Hyperbaric oxygen therapy of soft tissue necrosis due to centipede bite in a patient with diabetes.

OBJECTIVE: The purpose of this study is to demonstrate that hyperbaric oxygen therapy (HBOT) is an option for the management of rapidly progressive tissue necrosis after centipede bites in patients with diabetes. METHOD: In this case report, we introduce a patient with diabetes with soft tissue necrosis and secondary infection due to a centipede bite, who was treated with a multidisciplinary approach including HBOT. RESULTS: In this case study, HBOT, applied in the treatment of rapidly developing cellulitis after a centipede bite in a patient with diabetes, accelerated wound healing. Deep soft tissue infection stopped progression to necrotising fasciitis and prevented possible amputation, and facilitated the patient's return to social life in a short time. CONCLUSION: HBOT can be used in combination with other local and systemic, due to its anti-venom effect and treatment of extremity-threatening infection.

The Tuck-in Mastopexy.

BACKGROUND: Breast ptosis is an inevitable consequence of gravity and time. Every breast tends to become ptotic in different shapes and degrees. Many surgical techniques were described to solve this problematic issue. The aim of this article is to describe a mastopexy technique used for grades 1 to 2 ptosis, "tuck-in" mastopexy technique. METHODS: Keyhole pattern was used for skin markings. All the planned skin excision areas were de-epithelialized. Breast mound was elevated as a 1-piece flap with extensive subglandular dissection. Elevated breast flap was reshaped and repositioned. Skin incisions were sutured in 2 layers. RESULTS: Seventeen patients were operated on with this technique; average follow-up time was 10.1 months. No major complications were seen. The results were pleasing for both the patients and the surgeon. CONCLUSIONS: The "tuck-in" mastopexy technique uses breast mound as 1-piece flap, which has great vascularity from medial, superior, and lateral pedicles. Large areas of de-epithelialization facilitate reshaping and repositioning. It permits simultaneous or secondary breast augmentation with silicone gel implants. This easy-to-do technique has low complication rates and a short learning period.

Sphincter-Sparing Excision and Reconstruction Using Facial Artery Perforator Flaps for Lower Lip Carcinoma.

PURPOSE: This article discusses the results of orbicularis oris muscle-sparing surgery and reconstruction of defects through the use of facial artery perforator flaps and mucosal advancement flaps. PATIENTS AND METHODS: Patients with lower lip carcinoma were evaluated retrospectively. Patients who underwent reconstruction with facial artery perforator flaps and mucosal advancement flaps with clear surgical margins and no muscle invasion were included in this study. Frozen section examinations were performed intraoperatively. Patients with muscle invasion were excluded. RESULTS: Between 2005 and 2015, 42 patients were treated by the described method. Supraomohyoid lymph node dissections were performed in patients whose ultrasonography had detected suspicious lymph nodes (n = 4). No metastases were identified on pathologic examination of the lymph nodes, and no local or distant recurrences were seen during a mean follow-up time of 58.4 months (range, 16 to 82 months). CONCLUSIONS: The value of resecting the orbicularis oris muscle in cases in which there has been no muscle invasion is an ongoing subject of debate among surgeons. Preserving the muscle means preserving the function, and this is the main purpose of reconstruction. Using facial artery perforator flaps for reconstruction ensures good esthetic results while also maintaining the maximum oral opening. Sphincter-sparing excision and reconstruction with facial artery perforator flaps comprise a safe and reliable treatment method for selected cases involving lower lip carcinomas.

Tamoxifen-Related Thrombosis: An Experimental Study in Rat Venous Microvascular Anastomosis Model.

