A New Modification of Fan Flap for Large Lower Lip Defects.

BACKGROUND AND AIMS: The reconstruction of the lower lip defects which may result from malignancy, trauma, and burn is necessary for mastication, oral competence, salivary retain, articulation, and aesthetic appearance of the face. While small (30% of the lower lip) and medium (30%-80% of the lower lip) size defects are reconstructed using primary repair and local flaps, reconstruction of the large defects including total and near-total of the lower lip is very challenging entity. We introduce a new modification of the fan flap named extended fan flap for reconstruction of the total and near-total lower lip defects. MATERIAL AND METHODS: The extended fan flap was used for 12 patients with defects involving more than 80% of the lower lip due to squamous cell carcinoma excision. Most of the patients were males (80.9%) with an average age of 66.8 years (range, 47-82 years). RESULTS: No major complication is observed in the postoperative period. The functional and aesthetic results were satisfactory. The sphincter function for normal mastication, eating, and salivary retain was reestablished. No microstomy was seen and insertion of artificial dentition was possible for patients. CONCLUSION: We believe that the unilateral extended fan flap is a reliable and safe option with satisfactory functional and aesthetic results for total and near-total (more than 80%) lower lip defects.

Surgical treatment and functional outcomes of multicomponent soft tissue injuries of the wrist.

The aim of this study was to emphasize the importance of early surgical treatment of multicomponent soft tissue injuries of the wrist. A retrospective review was performed on 156 patients with multicomponent soft tissue injuries of the wrist who were treated between July 2007 and July 2015. All the patients included in the study were operated within the first 36hours of the injury and were hospitalized after the surgery based on the extent of their injury. The patients were evaluated in terms of age, gender, etiology, injured structures, total number of damaged structures, mean follow-up time, complications and reoperation. The results were evaluated based on tendon function, opposition, intrinsic muscles, deformities and sensation. According to these criteria, excellent results were obtained in 81.6% to 88.8% of the patients. Poor results were found in less than 4 percent of the patients. In conclusion, we believe that early surgical management of multicomponent soft tissue injuries of the wrist, a meticulous approach and regular physical therapy are required to achieve good functional outcomes.

Reduction of major amputations after starting a multidisciplinary diabetic foot care team: single centre experience from Turkey.

INTRODUCTION: It is widely recognized that a multidisciplinary team is effective in the management of diabetic foot ulcers. Contrary to developed countries, multidisciplinary diabetic foot care teams and/or clinics have not been constructed in most centres in developing countries. The aim of this study was to present our data regarding amputation rates and profiles before and after starting the Dokuz Eylul University multidisciplinary diabetic foot care team. METHODS: This study includes data from diabetic foot ulcer episodes which were managed in Dokuz Eylul University Hospital between January 1999 and January 2008. The data was collected prospectively during a minimum follow-up of 6 months in all ulcers. After January 2002, management of ulcers was coordinated by the diabetic foot care team (n=437). Amputation rates were compared to those who were admitted before January 2002 (n=137). RESULTS: Overall amputation and minor amputation rates were similar for both periods. However, major amputations were observed to be decreased after starting the Dokuz Eylul University multidisciplinary diabetic foot care team (20.4% vs. 12.6%, p=0.026). CONCLUSIONS: Our results demonstrated that major amputation rates can be reduced by team work. Formation of multidisciplinary diabetic foot care teams and clinics should be encouraged in Turkey.

Delayed prefabricated arterial composite venous flaps: an experimental study in rabbits.

Prefabrication of composite arteriovenous flaps with implantation of an autologous graft (cartilage) or an alloplastic material (porous polyethylene) was studied in 40 rabbits. Abdominal flaps based on bilateral epigastric pedicles were elevated. An ear cartilage graft or a porous polyethylene implant was inserted under the flap. Two weeks after the operation, 10 flaps with cartilage graft and 10 flaps with porous polyethylene were raised, converted to arteriovenous flaps, and resutured in place in the experimental groups. In the other 20 rabbits of the control groups, the flaps (10 with cartilage graft and 10 with porous polyethylene) were raised and resutured in place as conventional axial flaps. At the end of the second and fourth week postoperatively, samples were obtained from the flap tissues (including a part of the graft or implantation material) and were prepared for histologic examination in all rabbits. The viable areas of all flaps were assessed at the end of fourth week after the second operation. The mean survival rates were 99.4%, 99.7%, 99.5%, and 99.8% in the arteriovenous and control flaps prefabricated with cartilage graft and the arteriovenous and control flaps prefabricated with porous polyethylene respectively. The features of wound healing in the experimental and control groups were similar. The study showed that arteriovenous perfusion can nourish a prefabricated flap containing an implanted material (autologous or alloplastic) and these 2-week delayed composite flaps have a similar survival rate to delayed prefabricated conventional axial flaps.