Is HBOT treatment effective in recovering zone of stasis? An experimental immunohistochemical study.

Studies aimed at recovering the zone of stasis are one of the major issues of experimental burn studies. Hypoxia and oedema at that zone may cause irreversible changes. Due to anti-oedematous and antihypoxic effects of hyperbaric oxygen treatment (HBOT), it may be beneficial in recovering the zone of stasis. We performed an experimental study using 20 Sprague-Dawley rats, each weighing 350-450 g. The rats were first divided into two groups as 24h and 5 days. Subsequently, control and treatment groups (five rats in each group) were formed. For burn wounds, we used the burn comb model, which was described by Regas and Ehrlich. In the treatment group, 2.5 ATA HBOT was applied for 90 min twice daily. A 0.8-cm punch biopsy was performed and samples for histological examination were taken from the centre of burn area. The rats were sacrificed by administering '3 mci technetium-99m methoxy butyl nitrite' ((99)Tc(m) MIBI) through the femoral vein. Biopsy materials were evaluated by histological and immunohistochemical methods. Dorsal skin fragment, excised to 1cm margin, was imaged by scintigraphic measurements with a gamma camera. Wet and dry weight measurements of excised skin fragments were taken. As a result, HBOT showed a positive effect at the cellular level in the first 24h. It increased recovery potential by augmenting neovascularisation and decreasing oedema in the 5-day group.

A novel approach to cleft lip nose deformity: posterior dome graft technique.

The pathology of "nasal tip complex" remains as a problem to be solved in unilateral cleft lip nose deformity wherein open rhinoplasty and cartilage grafts are used frequently. For this reason, the research for the treatment of cleft-side tip projection lost and ala depression still continues. Our technique is to put the cartilage graft at posterior dome area after the release of cleft-side ala from vestibular mucosa and skin to elevate the ala depression and tip projection. This technique has been used on 16 patients between the years 2003 and 2007. This technique, different from the augmentation methods, aims to increase the direct lateral crura's elastic support strength and to support the new position of alar cartilage. This method will particularly be helpful in obtaining the long-term results in delayed and serious cases.

Dorsal V-Y advancement flap for amputations of the fingertips.

Amputations of the fingertip are the most common injuries to the upper limbs, and they cause greatest socioeconomic losses. The first choice of the technique of repair should be the simplest and fastest, with rapid restoration of function and an acceptable aesthetic appearance, and should return the worker to his job rapidly to prevent economic loss. Volar V-Y advancement flaps should therefore be considered first, but unless the dorsal loss is greater than the volar, this first choice of flap cannot be used because of the inadequate donor area. We present here a method for amputations that are proximal to the matrix of the nail. Seven volar oblique or transverse amputations were treated with dorsal V-Y advancement flaps with or without volar V-Y advancement flaps. All flaps survived. The procedure is simple, versatile, and a reliable way of reconstructing amputations of the fingertip that are proximal to the nailbed.

Reconstruction of lower half defects of the nose with the lateral nasal artery pedicle nasolabial island flap.

BACKGROUND: The superiorly based nasolabial flap is a well-known procedure. However, random pattern or subcutaneous pedicle flaps are insufficient for reconstruction of large defects. Artery pedicle flaps have a satisfactory blood supply, and for that reason, the required tissue can be raised for reconstruction of large defects of the nose. METHODS: Twelve cases were operated on with this technique. Reconstruction was performed with a lateral nasal artery pedicle island flap. The mean age of the patients was 68.4 years. Three patients required cartilage grafts for alar rim support. The cartilage grafts were harvested from the auricular conchal bowl. The follow-up period ranged from 15 to 33 months. RESULTS: There was no partial or total loss of the flap. There was no distortion on the face caused by smiling and pursing of the lips observed. Donor and reconstructed areas have an excellent appearance in all cases. The aesthetic results were satisfying for all patients as well. CONCLUSIONS: The authors' flap can be used for reconstructing large defects of the lower half of the nose, and reconstruction with a single stage yields a fast and satisfactory result. The authors advocate that the lateral nasal artery pedicle nasolabial island flap is an excellent choice for reconstruction of large defects in the lower half of the nose.

