surgery. Rosenberg Self-Esteem Scale and Beck Depression Scale were used for psychological evaluation. The Arizona Sexual Experiences Scale was used to evaluate sexual functions, as well.
Results. The average age of the patients was 41.2 +/- 5.6 and the average BMI was 29.3 +/- 3.18. The mean scores of Rosenberg Self-Esteem Scale before and after surgery was 1.36 +/- 0.94 and 1.02 +/- 0.63 (p < 0.05). The mean scores of Beck Depression Scale was 14.41 +/- 10.11 and 10.35 +/- 10.11 (p < 0.05), respectively. When the Arizona Sexual Experiences Scale was examined, a statistically significant positive effect was observed in all subgroups compared to the preoperative period.
Discussion and Conclusions. After breast reduction surgery, patients have a very high level of satisfaction physically. There are some studies showing that breast reduction surgery has a positive effect on women, especially psychologically, but very limited research has been done on sexual function. This study showed that breast reduction surgery increases self-esteem and provides a positive effect on emotional state. At the same time, it has been found that it has a positive effect on sexual functions and sexual life.
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Breast reduction surgery self-esteem sexual life
Comparison of Transcutaneous Fixation-Assisted Method with Classical Needle-Assisted Method in Prominent Ear Surgery
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AESTHETIC PLASTIC SURGERY
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Abstract
Background Prominent ear deformity is an autosomal dominant inherited deformity. Surgery is the most effective treatment method for prominent ear patients. Different prominent ear operations have been described in the literature.
In this study, it is aimed to compare the transcutaneous fixation-assisted method that we described in prominent ear repair with the classical needle-assisted method.
Methods Patients who were operated for bilateral prominent ear deformity between January 2017 and January 2020 were included in the study. Two different approaches were used in the operations. In the first group, conventional needles were used to adjust the position of the conchascaphal sutures. In the second group, transcutaneous suturing was used to adjust the position of the conchascaphal sutures. The duration of the operation was recorded. Patients were called for controls in 1-3-6 and 12th months; photographs were taken. Measurements were made in the preoperative period, in the intraoperative and at the postoperative 12th month. SPSS program was used for statistical analysis.
Results A total of 52 patients were included in the study. There were 27 patients in Group land 25 patients in Group 2. There was no significant difference between the groups in terms of demographic characteristics (p>0.05).
While the average operation time was 80.37 minutes in Group 1, the average operation time was 60.40 minutes in Group 2. The operative times between the groups were statistically significant (p<0.05).
There was no statistically significant difference between the groups in preoperative, intraoperative and postoperative measurements (p>0.05).
Conclusions As a result, transcutaneous fixation-assisted method is performed faster than the classical needle-assisted method and the results are understood right at the beginning of the operation.
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Author Keywords
Ear correction Fixation Otoplasty Prominent ear
Acquired Constriction Band Syndrome Affecting Multiple Digits - A Case Report
By
Kendir, MS (Kendir, Munur Selcuk) ; Dadaci, M (Dadaci, Mehmet) ; Uyar, I (Uyar, Ilker) ; Yildirim, MEC (Yildirim, Mehmet Emin Cem)
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JOURNAL OF HAND SURGERY-ASIAN-PACIFIC VOLUME
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Rubber band syndrome is a condition that usually affects children because of wearing a rubber band on the wrist or the ankle. Depending on the degree of pressure caused by the band, patients may present acutely with ischemia and necrosis of the tissues distal to the bands or chronically with change in shape, oedema, loss of function, sensation and rarely amputation. This condition is very rare in adults and most reports in literature are in patients with cognitive impairment or psychiatric illness. We report 62-year-old lady with a background of a psychiatric illness who presented with an acquired constriction band syndrome affecting multiple digits of both hands.
