Comparison of surgical techniques used for prevention of neuroma in order to make more clear the role of the epineurium. An experimental study.

AIM: Several studies have been conducted for the prevention of neuroma and recently published experimental studies include interventions on epineurium. The techniques which include interventions on epinerium were compared to reveal the role of epinurium in neuroma prevention. MATERIAL E METHODS: 55 Sprague-Dawley rats were divided into five groups. Two of the groups were negative and positive controls. The proximal nerve stump was left "free" in the negative control group, while the stump was implanted in a muscle pocket in the positive control group following sciatic nerve transection. Experimental groups include epineural ligation, epineural stripping and epineural capping procedures. Follow-up period was six months. After sacrification of the rats, histopathologic and immunohistochemical examinations were conducted as well as real-time PCR studies for the assessment. Statistical analysis was performed. RESULTS: The most prominent neuroma formation was detected in the epineural capping group, while the least neuroma was observed in the epineural ligation group. DISCUSSION: Statistically significant differences were obtained when the three experimental groups were compared with both control groups. Interestingly there was no significant difference in-between the control groups in terms of preventing neuroma formation. CONCLUSION: epineural ligation group were found to be superior to both control groups as well as experimental groups. Use of epineural capping was concluded to increase the formation of neuroma rather than preventing. Intramuscular implantation of nerve stump had no preventive effect on neuroma formation. KEY WORDS: Capping, Epineurium, Ligation, Neuroma, Stripping.

Comparison of surgical techniques used for prevention of neuroma in order to make more clear of the role of the epineurium: an experimental study.

AIM: Several studies have been conducted for the prevention of neuroma and recently published experimental studies include interventions on epineurium. The techniques which include interventions on epinerium were compared to reveal the role of epinurium in neuroma prevention. MATERIAL E METHODS: 55 Sprague-Dawley rats were divided into five groups. Two of the groups were negative and positive controls. The proximal nerve stump was left "free" in the negative control group, while the stump was implanted in a muscle pocket in the positive control group following sciatic nerve transection. Experimental groups include epineural ligation, epineural stripping and epineural capping procedures. Follow-up period was six months. After sacrification of the rats, histopathologic and immunohistochemical examinations were conducted as well as real-time PCR studies for the assessment. Statistical analysis was performed. RESULTS: The most prominent neuroma formation was detected in the epineural capping group, while the least neuroma was observed in the epineural ligation group. DISCUSSION: Statistically significant differences were obtained when the three experimental groups were compared with both control groups. Interestingly there was no significant difference in-between the control groups in terms of preventing neuroma formation. CONCLUSION: epineural ligation group were found to be superior to both control groups as well as experimental groups. Use of epineural capping was concluded to increase the formation of neuroma rather than preventing. Intramuscular implantation of nerve stump had no preventive effect on neuroma formation. KEY WORDS: Capping, Epineurium, Ligation, Neuroma, Stripping.

In vitro comparison of high-definition US, CBCT and periapical radiography in the diagnosis of proximal and recurrent caries.

OBJECTIVE: To assess the in vitro performance of high-definition (HD) US, CBCT and periapical radiography for the visibility of proximal and recurrent caries in teeth with and without restoration. METHODS: A total of 240 molar teeth were divided into eight groups each comprised of 30 teeth. Control groups consisted of teeth without caries (Group 1-4; N = 120), whereas diseased groups consisted of teeth with proximal caries (Group 5-8; N = 120 teeth). Finally, a total of four image sets were obtained as follows: i) PSP periapical radiography, ii) CBCT 0.075 mm voxel size, iii) CBCT 0.2 mm voxel size and iv) HD US images. The image sets were viewed separately by four observers by using a 5-point confidence scale. Intraclass correlation coefficients were calculated. The areas under the ROC curves were compared using chi-square tests. Significance level was set at α = 0.05. RESULTS: Intraobserver agreement for both readings for the four observers ranged between 0.848 and 0.988 for CBCT (0.075 mm) images; 0.658 and 0.952 for CBCT (0.2 mm) images; 0.555 and 0.810 for periapical images; 0.427 and 0.676 for US images. Highest AUC values were found for CBCT (0.075 mm) images and lowest for US images. Statistically significant differences were found among CBCT (0.075 mm) images and US images (p < 0.001), CBCT (0.2 mm) images and US images (p < 0.001) and periapical images and US images (p < 0.001) for the detection of proximal caries. CONCLUSION: Periapical and CBCT images outperformed HD US imaging in the detection of proximal dental caries.

The 30 October 2020 Aegean Sea Tsunami: Post-Event Field Survey Along Turkish Coast.

