Demonstration of circulation haemodynamics in random pattern thinned skin flap (an experimental study).

BACKGROUND: Clinical applications and indications of the thin skin flap have been widely documented but its circulation haemodynamics are still controversial. An experiment was conducted on pigs to show the survival and circulation haemodynamics of random pattern thinned skin flap. METHODS: Group I: Random pattern standard skin flaps; 5 x 5 cm (n=20 flaps), and 5 x 10 cm (n=20 flaps). Group II: Random pattern thin skin flaps; 5 x 5 cm (n=20 flaps), and 5 x 10 cm (n=20 flaps). Group III: Random pattern thin skin flaps with silicone sheet underneath; 5 x 5 cm (n=20 flaps), and 5 x 10 cm (n=20 flaps). RESULTS: The mean surviving skin area of the 5 x 10 cm flaps was 95.5% in Group I, 64.9% in Group II, and 33.67% in Group III. A statistically significant difference (P<0.05, ANOVA) was found between the groups. The mean surviving skin area of the 5 x 5 cm flaps was 100% in Groups I and II, and 68.2% in Group III. A statistically significant difference (P<0.05, ANOVA) was also found between Groups I and III, and Groups II and III. In microangiographical studies, the distribution of subcutaneous plexuses was clearly visible in Group I. In Group II the subdermal vascular plexus was observed less frequently and was thinner, particularly on the distal part of the flaps. In Group III dilatation of the subdermal vascular plexus was evident, particularly on the proximal section of the flaps. In the technetium-99m-labelled microspheres uptake of the 5 x 10 cm flaps, there was no statistically significant difference between the first segments in Groups I and II, Groups II and III (P>0.05, ANOVA). A significant difference was found between the second segments in Groups I and III (P<0.05, ANOVA). CONCLUSION: The results obtained in this study show that the effect of subdermal vascular plexus in the survival of the random pattern thinned skin flaps is supported by flap bed osmosis and plasma imbibition.

Mandibular condyle reconstruction with inlay application of autogenous costochondral graft after condylectomy: Cerrahpasa's technique.

PURPOSE: Mandibular condyle reconstruction with free costochondral grafting is the most common method because of some advantages, such as its biological and anatomic similarities to the condyle, and growth potential in juveniles. Application techniques of the costochondral graft were reported in numerous articles with several advantages and disadvantages up to now. The purpose of this article is to present a new modification in application of the costochondral graft to the ramus of the mandible. This technique is pretty simple, but very effective. MATERIALS AND METHODS: The new technique described here consisted of a costochondral graft application for temporomandibular joint reconstruction, which was inserted into the medullary cavity of the mandibular ramus in 4 patients. This modification provided the graft placement as anatomical as the original condyle and further stabilized the graft in its position and inhibited its displacement without any fixation. This technique is pretty simple because an additional incision to the preauricular, facial nerve dissection, wide exposition and stabilization efforts are not required. RESULTS: Clinical and radiological evaluations on 14-month mean follow-up of 4 cases showed very satisfactory functional results with normal anatomic adaptation and configuration. In all cases, function of mandible was considered to be good with at least maximal interincisal opening of 30 mm. Good anatomical position of the graft and good bony healing were seen on the radiographs. Additionally, there was no need for postoperative intermaxillary fixation. CONCLUSION: With this technique, temporomandibular joint reconstruction by the costochondral graft can be performed as far as possible to the original condyle position.

Local control of primary oropharyngeal malignant melanomas with limited tissue excision: a report of three cases.

Mucosal malignant melanomas are rare lesions, and they have different characteristics from their cutaneous counterparts. Since extended excisions of mucosal malignant melanomas located in the oropharyngeal region cause significant morbidity, limited surgical excision comes into consideration. Three cases of extensive oropharyngeal malignant melanomas were resected with 0.5-1.5-cm healthy tissue margins. The cases were followed for local recurrences. Case 1 applied radiotherapy and chemotherapy in addition to immunotherapy, and the patient is still alive without any local recurrences 18 months after surgery. The patient in case 2 underwent radiotherapy and immunotherapy and died 6 months after surgery. The patient in case 3 received chemotherapy in addition to immunotherapy and died 12 months after surgery as a result of distant metastasis. All cases were without any local recurrences. Surgical excision with limited tumor-free tissue margins may be the surgery of choice to prevent morbidity associated with wide resection of oropharyngeal malignant melanomas if other authors also reconfirm these results with many more cases in the future.