The effects of melatonin on the healing of burn wounds in pinealectomized rats.

BACKGROUND: The present study aims to investigate the favorable effects of melatonin on burn wound healing in rats. METHODS: In this study, forty Wistar-albino-type male rats were divided into four groups. Group 1 was the control group, Group 2 rats were treated using exogenous melatonin, Group 3 rats were pinealectomized, and Group 4 rats were pinealectomized then treated with exogenous melatonin. In all groups, a deep second-degree burn was created on the backs of the rats with a metal plate heated in boiling water. We monitored the progress of burn healing for seven days. At the end of them, we evaluated hydroxyproline levels, type III collagen, edema, inflammatory infiltration, congestion, vascular proliferation, fibrosis, the thickness of the zone of stasis and the epithelium to assess the progress of healing. RESULTS: The zone of stasis was less thick in Group 2 than the other groups (p=0.009). Type III collagen dyeing (p=0.031), fibrosis (p=0.011) and edema (p=0.031) were higher in Group 2 than the other groups. Congestion was higher in the control group than Group 4 (p=0.031). Other evaluated parameters showed no significant differences among the groups. CONCLUSION: In this study, it was noted that once total melatonin levels exceeded a certain threshold, a preventive effect was exerted on burn wound damage progression by reducing the zone of stasis. Melatonin may also prevent the development of hypertrophic scarring. Melatonin may be a potential therapeutic option that can supplement traditional treatment in burn wounds; however, further studies with higher doses of exogenous melatonin administered over longer periods are needed to further evaluate the effects noted in this study.

Ethyl Alcohol Versus Botulinum Toxin A: A Comparative Study of the Visual and Histopathological Outcomes in the Rabbit Anterior Auricular Muscle Model.

BACKGROUND: Botulinum toxin has long been known for its paralytic effects at the neuromuscular junction. Although it has been widely used for vascular and nervous tissues, there has been no study of the aesthetic effects of the application of ethanol to muscle tissues to date. OBJECTIVE: The authors aimed to demonstrate the effects of the application of ethanol to muscle tissues after an intramuscular injection and to compare the effects of botulinum toxin A (BTA) and ethanol. METHODS AND MATERIALS: A total of 28 rabbits were divided into 4 groups (n = 7 each). Botulinum toxin A (5 units) and different concentrations of ethanol (5 cc) were injected into the left and right anterior auricular muscles of all rabbits, respectively. Ear ptosis was assessed, and histopathological examination was performed after all rabbits were euthanized in the eighth week. RESULTS: Muscle function was affected earlier in ethanol-treated ears than in botulinum-treated ears; however, the ptotic effect lasted for a significantly shorter duration in ethanol-injected ears than in BTA-applied ears. CONCLUSION: Ethanol can block muscle function reversibly and can serve as an alternative to BTA, particularly when rapid results are desirable.

Does Estradiol Level in Platelet-Rich Plasma Improve Efficacy of Androgenic Alopecia Treatment?

BACKGROUND: Although some studies in the literature report that autologous and homologous platelet-rich plasma (PRP) can be employed in the treatment of androgenic alopecia (AGA), no study, to the authors' knowledge, has examined the estrogen concentration of prepared PRP. OBJECTIVES: The authors aimed to determine the presence of estrogen in PRP and to investigate the effect of estrogen concentration of PRP on AGA treatment. METHODS: Between 2017 and 2018, 30 male patients with hair loss complaints were included in this prospective study. Autologous PRP was injected in patients in Group 1. Homologous PRP with high estrogen levels was injected in the patients in Group 2. PRP was injected in both groups 4 times at 0, 1, 3, and 6 months. The obtained photographs were evaluated and hair densities of each patient at controls were calculated. RESULTS: The mean estrogen level measured in PRP was statistically significantly higher in Group 2. In both groups, the increase in hair density was observed from the first month, but this increase was statistically significantly higher in all controls in Group 2. In Group 2, there was a statistically significant increase in the 1st and 3rd months compared with the previous control, but there was no difference between the 6th and 12th months and the 3rd month. CONCLUSIONS: Increased hair density is greater and earlier in the group receiving estrogen-rich PRP than in the group utilizing autologous PRP. The authors think that estrogen-rich PRP may be employed in the treatment of AGA in the presence of an appropriate donor.

Comparison of the Efficacy of Homologous and Autologous Platelet-Rich Plasma (PRP) for Treating Androgenic Alopecia.

