Comparison of aesthetic outcome with round and three-armed star flap umbilicoplasty.

Background: The umbilicus is an indicative aesthetic component of the abdomen. Many umbilicoplasty techniques have been defined and the most commonly used method is the round incision technique. In this paper, we present a new umbilicoplasty technique involving the use of a three-armed star flap and compare it with the round technique. Methods: Forty-eight female patients who underwent umbilicoplasty during abdominoplasty and free deep inferior epigastric perforator flap (DIEP) procedures between February 2011 and December 2016 were included in the study. Twenty patients had round umbilicoplasty, whereas in the remaining 28 patients the three armed star flap technique was used. Aesthetic outcomes of both techniques were evaluated by a questionnaire which was completed by the patients and two independent surgeons. Results: The mean follow-up period was 22 months. Hypertrophic scarring was seen in one patient with the three armed star flap technique and in two patients with the round technique and a cicatricial ring formation occurred in one patient with the round technique. The patient and surgeon questionnaire scores were significantly higher in the 3-armed star flap group. (p < .05) Conclusion: In this study, round umbilicoplasty technique has been compared with the three armed star flap technique. Patient satisfaction surveys and evaluation by two independent surgeons revealed better cosmetic results with the new technique. We believe that this new technique could be preferred over the round technique since it prevents stenosis, circular scar contraction and provides a natural contour between the umbilicus and abdomen.

A New Technique in Management of Depressed Posttracheostomy Scars.

BACKGROUND: The goals of tracheostomy scar revision are filling of the depressed area, providing easy sliding of skin over the trachea. There are various techniques described to correct this situation. In this article, a modification of split sternocleidomastoid (SCM) muscle flap used in the correction of posttracheostomy defects is described. METHODS: Thirteen patients who had depressed scars after tracheostomy are included in this study. The mean patient age was 44 years (range, 27-56 years). All patients who suffered from tracheal tug, dysphagia, and bad appearance are included in the study. The area with the depressed scar is de-epithelialized after incising around the depression. Bilateral SCM muscles are split in the coronal plane toward superior half of the muscle while leaving the posterior part of the muscle attached to the bone. After elevation, both SCM muscle flaps are overlapped in the midline. RESULTS: The mean follow-up period of the patients was 11 months (range, 5-20 months). Tracheal tug and dysphagia complaints were resolved in all patients. The depressed area due to the scar was either reduced or completely recovered in all the patients. Apart from 1 hematoma case, none of the early or late complications such as infection, wound dehiscence, skin necrosis, seroma, recurrence, or neck contracture was seen. CONCLUSIONS: We think that this technique, which gives functionally and aesthetically satisfying results, can be used safely in depressed scars formed after tracheostomy and treatment of functional impairment due to this procedure.

Beneficial effects of Salvia miltiorrhiza in the healing of burn wounds: an experimental study in rats.

INTRODUCTION: Burn healing is a complicated process and very few treatments can positively alter its effects. The aim of this study was to investigate the effects Salvia miltiorrhiza (SM -Danshen), a traditional Chinese medicine, on burn wound healing. MATERIAL AND METHODS: Twenty rats were included in this study and divided into two groups. 3 × 2 cm wide burn areas were created in the dorsal skin of all the animals with thermal contact. Intraoral 1 ml/day saline and 1 g/kg/day SM were given in control and experiment groups, respectively. Fourteen days following the burn injury burn zones were evaluated with indocyanine green-SPY imaging device, and multiple samples were collected for histopathological evaluation. Standard photographs were taken for the evaluation of necrotic skin areas. RESULTS: Neovascularization was increased in the SM group when compared with the control group (p = 0.0406). SPY studies revealed a meaningful increase in the tissue perfusion in the SM group (p = 0.0286). The average amount of necrotic area in the control and experiment group on the postoperative 14th day was 71.6% (±16.51) and 42.5% (±10.64) respectively (p = 0.0002). CONCLUSION: Our study shows that SM can decrease the amount of necrosis in burn wounds by increasing tissue perfusion and neovascularization.

Key and Keyhole Model for Dorsal Onlay Cartilage Grafts in Correcting Nasal Deformities.

BACKGROUND: The shaping of the cartilage and keeping it in place is very significant for patients who need nasal reconstruction with costal grafts at traumatic or secondary rhinoplasties. In this study, a template is prepared during the surgery that shows the dorsal defect in a 3-dimensional manner and acts as a guide while shaping the cartilage. METHODS: Seventeen patients who required secondary rhinoplasties because of trauma or previous operations were included in this study. The patients were operated on between the years 2009 and 2013. The mean age of the patients was 24 years (19-38 years). According to the surgical technique, bone wax was placed in a sheath prepared from the finger of a sterile nylon surgical glove before the dorsal reconstruction. It was placed to the nasal dorsum and shaped over the skin with digital maneuvers. Afterward, the bone wax was stripped off the nylon glove, and it was used as a template to shape the cartilage graft. RESULTS: No need for revision rhinoplasties was seen in any of the patients during the mean follow-up period of 19 months. The patients stated that they were satisfied by both the functional and the aesthetic results. CONCLUSIONS: The bone wax template and the defect fit in a key and keyhole fashion. It is supported by multiple points on the nasal bone and the septum. Thus, it does not slide and its warping is avoided. We think that it gives satisfactory results and it shortens the learning process.