Uses of scapular island flap in pediatric axillary burn contractures [correction of conractures].

Pediatric axillary post-burn contractures one of the most challenging problems which follow treatment of the upper extremity burns. We preferred to use scapular flaps for surgical treatment of pediatric axillary contractures instead of skin grafting or Z-plasties. In this clinical study we present 13 pediatric cases treated with scapular island flaps. In pediatric scapular flap cases, the technique which we used was to extend the flap's pedicle dissection was continued to the level of bifurcation of subscapular artery. Bypassing the flap triangular space allowed us to cover the anterior part of the axillary contractures. We observed that the scapular flap repairs have many benefits to skin grafting including no recurrence of contracture and stable coverage of the shoulder joint. The other advantages of scapular island flap are that the donor site is closed primarily, and it provides an adequate amount of pliable skin while not compromising the function and range of motion of joints. In conclusion, the island scapular flap is a good choice for reconstruction of various axillary contractures in pediatric population.

Reconstruction of the anterior surface of the ear using a postauricular pull-through neurovascular island flap.

The auricular conchal cavity is a shallow structure in the central part of the ear. It is not only 3-dimensional, but it is a gateway to the external ear canal. Many methods have been described for reconstruction of the defect of concha-antihelix: split- or full-thickness skin grafts, regional skin, chondrocutaneous and musculocutaneous flaps, but none of the authors have described this flap with neurovascular pedicle. We used postauricular neurovascular pedicle island flap for conchal and periconchal areas of anterior surface of the external ear because it matches to the skin color, thickness and texture; scars are well hidden, and there is no donor-site morbidity. Moreover, it has a constant and reliable neurovascular pedicle. The flap edema which was present in the early postoperative period began to resolve gradually after 3 weeks and disappeared in a few months. The esthetic results were excellent in all of the patients and very satisfying for the patients, too. The sensibility was positive by light touch, pin-prick, temperature and static 2-point discrimination in the postoperative control. The static 2-point discriminations in the transferred flap and in the other ear, which corresponds to the same area, were measured. The results were nearly the same as normal values. We advocate postauricular neurovascular pedicle island flap for conchal and periconchal areas of anterior surface of the external ear because it matches the skin color, thickness and texture; scars are well hidden, and there is no donor site morbidity. Moreover, it has a constant and reliable neurovascular pedicle.

Use of adhesives in cleft palate surgery: a new flap fixation technique.

N-Butyl-2-cyanoacrylate (NB2C) is a synthetic tissue adhesive, and it has been used in many surgical procedures. This study was aimed at evaluating its efficacy in cleft palate repairs. Fifteen patients with soft palate and hard palate clefts had clefts repaired with the use of this synthetic adhesive. The ages at repair ranged from 11 months to 17 years, with an average of 2.4 years. Follow-up time ranged from 14 months to 24 months. No complications were found. The advantages of using NB2C were shorter operative time, more pushback gained, better hemostasis, early and well-tolerated feeding, tension-free closure, and better patient comfort. This study shows NB2C as a useful adjunctive material for affixing the mucoperiosteal flaps to the hard palate.

Combined intraoral and nasal approach to Tessier No:0 cleft with bifid nose.

The surgical correction of craniofacial clefts is an extremely difficult field in pediatric plastic surgery. Facial clefts are rare entities that most plastic surgeons will rarely have to manage. Various surgical techniques devised by some authors for facial clefts have not still widely accepted. The bifid nose deformity is generally an indicator of Tessier No:0 clefts, with various degrees of skeletal problems. The nasal roof area is an important key point in determining the appropriate surgical technique for reconstruction. In this report, a case of Tessier No:0 with a moderate nasal bifidity and ours novel surgical repair technique combining oral and nasal incision are presented.