The effects of limited adventitiectomy on vascular anastomosis: An experimental study in rats.

OBJECTIVE: Blockages in anastomotic vessels cause complete loss of free tissue transfer and replanted limb. Many studies have been conducted in the last 30 years to solve this problem. There are insufficient studies dealing with the effects of the limited adventitiectomy done before surgery for sympathetic overactivity leading situations. The aim of this experimental study is to reveal the effects of limited adventitiectomy. METHODS: In this study, limited adventitiectomy was performed in a wide area before surgery, and the effect of this practice on the vessel diameter and anastomosis was investigated. RESULTS: Rapidly growing dilatation and increase in vessel diameter was observed, and dilatation continued in the limited adventitiectomy group. CONCLUSIONS: The preoperative performed limited adventitiectomy is a useful preparation for super microsurgery. Especially in clinical practice before the free flap surgery, limited adventitiectomy can be applied if the recipient site is expected to have vascular problems.

Endoscopy-Assisted Single-Incision Technique to Harvest the Conchal Cartilage and Temporal Fascia Simultaneously by Using Phaco Slit Knife.

Conchal cartilage and temporal fascia grafts are useful materials for secondary rhinoplasty cases. Generally, surgeons require to access autologous grafts fast and effortlessly. Harvesting 2 different types of graft, such as cartilage and fascia, however, are associated with limitations, such as additional surgery time, extra incisions, and postoperative additional distortions at the graft-host interface. The authors evolved a modified single incision that would harvest conchal cartilage and temporal fascia simultaneously by using 4 mm endoscope and 3 mm angled phaco slit knife.

Severe Obstructive Sleep Apnea Due to Massive Cervical Lipohypertrophy.

Obstructive sleep apnea is a difficult problem to deal with. Many studies on the pathogenesis of obstructive sleep apnea were performed in the past, and we present cervical lipohypertrophy causing severe obstructive sleep apnea in this article.

Digital artery perforator flaps: an easy and reliable choice for fingertip amputation reconstruction.

OBJECTIVE: The aim of this study was to evaluate the use and efficacy of digital artery perforator (DAP) flaps in fingertip reconstruction. METHODS: From 2007 to 2011, 7 fingers of 5 patients (4 male, 1 female) underwent fingertip reconstruction with extended DAP flaps following traumatic fingertip amputation. Average flap size was 4.25 cm². RESULTS: All flaps survived except one case in which partial skin necrosis was observed and treated with wet-dressing. Donor sites were closed with full-thickness skin grafting in 5 and primarily in 2 fingers. We did not observe hypersensitivity or cold intolerance in repaired fingers. CONCLUSION: The DAP flap is a reliable, free-style perforator flap that can be used for all types of fingertip injuries.

Inappropriate use of foreign materials in temporomandibular joint ankylosis surgery: report of two cases.

Gap and interpositional arthroplasties are the most commonly used methods in the treatment of temporomandibular joint ankylosis. Complete resection of ankylotic segments, fibrotic band release and creating gap between the condyle and the glenoid fossa have great importance. Two patients were admitted to our clinic with complaints of difficulty in opening mouth and joint pain. In physical examination, maximum mouth opening values were recorded as 7 mm in one patient and 9 mm in another. An operation was planned due the presence of radiological grade 4 bilateral bony ankylosis. During the operation, foreign materials were found in the joint spaces of the patients. The first patient had a piece of nylon bag in the joint space, whereas the second patient had a silicon sheath used for wound therapy. Following removal of these materials, as a result of the recreation of joint spaces and the placement of suitable silicon blocks, 32 and 34 mm of mouth openings were noted during follow-up. In conclusion, recreated temporomandibular joint spaces after ankylosis surgery may be filled with a variety of autogenous or non-autogenously materials. However, the use of wrong materials inevitably causes recurrence and even worsens the primary condition.

Minimally invasive approaches in severe panfacial fractures.

BACKGROUND: Minimally invasive approaches to severe panfacial fractures are being used increasingly to reduce surgical trauma and the related complications. In this study, it was aimed to determine the ideal surgical approaches in severe panfacial fractures. METHODS: Sixteen patients with severe panfacial fractures were included in this study. Minimally invasive approaches were used for Le Fort III fracture in six patients, for Le Fort II fracture in four patients, and for bilateral maxillary and orbital floor fractures in six patients. We used subciliary, intraoral vestibular, lateral eyebrow incisions to reach orbital, maxillary, zygomaticomaxillary buttress, and nasoethmoidal fractures, respectively. RESULTS: All fractures were repaired with miniplates and screws. No hematoma, wound infections or other complications were observed. CONCLUSION: Minimally invasive approaches in severe panfacial fractures are considered suitable and effective in terms of aesthetic results.

Treatment of post-burn upper extremity, neck and facial contractures: report of 77 cases.

BACKGROUND: Post-burn contractures severely deteriorate life quality. We aimed to present our treatment protocols for post-burn sequelae and the contractures that cause functional limitations. METHODS: Seventy-seven cases with post-burn contracture were treated in our clinic. Post-burn contractures occurring after a burn injury affected the upper extremity, face and neck in 60, 17 and 6 cases, respectively. Skin grafts, local flaps such as advancement flaps, Z-plasties, K-plasties, regional flaps such as posterior interosseous flap, tissue expanded flaps, and free flaps were used according to the severity of the contractures. RESULTS: In one patient with type II axillary contraction, recurrence was seen. Full range of motion was achieved in the 3.6-year follow-up period in elbow contractures. Eight of 71 phalangeal joint contractures recurred. Two patients underwent reoperation for neck contracture recurrences. CONCLUSION: Excellent results were seen with prefabricated flaps, which were used for the facial reconstruction.

Reconstruction of intraoral defects with superior labial artery musculo-mucosal flap: a preliminary clinical study.

OBJECTIVES: In this article, we present the use of the superior labial artery musculo-mucosal (SLAMM) flap for intraoral reconstruction. PATIENTS AND METHODS: The study included five patients (2 females, 3 males; mean age 36 years; range 11 to 56 years) who consulted at our clinic between October 2008 and January 2010. Five oral defects were reconstructed with the SLAMM flap. Three patients underwent reconstruction with SLAMM flap following oncologic resection. The other two patients had traumatic defects in the oral cavity which necessitated flap application. First, the distal end of the flap was incised and the superior labial artery was identified after dissection. After ligation of the artery, the mucosa, submucosa and the cuff of orbicularis oris muscle were elevated. The dissection was extended laterally and anteriorly, depending on the necessary flap size. RESULTS: None of the patients had partial or total flap necrosis. During the follow-up period, contracture developed in only one patient. Successful reconstruction was observed in all patients. CONCLUSION: The superior labial artery musculo-mucosal flap is a simple and feasible technique which can be used for reconstruction of intraoral defects.