Makale Arama

Aim: In autologous breast reconstruction, there is pain in the recipient site due to rib cartilage intervention in the postoperative period. In this study, we aimed to reveal the effect of the rib-sparing internal mammarian vessel approach on postoperative pain in breast reconstruction by comparing it with the noncostal-sparing approach.
Patients and Methods: Between 2018 and 2022 twenty five patients underwent surgery were included in the study. Groups were divided according to internal mammary artery(IMA) exposure techniques. Group 1: Patients who underwent rib-sparing surgery(n=9), Group 2: Patients who underwent rib cartilage resection(n=16). Patient Controlled Analgesia(PCA) pump usage time, morphine dose used, and early and late pain scores were noted in both groups in the postoperative period.
Results: The mean age of the patients was 49.8 years. No complications were encountered in the early and late postoperative period. All flap transfers were successful. Mean PCA duration was 24±1.41 hours in group 1 and 26.31±1.62 hours in group 2. The dose of morphine was 9.67±1 mg in group 1 and 23.93±3.02mg in group 2. The early pain score was 2.89±1.16 in group 1 and 5.18±1.22 in group 2. Late pain scores were 2.11±0.98 in group 1 and 2.75±0.77 in group 2.
There was a statistically significant difference between the morphine dose and early pain scores of the groups (p<0.01). There was no significant difference between the duration of PCA use (p=0.3) and late pain scores (p=0.07) (p>0.05).
Conclusion: In conclusion, we think that costal sparing surgery significantly reduces pain in the early period during recipient site preparation in autologous breast r econstruction.

Aim: Axillary defects mostly occur after burn contracture releases or hidradenitis suppurativa debridements. Reconstruction of this type of defect is a challenge since the ultimate aim is maintaining a pliable coverage with full mobility of the shoulder joint. Scapular flap is one of the reconstructive options in axillary defect coverage. This study is aiming to present reconstruction of axillary defects with scapular island flaps for different indications and to discuss the outcomes of the donor sites so as to suggest it as a workhorse flap in axillary reconstruction.
Patients and Methods: A total of 7 patients treated with 8 scapular island flaps between 2015 and 2019 were included retrospectively. Five patients were operated for hidradenitis suppurativa and 2 patients reconstructed for axillary contracture. All scapular flap pedicles were skeletonized and transferred to the axilla through the triangular space.
Results: Flap dimensions ranged from 84cm2 to 128 cm2 without exceeding 8cm of the width. Donor site scars widened between 3 months to 6 months post-operatively and independent of patient age. Donor site scars ranged from 1.5-2.6 cm after at least 3 months of follow-up. All flaps survived without any complication except one with a tip necrosis that healed with secondary intention.
Conclusion: Scapular island flaps can cover defects of the axilla created by various causes. Horizontal extension of the flap protects it from burn scar involvements of the posterior axillary line and the arm. Although widening of the scars seems to be a disadvantage, thin and pliable skin coverage with ease

Aim: Nearly 30% of the patients with cleft palate need another surgery for velopharyngeal insufficiency. While
preoperative radiologic evaluation is necessary for planning, postoperative evaluation is also so important. In
this study, we plan to share our experience about evaluation of the velopharynx with dynamic MRI at patients
who were operated oving for velopharyngeal insuf ficiency.
Patients and Methods: The study included seventeen patients who were presented with velopharyngeal
insufficieny and we applied dynamic MRI for postoperative evaluation between April 2014 and May 2020.
Pharyngeal flap was applied for 7, posterior augmentation was performed for 7 (2 costal cartilaginous, 5 fat
graft) and myomucosal repair was done for 3 patients with submucosal cleft. Dynamic MRI were obtained
preoperatively and postoperatively at 3rd month. Postoperative results were evaluated with dynamic MRI.
Results: The study included seventeen patients, with an age range of 9-29 (mean 13± 2.5), 11 women (65%),
and 6 men (35%). Posterior wall located grafts were found at the second cervical vertebra and viable. While
there was no nasal air escape in superior pharyngeal flap applied patients at sagittal plane, in axial dynamic
images, gap was detected which is all essential for airway and must be obtained. The levator muscle direction
was observe normal postoperatively at patients with submucous clef. Nasal air escape area was decreased
in both methods significantly comparing with preoperative measu rement (p<0.05)
Conclusion: Because of the three-dimensional and dynamic structure of the velopharynx, it must be evaluated
in both planes and dynamic. Although there are many techniques for this purpose, none of them is ideal or
objective. Dynamic MRI can be used for postoperative follow-up as it is used for preoperative planning.
Evaluation of the pharyngeal flap atrophy , grafts and also gap size are provided with qualitative values .

