Effect of Oral Cilostazol on the Patency of Microvascular Anastomoses in Rats.

In order to evaluate the effect of cilostazol on patency of microvascular anastomoses, a double blind control study was performed on microanastomoses of the femoral artery in rats. Thirty female Spraque- Dawley rats were divided into two groups according to a blind protocol. One group (group A) was given cilostazol orally (10 mg/ kg) 2 hours before the operation and for 7 days post-operatively. The other group (group B) received normal saline solution orally in the same amounts and at the same times as group A. The femoral artery anastomoses were performed under standard microvascular conditions. Seven days post-operatively, the patency of the arterial anatomoses was evaluated by Acland\\\'s test and histological study. The patency rate by Acland\\\'s test was 73% in group A, and 53% in group B. There was no significant difference between the patency rates of these two groups (p = 0.082). The area of the patency of the lumen by histological study was 61.67% in group A and 48% in group B. There was no significant difference between the groups in relation to patency of the microanastomoses (p = 0.381). There were no complications observed in this study.

The efficacy of wall-typed suction and polyurethane foam in vacuum assisted wound dressing system.

Vacuum assisted wound dressing was introduced as one of the methods for wound management in problematic wounds. This system which was expensive included a controllable vacuum suction unit and polyurethane foam. In this study we evaluated the efficacy of a controllable wall-typed suction that was available in the patient ward to be used with various types of polyurethane foam in the market. One type of the polyurethane foam that had suitable pore size and good porosity was selected and used in 4 patients with sacral pressure ulcers and 1 patient with both sacral and trochanteric pressure ulcers. These patients were not candidates for surgery and their ulcers were not improved by conventional dressing. The vacuum dressing system was applied to the ulcers for 2 months. The sizes of the ulcers were reduced statistically (p=0.042) without complication. In conclusion, the controllable wall-typed suction and polyurethane foam could be used effectively for wound dressing in problematic wound and ulcer.

Single artery digital replantation.

Microvascular replantations of amputated distal fingers were reviewed in 11 cases in which single arterial repair without venous repair was done. usually, the standard replantation consists of re-anastomosis of arteries and veins. In this study, venorrhaphy could not be achieved since no vein of sufficieny size was found. Survival rate of replanted digits was 68.8 percent (11 from 16 digits), which compared favorably to other reports. This technique offers better cosmetic and functional outcome than reattachment as a composite graft or stump closure. The result of our study confirms the possiblitity of single arterial digital replantation with an acceptable outcome in selected cases. Cases analysis and surgical technique will be discussed in detail.

Frontalis muscle transfer for the treatment of upper eyelid ptosis.

The management of severe blepharoptosis is problematic. A variety of surgical approaches do not yield good results especially in the presence of poor levator function. In this report, direct frontalis muscle transfer was used for the treatment of severe blepharoptosis with poor levator function. Twenty-one patients with severe blepharoptosis and poor levator function were operated during the period from 1995 to 1998 using this technique. Excellent and good results were achieved in 8 and 13 patients (38.1% and 61.9%), respectively. Two patients (9.5%) had complications. One was entropion and the other was hematoma, both of which were improved by reoperations. All patients had lagophthalmos postoperatively which subsided one month after surgery without complication. The patients were all satisfied.

Skull base surgery: Access to anterior and middle cranial fossa.

Although skull base lesions, which differ in comparison to other areas of pathology, are difficult to deal with, much has been published of the subject in the last two decades. Access, visualization, surgical skill, and technique are keys of surgical success. Since June 1995 – December 1996, 47 cases were performed by the basal skull group; (neurosurgeon, ENT, ophthalmic and plastic surgeons). Among these cases, 28 fronto-orbito-zygotomies were performed for anterior and middle cranial fossa lesions including tumors of the cavernous sinus, vascular aneurysms and orbital tumours, etc. Most benign lesions were totally removed and functional preservation was achieved in most cases. Only one case of morbidity from injury to the frontal nerve and two mortalities from intracerebellar haemorrage and sepsis occurred. Access is the major crucial factor which can determine the functional result, and involvement of multidisciplinary fields will provide good cosmetic results.

Parascapular free flap for facial augmentation in progressive facial hemiatrophy.

Three cases of progressive hemiatrophy which werre treated by de-epithelialized parascapular free flaps are reported. This flap is accesble, easy to dissect and has constant anatomy of the nutrient vessels. The bulkiness of the flap is adequate for severe deformities.

Pierre robin anomalad with rare oblique lower lip cleft : A case report.

We report an unusual case of the Pierre Robin Anomalad who had not only triad of glossoptosis, micrognathia and incomplete cleft palate, but also had right sided choanal atresia, absebce of the right hard palate and a lower lip oblique cleft on the right side with small lobules along the cleft. The defects were corrected surgically twice when the infant was 11 and 18 months old with satisfactorily results.

Lateral supramalleolar flap.

Soft tissue coverge of the heel and ankle area is one of the most difficult problems encountered in reconstruction particularly when the major arterial trees of the lower extremity are injured. Lateral supramalleolar flap, an axial pattern skin flap, based on the cutaneous branch of the perforating branch of the peroneal artery, can be effectively utilized as a mean of resolution. Sacrifice of the main arteries (anterior, posterior tibial artery, or peroneal artery) is avoided, which is the great advantage of this flap. Twelve patients, ages 8 to 55 years, underwent the operation employing this type of flap. Four cases of soft tissue lost on the foot, were covered with such flaps. The flap healed satisfactorily except for two cases, one had minor skin slough at the edge of the flap and the other one had necrosis of one had necrosis of one third of the flap, requiring subsequent debridement, but healing took spontaneously. The only one disadvantage of this flap is the donor site scar.