On 30 October 2020, a strong normal-faulting earthquake struck Samos Island in Greece and Izmir Province in Turkey, both in the eastern Aegean Sea. The earthquake generated a tsunami that hit the coasts of Samos Island, Greece and Izmir, Turkey. National teams performed two post-tsunami field surveys on 31 October to 1 November 2020, and 4-6 November 2020, along the Turkish coastline; while the former was a quick survey on the days following the tsunami, the latter involved more detailed measurement and investigation focusing on a ~ 110-km-long coastline extending from Alaçati (Çesme District of Izmir) to Gümüldür (Menderes District of Izmir). The survey teams measured runup and tsunami heights, flow depths, and inundation distances at more than 120 points at eight different localities. The largest tsunami runup among the surveyed locations was measured as 3.8 m in Akarca at a distance of 91 m from the shoreline. The maximum tsunami height of 2.3 m (with a flow depth of 1.4 m) was observed at Kaleiçi region in Sigacik, where the most severe tsunami damage was observed. There, the maximum runup height was measured as 1.9 m at the northeastern side of the bay. The survey team also investigated tsunami damage to coastal structures, noticing a gradual decrease in the impact from Gümüldür to further southeast. The findings of this field survey provide insights into the coastal impact of local tsunamis in the Aegean Sea.

Treatment of partial-thickness burns with a tulle-gras dressing and a hydrophilic polyurethane membrane: a comparative study.

OBJECTIVE: The purpose of this revisited study was to compare the clinical efficacy and long-term scar evaluation of a hydrophilic polyurethane membrane (HPM), Omiderm (Omikron Scientific Ltd., Rehovot, Israel) and an antimicrobial tulle-gras dressing (TGD), Bactigras (Smith & Nephew) in the management of partial-thickness burns. METHOD: Patients with partial-thickness burns were enrolled in this prospective study. Burn areas were divided into two areas and both dressings were applied to each field at the same time. Time to full re-epithelialisation and scar evaluation were compared using the Vancouver Scar Scale (VSS). RESULTS: A total of 21 patients, mean age 36.8 years, with 22 burns areas participated. The results showed that there is no statistically significant difference in terms of full epithelialisation time in the application of either dressing (p>0.05). However, with deep dermal burns, the HPM provided slightly faster epithelialisation (p>0.05). A VSS assessment showed no statistically significant difference (p>0.05) between applying either dressing materials. CONCLUSION: This study indicated that both dressings had the same effectiveness in treatment of partial-thickness burn wounds. However, the use of the HPM, especially in deep dermal second-degree burns, should be one of the first-line clinical choices, based on the advantages discerned by this study.

Three-layer primary closure of the bipedicled TRAM flap donor site for unilateralbreast reconstruction: a 15-year experience with 124 consecutive patients.

BACKGROUND/AIM: The pedicled transverse rectus abdominis myocutaneous (TRAM) flap remains widely used as a breast reconstruction technique. The bipedicled TRAM flap is not as preferable as it was formerly, mainly because of its donor site complications. However, in a number of situations, a bipedicled TRAM flap may be the only alternative. Therefore, a three-layer primary closure technique used with bipedicled TRAM flap breast reconstructions that can avoid donor site complications without using a mesh is presented. MATERIALS AND METHODS: A retrospective study was performed that included patients who underwent bipedicled TRAM flap breast reconstruction with the three-layer primary closure technique. Between 2000 and 2015, 124 breast reconstruction patients were reviewed for donor site morbidity. RESULTS: During the 15-year study period, 106 patients had conventional bipedicled TRAM flaps and 18 had bipedicled TRAM flaps with a surgical delay procedure. For all groups, none of the patients developed abdominal wall hernia, but three patients had bulging. Partial flap loss was the most common flap complication, present in 6 flaps (4.8%). CONCLUSION: The suturing technique studied provided abdominal wall closure without the use of a mesh even when utilizing a bilateral pedicle with very low complication rates.

Pre-expanded Thoracodorsal Artery Perforator Flap.

The size of the thoracodorsal artery perforator (TDAP) flap or pedicle, in general, may be found to be inadequate. Pre-expansion of the flap before harvest can be a solution to increase the size of the TDAP flap in such instances. The pre-expanded TDAP flap can be used to reconstruct large-sized defects with the advantage of primary closure of the donor site. This article presents details on the surgical technique and provides discussion of the authors' experiences.

Effect of Allogeneic Platelet Lysate and Cyanoacrylate Tissue Glue on the Fibrovascularization of the Porous Polyethylene Implant.