Abstract

Aim: This study was designed to compare the effect of the classical bull horn excision pattern lip lift technique (group I) and the lip suspension technique (group II) which was performed using a dermal flap prepared on the upper lip with the same pattern incision, on patient satisfaction and scar appearance in lip lift surgeries.

Patients and Methods: Twenty-eight female patients aged 48-66 years, operated by the author between 2016 and 2023, were analyzed in two groups. The first group included 14 patients who were operated on with the classical bull horn excision pattern lip lift technique, and the second group included 14 patients who were operated with the lip suspension technique using a dermal flap prepared on the upper lip with the same pattern incision under local anesthesia. At the end of the 6th month, the patients in both groups, who were followed up for 6 months, were asked about their satisfaction with the overall aesthetic result using the global aesthetic improvement scale. In addition, an evaluator surgeon scored the postoperative scar using the Vancouver scar scale. All results were evaluated statistically.

Results: 9 of 14 patients (66%) stated very much improvement in the group 2 in which the dermal suspension flap was used, while 6 of 14 patients (%42.9) stated very much improvement with classical technique in Group 1, in the postoperative assessment at 6th month. Likewise, when the scar score performed by the evaluator surgeon was examined in 6th month. The scar scale was 14 in group 1 and 4 in group 2. In Group 1, the values of the patients ranged from 0 to 4, and the mean value was 1.0. In Group 2, the values ranged between 0-2 and the mean value was 0.3. Overall patient satisfaction was clinically significantly higher in group 2 when compared with group 1 and the scar was found to be clinically significantly less in group 2 when compared with group 1, even though there is no statistical significance (p>0.05) between 2 groups in overall patient satisfaction and scar score, probably due to limited number of patients in groups.

Conclusion:

It has been concluded that lip lift surgeries performed using the dermal suspension flap technique can contribute as a valuable alternative to the classical excision method, due to both higher overall aesthetic patient satisfaction and less scarring in our patients.

Postburn contractures in the upper extremities limit the function of the hand and arm. A 25-year-old female patient was admitted to our outpatient clinic for contracture of the left wrist since the age of three. On examination, the patient had an extension contracture of approximately 120 degrees in the left wrist. The patient's contracture was opened with an incision and the defect was closed with an abdominal flap. We think that abdominal flap is a good alternative for the treatment of postburn contractures.

\r\n Purpose: Mesh erosions that necessitates excision can develop in Trans Obturator Tape (TOT) surgeries which are widely used in the treatment of stress urinary incontinence.

\r\n

\r\n In our study, we described a method of vaginal flap placed under suburethral sling to prevent urethral mesh erosion related with TOT surgery and evaluated the patients for postoperative complications.

\r\n

\r\n Materials and methods: In our study, 22 patients who had TOT and cystocele operations simultaneously and to whom flaps composed of vaginal tissue were placed in front of the urethra under the mesh between December 2014 and May 2018 were evaluated retrospectively. Patients were evaluated for urethral mesh erosion, vaginal mesh erosion, complaints of urgency and dyspareunia, urinary retention, and need for secondary surgery.

\r\n

\r\n Results: The mean postoperative follow-up of the patients were 8,95±8,45 months. 20 patients had simultaneous TOT and cystocele operations (%90,9), 2 patient had vaginal hysterectomy, TOT and cystocele operations simultaneously (%9,1). Urethral mesh erosion developed in none of the patients during the follow-up period. Vaginal mesh erosion and dyspareunia was observed in only one menopausal patient. Urinary retention and overflow incontinence developed in another patient. Vaginal hysterectomy, TOT and cystocele operations were made simultaneously in this patient. Mesh of this patient was cut later on.