Tamoxifen is an estrogen receptor modulator and has been shown to increase risk for microvascular flap complications. This study aimed to investigate the clinical and histopathological effects of tamoxifen use in venous microvascular anastomosis model in rats. The role of vitamin E combination therapy and discontinuing tamoxifen therapy preoperatively were also evaluated.Forty rats were equally divided into 4 groups as follows: group 1 was given saline by oral gavage, group 2 was given tamoxifen citrate, group 3 was given tamoxifen citrate and vitamin E, and in group 4, tamoxifen citrate was given everyday except between days 12 and 16. In each group, femoral veins were dissected in each side and end-to-end anastomosis was performed in one side. Clinical and histopathological evaluations were performed. The ratio of total endothelial area to total vein area in a cross-sectional view of the vein was evaluated and compared.All veins with anastomosis in postoperative 15 minutes were found to be patent. In postoperative 1 week in groups 1 to 4, visible thrombus were present in 1, 3, 2, and 3 samples, respectively. Vitamin E group showed similar histopathological findings with control group. The ratio of endothelial layer to total vein cross-sectional area was increased in groups 2 and 4 in all samples. The increase was statistically significant between groups 2NA and 3NA (P = 0.023) and 2A and 1A (P = 0.006).Chronic tamoxifen consumption in the presence of anastomosis have led to prominent endothelial proliferation in rat femoral veins. Vitamin E combination therapy reversed this endothelial proliferation and should be focused in future studies.

Saphenous artery-based flap models in rats: new flap designs for experimental studies.

BACKGROUND: Experimental research using laboratory animals provides substantial data about reconstructive surgery. However, the literature does not include any experimental studies that have used flap models on the hind limbs of rats. To gain an understanding of the physiology of lower-extremity flaps and of flap failures, this study assessed the cutaneous perforators of the saphenous artery, and new flap models were designed for the hind limbs of rats. MATERIALS AND METHODS: The experiment was designed to include three stages and used 35 rats. The first stage involved mapping the perforators of the saphenous artery. In the second stage, the contents and structures of McFarlane, epigastric, and anterior hind limb flap tissues were compared histologically. The third stage of the study involved designing and comparing different flaps for the hind limbs of the rats and included random flaps, perforator-based peninsular flaps, perforator-based island flaps, and perforator-based flaps with rotated pedicles. Postoperative necrosis ratios were evaluated using computer-based software. RESULTS: Mapping of the saphenous artery perforators revealed an average of 2.2 septocutaneous arteries in each hind limb. Histologic studies showed thick dermis and panniculus carnosus in the McFarlane flaps, thick dermis, and thin panniculus carnosus layers in the epigastric flaps, and thin subcutaneous tissue with no panniculus carnosus tissue in the skin of the hind limbs. The results of the flap studies that used random flaps showed a 52.4% necrosis, while there was no necrosis when perforator-based peninsular flaps, island flaps, and flaps with rotated pedicles were used. CONCLUSIONS: New flap models used on the saphenous artery perforators of the hind limbs of rats can provide valuable information about the physiology of lower-extremity flaps. New studies can also be designed based on these flap models to acquire more knowledge about pathologic conditions such as ischemia and venous insufficiency.

An emerging etiological factor for hand injuries in the pediatric population: public exercise equipment.

OBJECTIVE: The purpose of this study was to describe the role of public exercise equipment in pediatric hand traumas as a preventable etiological factor. METHODS: Pediatric patients with hand injuries referred from the emergency department were evaluated retrospectively. Age and gender of the patients, timing, etiology, mechanism of hand trauma, localization of the injury, diagnoses of the patients, and hospitalization rates were reviewed. RESULTS: Amongst the 310 pediatric patients evaluated, 31 patients (10%) experienced injury related to public exercise equipment. Within this group of patients, most were between 5 to 9 years of age, and all injuries were blunt and crush type. Lacerations and fractures were the main diagnoses. Complex injuries that required inpatient care were reported in 19.3% of the patients. CONCLUSION: Public exercise equipment-related injuries are increasingly prevalent in pediatric hand traumas. Preventive actions such as shielding the moving parts should be taken to reduce these rates.

Dentures as Learning Materials for Maxillomandibular Fixation by Erich Arch Bars.

Maxillomandibular fixation with Erich arch bars is an economic method for handling mandibular fractures. Unfortunately, this method has some disadvantages, such as long operating time, periodontal trauma, and risk of puncture injury to the operator. To overcome these disadvantages, we propose teaching the pits and pearls of maxillomandibular fixation with Erich arch bars to trainees using dentures of a patient. Experiencing the method on dentures will shorten the learning curve.

