Columellar Scar Perception in Open Rhinoplasty. Interplay of Scar Awareness, Body Cathexis and Patient Satisfaction.

INTRODUCTION: Open and closed approaches for rhinoplasty have individual advantages and disadvantages; however, the resultant columellar scar of the open approach is directly considered as a disadvantage. This study focuses on the columellar scar awareness and its implications on overall satisfaction of the patients after open rhinoplasty. PATIENTS AND METHODS: A total of 91 patients who have undergone open rhinoplasty were included in this study. A written questionnaire algorithm consisting of 4 sequential questions was applied. Except for the first question [Do you have any scar(s) caused by any trauma, operation or any other reason on your face?], every question was answered on a scale from 1 to 5. The respondents were given the 25-question "Modified Body Cathexis Scale (MBCS)"and their scars graded using the "Columellar Scar Assessment Scale" (CSAS). The data were statistically interpreted. RESULTS: Of the 91 open rhinoplasty patients, 12 of them responded with a "yes" to the first question reporting their columellar scars. There was no significant difference with regards to patient satisfaction regarding these patients (p > 0.05). However, those who reported the scar yielded a significantly lower MBCS scores. 9 patients declared that they exerted effort to conceal their scars. Those who concealed their scars and those who did not yielded a significant difference in patient satisfaction. The CSAS scores of those who reported the columellar scar were significantly higher than those who did not. CONCLUSION: Our study suggests that MBSC can be a valuable tool for determining the impact of outcomes from the patient's standpoint, and awareness of the columellar scar is not related to patient satisfaction but with bodily perception. LEVEL OF EVIDENCE IV: 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 .

Freed Lower Lateral Cartilages with Intact Lateral Attachments: A Versatile Approach in Tip Plasty.

BACKGROUND: Tip plasty is an important procedure that contributes much to obtaining an aesthetically pleasant nose. To increase precision during the tip plasty procedure, control over the lower lateral cartilages should be maximized. This can be accomplished by extending the exposure of the cartilage framework. We present our "Freed Lower Lateral Cartilages With Intact Lateral Attachments" approach through which inferior lateral cartilages are being dissected free from their attachments, while only their lateral bases (lateral crural parts) are left intact. PATIENTS AND METHOD: A total of 1752 consecutive patients operated on with this approach were included. All patients were cosmetic rhinoplasty patients operated on between the years 1999 and 2014. During tip plasty, the lower lateral cartilages of all patients were totally dissected from all their attachments, while the lateral bases were left intact. The suture and graft techniques for the tip plasty procedure were then applied to reconfigure the tip region. RESULTS: The approach was used successfully in 1752 patients in a 15-year period. The mean age of patients was 33.5 years. The complication rate was 6.4 % and the revision rate was 4.7 % for the patients. Only 1.2 % of patients needed a revision surgery for tip and/or alar region. None of these patients needed further revision. The aesthetic and functional outcomes revealed high satisfaction rates. CONCLUSION: The "Freed Lower Lateral Cartilages With Intact Lateral Attachments" approach in tip plasty facilitates manipulation of the tip region while maintaining precise control to provide definition in terms of symmetry and three-dimensional configuration. Furthermore, it constitutes an autologous and practical platform on which nondestructive techniques can be performed in a combined and synergistic fashion. LEVEL OF EVIDENCE IV: 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 .

The average values of the nasal anthropometric measurements in 108 young Turkish males.

OBJECTIVE: The aim of the study was to describe the average values of the nasal anthropometric measurements in young Turkish male population. METHODS: Study group consisted of 108 volunteer young Turkish males whose age were 18-30 years (mean age 22.31 year). All subjects were students in Yasar Dogu School of Physical Education and Sport of University of Ondokuz Mayis. RESULTS: The means total length and nasal bridge length of the nose were 56.92 and 55.26 mm, respectively. The means of the nasal bridge width and morphologic nose width were 29.74 and 33.63 mm, respectively. The mean width of the anatomic nose was 23.14 mm. The mean width of the nostril floor was 11.00 mm. The means length and width of the ala were 19.93 and 4.81 mm, respectively. The means of length and width of the columella were 9.34 and 5.34 mm, respectively. The mean frontonasal angle was 134.96 degrees and the mean nasolabial angle was 90.32 degrees. CONCLUSION: The nose was the dominant feature in the facial region. Anthropometric measurements related with the nose measured were compared with the available literature. Average values of the nose in this population may be used as a landmark for guidance to plan corrective surgery of the nose.

Estimation of breast prosthesis volume by the Cavalieri principle using magnetic resonance images.

BACKGROUND: The purpose of this study was to search the accuracy and reproducibility of the Cavalieri method for the estimation of the breast prosthesis volume on magnetic resonance images (MRI). METHODS: Nine breast prostheses were scanned in axial and coronal section planes by MRI. The consecutive sections in 5-mm thickness were taken, after which the volumes of the prostheses were measured and estimated by means of the fluid displacement technique and three-dimensional postprocessing software, respectively. The volumes of the prostheses also were estimated by three performers using the Cavalieri principle to check the accuracy and interobserver interrelation of the suggested technique RESULTS: There were no significant differences between the Cavalieri estimate and the real volumes of the breast prostheses (p > 0.05), nor between the performers's volume estimates (p > 0.05). The orientation of the section planes did not affect the accuracy of the estimates (p > 0.05) CONCLUSIONS: This report describes a rapid, simple, accurate, and practical technique for estimating the volume of the breast prostheses without changing the routine process in the clinics. It was concluded that the combination of MRI with the Cavalieri principle is a direct and accurate technique that can be applied safely for estimating the volume of the breast prosthesis in 4 min and 34 s per prosthesis.