\r\n

\r\n Coclusion: The surgical technique we used in our cases kept urgency and vaginal mesh erosion in a minimal level besides totally preventing urethral mesh erosion in a mean short-term follow-up period of 9 months.

\r\n

Objective: Mucormycosis is an infrequent opportunistic fungal infection which may cause an aggressive and invasive soft tissue necrosis. It is usually developed in patients with immune system deficiency, and rarely seen in immunocompetant patients.  We report prognosis and treatment of the immunocompetant patients that developed facial cutaneous mucormycosis after short term corticosteroid therapy.

Material and Method: The patients who were admitted to Manisa Celal Bayar University Hospital after multitrauma and given short term corticosteroids due to cranial and spinal injuries and became immuncompromised and diagnosed as facial cutaneous mucormycosis between 2016 and 2018 were included in the study. Prognosis, medical and surgical treatment outcomes of therapy is reported.

Results: One patient with malar and maxillary involvement was treated with medical therapy and serial debridements and infection was cured. Reconstruction with free flaps were done, acceptable functional and aesthetic results were achieved. Two patients had adequate therapy and reconstructed with local flaps.   One patient was not operated due to recurrent fungal osteomyelitis and intracranial inflammatory findings, and regression in MRI was seen.

Conclusion: Mucormycosis should be kept in mind in contaminated wound infections in patients who have been treated with corticosteroids even for a short time after multitrauma. Rapid, repetitive and aggressive debridemants should be performed and reconstruction should be planned after cure of the fungi.

ABSTRACT

Introduction: Most of the large defects in the hand are required vascularized skin coverage because they exposed tendons and bones. A pedicled groin flap has been offered as a standard flap for this indication. But immobilization of the upper extremity can be a disadvantage. Raising the groin flap is also possible as a free flap. The disadvantage of free flap is a time-consuming microsurgical procedure. We aimed to compare the pedicled and free groin flap reconstructions in patients with large hand defects based on patient-reported outcomes.

Materials and Methods: Sixteen patients who had groin flaps pedicled or free for the large defects of their hands were included in this study between 2013-2020. This study was performed retrospectively clinical survey work. Patients were divided into two groups: the pedicled groin flap group (n=8) and the free groin flap group (n=8). Patients were followed for 2 years. The patients were subjected to DASH and SF-36 tests after a postoperative period. Pre- and postoperative pain were evaluated with the Visual Analogue Scale. On which day they could walk and sit in the toilet without pain and not needed a second person for daily work, the patients were asked.

Results: Half of the patients with pedicled flaps had serious elbow and shoulder pain and required physical therapy. The wound healing was completed significantly earlier in the free groin flap group (p<0.05). The mean hospital stay in the pedicled group was longer than the free flap group (21 days and 13 days, respectively), which was statistically insignificant. The DASH scores were found to be 92 and 72 in the subacute and chronic stages in the pedicled flap group, whereas 52 and 24 were found in the free flap group, respectively (p = 0.012 and 0.002). According to SF-36 scores, physical functions were impaired significantly in the pedicled flap group (p < 0.001). The number of days needed by the second person for daily work was 79 in the pedicled group and 24 in the free flap group (p = 0.041). Sitting in the toilet without pain was started on the 63rd day in the pedicled group and on the 15th day in the free flap group (p = 0.036).

Conclusions: By transferring the groin flap as a free flap, the problems related to shoulder and elbow joints have disappeared, hand rehabilitation could be started earlier, and the time to return to daily work was shortened. So, if the groin flap is preferred, free style should be considered first.

Abstract

Animal bites to the face can cause serious defects. In select cases when the avulsed part has been carefully preserved and brought-in with the patient, replantation may be the best solution.