BACKGROUND: Androgenetic alopecia (AGA), the most common cause of hair loss in both sexes, accounts for 95% of all cases of hair loss. Although the literature has suggested that both nonactivated (n-PRP) and activated autologous (a-PRP) PRP can be used to treat AGA, we did not find any study investigating the use of homologous PRP (h-PRP) for this purpose. Also, to the best of our knowledge, there are no studies comparing the efficacy of h-PRP, a-PRP, or n-PRP on AGA therapy. OBJECTIVES: The aim of this study was to compare the increase in hair density, average number of platelets, complications, preparation, and duration of application in the treatment of AGA using a-PRP, n-PRP, and h-PRP. METHODS: Between 2014 and 2015, we studied male patients who had experienced increased hair loss in the last year. Patients were divided into three groups: Group 1 received n-PRP, Group 2 received active PRP, and Group 3 received h-PRP. For Group 1, PRP was prepared by a single centrifugation prepared from the patient's own blood. For Group 2, the PRP was prepared from the patient's own blood, but a second centrifugation was applied for platelet activation with calcium chloride. For Group 3, the PRP was prepared from pooled platelets with the same blood group as the patient from the blood center. PRP was injected at 1, 2, and 6 months. The hair density (n/cm2) of each patient before and after injection was calculated. Each patient was assigned a fixed evaluation point at the time of application to calculate hair density. RESULTS: At 2, 6, and 12 months after the first treatment, the increase in hair density was calculated as 11.2, 26.1, and 32.4%, respectively, in Group 1; 8.1, 12.5, and 20.8%, respectively, in Group 2; and 16.09, 36.41, and 41.76%, respectively, in Group 3. The increase in hair density was statistically significantly greater in Group 1 than in Group 2 and more so in Group 3 than in both groups among all controls (p < 0.05). CONCLUSION: The efficacy of both PRPs was determined in AGA treatment in our study. However, it was determined statistically that the increase in hair density with h-PRP was greater than with autologous PRP groups. We believe that h-PRP therapy can be used in patients with AGA presenting with hair loss. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Comparison of the Effect of Platelet-Rich Plasma and Simvastatin on Healing of Critical-Size Calvarial Bone Defects.

OBJECTIVE: In previous studies, it has been shown that both simvastatin (chlolesterollowering drug) and platelet-rich plasma (PRP) were capable of promoting bone formation. The aim of this study was to compare the effects of PRP and simvastatin on healing of critical-size bone defects. METHODS: A total of 33 rats (3 for PRP preparation) were used in the experiment. Critical-size defect 8-mm diameter was created in 30 rats' calvarium. Rats were divided into 3 groups. Each group contained 10 animals. In Group A the defect was filled with phosphate-buffered saline only, in Group B with 0.5 mL PRP, and in Group C with 0.1 mg simvastatin. The defects were evaluated by radiographic analysis at 8th and 16th weeks. The animals were sacrificed 16 weeks after the surgery. Histological examination was performed to assess the new bone-forming area. Vessels, fibroblasts, osteoblasts, and osteoclasts were marked in 524749.1-µm area and counted with using Clemex Vision Lite 3.5 Image Analysis program. The results were statistically analyzed.

Central Pedicle Reduction in Gigantomastia Without Free Nipple Graft.

BACKGROUND: Various pedicle techniques have been described in breast reduction surgery. However, in cases of massive hypertrophy, the free nipple graft technique is still being performed by some surgeons out of fear of losing the nipple-areolar complex (NAC). As such, we evaluated patients with severe gigantomastia who underwent the central pedicle horizontal scar reduction mammaplasty technique. METHODS: The records of 257 patients who underwent the central pedicle reduction technique were retrospectively reviewed. The demographic properties of the patients and the distances from the midclavicular point to the nipple were recorded. Patients whose distance from the midclavicular point to both nipple areolar complexes (NACs) was 38 cm or greater were included in this study. Resection weights and postoperative complications were evaluated. RESULTS: The distance from the midclavicular point to both NACs was 38 cm or greater in 53 patients (106 breasts). The age range of the patients was 17 to 73 years, and the mean body mass index was 39.6 kg/m. The range of distances from the midclavicular point to the nipple was 38 to 52 cm. The weight of the breast tissue excised ranged between 1450 and 2785 g. None of the patients experienced total nipple loss postoperatively, and all of the patients were satisfied with the aesthetic results. CONCLUSION: We were able to reduce all of the breasts safely, without using the free nipple grafting technique, even in very large breasts. This study shows that the central pedicle horizontal scar reduction technique is a very safe and effective method for use in massive reductions. Therefore, we strongly recommend using the central pedicle reduction mammaplasty technique in cases of gigantomastia.

The effect of combined use of platelet-rich plasma and adipose-derived stem cells on fat graft survival.