Because of limited autogenous tissue sources, donor site morbidity, and difficulty of shaping the autologous tissue, surgeons often need to use alloplastic frameworks in reconstruction of 3-dimensional tissue defects. Synthetic porous polyethylene (PP) implant is widely used in plastic surgery for 3-dimensional reconstruction of the lost or highly deformed tissues. One of the main factors of PP implant exposure is delayed fibrovascular ingrowth. In the present study, the authors investigated the effect allogeneic plateletlysate (PL) and cyanoacrylate tissue glue (CTG) (2-octyl cyanoacrylate) on the fibrovascularization of the PP implant.Twenty adult female Wistar rats were divided into 4 groups equally, according to the different surgical techniques and implanted materials used. Only PP implant was implanted subcutaneously through a skin incision on the chest wall skin of the rats in the control group; however, CTG was applied with PP implant in the cyanoacrylate group, PL was applied with PP implant in the platelet group, CTG and platelet was applied together with PP implant in the combination group. All of the implants in each group were histologically assessed at postoperative second week. Determination of the collagen density in the tissues, inflammation, and necrosis and vascularization status was assessed semiquantitatively.A denser collagen structure, low inflammation, and necrosis were found in PL groups. There was, however, a significant decrease in vascular density with PL-treated groups. PL treatment may have a potential to reduce complications related to PP implants.

Is It Possible to Increase Flap Viability by Hydrostatic Dilation?: An Experimental Study in the Rat Abdominal Fasciocutaneous Flap Model.

INTRODUCTION: Ergun et al previously demonstrated the efficacy of hydrostatic dilation in a TRAM flap model in an experimental study. We investigated the effect of hydrostatic dilation on a fasciocutaneous flap model. METHODS: Eighteen female Wistar rats were equally divided into 3 groups, of which 1 served as a control. In the second, the abdominal fasciocutaneous flap surgical delay procedure was performed by division of the left superficial inferior epigastric (SIE) vessels. In the third, hydrostatic dilation was performed on the left SIE artery and vein, with a mean pressure of 300 mm Hg, while elevating the flap on the right-sided SIE pedicle. The groups were compared by microangiography and by the survival ratio of abdominal flaps 7 days after elevation. RESULTS: The mean (SD) flap necrosis rates were as follows: control group, 44.75% (4.31%); delay group, 33.32% (7.11%); and hydrostatic dilation group, 32.51% (5.03%). There was a significant difference between the control group and the other 2 groups (P < 0.05). There was no difference between the delay and hydrostatic dilation groups with respect to surface area necrosis. The microangiographies showed remarkable increased vascularity in the delay and hydrostatic dilation groups. CONCLUSIONS: Hydrostatic dilation is a new method of enhancing flap viability that could be used in clinical cases in place of surgical delay once further studies and clinical trials are completed.

Finger injury from over-exposure to an industrial gamma radiation source.

The aim of this paper was to report a rare cause of radionecrosis and its long-term results. Iridium-192 ((192)Ir) is commonly used for radiography as a gamma ray source to locate flaws in welds and metal components in gas and oil industry. A 38-year-old man was subjected to radiation unintentionally. One month after the exposure wounds were appeared on the second and third fingers, and they were treated by conventional wound care and hyperbaric oxygen therapy. However wounds were relapsed one year later that brought the patient to us. The wounds were treated by wound care and hyperbaric oxygen therapy. When the patient was brought to us one year later the result was interesting. The third finger's pulp (there was not any wound one year before) was contracted and one third of the distal phalanx was exposed.

Custom-made approach to a patient with post-burn breast deformity.

Second and third degree burns on breasts at preadolescent period may cause severe breast deformations. This deformation can be variable depending on severity and location of the burns, personal adolescent patterns, and treatment modality in acute burn period. A 21 year old female patient admitted to our department for her breast deformation due to burn contracture at the inferior pole of the right breast. On physical examination we defined that development of the volume of the right breast was equal to the left, and inferior pole of the right breast was flattened due to contracture, and nipple was projected to inferior. We found that inframammary crease of the right breast was 2 cm lower than that of left; andthe distance of nipple-inframamary crease was 4.7 cm while areola-inframmary crease was 2 cm. New nipple-areola complex level was identified according to left breast's level. Medial and lateral lines were planned to merge inferiorly at 2 cm above inframmary crease in a plan similar to vertical mammaplasty. Superior pedicle carrying nipple areola was desepitelised. Lower parenchymal V flap was transposed superiorly and attached to the pectoral muscle. Inferior parts of the lateral and medial glandular flaps were excised to form new inframammary crease. The desired laxity of skin at the lower pole was obtained by performing a new Z- plasty between lateral and medial skin flaps. Breast symmetry was confirmed by postoperative objective measurements between left and right breasts. Patient's satisfaction and aesthetic appearance levels were high. Breasts deformation patterns caused by burns, trauma and mass exsicion due to cancer could not be addressed with traditional defined techniques. Special deformations can be corrected by custom made plannings as we presented here.