Clinical Experience With the Combination of a Biceps Femoris Muscle Turnover Flap and a Posterior Thigh Fasciocutaneous Hatchet Flap for the Reconstruction of Ischial Pressure Ulcers.

BACKGROUND: The reconstruction of ischial pressure ulcers is problematic because of the distinctive anatomical properties of the region and high recurrence rates. To date, no single technique has been proven to be effective in reducing recurrence of the ulcers. We present our experience with the combination of a biceps femoris muscle turnover flap and a posterior thigh fasciocutaneous hatchet flap and discuss the long-term results. METHODS: A retrospective clinical analysis of 15 patients with grade 4 ischial pressure ulcers reconstructed with biceps femoris muscle turnover flaps and laterally based posterior thigh fasciocutaneous hatchet flaps was carried out between January 2010 and January 2013. Debridement and reconstruction of the ulcers were accomplished in a single stage. The posterior thigh fasciocutaneous flap was elevated in a hatchet style. The long and/or short head of the biceps femoris muscle were dissected from their insertions, turned over on their major pedicles, and their distal portions were used to obliterate the cavitary defect. The skin defect over the muscles was covered by the fasciocutaneous hatchet flap. The average age of the patients was 42.6 years and the mean follow-up time was 27.2 months. RESULTS: Three patients had the following early postoperative complications: hematoma, suture dehiscence, and the necrosis of the short head of biceps muscle. Only 1 patient had a recurrent ulcer 15 months after surgery, which was treated with debridement and the readvancement of the fasciocutaneous flap. The overall recurrence rate was 6.6%. CONCLUSIONS: The biceps femoris muscle turnover flap combined with the posterior thigh fasciocutaneous hatchet flap is a worthwhile option to consider for the reconstruction of ischial pressure ulcers and this technique produces favorable results in terms of the lack of recurrence and complications. The use of the muscle and fasciocutaneous tissue as 2 different flaps, which have different roles in the early and late postoperative period, reduces the recurrence rate.

Selective Nerve Block Combined With Tumescent Anesthesia.

PURPOSE: To evaluate the effect of selective nerve blocks before tumescent anesthesia on the pain and anxiety levels of patients. METHODS: A prospective study was performed with 80 patients. Forty consecutive patients received tumescent anesthesia, and 40 consecutive patients received selective nerve blocks followed by tumescent anesthesia. Patients filled out a questionnaire regarding their preoperative, intraoperative, and postoperative pain and anxiety levels. The results of the questionnaire were evaluated with an independent samples t test. RESULTS: The 2 study groups showed similar distribution in age, sex, and diagnosis. No complications related to tumescent anesthesia or nerve blocks were observed. The group that received tumescent anesthesia with selective nerve blocks reported lower pain scores in anesthesia injections than the group that received tumescent anesthesia alone. The intraoperative and postoperative pain and anxiety levels between the groups were not different. CONCLUSION: Tumescent anesthesia combined with selective nerve blocks in hand surgery decreased the pain associated with injections and increased patient satisfaction. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.

Basal cell carcinoma of the head and neck region: a retrospective analysis of completely excised 331 cases.

The aim of the study is to analyze all completely excised BCCs in the head and neck region with regard to age, sex, personal and familial history, skin type, tumor localization and size, histopathological subtype of tumor, reconstruction method, and recurrence rates. Incompletely excised BCCs were not included in this study since incomplete excision is the most important preventable risk factor for recurrence. In 320 patients, 331 lesions were retrospectively evaluated by dividing into the following 8 subunits: scalp, frontotemporal, orbital, nose, cheek, auricula, perioral, and chin-neck area. Most of the patients were in 60-70 age group (34.7%). The nose (32.3%) was the most common site of presentation. Clinically, all lesions and, histopathologically, most of the lesions (42.2%) presented were of the nodular type. All cases of recurrence after complete excision (n = 9, 2.7%) were located in the median parts of the head and neck region and were mainly diagnosed histopathologically as sclerotic and micronodular. Even though completely excised, head and neck region BCCs, especially which are more prone to recurrence due to anatomical and histopathological properties, should be more closely monitored in order to decrease morbidity and health care costs.