BACKGROUND: Free fat grafts have an unpredictable survival rate that limits their successful use. To increase the viability of fat grafts, it is important to minimize the reabsorption rate. OBJECTIVE: Our aim was to investigate whether the combined use of platelet-rich plasma (PRP) and adipose derived stem cells (ADSCs) would contribute an improvement in lower resorption rates of fat grafts. METHODS: Inbred Fischer 344 rats were randomized into 4 groups (n = 10). Fat grafts were mixed with Dulbecco modified Eagle medium in group A, with PRP in group B, with ADSC in group C, and with PRP + ADSC in group D and were injected to the scalp.In vitro growth factor (vascular endothelial growth factor, transforming growth factor-ß, and fibroblast growth factor) levels were compared using enzyme-linked immunoassay method. After 12 weeks weight, volume and histology of the transplants were evaluated. RESULTS: The mean weight and volume of the fat grafts were highest in group D. Histopathological investigations revealed that the number of viable adipocytes and blood vessels were highest in group D. The level of growth factors was significantly higher in stem cell plus PRP group. CONCLUSION: Adipose-derived stem cells combined with PRP can enhance the survival of transplanted fat tissue.

Saving the zone of stasis in burns with melatonin: an experimental study in rats.

BACKGROUND: Studies aimed at recovering the zone of stasis are one of the major issues of experimental burn studies. Many drugs including antithrombotics, anticoagulants, anti-inflammatories have been investigated experimentally for saving the zone of stasis. In this study, the effect of the systemic melatonin on the zone of stasis was evaluated. METHODS: Twenty Wistar Albino rats were used in the study. Rats were assigned to two groups (n=10). The metal comb 1x2 cm in size was immersed in boiling water and held for 20 seconds on the back of the rats to create burn wounds.No treatment was given to the control group. Melatonin was given at a dose of 10 mg/kg/d by intraperitoneal injection in the treatment group for 7 days. Daily digital photographs of both groups were obtained. Total necrotic burn areas and the zone of stasis were assessed with Auto CAD and Visual Analyzing computer programs. At the end of one week, rats were sacrificed and skin biopsies were taken for histological examination. Edema, congestion, inflammatory infiltration, vascular proliferation and fibrosis were the parameters evaluated. Data were evaluated statistically by Chi-square test and Student-t test RESULTS: When histopatologic data and the measured values for total necrotic areas and zone of stasis of the experimental group werecompared to control group, the results were statistically significant (p<0.05). CONCLUSION: According to the results of this study, melatonin is efficient in saving the zone of stasis in burns.

Intra-articular platelet-rich plasma injection for the treatment of temporomandibular disorders and a comparison with arthrocentesis.

BACKGROUND: Temporomandibular joint (TMJ) internal derangements are progressive painful conditions and cause joint dysfunction, joint sound, malocclusion, and locking of the mouth. Conservative and invasive techniques can be used for the treatment of TMJ internal derangements. The objective of the present study was to examine the benefit of an intra-articular platelet-rich plasma (PRP) injection and to compare this with arthrocentesis. METHODS: Twenty patients (female: male; 15:5; age 26, 3 ± 9.3 years) for a total of 32 joints with reducible anterior disc dislocation, as confirmed by Magnetic Resonance Imaging (MRI), were divided into two groups. PRP was used for the study group, and arthrocentesis was used for the control group. Pain intensity, maximal interincisal opening, and TMJ sounds were assessed and compared for evaluation of treatment success. RESULTS: There was a statistically significant reduction in pain intensity and joint sound and an increase in mouth opening in the study group when compared with the control group. CONCLUSIONS: This study shows that intra-articular PRP injection for the treatment of reducible disc displacement of the TMJ is a more effective method than arthrocentesis.

Management of neglected periorbital squamous cell carcinoma requiring orbital exenteration.

With its perineural invasion capacity, periorbital squamous cell carcinoma (SCC) may easily invade orbital structures. When SCC invades the orbital musculature or the orbit itself, orbital exenteration, one of the most disfiguring operations on the face, is required. We reviewed elderly patients with periorbitally localized SCC requiring orbital exenteration to evaluate reconstructive options and survival. A chart review of patients' records was conducted to identify all patients older than 65 years with periorbital malignancy requiring orbital exenteration from 2006 to 2011. A total of 9 patients who met the criteria were included in the study. The mean age at surgery was 77 ± 6.7 years, and the mean defect size was 74.2 cm2. All patients had a similar history of late presentation to a doctor because of hesitation to undergo surgery. The temporoparietal fascia flap, galeal flap, free gracilis flap, and free vastus lateralis musculocutaneous flap were the treatment options for reconstruction of the defects. All patients died during follow-up, and the mean survival was 15.7 months (range, 6-36 months). Only 2 of them had relapse before the death. Our small series suggest that elderly patients with periorbital SCC requiring orbital exenteration may not have enough survival to relapse because of the death from different causes without relapse or any sign of spreading cancer. Also, prolonged surgery with free flap reconstruction may increase the risk of postoperative intensive care unit requirement. Because local flaps may work very well for reconstructing the orbital exenteration defects, free flap option should be kept for selected cases.