Minced nerve tissue in vein grafts used as conduits in rat tibial nerves.

INTRODUCTION: Peripheral nerve injuries are encountered frequently in clinical practice. In nerve repair, an end-to-end suture is the preferable choice of treatment. However, where primary closure is not possible, the defect is to be repaired with a nerve graft. METHODS: A total of 21 female Wistar rats weighing 230 to 290 g were used in the study. They were classified into the following 3 groups: (I) nerve graft, (II) vein graft, and (III) minced nerve graft. In group I, after exposure of the tibial nerve, a 1-cm-long nerve gap was created on the tibial nerve, and the defect was repaired epineurally by using the autogenous nerve. In group II, the 1-cm tibial nerve defect was repaired by using an autogenous vein graft. In group III, a 1-cm nerve graft was divided to 3 equal parts, with one of the nerve parts being minced with microscissors and placed in the vein graft lumen. Thereafter, a 1-cm tibial nerve defect was repaired by the vein graft filled with minced nerve tissue. The tibial function indices (TFIs) were calculated for functional assessment using the Bain-Mackinnon-Hunter formula. Light and electron microscopic evaluations were performed for morphometric assessment. In addition, the myelinated fibers were counted in all groups. RESULTS: The TFIs of group II were found to be the lowest among all the groups after the sixth week, whereas the TFI of group I was found to be better than the other groups after the sixth week. There was no difference in TFIs between group I and group III. On the basis of the number of myelinated fibers, there was no statistically significant difference between group I and group III, whereas the difference was significant (P<0.05) between groups I/III and group II. Presence of peripheral nerves in light microscopic evaluation revealed normal characteristics of myelinated fibers in all groups. The myelinated axon profile was near normal in the nerve graft group in electron microscopic evaluation. However, there were more degenerated axons with disturbed contours and vacuolizations in the vein graft group compared to the minced nerve graft group. CONCLUSIONS: We can conclude that using minced nerve tissue in vein grafts as a conduit increases the regeneration of nerves (almost like the nerve graft group) and it may not be caused by donor-site morbidity. It can be used in the repair of nerve defects instead of autogenous nerve grafts after further experimental evidence and clinical trials.

Bilobed flap for web reconstruction in adult syndactyly release: a new technique that can avoid the use of skin graft.

AIM: The aim of the study was to describe the use of a bilobed flap for web formation of syndactyly release, which decreases the need for graft and also avoids the use of skin grafting in syndactyly cases. METHODS: A retrospective review of this procedure was performed for 15 web space reconstructions. Patients were aged 20-23 years. The mean follow-up period was 7-12 months (mean 7 + 3.2). The operations were performed for the beneficial use of the dorsal hand skin by lowering the need for a skin graft. The flap was on the dorsum of the hand and proximal phalanx and was used for web formation. RESULTS: Surgery was completed without skin grafting in nine cases of 14 web spaces; two of them were complex/complete syndactylies, and two of them were simple/complete syndactylies. We used a skin graft in one patient because of triangular flap necrosis in a second operation. The use of a bilobed flap allowed the construction of web spaces, providing satisfactory cosmetic outcomes. No partial necrosis or complications was observed in bilobed flaps. No secondary correction was needed during the follow-up period. CONCLUSION: The present surgical technique could be a new surgical option for web formation and reconstruction in primary and secondary cases, especially in an adult population in which the skin on the dorsum of the hand is more pliable. LEVEL OF EVIDENCE: IV.

Reconstruction of postburn cervical contractures using expanded supraclavicular artery flap.

Postburn cervical contractures involving the anterior neck represent a serious social, public, and medical problem. The expanded supraclavicular artery flap is a good reconstructive option for these defects to improve functional and aesthetic appearance. Its main vascular supply is the supraclavicular artery, and it may be harvested as either a skin pedicled flap or an island flap. In our clinic, 10 patients with severe cervical burn contractures were reconstructed with preexpanded supraclavicular artery flaps between 2005 and 2012. All the flaps primarily healed with good functional and cosmetic results, and the donor sites primarily closed without any tension. A complete range of motion at the cervical region was obtained in all patients by the end of the reconstruction period. The preexpanded supraclavicular artery flap is a suitable alternative for coverage of the cervical defects after the release of the burn contractures. It is a thin tissue of both good color and texture, and is easy to harvest.