In other cases, few strategies are present. The classical “watchful waiting” strategy to treat such patients could be described as letting the wound to heal and only then, initiate reconstruction. Wound scarring and patient’s psychological disturbance due to prolonged rehabilitation are its biggest disadvantages. However, a proactive method with reconstruction initiated early during the convalescent phase, can result in faster rehabilitation.

Herein, we present detailed description of a successful early reconstruction of the perioral area in a teenage girl following a dog bite; the reconstruction encompassing the anatomical, functional and aesthetic spectrum. Thus, we believe, proactive strategy has a huge potential in the modern era of reconstructive head and neck surgery.

Aim: Bites are an essential cause of injury since the world. Treatment of bites is made according to specific guides and principles. The study's purpose is to examine the demographic characteristics of patients hospitalized due to bite wounds and to be a guide for new studies and treatments by sharing surgical treatment experiences.

Material and Method: Patients who were bitten and required surgical treatment were included in the study. Demographic characteristics, tetanus, and rabies prophylaxis applications, infection agents isolated from the wound site, antibiotherapies applied, and surgical treatments were recorded.

Results: Of the patients, 43 were male and mean age (±SD) of 34.5±23.8years (range, 3-85 years). Bites were in the head and neck region in 13(65%) of patients under 15 years old and in 12(27.3%) of the patients over 15 years old. In extremities, the injury was present in 7(35%) patients under 15 and in 28(63.6%) patients over 15 years old. Of the injuries, 50(78.1%) were caused by dogs, 8(12.5%) by wild animals (7 pigs, one wolf), 4(6.3%) by other pet species (horse, donkey, cow), and 2(3.1%) by humans. The intervention was made to all the patients according to guide of rabies prophylaxis specified by the Ministry of Health, General Directorate of Public Health. Irrigation was applied to the wound site with plenty of pressurized and soapy water. Forty patients received tetanus prophylaxis, 62 patients received rabies prophylaxis, and rabies immunoglobulin was applied to patients considered as suitable. Prophylactic amoxicillin clavulanate treatment was started in 38 of the patients, crystalline penicillin-G in 12, sultamicillin in 6, the combination of sultamicillin and aminoglycoside in 6, and cefazolin treatment in 2. 12(18.8%) patient underwent an urgent operation for repair process without any microbiological examination on the date of arrival. Among the patients to whom repair was applied on the first day, 7 had primary saturation, 3 had a local flap, 1 underwent ear, and 1 underwent nasal replantation, one patient had femoral artery repair, and one patient had peroneal nerve repair. Among 52 patients who underwent late repair, primary suturation was applied to 35, skin graft to 4, local flap to 17, and paramedian forehead flap to 2. No complication was seen in any of the patients who underwent early and late repairs.

Conclusion: Bacterial burden of the wound can be reduced enough to allow urgent repair owing to the irrigation of the wound with plenty of pressurized and soapy water in bites. 

Aim: We aimed to report our experience of a digital artery perforator flap use in fingertip and pulp defects reconstruction

 Materials and Methods: 8 patients underwent reconstruction with digital artery perforator flap for their finger defects were enrolled in the study. The patients were evaluated in terms of etiology, sex, age, comorbidities and outcomes.  The size of the flaps ranged from 20 x10 mm to 25 x20 mm.

 Results: The average age of the patients was 43,6 (range:19-66) years. 6 of 8 flaps survived completely and healed uneventfully.1 flap was totally lost where as 1 flap had partial skin necrosis.  No patients complained of cold intolerance or residual joint contracture. Mild hooked nail deformity occurred in one of the patients.

 Conclusions:  The DAPF is a reliable and versatile flap for fingertip defect reconstructions in non smoker patients without comorbidities. Single-stage operating procedure, ease of harvest, rapid recovery and preservation of digital arteries are the most important advantages.

The endoscopic approach for brow lifting has many advantages such as better exposure of the operative
field, shorter scars, reduced risk of alopecia and scalp sensory changes. Correct dissection technique,
release of the soft tissue attachments and efficient fixation of the forehead flap play an important role
in the outcome of the procedure. In this paper, we describe a modification of cortical tunnel fixation
technique, which allows delivering thick, weight-bearing suture s easily from the tight cortical tunnel.