Treatment of migration and extrusion of the gold weight eyelid implant with fascia lata sandwich graft technique.

Gold weight implantation is generally considered a safe procedure for the treatment of paralytic lagophthalmos. The most frequently seen complications are extrusion, malpositioning, and migration of the implant. To decrease the rate of these complications, several modifications were defined in the composition and the shape of the implant as well as the surgical technique itself. Despite these precautions, implant revision rates are still as high as 8% to 14%. Nowadays, implant-covering or implant-wrapping procedures are becoming more popular to avoid implant-related problems. However, there is limited information in the literature regarding the management of these complications. In this study, we aimed to present the treatment of migration and extrusion of the gold weight implant in a patient with Moebius syndrome by wrapping the implant with autogenous fascia lata graft.

The effect of recombinant hirudin on rabbit ear flaps with venous insufficiency.

The effect of recombinant hirudin, which is the most powerful antithrombotic agent, on flaps with venous insufficiency was investigated. Oedema and congestion are frequent on flaps, causing necrosis unpredictably. Venous insufficiency and thrombosis are experimentally and clinically more frequent than arterial occlusion. Twenty-one adult New Zealand rabbits were used in this study. Skin flaps (3 × 6 cm) were elevated on a 1-cm-wide pedicle on rabbit ears. The artery, nerve, and vein were exposed and examined with the aid of a surgical microscope. Venous insufficiency was established by cutting the vein and nerve. In the control group, no additional surgical or medical procedures were performed and the ear flap was inset to its original location. Subcutaneous low molecular weight heparin (LMWH; 320 IU/kg) was administered to a second group of rabbits after the same surgery, and recombinant hirudin (2 µg) was administered via the pedicle artery 5 minutes after the vein and nerve were bound and cut in a third group of rabbits. Compared with control and LMWH groups on day 3 and 7, the hirudin-treated group had less hair loss, lower oedema scores and less haematoma formation. Furthermore, a lower size of necrotic areas and an increase in the circulating area on day 7 was found in the hirudin-treated group. In addition, angiography revealed new vessel development (neovascularisation) only in the hirudin group. On histologic sections, hirudin-treated animals had lower oedema, inflammation and congestion scores than animals in the other two groups. Thus, when administered into the ear flap through the pedicle as a pure recombinant preparation, hirudin increased flap survival by its antithrombotic effects and by accelerating neoangiogenesis. Recombinant hirudin may be used in clinical practice to treat flaps with venous problems and to increase survival rates.

A new facial artery free-style perforator flap and conchal cartilage graft for one-step reconstruction of the alar defects.

The nose is the most commonly affected area by basal and squamous skin carcinomas of the head and neck area (D'Arpa et al. J Plast Reconstr Aesthet Surg. 2009, 62:36-42). The nasolabial flap is a very well known local flap that provides excellent color and texture matches. However, its major drawback is that it requires a 2-stage procedure to restore an adequate nasal cheek groove (Karsidag et al. J Craniofac Surg. 2010;21:1887-1889). In the perforator flaps, there are numerous studies that describe flaps whose vascular supply depend on perforators from the fascial artery.We planned to harvest a perforator flap around the medial cheek area, which included one cutaneous perforator from the facial artery. Free-style facial artery perforator flaps and auricular conchal cartilage framework were performed in 9 patients who have alar defect due to malignancies.From September 2010 to December 2011, the free-style facial perforator artery flap was performed in 9 patients at the Plastic and Reconstructive Surgery Department of the Ankara Numune Training and Research Hospital, Turkey. The whole flap was used to reconstruct the whole alar unit, which includes cartilaginous tissues.Our aim is to define a one-stage reconstruction technique with a perforator-based flap. Our flap is supplied by a perforating branch of the facial artery. We develop this method because of its reliable vascularization, that is, the possibility of performing one-stage technique with sensation preservation.In conclusion, we strongly recommend one-stage reconstruction in any kind of alar region defect with this versatile facial perforator flap.

The intraneural hemangioma of the digital nerve: case report.

Intraneural Hemangioma of the digital nerve is rare and so far three cases have been reported in the literature. We present a case of 12- year- old boy with painless soft tissue mass in the right hand and numbness on the radial aspect of the index finger. Magnetic Resonance Imaging showed an isointense subcutaneous lesion without discrete borders in the first web space classically of hemangioma with the radial digital nerve extension. On exploration, the intraneural extension of the hemangioma was confirmed and total resection, microsurgical primary digital nerve repair was done. The patient became better and at 6 months follow up the index finger sensation improved. The patient had no reccurence and he is still under follow up.

Giant pleomorphic adenoma of soft palate leading to obstruction of the nasopharyngeal port.

Pleomorphic adenoma is the most common tumor of minor salivary glands, but it is rarely located in the soft palate. It is generally a small mass at the time of diagnosis, but if it is neglected it can rarely become larger, leading to obstructive symptoms such as snoring, hypernasal speech, and dysphagia. Surgical removal of the mass is curative. In this paper, we present a case of an unusually large pleomorphic adenoma of the soft palate leading to snoring and hypernasal speech. The defect that resulted from the excision of the mass is covered with a uvular flap.

Rhabdomyomatous mesenchymal hamartoma.

The authors report the case of a 6-month-old boy seen at Ankara Numune Hospital because of a papillomatous lesion centrally located on the chin. The lesion was excised under local anesthesia, and histologic examination revealed numerous eccrine glands and muscle bundles, neuronal tissues, and fatty tissue covered by stratified squamous epithelium. According to the histologic findings, the lesion was diagnosed as rhabdomyomatous mesenchymal hamartoma, which is known to be a rare lesion of childhood.

A retrospective study on epidemiology and treatment of maxillofacial fractures.

There are many different studies about the epidemiology and characteristics of maxillofacial fractures. In the authors' clinic a study was done regarding the characteristics of patients with maxillofacial fractures. 553 patients were investigated retrospectively. The causes, localizations, fracture types, treatments modalities, and complications were evaluated. The most common cause of maxillofacial fractures was traffic accidents (90.15%) followed by interpersonal violence (2.71%). The most common fracture site was the parasymphisis (30.9%) in mandibular fractures and the orbital rim in midface fractures. Young (26-41 years of age) male (82.64%) patients were more prone to maxillofacial injury. The most common treatment modality is rigid fixation with miniplates. This study concerns the fracture types, localizations, and ideal treatment methods according to these characteristics and complications. From such data, the ideal treatment method depends not only on the fracture type and localization but also the surgeon's experience and preference.