Rhabdomyosarcoma in an adult hand.

Rhabdomyosarcoma (RMS) is a malign tumour which arises from cells committed to a skeletal muscle lineage. It constitutes 4%-8% of all childhood malignancies but is rare in adults. The rare pleomorphic subtype occurs almost exclusively in adults and most often involves the extremities. RMS of the hand or foot comprise a minority of extremity cases. An adult patient with rhabdomyosarcoma in the hand, which is very rare, is presented in this article. General characteristics of the tumour and the treatment strategies are discussed.

Contact with wet cement: an unrecognized cause of chemical burn.

Chemical burns account for a small percentage of admissions to burn units. Wet cement is a poorly recognized cause of chemical burn. As the construction industry is growing, individuals will likely have more contact with this material and be more prone to its harmful effects. Wet cement can cause severe full-thickness burns with prolonged contact, but this property is not well known among professional users. The lack of information about the potential hazards of wet cement makes it an important problem that must be considered more seriously as a risk factor for chemical burn. Increasing public knowledge of the necessary preventive measures is crucial for avoiding this type of chemical burn injury. Here, we report a case with full-thickness burn that occurred while working with wet cement without proper protection.

Formation of osteocartilaginous exostosis resulting from the raising of a lateral supramalleolar flap.

An osteocartilaginous exostosis developed in a 4-year-old boy in whom a distally-based lateral supramalleolar adipofascial flap had been used to cover a defect in the dorsum of the foot. The bony exostosis was first noticed four months after the operation. It was excised with no complications and there has been no recurrence after two years follow-up. The exostosis was thought to result from stripping the perichondrium over the epiphyseal plate while the flap was being raised. This unique complication has not to our knowledge been reported after harvest of a flap before.

Efficacy of bipolar release in neglected congenital muscular torticollis patients.

Surgical correction of the congenital muscular torticollis (CMT) is recommended for patients with unsuccessful conservative treatment. The aim of this study is to evaluate the efficacy of surgical release of congenital muscular torticollis in neglected cases. We retrospectively evaluated the data of our patients in terms of age, sex, clinical presentation, localization of the lesion, diagnostic tests, and additional abnormalities. The age at operation ranged from 6 to 23 years. Complete muscular release as determined by pre-operative and postoperative range of motion measurements was achieved in all of the patients by bipolar release. In this study, neck motion and head tilt showed marked improvement with surgical treatment in cases with CMT who were admitted to the hospital lately. Congenital muscular torticollis patients can benefit from surgical intervention above the age of 5. Bipolar release is an adequate and complication-free method.

An unusual cause of cold injury: liquified petroleum gas leakage.

Liquefied petroleum gas (LPG) is an odorless and colorless gas that is a mixture of hydrocarbons (propane and butane). It is now more commonly preferred among drivers as an auto-gas throughout the world because it is cheaper than petrol or diesel and produces the same amount of energy. Because of its rapid vaporization and consequent lowering of temperature, it may cause severe cold injuries. A 33-year-old male who suffered from hand burn due to LPG is presented in this article. In LPG-converted cars, if the conversion has not been done properly, LPG may leak. Thus, the public must be informed of this potential danger while undertaking repairs of their vehicles.

Extensor tendon rupture due to cutaneous leichmaniasis: a case report.

Acute cutaneous leishmaniasis is a parasitic infectious disease prevalent in tropical areas. Most doctors in non-endemic countries are not familiar with this disease. Spontaneous tendon ruptures occurring by different mechanisms have been described in the literature but a tendon rupture caused by a skin ulcer secondary to a parasitic infection has not been reported before. In this article clinical and diagnostic features of cutaneous leishmaniasis are reviewed and a case with spontaneous extensor tendon rupture due to cutaneous leishmaniasis is presented.

Reconstruction of total lower lip defects using radial forearm free flap with subsequent tongue flap.

