Aesthetic Unit-Based Reconstruction of Periorbital Defects.

PURPOSE: The aim of this study was to perform a retrospective analysis of patients who underwent periorbital area reconstructions, determine their sociodemographic characteristics, analyze the effects of defect etiologies and locations classified according to periorbital subunits on our reconstruction options, and to present our treatment outcomes and clinical experience. METHODS: A retrospective chart review of 23 patients operated in our department between January 2010 and March 2013 and underwent periorbital area reconstructions, was performed. In addition to the demographic characteristics of the patients; defect etiologies, locations according to Spinelli aesthetic subunits, and the degrees of involvement were determined. RESULT: Analysis of the reconstructive methods showed that primary closure with lateral cantholysis was performed in 1 patient with a defect involving less than 50% of zone 1 along with a partial defect involving less than 50% of zone 2. In another patient with a full-thickness defect involving 75% of zone 1, reconstruction was made with a temporally based monopedicle forehead transposition (Fricke) flap prepared from the lower eyelid, and a conchal cartilage graft. In 2 other patients with partial defects involving more than 50% of zone 2; reconstruction was made with full-thickness skin grafts taken from the retroauricular area. Four patients had full-thickness defects that involved 50% to 75% of zone 2; 3 of them were reconstructed with a Tenzel lateral semicircular rotation flap and 1 with a Tripier flap. In 3 patients who had full-thickness defects involving 75% of zone 2; reconstruction was made with a paramedian forehead flap and conchal cartilage graft. In 3 patients with full-thickness defects involving more than 75% of zone 2, a Mustarde cheek rotation flap was used for reconstruction. Six patients had defects in zone 3, 3 of them were reconstructed with a glabellar flap, 2 with a paramedian forehead flap, and 1 with a bilobed flap. One patient with a defect that involved 50% of zone 4 was reconstructed with a McGregor flap. CONCLUSIONS: Construction of a reconstructive algorithm by separation of the eyelid into aesthetic units and use of local healthy tissues provide functionally and aesthetically acceptable results.

Dilemma in pediatric mandible fractures: resorbable or metallic plates?

BACKGROUND: The aim of this study was to compare the efficiency of resorbable and metallic plates in open reduction and internal fixation of mandible fractures in children. METHODS: Thirty-one patients (mean age, 8.05 years; range 20 months-14 years) were operated on various fractures of the mandible (26 [60.4%] symphysis- parasymphysis, 12 [27.9%] condylar-subcondylar fractures, 5 [11.6%] angulus and ramus fractures). Twelve patients were treated with resorbable plates and 19 patients with metallic plates. Mean follow-up time was 41 months (11-74 months) in the metallic hardware group and was 22 months (8-35 months) in the resorbable plate group. Both groups were investigated for primary bone healing, complications, number of operations, and mandibular growth. The results were discussed below. RESULTS: Both groups demonstrated primary bone healing. Minor complications were similar in both groups. The metallic group involved secondary operations for plate removal. Mandibular growth was satisfactory in both groups. CONCLUSION: Resorbable plates cost more than the metallic ones; however, when the secondary operations are included in the total cost, resorbable plates were favourable. As mandibular growth and complication parameters are similar in both groups, resorbable plates are favored due to avoidance of potential odontogenic injury, elimination of long-term foreign body retention and provision of adequate stability for rapid bone healing. However, learning curve and concerns for decreased stability against heavy forces of mastication accompanied with the resorbable plates when compared to the metallic ones should be kept in mind.

The use of dermal automesh for incidental hernia repair in abdominoplasty: Clinical, biochemical, and radiological results.

Abdominal wall hernias are often diagnosed on clinical examination or encountered intraoperatively during an abdominoplasty. The aim of this study is to evaluate the long-term results of the use of dermal automesh for the repair of incidental hernias during abdominoplasty operations, and to perform a comparative analysis of the biomechanical strengths of dermal automesh vs biological tissue graft. Between 2008-2012, dermal automesh was used in 12 patients for hernia repair. After repair of hernia, dermal automesh was applied over the repaired area in an onlay fashion. Postoperative follow-up was performed by physical examination and magnetic resonance imaging (MRI) of the abdominal wall. Biomechanical test was performed with prepared samples from excised abdominal panniculus for tensile strength and yield power. Mean age was 45 years (range = 36-54 years). Total follow-up was 26 (14-52) months. MRI studies showed that there were no hernias or defects of the anterior abdominal wall. The tensile strength of the dermal mesh was measured as 15.9 ± 6.0 Mpa (6.4-24.5), maximum load before yield measured 680 ± 175.2 N (336.0-856.0). In conclusion, dermal automesh is a useful option for surgeons who encounter undiagnosed hernias during abdominoplasties.