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Author Keywords
Acquired hand diseases Constriction band syndrome Rubber band syndrome Evaluation of the Effect of Subciliary Approaches on Lower Eyelid Position in Infraorbital Rim Fractures
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FACIAL PLASTIC SURGERY
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Background Periorbital fractures are a condition encountered after high-energy trauma in the face region. In the follow-ups after surgical repair, some changes may occur in the lower eyelid. Scleral show, ectropion, entropion, and canthal malposition are the most common complications. In this study, the effect of subciliary soft tissue approaches on lower eyelid position in patients with infraorbital rim fracture was investigated.Methods Patients admitted with orbital lower rim fracture between January 2017 and January 2021 were included in the study. A total of 90 patients, 15 patients in each group, were followed up for 6 months. Before the operation, the patients were randomly assigned to the groups by an impartial observer and the surgeons who would perform the operation were informed about the method. The patients were divided into six groups according to the type of soft tissue approach for fracture repair. Results There were 6 groups in total and each group included 15 patients. The mean age was 41.4 in group 1, 50.6 in group 2, 38.2 in group 3, 36.4 in group 4,38 in group 5, and 39.9 in group 6. There was no statistically significant difference between the groups in terms of age (p = 0.090), gender distribution (p = 0.835), and smoking (p = 0.685). Ectropion was observed in 14 of 73 male patients and 5 of 17 female patients. Ectropion was observed in 9 of 38 smokers and 10 of 52 nonsmokers. When all groups were evaluated together, the scleral show measurement was 0.072 on the operated side and 0.034 on the healthy side. This measurement was statistically significant (p = 0.000).Conclusion Subciliary skin-only or step incision approaches can be used safely in the exposure of infraorbital rim fractures, but both approaches must be supported by canthopexy.
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eyelid malposition lower eyelid surgery periorbital fractures cleral show
Self-mutilation Finger tying
Reconstruction of Axillary Defects With Propeller Parascapular Flap After Resection in Patients With Advanced Hidradenitis Suppurativa
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Yildirim, MEC (Yildirim, Mehmet Emin Cem) ; Dadaci, M (Dadaci, Mehmet) ; Uyar, I (Uyar, Ilker) ; Ince, B (Ince, Bilsev) ; Uyanik, O (Uyanik, Orkun)
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WOUNDS-A COMPENDIUM OF CLINICAL RESEARCH AND PRACTICE
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Introduction. Wide excision of affected skin tissue and the apocrine glandular region is the standard treatment for advanced HS. Various flap types have been used for coverage. Objective. This study was conducted to assess the use and outcomes of propeller parascapular flaps for unilateral or bilateral axillary defects after excision in patients with advanced axillary HS. Materials and Methods. This retrospective case series reports on 11 patients with unilateral (7 patients) or bilateral (4 patients) advanced HS treated with propeller parascapular flap surgery between July 1, 2016, and December 31, 2018. Flap dimensions were measured. Patients were evaluated in terms of 2 main postoperative complications: postoperative recurrence and flap viability. In addition, other complications such as bleeding, infection, dehiscence, contracture, and hypertrophic scarring were noted. Results. The average flap area was 160 cm(2). One flap dehisced; no infection, partial necrosis, or total flap loss occurred, and no recurrence was observed. The mean follow-up period was 18 months. At final follow-up, no patient had contractures that caused restricted movement of the shoulder joint. Conclusion. Parascapular flaps should be the first choice in patients with advanced HS owing to low donor area morbidity, low recurrence rate, wide rotation arc, and sufficient flap size.
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axillary defec thidradenitis suppurativa propeller parascapular flap
Effect of Vitamin D Deficiency on Hypertrophic Scarring
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DERMATOLOGIC SURGERY
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BACKGROUND Although many different diseases have been reported with vitamin D deficiency, the authors failed to find any studies on the association of hypertrophic scarring (HS) in the literature.
OBJECTIVE The authors aimed to determine the relationship between vitamin D deficiency and HS and investigate the effect of replacement therapy on HS development in patients with vitamin D deficiency.
PATIENTS AND METHODS Patients who presented to the authors' outpatient clinic with HS between 2013 and 2016 were included in the study. In the first stage, all the patients with HS complaints were assessed for vitamin D levels. In the second stage, 50 patients with a vitamin D level less than 25 ng/mL and a linear scar after at least 1 year of trauma were randomly divided into 3 groups. Group 1: patients who did not accept any medical or surgical treatment; Group 2: patients who were subjected to vitamin D replacement only; Group 3: patients who underwent surgical excision and suturation after vitamin D replacement.
RESULTS A statistically significant correlation was found between HS and vitamin D levels (p < .05). A statistically significant decrease in scar width was observed in Group 3 (p < .05).
