Predicting skin deficits through surface area measurements in ear reconstruction and adult ear surface area norms.

Ear reconstruction is one of the most challenging procedures in plastic surgery practice. Many studies and techniques have been described in the literature for carving a well-pronounced framework. However, just as important as the cartilage framework is the ample amount of delicate skin coverage of the framework. In this report, we introduce an innovative method of measuring the skin surface area of the auricle from a three-dimensional template created from the healthy ear.The study group consisted of 60 adult Turkish individuals who were randomly selected (30 men and 30 women). The participant ages ranged from 18 to 45 years (mean, 31.5 years), and they had no history of trauma or congenital anomalies. The template is created by dividing the ear into aesthetic subunits and using ImageJ software to estimate the necessary amount of total skin surface area required.Reconstruction of the auricle is a complicated process that requires experience and patience to provide the auricular details. We believe this estimate will shorten the learning curve for residents and surgeons interested in ear reconstruction and will help surgeons obtain adequate skin to drape over the well-sculpted cartilage frameworks by providing a reference list of total ear skin surface area measurements for Turkish men and women.

The feasibility of tissue expansion in reconstruction of congenital and aquired deformities of pediatric patients.

Skin expansion is one of the major developments in reconstructive surgery. The use of tissue expansion has been popularized among plastic surgeons and has become the treatment method of choice for many congenital and acquired defects in a wide variety of diseases in adults and then later in children. The authors analyze their clinical experience in the treatment of burn scars and complex defects by tissue expansion in pediatric patients. The study included thirty five expansion procedures performed in 25 patients. Smooth surface expanders with a remote valve were used in the scalp (22), face (2), neck (3), hand (2), thorax (2), breast (1), palate (2), abdomen (1). Self-inflating osmotic tissue expanders were used in four patients, one of them had cleft palate and the other two of them had congenital hand anomalies and the last one had frontal scar and alopecia in the frontal hairline. In 19 out of 25 cases (76%) tissue expansion was achieved without complications. At the same time, in 1 cases minor complications and in 5 cases major complications occurred. The number of expanders per patient was only one in 16 cases. More than one expander was used to remove parts of the same injury in 9 cases. Our study may help to draw attention again on different aspects in tissue expansion and critically focus on each step of the tissue expansion both using self-filling tissue expanders and smooth surface tissue expanders with a remote valve.

Anomalous large unique muscle belly of flexor digitorum superficialis and the absence of palmaris longus in the forearm.

Anomalies of muscles of the upper extremity are frequently encountered and anatomic variations of the flexor digitorum superficialis (FDS) muscle-tendon unit are frequently reported by anatomists and clinicians. FDS anomalies can be in forms of tendon interconnections, substitution, absence or muscle belly variations and most of the times the anomalies of FDS produce few clinical symptoms. We report a rare and unusual case of FDS anomaly with a unique and large muscle belly. The deformity is type V according to the classification of Elliot et al. in which the muscle belly extends to four digits (the index, middle, ring and little finger) in the right hand of patient and there is absence of the palmaris longus tendon. The hand surgeon should be able to realise all variations of the FDS tendon and should be prepared for unexpected findings during surgery.

Severe symmetrical facial lipoatrophy in a patient with discoid lupus erythematosus.

Acquired partial lipodystrophy is a rare disorder, and it is characterized by the absence of subcutaneous fat from the face, the neck, the trunk, and the upper extremities. The etiology of acquired partial lipodystrophy includes scleroderma and discoid lupus erythematosus. Literature review reveals studies involving 10 patients until today with lipoatrophy due to or after the onset of discoid lupus erythematosus; all are female patients. We want to report a young male patient with progressive symmetrical facial lipoatrophy. In addition, he has discoid lupus erythematosus and celiac disease. Fat grafting and adjuvant oral coenzyme Q10 tablets (Deka-none; Deka Pharmaceuticals, Istanbul, Turkey) were administered for treatment. To our knowledge, this case involves the first male patient in the literature presenting with symmetrical facial lipoatrophy with very prominent periorbital lipoatrophy and bitemporal hollowing symptoms.