Use of dorsal intercostal artery perforator flap in the repair of back defects.

BACKGROUND: The dorsal intercostal artery perforator (DICAP) flap is a well-vascularised flap that is elevated above the dorsal branch of the vertebral segments of the posterior intercostal artery. The aim of this study was to repair back defects using DICAP flaps. MATERIALS AND METHODS: Eight patients who had undergone reconstruction with DICAP flaps for defects located on the back of the torso due to conditions of various aetiologies between 2011-2014 were included in this study. Patient age and gender, aetiology of the condition, dimensions of the defect and the flap, site of the defect, and postoperative complications were recorded. RESULTS: Three females and five males were included in this study. The age of the patients ranged between 19-71 years (mean = 53.6 years). The aetiology was skin tumour in five patients and pressure wound, gunshot injury, and plate screw exposition subsequent to spinal surgery in one patient each. The sites of the defects were successfully closed in all patients, and no flap loss was observed in any patient. CONCLUSIONS: DICAP flaps have some advantages compared to conventional muscle and muscle skin flaps, such as greater protection of muscle functions, less invasiveness, and lower donor site morbidity. This flap has a high mobilisation capacity due to its elevation above nine bilateral perforator arteries. Therefore, the DICAP flap is useful for the repair of median and paramedian back defects. Based on its advantages, it is suggested that the DICAP flap should be considered as a useful option for the repair of back defects.

Congenital Lateral Cleft Palate of Unknown Etiology.

The term cleft palate (CP) refers to midline defects extending from the prealveolar ark to the uvula, and these defects present with varying degrees. CP may be complete, incomplete, unilateral, bilateral, or submucosal. It is often observed with cleft lip (CL). In various studies, the incidence of isolated CP has been reported as 1.3 to 25.3 per 1000 births. As a result of deterioration of the anatomical structure of the palate, illnesses such as regurgitation, respiratory tract infections, otitis, and speech disorders may occur. These defects are often observed in the midline and are rarely laterally localized. Cleft palates with lateral localization are outside the natural midline cleft closure line and cause clinical complaints similar to other types of CP. Two cases of laterally localized CP have previously been published in the literature. The case presented here is the third known case to be reported.

Effects of ozone pretreatment on viability of random pattern skin flaps in rats.

BACKGROUND: Medical ozone is a chemical agent that consists of three oxygen atoms and has antioxidant, angiogenic and vasodilator effects. This study evaluated the effects of medical ozone pre-treatment on flap survival. MATERIALS AND METHODS: Rats were divided into four groups of 10 rats each and a 9 × 3 cm McFarlane flap was used. Sham group: Neither surgical nor ozone pretreatment was used. CONTROL GROUP: No pretreatment was used after surgery. Preoperative ozone group: Preoperative 1 mg/kg ozone was given intraperitoneally for 7 days. No pretreatment was used after surgery. Postoperative ozone Group: Postoperative 1 mg/kg ozone was given intraperitoneally for 7 days. After postoperative 1 week, all groups were evaluated by surface area measurement, histopathology and electron microscopy. RESULTS: With the experimental McFarlane flap model, the experimental groups had better surface area measurements, along with histopathological and electron microscopic results when compared with the control group. CONCLUSION: Medical ozone had positive effects on flap survival due to its antioxidant, angiogenic and vasodilator qualities.

Comparison of the fistula risk associated with rotation palatoplasty and conventional palatoplasty for cleft palate repair.

OBJECTIVES: The aims of the cleft palate repair techniques are to reduce the velopharyngeal insufficiency risk and oronasal fistula development to minimal levels without affecting the maxillofacial development. In this article, we present a retrospective study comparing the conventional palatoplasty techniques with the new technique of rotation palatoplasty for the risk of development of oronasal fistula. MATERIALS AND METHODS: Of the 100 patients who were operated on because of cleft palate between the years 2002 and 2008, 12 patients had Furlow palatoplasty, and 88 patients received the Veau-Wardill-Kilner (V-Y pushback) operation (group C). A total of 67 patients who were operated on between 2008 and 2011 had rotation palatoplasty (group R). RESULTS: One hundred patients were men, and 67 were women. Among all the patient groups, 22.8% were classified as Veau 1, 24.6% were classified as Veau 2, 37.1% were classified as Veau 3, and 15.6% were classified as Veau 4. The rate of fistula was found to be 17.7% in all patients. Fistula development was found in 6% of the patients in group R (4/67) and in 18% of the patients in group C (18/100). The difference between group R and group C regarding the number of patients who developed fistula was statistically significant (P = 0.011). CONCLUSIONS: The Veau classification of the cleft palate affects the risk of fistula development, and the risk for fistula after rotation palatoplasty is lower than that associated with the V-Y pushback technique.

Kutlay technique for hypospadias repair.