CONCLUSION Increasing vitamin D levels to above 25 ng/mL before scar revision and vitamin D deficiency in patients with HS may help reduce scar width.
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Keywords Plus
DISEASE SKIN KELOIDS RISK
The effects of breast reduction operation on patients' mood and sexual life
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ARCHIVES OF PSYCHIATRY AND PSYCHOTHERAPY
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Aim. Breast hypertrophy is a condition that can negatively affect the quality of life of women in physical, psychological and sexual aspects. In this study, the effects of breast reduction operation on the psychological and sexual life of the patients in the postoperative period were investigated.
Material and Methods. 31 patients who underwent breast reduction surgery were included in the study. The patients were evaluated preoperatively and 6 months after surgery. Rosenberg Self-Esteem Scale and Beck Depression Scale were used for psychological evaluation. The Arizona Sexual Experiences Scale was used to evaluate sexual functions, as well.
Results. The average age of the patients was 41.2 +/- 5.6 and the average BMI was 29.3 +/- 3.18. The mean scores of Rosenberg Self-Esteem Scale before and after surgery was 1.36 +/- 0.94 and 1.02 +/- 0.63 (p < 0.05). The mean scores of Beck Depression Scale was 14.41 +/- 10.11 and 10.35 +/- 10.11 (p < 0.05), respectively. When the Arizona Sexual Experiences Scale was examined, a statistically significant positive effect was observed in all subgroups compared to the preoperative period.
Discussion and Conclusions. After breast reduction surgery, patients have a very high level of satisfaction physically. There are some studies showing that breast reduction surgery has a positive effect on women, especially psychologically, but very limited research has been done on sexual function. This study showed that breast reduction surgery increases self-esteem and provides a positive effect on emotional state. At the same time, it has been found that it has a positive effect on sexual functions and sexual life.
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Author Keywords
Breast reduction surgery self-esteem sexual life
A Rare Case: Primary Venous Malformation in Parietal Bone
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Yarar, S (Yarar, Serhat) ; Uyar, I (Uyar, Ilker) ; Yildirim, MEC (Yildirim, Mehmet Emin Cem) ; Dadaci, M (Dadaci, Mehmet) ; Ince, B (Ince, Bilsev)
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SKIN APPENDAGE DISORDERS
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Primary intraosseous vascular malformations (PIVMs) are rare intraosseous lesions, accounting for approximately 0.5-1% of all intraosseous tumours. In this case report, we aimed to present a rare case of intraosseous vascular malformation causing a large lytic area in the parietal bone. A 25-year-old male patient was admitted to the clinic with a mass on the parietal bone. On physical examination, it was observed that the hair density on the mass was decreased, the mass had a soft consistency, and there was no pain on palpation. The patient was operated under local anaesthesia with a provisional diagnosis of a trichilemmal cyst. However, intraoperative diagnosis was a vascular malformation. There was a 3-cm full-thickness defect on the parietal bone caused by the lesion. The mass was excised completely while preserving the integrity of the dura. The resulting defect was reconstructed with bilateral rotation advancement flaps. The calvarial defect was not reconstructed due to equipment inadequacy. No complications were encountered in the postoperative period. Ninety-three PIVM cases have been reported in the skull since 1845. In very few of these cases, the mass is located in the parietal bone. The pathogenesis of PIVMs is not completely understood. The definitive diagnosis is made by histopathological examination. The therapeutic gold standard is surgery. Surgeons should keep in mind that radiological examination before the operation could prevent undesirable complications.