Subtotal and total reconstruction of the lower lip is a challenge for the plastic surgeon. Large defects extending to the chin area can be difficult to manage with only local flaps, and free flaps are better suited. In an attempt to restore the lower lip with the vermilion, the authors used the radial forearm free flap with anteriorly based ventral tongue flap in 5 patients. The tongue flap is used 3 months after the free flap procedure, and this flap is divided 3 weeks later. The tongue flap transfer, adaptation, and division are done under local anesthesia. In all patients, the aesthetic result was excellent compared with the complexity of the reconstructed defect. Patient compliance was uneventful. Although it is a 3-stage reconstruction, combination of radial forearm flap with the tongue flap offers functional and fine aesthetic results.

[The reconstruction of soft tissue defects in the elbow area: a treatment algorithm proposal]. / Dirsek bölgesi yumusak doku defektlerinin rekonstrüksiyonu: tedavi algoritma önerisi.

BACKGROUND: The reconstruction of soft tissue defects of the elbow area (including antecubital fossa and peri-olecranon area) should be performed with the most appropriate soft tissue and functional rehabilitation immediately. METHODS: Ten patients were included in this study. One had a brachial artery defect, another had postburn axillary contracture deformity, and a third had an ulnar bone body fracture in addition to their soft tissue defects, while the remaining seven had only soft tissue defect. Patients underwent surgical closure either by local arm fasciocutaneous flap (1), radial forearm flap (1), multiple Z-plasty (1), pedicled latissimus dorsi muscle flap (3), or with the antecubital fasciocutaneous island flap (4). RESULTS: The follow-up was 9 months to 4 years (mean: 19 months). All the flaps achieved wound closure without losing the range of motion at the elbow joint. CONCLUSION: Surgical closure of the antecubital fossa and peri-olecranon areas can be a challenge for plastic surgeons since this area includes numerous neuro-vascular bundles and a functional joint. Therefore, we describe herein an algorithm for the treatment of defects in these areas from the inspiration in our clinical experience and a literature review. Our algorithm will help to decide the most appropriate choice among all of the surgical options available.

Close range gun shot injuries of the hand with the "mole gun".

INTRODUCTION: A mole gun is a handmade weapon used as a trap to kill moles by farmers. Their action is based on a simple hammer mechanism: when the moles put their head through the metal ring to get hold of the food, they trigger the mechanism. The hammer strikes the primer, which ignites the gunpowder, propelling the pellets from the barrel. The purpose of this study was to report our experiences in a group of patients who accidentally suffered injuries by mole guns to the hand. METHOD: Since 2000, 20 patients had attended the clinic with mole gun shot injuries to the hand. RESULTS: The mean age of patients was 38 years. Thirteen cases involved skin defects over the dorsum of the hand associated with extensor tendon and bone injuries. The skin defect was covered with posterior interosseous artery (PIA) flap in 12 cases. In one case, the PIA pedicle was found to be injured so radial forearm flap was used. The main intervention time for these cases was 6.2 days. All flaps except two PIA flap survived uneventfully. One flap was completely lost while other survived with distal necrosis. In remaining seven cases the thumb was the main injured part; it had complete disruption of its arterial supply and was managed with amputation with or without matarcarpal removal. These cases were managed immediately. CONCLUSION: The risk of injury to the PIA by pellets is low in such close range shots to the hand and PIA flap could be used to cover the defects. In such cases, initial debridement should be minimal and the soft tissue, tendon, and bone injury can be managed in the same stage during the first week of injury.

The importance of maintaining the structural integrity of the lateral crus in tip rhinoplasty.

BACKGROUND: A novel technique for maintaining nasal tip support and external nasal valve integrity is proposed. The procedure involves mobilizing the lateral crus to a more cranial position after altering its shape from convexity to a more flat shape. METHODS: With the described technique, the lower lateral cartilage is dissected free from the skin in a retrograde fashion after an inter cartilaginous incision. The ligament between the lateral crus and the upper lateral cartilage is cut. The vestibular mucosa is not freed. With this maneuver,the lateral crus usually flattens sufficiently. When the convexity flattens, an extra millimeter of cartilage at the cephalic end is gained in the horizontal dimension. When the cut vestibular mucosa is sutured back to its place, the cephalic end of the lateral crus is advanced over the upper lateral cartilage. This technique allows durable support to maintain patency of the nasal valve. No bridges are burned because no cartilage is excised. The surgeon is left with the flexibility to modify the result on the operating table. RESULTS: The technique was successfully used for 48 consecutive patients over a 3-year period. All the operations were primary rhinoplasties performed using a closed technique. The mean age of the patients was 32 years. For 72% of the patients, septoplasty also was performed. None of these patients had to undergo reoperation. CONCLUSION: The authors emphasize the importance of the lateral crus in rhinoplasty and demonstrate that good results at the tip of the nose can be accomplished without cephalic trimming, averting related complications in selected cases.