Reconstruction of large alopecia with old technique: V-Y-S plasty.

Treatment of alopecia following burns, trauma or tumour surgery is challenging. Local flaps for small or medium sized defects and tissue expansion for larger defects is the common approach. Tissue expansion is a two-stage procedure and the inflation process causes difficulty for patients. V-Y-S plasty is safe and one-stage method of tissue reconstruction for scalp, face and other parts of the body. We performed this method safely for very large alopecia reconstructions in the scalp.

Keloid formation after circumcision and its treatment.

Circumcision is performed in many communities around the world for either medical, ethnic, or religious issues. It is a safe procedure when it is performed by a fully trained surgeon. However, complications such as bleeding, infection, diminished penile sensation, urethral injury and amputation of the glans are occasionally seen. Keloid is the result of excessive deposition of collagen in the dermis and subcutaneous tissues. It usually develops at the site of trauma or surgical injuries. Keloid formation on the penis is a very rare condition. In this study, we present a case of keloid formation after circumcision and review the related literature.

The versatile use of temporoparietal fascial flap.

BACKGROUND: The pedicled or free temporoparietal fascial has been used in many areas, especially in head and neck reconstruction. This thin, pliable, highly vascularized flap may be also transferred as a carrier of subjacent bone or overlying skin. OBJECTIVE: The aim of this study is to report our experience in versatile use of temporoparietal fascial flap (TPFF) and discuss the surgical anatomy and technique. PATIENTS AND METHODS: A total number of 57 TPFFs have been used in periorbital, mid-facial, auricular, and tracheal reconstruction due to tumor resection, trauma, and congenital ear deformities. RESULTS: All the flaps were successfully transferred without any major complication. The cosmetic results were quite satisfactory to all patients. CONCLUSION: The advantages and minimal donor site morbidity of TPPF makes this flap a good choice in many reconstructive procedures.

Anatomic and functional improvements achieved by rehabilitation in Zone II and Zone V flexor tendon injuries.

OBJECTIVE: The aim of this study was to compare anatomic and functional improvements in zone II and zone V flexor tendon injuries and to determine the effect of injury level on disability. DESIGN: Seventeen patients (53 digits) with zone V and 14 patients (25 digits) with repaired zone II flexor tendon injuries were enrolled in this study. All patients were treated with Modified Kleinert protocol and followed up for a median of 60 mos. The anatomic improvement was assessed by total active motion scoring system of the American Society for Surgery of the Hand. Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) questionnaire and the grip strength value were used for the evaluation of functional improvement. RESULTS: Two groups were similar with respect to age (P = 0.147), sex (P = 0.889), type of repair (P = 0.453), and follow-up period (P = 0.499). According to total active motion scoring system, good to excellent results (75%-100% of the normal total active motion value) were achieved in 52% of the digits with zone II and 83% of digits with zone V flexor tendon injuries (P = 0.004). The recovery in the grip strength, in comparison with the uninjured hand, has been found to be 71% and 53% in zone II and zone V injuries, respectively (P = 0.112). There was no difference between Quick DASH index scores of two groups (P = 0.721). The grip strength percentage (r = -0.435; P = 0.014) and total active motion recovery results (r = -0.541; P = 0.002) of the patients were moderately correlated with Quick DASH scores. CONCLUSIONS: Early passive mobilization in patients with zone V injuries resulted in higher percentage of good to excellent results when compared with zone II injuries. However, this does not translate into recovery in grip strength and disability. This study suggests that although the level of the injury is an important factor for the anatomic improvement, it may not be the predictor of functional improvement.

Results of transmasseteric anteroparotid approach for mandibular condylar fractures.

Management of condylar fractures has been the subject of much disagreement and debate. There is no general consensus for definitive treatment. Although there is a growing tendency for open reduction and internal fixation technique, risks and morbidity of the surgical procedure are still a point of concern for maxillofacial surgeons. To reduce potential complications and improve surgical exposure, the transmasseteric anteroparotid approach was introduced. Since 2008, we have operated on 6 patients (7 fractures) using this approach. The technique is easy to learn, provides adequate surgical exposure for open reduction internal fixation, and has few complication rates.

Isolated fibrous dysplasia of the zygomatic bone.

Fibrous dysplasia is a nonneoplastic, hamartomatous, developmental disease of the bone of obscure etiology. The disease is generally presented as a continuously growing, painless mass at late childhood. It is mostly seen in the maxilla and the mandible in facial skeleton. Involvement of the zygomatic bone is far rarer. Fibrous dysplasia of the zygomatic bone may cause orbital dystopia, diplopia, proptosis, loss of visual acuity, swelling, mass formation, or facial asymmetry. We present 2 cases of fibrous dysplasia with isolated zygomatic bone involvement.

Neutrophil apoptosis in patients with beta-thalassemia major.

Increased susceptibility to infection is reported in patients with beta-thalassemia major due to toxic effect of iron on neutrophil functions and reticuloendothelial system dysfunction. This study investigated the association between the neutrophil apoptosis and frequency of infection episodes, desferrioxamine treatment, and serum ferritin levels in patients with beta-thalassemia major. A total of 35 children diagnosed with beta-thalassemia major were enrolled. Group 1 consisted patients who were receiving desferrioxamine (DFO) and group 2 consisted of patients who did not start to receive DFO. A total of 15 healthy children were enrolled to serve as a control group. Frequency of infection episodes within a year was noted from hospital records. In all patients, the same method based on flow cytometry (annexin V labeled with FITC) was used to assess neutrophil apoptosis. Neutrophil count and percentage of apoptotic neutrophils did not differ significantly between the groups. When frequency of infection episodes among groups was evaluated, frequency of infection episodes of the patients who were receiving DFO was significantly higher than in the other groups. When correlation between neutrophil apoptosis and frequency of infection episodes, serum ferritin levels, and neutrophil count of the patients was analyzed according to groups, no significant correlation was found. The results indicate that high serum ferritin level and DFO use in patients with beta-thalassemia major do not enhance neutrophil apotosis in vivo and enhanced neutrophil apoptosis cannot be a possible cause for increased susceptibility to infections in these patients.

Horseshoe kidney with mesangioproliferative glomerulonephritis and goiter.

Horseshoe kidney is a relatively common renal anomaly with which many structural and developmental anomalies have been shown to be associated. However, there are only a few case reports regarding the association of membranous glomerulonephritis and focal sclerosing glomerulonephritis in patients with horseshoe kidneys. We report a girl who was evaluated for hematuria and proteinuria, and found to have horseshoe kidney. Renal biopsy demonstrated mesangioproliferative glomerulonephritis. She also had simple diffuse goiter.