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Venous Malformation Parietal bone
Evaluation of the effectiveness of the tuba uterina tubular flap in the peripheral nervous system regeneration in rats
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Yildirim, MEC (Yildirim, Mehmet Emin Cem) ; Dadaci, M (Dadaci, Mehmet) ; Ince, B (Ince, Bilsev) ; Uyar, I (Uyar, Ilker) ; Yarar, S (Yarar, Serhat) ; Oltulu, P (Oltulu, Pembe) ; Aygul, R (Aygul, Recep)
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JOURNAL OF PLASTIC SURGERY AND HAND SURGERY
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Nerve conduits could be used to provide a bridge between both nerve endings. In this study, the tuba uterina of female rats were prepared in a vascularized pedicled flap model and it used as a nerve conduit. The aim was to investigate the effectiveness of a vascularized pedicle nerve conduit and its ciliated epithelium in a sciatic nerve defect. The study was conducted between May and August 2018, and used a total of 60, 14-16-week-old female Wistar albino rats. Six groups were created; Cut and Unrepaired Group, Nerve Graft Group, Flap-Forward Group (Tuba uterina tubular flap, forward direction), Flap-Reversed Group (Tuba uterina tubular flap, reverse direction), Graft-Forward Group (Tuba uterina tubular graft, forward direction) and Graft-Reverse Group (Tuba uterina tubuler graft, reverse direction). Nerve regeneration was evaluated 3 months (90 days) after the surgery by the following methods: (1) Sciatic Functional Index (SFI) measurement, (2) Electromyographic (EMG) assessment, (3) Microscopic assessment with the light microscope and (4) Microscopic assessment with the electron microscope. According to the SFI, EMG and microscopic assessments with the light and electron microscope, it was observed that the transfer of tuba uterina tubular conduit as a graft was statistically better in its effect on nerve regeneration than flap transfer, but also indicated that the direction of the ciliated structures had no significant effect. We believe that as this model is improved with future studies, it will shed light on new models, ideas and innovations about nerve conduits.
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Author Keywords
Nerve regeneration nerve conduits tuba uterina conduit plastic surgery repair tissue defect Microvascular
Histopathological evaluation of the effect of hyperbaric oxygen therapy on capsule occurrence around silicone breast prosthesis: an experimental study
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Yarar, S (Yarar, Serhat) ; Arslan, A (Arslan, Abdullah) ; Ince, B (Ince, Bilsev) ; Yildirim, MEC (Yildirim, Mehmet Emin Cem) ; Oltulu, P (Oltulu, Pembe) ; Uyar, I (Uyar, Ilker) ; Dadaci, M (Dadaci, Mehmet)
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JOURNAL OF PLASTIC SURGERY AND HAND SURGERY
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In general, capsular contracture is the underlying cause of complications such as pain, stiffening, breast asymmetry, and animation deformity that are seen in the late postoperative period due to the use of silicone breast prostheses. Considering the positive effects of HBO therapy on wound healing, the objective of this study was to investigate the effect of HBO therapy on capsule reaction occurring due to silicone implants.
Material and Methods
Rats were divided into four groups. 1 cm x 1 cm silicone implants with rough surface were inserted in subcutaneous plane on the m spinotrapezius muscle fascia at just right of the dorsal region midline in rats in Group 1, while implants with same properties were inserted beneath m spinotrapezius muscle in rats in Group 2.
Implants with the same properties were inserted in the subcutaneous area on the m spinotrapezius muscle in rats in Group 3 and into the area under the muscle in rats in Group 4. Beginning from the first postoperative day, rats in Groups 3 and 4 received HBO therapy for 90 min under 2.5 ATM pressure as one session a day over 15 days.
Results
The mean capsule thickness was statistically significantly lower in the groups treated with HBO compared to the control groups. Fibroblast, neutrophil and macrophage counts were statistically significantly lower in the groups treated with HBO compared to the control groups.
Conclusion
We believe that HBO therapy can be used as an adjuvant treatment options to decrease capsule contraction occurring after silicone implant application.
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Implant splastic surgery
Reconstruction of Below Knee Stump with Free Plantar Fillet Flap: A Case Report
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Dadaci, M (Dadaci, Mehmet) ; Yildirim, MEC (Yildirim, Mehmet Emin Cem) ; Uyar, I (Uyar, Ilker) ; Ince, B (Ince, Bilsev)
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WORLD JOURNAL OF PLASTIC SURGERY
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Here, we present a 45-year-old male patient who had right leg fracture in several pieces, arterial ischemia, multiple muscle, tendon losses and degloving injury on the distal thigh and knee undergoing emergency surgery due to a high-energy traffic accident and explain our experience with reconstruction of below knee stump using free plantar fillet flap in order to prevent above knee amputation in a patient with vascular injuries, multi-part fractures and soft tissue losses in the lower extremity.