OBJECTIVE: Although many techniques have been described, new techniques with a wide range of therapeutic options are needed. The Kutlay technique is a novel technique that is based on the reconstruction of the neourethra with two horizontal meatal-based skin flaps. In the present study, the data of 31 patients who underwent surgery with the Kutlay technique are presented. PATIENTS AND METHODS: Thirty-one patients with hypospadias with an average age of 5.6 years who did not have previous hypospadias repair were operated on with the Kutlay technique. Ten patients had chordee. Among those patients, three patients were circumcised. RESULTS: The patients were followed up for 4-13 months (average, 9.3 months). During the follow-up period, a fistula was observed in only one patient. None of the patients developed neourethral dehiscence, meatal stenosis, urethral stricture, wound infection, penile torsion, hematoma, or persistent or recurrent chordee. On uroflowmetry studies, the maximum flow rate of the patients was approximately 10.5 ml/s (range, 6-17 ml/s). The patients were observed to void with a single straight urinary stream in a forward direction. CONCLUSION: The Kutlay technique is a technique that is easily applied in patients with chordee and that provides a low risk of fistulas and acceptable functional and esthetic results. The factors that reduce the risk of fistula are the lack of the superposition of the suture lines of the skin and the urethra, the reconstruction of the urethra with well-vascularized flaps, and the replacement of the neourethra in its appropriate location through the tunnel created in the glans.

Upper extremity injuries due to threshing machine.

BACKGROUND: The aim of this study was to report the patients who were admitted to our hospital with upper extremity injuries due to threshing machine, to determine the most appropriate classification, to estimate the treatment modalities, and to discuss the prevention methods. METHODS: Twenty-five patients who had suffered injuries sustained by a threshing machine were retrospectively investigated. The patients were analyzed with respect to age, gender, admission month, hospitalization period, the type of injured tissue, and the treatment modality. RESULTS: Twenty-four of the patients were male and one was female, and the mean age of the patients was 19.4 (2-51) years; 60% of the patients were under the age of 15. The patients were admitted most commonly in the month of August. CONCLUSION: We believe that shielding the rotating components of farming machinery that cause injuries, informing and educating farming families (by physicians), forbidding the entrance of children to areas with agricultural machines, providing information to children in schools (in those regions with developing agriculture) about agricultural accidents and their prevention methods, and adjusting the working hours of farming personnel, especially in the hottest months of the year, may be beneficial in preventing accidents due to farming machinery.

Pregnancy and trauma: analysis of 139 cases.

OBJECTIVE: The aim of this study was to examine the diagnoses and treatment methods and demographical and clinical characteristics of pregnant women who were exposed to trauma and in additon, review of the literature was carried out in this regard. MATERIAL AND METHODS: One hundred thirty-nine pregnant women who presented at the Yüzüncü Yil University between January 2006 and September 2009 with local or general body trauma complaints were analysed retrospectively. RESULTS: The average age of the cases was 26.72±6.29 years and the age group ranging from 21-34 composed the majority. When they were studied according to their etiologies, falls during daily activities formed 43.9%. When they were analyzed in terms of their gestational weeks, 64.46% were in the 3(rd) trimester. Pregnant cases with trauma resulted in maternal (3 cases) and fetal (9 cases) loss. It was found that 19 cases who had imaging techniques involving radiation and whose gestation was continuing had a problem-free gestation period and healthy children. CONCLUSION: It is mandatory to evaluate both mother and fetus together when trauma exposure is in question, the general well-being of the fetus should be provided and the mother should be informed about the presence of advanced trauma life support.

[The effects on complications and myopathy of different voltages in electrical injuries]. / Elektrik çarpmalarinda voltaj farkinin komplikasyonlar ve miyopati üzerine etkisi.

BACKGROUND: The purpose of this study was to investigate the demographic and clinical characteristics of electrical injuries, laboratory findings, complications, and mortality and morbidity rates of these injuries. METHODS: Patients with electrical injuries admitted to the emergency department between January 2006-2010 were retrospectively analyzed. The cases were evaluated by age, gender, source of electrical power (low-high voltage), seasonal distribution, ECG changes, laboratory findings, clinical care units, complications, and mortality rate. RESULTS: Eighty-four (57.1%) of the cases were exposed to low-voltage electricity (Group I), while 63 (42.9%) of the cases were exposed to high-voltage electricity (Group II). The majority of cases with electrical injuries were aged 26-45 years. Thirty of the women (85.7%) were wounded by low-voltage while 58 of the men (51.8%) were wounded by high-voltage electricity. Alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, creatine kinase, and CK-MB levels were higher and the level of calcium was lower in Group II. Complications (pathologies due to fall from high levels, cardiac dysrhythmias, compartment syndrome) and the mortality rate were higher in Group II. CONCLUSION: In cases with high-voltage electrical injuries, cardiac complications, complications due to fall from high levels and the mortality rate increase in conjunction with the degree of the muscle damage.