Urethroplasty Using A Turnover Flap for Correction of Problematic Urethrocutaneous Fistula: A Case Report.

Urethral fistula formation after urethroplasty for hypospadias is a frequent complication. Repeated failures can occur even after multiple attempts at repair. A surgical procedure is described for a problematic resistant urethrocutaneous fistula (UF) with the transverse turnover flap using the Buck's fascia of the corpus cavernosum. A 23-year-old male was admitted to our hospital with recurrent coronal UF. We placed a suprapubic catheter in the bladder and operated the patient with the flap technique combined with glanuloplasty. In 3rd month follow up, the patient had no fistula with normal voiding.

Evaluation of soluble CD200 levels in type 2 diabetic foot and nephropathic patients: association with disease activity.

BACKGROUND: CD200 (OX-2) is a novel immune-effective molecule, existing in a cell membrane-bound form, as well as in a soluble form in serum (s OX-2), which acts to regulate inflammatory and acquired immune responses. MATERIAL AND METHODS: We planned this study to evaluate the sOX-2 levels of type 2 diabetic foot (group B), and compare it with that of healthy controls (group A). The patient group had the following values: DM period: 27.9±10.3 year [mean ±SD], HbA1c: 9.52±2.44% [mean ±SD]. RESULTS: Blood samples for sCD200 measurement were always taken in the morning between 8 and 10 A.M.. The results were reported as means of duplicate measurements. Concentrations of sOX-2 in the serum samples were quantified using an ELISA kit. Serum hs-CRP levels were measured using an hs-CRP assay kit. The sOX-2 level in group B was 173.8±3.1 and in group A was 70.52±1.2 [p<0.0001). In subgroup analysis of T2DM-DFI patients, we noticed that sOX-2 levels were higher in WGS (Wagner grading system) I and II patients than in WGS III and IV patients. The HbA1c, BUN, creatinine, hs-CRP levels, and sedimentation rates were higher in the patient group (p<0.0001, p<0.001, p<0.001, p<0.005, and p<0.0001, respectively). CONCLUSIONS: We suggest that there are vascular, immunologic, and neurologic components in DFI, whereas autoimmune diseases and inflammatory skin disorders have only an immunologic component. This is possibly evidence of a pro-inflammatory effect seen in DFI as a vascular complication.

Functional reconstruction of the lower lip with Fujimori flap and long-term follow-up with clinical and electrophysiologic evaluations.

PURPOSE: The Fujimori gate flap is an innervated flap raised from the nasolabial area for reconstruction of the lower lip. No electromyographic or clinical long-term studies have analyzed the long-term outcomes of lower lip reconstruction performed using this method. The aim of the present study was to assess the outcomes of lower lip reconstruction with the Fujimori gate flap using clinical and electrophysiologic examinations. PATIENTS AND METHODS: Ten patients who had been treated with this procedure were evaluated clinically and electrophysiologically. The follow-up period was 1 year for all patients, and the patients underwent regular assessments. RESULTS: All flaps survived completely, and no wound healing problems were encountered. Four patients underwent revision in the late postoperative period. The electrophysiologic studies revealed the presence of reinnervation in all 10 patients. CONCLUSIONS: In the present study, we found that the Fujimori gate flap is a versatile flap for ideal reconstruction of lower lip defects. Our electrophysiologic assessments showed that the transferred muscle had undergone reinnervation and that the donor area innervation had been preserved. The findings from the serial clinical and electrophysiologic assessments indicated satisfactory results.

Suprathel(®) -assisted surgical treatment of the hand in a dystrophic epidermolysis bullosa patient.

Epidermolysis bullosa (EB) is a progressive familial disorder composed of dermal mucosal blisters, flexion contractures and pseudosyndactylies. Flexion contractures and pseudosyndactyly can be treated with surgery but usually require skin grafting. Because of poor wound healing, skin graft harvesting is a challenge in these patients. In order to prevent donor-site morbidities due to skin graft harvesting some alloplastic materials were introduced. In this study, we focused on Suprathel(®) as a new allograft material for covering the skin defects of a patient with dystrophic EB.

Effect of the delay phenomenon on survival of rat island skin flaps with total venous occlusion.

Necrosis is an inevitable result in flaps with total venous occlusion even if arterial flow is sufficient. The purpose of this study was to investigate the effect of surgical delay on rat island skin flaps with total venous occlusion, using 20 Swiss albino rats. Two epigastric island flaps were elevated in each rat. Flaps of experimental and control groups were elevated in the same animal. In the experimental group (n=20), flap boundaries were incised down to the fascia and the incisions were sutured as a delay procedure at the first stage. After 7 days, the 3 x 6-cm epigastric island flap was elevated, the inferior epigastric vein was ligated, and was cut under X60 magnification. Then, all flaps were sutured back to their original beds. In the control group (n=20), the same surgical procedure as in the experimental group was repeated without a delay procedure. Viability was assessed at postoperative days 1, 3, and 7. At the end of day 7, all flaps in the control group were totally necrosed; however flaps in the experimental group survived partially. The surviving area ranged between 24 and 74 percent (mean: 60 +/- 15 percent). The differences between the two groups were found to be statistically significant, using Student's t-test ( p<0.005). Surgical delay could not completely save a flap with totally interrupted venous return. Nevertheless, a 60 +/- 15 percent portion of these flaps could survive with the help of a simple delay procedure.

Complications and removal rates of miniplates and screws used for maxillofacial fractures.

Complications of miniplates and screws used for maxillofacial fractures were analyzed, and complications were evaluated in relation to fracture site. Motor vehicle accidents were the cause of all fractures in this study. During the last 7 years (1994-2001), noncompressive titanium miniplates and screws were used for stabilization of maxillofacial fractures. In 66 patients, 87 fracture sites were stabilized using 296 miniplates and 1,184 screws. The mean age of the patients was 31 years (age range, 6-64 years). The percentage of male patients was 77% and the percentage of female patients was 23%. Miniplates and screws were used in 6 patients (10%) who were younger than 15 years of age at the time of the surgery. The follow-up period ranged between 3 months and 7 years. The overall miniplate and screw removal rate was 7%. The rates of removal according to the fracture site are as follows: mandible, 4.4%; zygomaticofrontal junction, 1.4%; inferior orbital rim, 0.7%; maxilla, 0.3%; and frontal sinus wall, 0.3%. Removal causes were infection, 2%; extrusion, 1.7%; visibility, 1.4%; pain, 1%; malunion, 0.7%; and miniplate fracture, 0.3%. The minimum time period between insertion and removal was 3 months and the maximum period was 14 months. Infection and extrusion were the main complications for removal of miniplates and screws from the mandible, whereas miniplates and screws were removed from the zygoma because of visibility (zygomaticofrontal region) under the skin in the vast majority of the patients. The maxilla was the least operated region for miniplate and screw removal. In all patients in this study, the preoperative physical symptoms were relieved after miniplate and screw removal. Miniplates and screws are very useful tools in maxillofacial fracture management, but sometimes they have to be removed. In the authors' series, the removal rate was 7%, and this rate can vary with the severity of the trauma and location of the fracture.