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Author Keywords
Reconstruction Knee stump Free plantar fillet flap Turkey
Our Clinical Experiences in Lower Eyelid Reconstruction
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TURKISH JOURNAL OF PLASTIC SURGERY
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Objective: Different treatment principles have been applied in the reconstruction of partial or full layer defects of the lower eyelid. The use of the most similar tissue for eyelid reconstruction is important for both functional and esthetic results. This study aims to investigate the reconstruction methods performed in lower eyelid defects and to evaluate their esthetic and functional results. Patients and Methods: In this study, patients who underwent reconstructive surgery from 2012 to 2016 in our clinic were investigated. Cases of primary repairs after skin tumors located in the lower eyelids were excluded from the study. The sociodemographic characteristics of patients, the type and location of the tumor, defect size after surgery, anterior and posterior lamellar defects, and reconstruction methods used were retrospectively reviewed. Results: Thirty-seven patients were included in the study. Fifteen were male and 22 were female. There was only anterior lamellar defect in 29 patients and full-thickness lower eyelid defect in 8 patients. Anterior flaps used in lamellar defects were identified as glabellar flap, Limberg flap, advancement, transposition flap, nasolabial flap, forehead flap, and cheek flap. Chondromucosal graft, palatal mucosal graft, and buccal mucosal graft were used for repairing posterior lamellar defects. Conclusion: Separate reconstruction of the posterior and anterior lamellae is important to provide good functional and esthetic results in lower eyelid reconstruction. Depending on the size of the defect, using a single local flap or a combined flap with posterior lamella repair provides highly acceptable results.
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Author Keywords
Lower eyelid posterior and anterior lamellare construction
A Different Stabilization Technique of Autogenous Cartilage Grafts in Saddle Nose Deformity: Prevention Warping and Resorption
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Gundeslioglu, AO (Gundeslioglu, A. Ozlem) ; Yildirim, MEC (Yildirim, Mehmet Emin Cem) ; Yarar, S (Yarar, Serhat) ; Uyar, I (Uyar, Ilker) ; Ismayilzade, M (Ismayilzade, Majid)
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JOURNAL OF CRANIOFACIAL SURGERY
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Background: Saddle nose deformity (SND) is a collapse of the cartilage and bone structures forming the dorsal projection of the nose. After the use of autologous cartilage in the treatment of SND, resorption and warping continue to be a problem.
Methods: This study presents results from 11 patients with SND types III and IV from 2005 to 2017 treated with autologous cartilage fixed with microplates and microscrews. The patients were monitored for at least 1 year. Resorption and warping were measured using postoperative photographs of the patients in the 3rd and 12th months after treatment.
Results: No signs of resorption or warping were noted in the patients.
Conclusions: Our findings indicate autologous cartilage use with microplates and microscrews is a viable, long-term treatment option for patients with SND types III and IV.
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Author Keywords
Autologous costal cartilage microplate saddle nose
Facilitating triple rhomboid flaps for meningomyelocele defect closure using a honeycomb structure as a template
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Karacor-Altuntas, Z (Karacor-Altuntas, Zeynep) ; Dadaci, M (Dadaci, Mehmet) ; Erdi, F (Erdi, Fatih) ; Ince, B (Ince, Bilsev) ; Uyar, I (Uyar, Ilker) ; Yarar, S (Yarar, Serhat)
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CHILDS NERVOUS SYSTEM
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Purpose Various reconstruction options are available for the soft-tissue coverage of meningomyelocele defects. For small defects, primary closure or local single flaps may be sufficient, while large defects require more complex reconstructive techniques. This study suggests an easy way for surgeons to close large meningomyelocele defects using triple rhomboid flaps.
Methods The hexagonal structure of a honeycomb was considered when planning for the coverage of large meningomyelocele defects. The intact skin around the defect was imagined as multiple hexagons, which allowed us to plan triple rhomboid flaps correctly and more easily. This technique was used in seven patients with defects ranging from 7 x 5 to 12 x 8 cm in size.
Results No major postoperative complications were seen. Minimal dehiscence was observed in two patients and healed secondarily.
Conclusions The honeycomb modification for planning triple rhomboid flaps is an easy, practical, and memorable approach for surgeons reconstructing large meningomyelocele defects.
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Author Keywords
Meningomyelocele Surgical flaps Wound closure Techniques