Clinical outcomes of suture delay in forehead flap.

The delay phenomenon is a surgical procedure performed to raise a wider skin flap and to improve the survival of skin flaps. Surgery, chemicals, sutures, and lasers can be used for the delay procedure. In this study, delayed forehead flaps created by suturing were used for coverage of nasal skin defects in eleven patients. In 7 patients, the cross-paramedian forehead flap was used to increase the extent of flap lengthening. In the first session, suture delay was performed on both sides of the forehead flap margin. In the second session, the flap was elevated and sutured to its new position, 7 to 10 days after the initial surgery. All flaps were completely viable, and patient satisfaction was optimal in all cases. The positive effect of surgical delay on flap survival has been shown in experimental and clinical studies. However, experimentally, suture delay or chemical delay procedures have been shown to be beneficial in flap survival only. Suture delay seems to be an inexpensive, effective, easily performed, atraumatic, and safe technique, especially among patients with systemic diseases such as diabetes or cardiovascular diseases, smoking patients who may lose the flap, or patients who need very wide and long flaps.

Effects of topical mitomycin and trimetazidine on myringosclerosis.

INTRODUCTION: Myringosclerosis, one of the most common complications of ventilation tube placement, is a kind of tympanosclerosis and is defined as subepithelial hyalinization of the tympanic membrane. There are two arguments in the development of myringosclerosis: inflammation triggering the development of myringosclerosis and free oxygen radicals released during inflammation causing myringosclerosis. OBJECTIVE: The aim of the present study was to explore the effects on the development of myringosclerosis of mitomycin, which has anti-inflammatory effects, and trimetazidine, which is believed to inhibit free oxygen radicals when given systemically. MATERIALS AND METHOD: The study was carried out on rabbits. Animals were divided into five groups, with six rabbits in each group: three control groups (paracentesis only, paracentesis+tube placement, and no intervention), a trimetazidine group, and a mitomycin group. Mitomycin (0.4 mg/mL) and trimetazidine (20 mg/mL) were applied topically to the tympanic membrane, and the presence and degree of sclerosis were graded histopathologically after Masson's trichrome staining. RESULTS: In the histopathologic examination, sclerosis that developed in the tympanic membranes of rabbits that had undergone paracentesis or paracentesis plus tube application or received trimetazidine was significantly more extensive than sclerosis in the membranes of unoperated animals and those that had been administered mitomycin. CONCLUSIONS: Paracentesis in rabbits, independent of tube placement, causes sclerosis of the tympanic membrane. Results show that topical use of mitomycin, due to its anti-inflammatory effect, had alleviating effects on myringosclerosis, whereas topical trimetazidine did not.

Effects of topical chlorhexidine applied to the rabbit nasal mucosa.

OBJECTIVE: To search the effects of administration of various concentrations of a wide-spectrum antimicrobial agent, chlorhexidine, to the nasal mucosa. MATERIAL AND METHODS: About 0.20, 0.12, 0.06 and 0.03% concentrations of chlorhexidine gluconate were applied to the rabbit nasal mucosa as one puff twice a day throughout 5 days. Another group, treated with serum saline to the nose, behaved as the control group. On the fifth day following drug administration, specimens were taken from nasal mucosa of the rabbits and examined under light microscope. RESULTS: As a result of comparison between drug treated group and control group, with increasing drug concentrations progressively increased neutrophil infiltration in mucosa, ciliary loss in cells, and occasional metaplasia were observed. CONCLUSION: There is a linear, positive and strong association between concentrations of chlorhexidine and its irritative effects on rabbit nasal mucosa. While 0.20 and 0.12% concentrations of chlorhexidine cause excess irritation on the nasal cavity, 0.06 and 0.03% concentrations of chlorhexidine gluconate causes lower irritation and effects on the animals which have experimentally induced rhinosinusitis must be evaluated.

The treatment duration of acute maxillary sinusitis: how long should it be? A nasal smear controlled study.

The aim of this study was to determine the most appropriate duration of treatment in acute maxillary sinusitis. The study was performed prospectively on 40 adult patients with acute maxillary sinusitis diagnosed by sinus puncture. Patients were randomized as to several treatment periods and treated by various antibiotics according to culture-sensitivity results. Patients in group 1 received treatment for 7 days; groups 2, 3, and 4 received 14, 21, and 28 days, respectively. The patients were followed up with nasal smear findings on certain intervals during the 56-day follow-up period. Statistically significant differences were found beginning from the 21st day between group 1 and the other groups. However, there were no statistical differences among groups 2, 3 and 4. These findings show that the most appropriate duration of treatment in acute maxillary sinusitis should be at least 14 days according to nasal smear results.