Use of longitudinal invaginating matrix sutures in microarterial sleeve anastomoses.

A different approach to end in end anastomosis was tested to minimise the undesirable traits of classic and sleeve (telescoping) methods. Our approach aimed to maintain full contact at the level of the anastomosis by using longitudinal matrix sutures as a new invaginating suture technique in microarterial sleeve anastomosis. Classic end-to-end anastomosis with seven to eight stitches, Lauritzen's end-in-end anastomosis with four stitches, and our modified end-in-end anastomosis with two horizontal matrix sutures were made in 10, 20, and 25 rat femoral arteries, respectively. Nine, 17, and 18, respectively were patent at early evaluation; and eight, 13, and 14 at the time of late evaluation. There was no significant difference in between the patency rates of the groups. Histopathological examination showed large strictures and the formation of intra-luminal organised thrombus with thin intramural fibrin precipitation in occluded specimens. The longitudinal matrix sutures in the sleeve anastomoses, which passed through all layers of the vascular wall, injured the intima (a vertical rupture) and constricted the lumen.

Radiologic and histological evaluation of otogenic sliced cartilage grafts at the tip of the chin of rabbits: an experimental study.

OBJECTIVES: Cartilage grafts have been commonly used in plastic and reconstructive surgery applications for many different goals, such as auricular reconstruction and rhinoplasty. The use of autologous cartilage is ideal for many reasons. An attempt was made to produce an experimental animal model to test the efficacy of otogenic Surgicel-wrapped sliced cartilage. METHODS: In this experimental study, cartilage grafts were harvested from rabbits' ears. These grafts were cut in pieces of 0.5 mm to 1 mm using a no. 11 blade. This cartilage mass was wrapped in one layer of Surgicel (oxidized regenerated cellulose) and inserted in the chin of the rabbits. MR analyses were made at 1 week and 6 months and histological analyses were made at 6 months. RESULTS: Cartilage grafts maintained approximately 80% of their dimensions in MRI. The proportion of necrosis was between 30% and 50% and the proportion of resorption was approximately 20% in the histological studies.

Enhancement of nerve regeneration and orientation across a gap with a nerve graft within a vein conduit graft: a functional, stereological, and electrophysiological study.

In this study, the right sciatic nerves of 40 rats were used to determine whether a nerve graft within a vein graft might accelerate and facilitate axonal regeneration, compared with a nerve graft alone. The animals were separated into four groups, as follows: group 1, sham control; group 2 (control), segmental nerve resection and no repair; group 3, segmental nerve resection and nerve grafting; group 4, segmental nerve resection and reconstruction with a nerve graft within a vein conduit graft. For all groups, sciatic functional indices were calculated before the operation and on postoperative days 7 and 90. On postoperative day 90, the sciatic nerves were reexposed and nerve conduction velocities were recorded. The sciatic nerves were harvested from all groups for counting of the myelinated axons with a stereological method. No statistically significant differences with respect to return of gait function, axon count, or nerve conduction were noted between groups 3 and 4 (p > 0.05). However, functional recovery in group 4 on postoperative day 90 was significant, compared with group 2 (p < 0.05); the recovery difference between groups 2 and 3 was not significant (p > 0.05). This study was not able to demonstrate any functional benefits with the use of a nerve graft within a vein graft, compared with standard nerve grafting.

Natural-looking umbilicus as an important part of abdominoplasty.

The umbilicus is an important and essential aesthetic component of the abdomen. Many surgeons use different methods to relocate umbilicus during abdominoplasties. We prefer to use a simple combination of different well-known principles to form the neo-umbilicus. The main steps of the procedure are to make an elliptical vertical incision, to do vertical abdominal fascial plication, to embed the umbilical stalk in this plication by suturing the umbilical skin and the rectus fascia together to maintain the umbilical dimple, to place it at the vertical incision made in the abdominal skin at a predetermined point. Silk sutures are used for the abdominal fascial plication and neo-umbilical fixation. Liposuction from the neo-umbilicus to xiphoid along the midline of the upper abdomen creates a minimal superior sulcus. In each patient, a three-dimensional umbilicus with sufficient depression was obtained. All patients, including one case with complications, were pleased by the final aesthetic results.

Reconstruction of columella, membranous septum, and upper lip in a single stage operation.

Reconstruction options for columellar defects together with membranous septum, nasal base, and upper lip are restricted. We present a case successfully treated with bilateral cheek advancement flaps with upper medial, perialar skin flaps to reconstruct the upper lip, columella, nasal base and membranous septum in a single session. This method provides adequate tissue with minimal cosmetic deformity in a single stage for repairing such compound defects.

Using human hair as suture material in microsurgical practice.

For practice in microsurgery, animal models and microsurgical instruments are required. The use of some synthetic and non-animal materials such as human placenta and other tissues have also been suggested for practicing. The other material that is needed is microsuture. These materials are expensive and often not easily obtained. To meet this requirement, the authors present human hair as a microsuture material for microsurgical practice.