Percutaneous electrothrombosis: a minimally invasive technique for the treatment of deep hemangiomas.

BACKGROUND: A percutaneous electrocauterization technique for the treatment of deep hemangiomas is introduced as an alternative and minimally invasive treatment mode. METHODS: Percutaneous electrothrombosis was applied through a needle-catheter that is a small silicone catheter with a needle guide in it. Thus, it is possible to do needle-point monopolar electrocauterization only at the needle tip because of the insulation of the other parts of the needle by the silicone catheter. By retracting the needle with catheter on it during electrocauterization, electrothrombosis was achieved through and around the channel of the needle, leaving vascularized tissue areas between the channels to perfuse the skin or mucosa covering the hemangioma. RESULTS: This technique was applied as a single treatment or before surgery for the treatment of cavernous hemangiomas to more than 40 patients. However, adequate documentation was found for only 10 patients. After percutaneous electrocauterization of deep hemangiomas, discrete areas of skin necrosis appeared in some patients during the healing period, but the subsequent debridement and surgical excisions were easier because of the thrombosis effect of the technique due to the diffuse denaturation and fibrosis through and around the electrocauterization channels. The follow-up period was 1-13 years. CONCLUSION: The proposed percutaneous electrocauterization technique for the treatment of deep hemangiomas achieved four effects: (1) volume reduction, (2) bleeding reduction, (3) anesthesia time reduction, and (4) cost reduction. The technique can be defined as a minimally invasive and effective alternative treatment for deep hemangiomas.

Enhancement of nerve regeneration and orientation across a gap with a nerve graft within a vein conduit graft: a functional, stereological, and electrophysiological study.

In this study, the right sciatic nerves of 40 rats were used to determine whether a nerve graft within a vein graft might accelerate and facilitate axonal regeneration, compared with a nerve graft alone. The animals were separated into four groups, as follows: group 1, sham control; group 2 (control), segmental nerve resection and no repair; group 3, segmental nerve resection and nerve grafting; group 4, segmental nerve resection and reconstruction with a nerve graft within a vein conduit graft. For all groups, sciatic functional indices were calculated before the operation and on postoperative days 7 and 90. On postoperative day 90, the sciatic nerves were reexposed and nerve conduction velocities were recorded. The sciatic nerves were harvested from all groups for counting of the myelinated axons with a stereological method. No statistically significant differences with respect to return of gait function, axon count, or nerve conduction were noted between groups 3 and 4 (p > 0.05). However, functional recovery in group 4 on postoperative day 90 was significant, compared with group 2 (p < 0.05); the recovery difference between groups 2 and 3 was not significant (p > 0.05). This study was not able to demonstrate any functional benefits with the use of a nerve graft within a vein graft, compared with standard nerve grafting.

The quantitative evaluation of palatal elongation after Furlow palatoplasty.

PURPOSE: Furlow "double-opposing Z-palatoplasty" (FP) operation lengthens the soft palate by using only soft palate tissues. It is used in cleft palate repair and velopharyngeal incompetence. The aim of this study was to define the importance of the length and ratio of the soft palate elongation after FP. PATIENTS AND METHODS: This study included 17 patients who were operated on by the same surgeon using FP. The mean follow-up period time was 4.5 years. Preoperative, intraoperative, and late postoperative velar lengths were measured and elongation ratios were calculated. RESULTS: Mean intraoperative elongation and ratio were 16.11 mm and 69.05%, and mean late postoperative elongation and ratio were 12.47 mm and 55.47%, respectively. CONCLUSION: Significant and permanent elongation in velar length was obtained using the FP.

Natural-looking umbilicus as an important part of abdominoplasty.

The umbilicus is an important and essential aesthetic component of the abdomen. Many surgeons use different methods to relocate umbilicus during abdominoplasties. We prefer to use a simple combination of different well-known principles to form the neo-umbilicus. The main steps of the procedure are to make an elliptical vertical incision, to do vertical abdominal fascial plication, to embed the umbilical stalk in this plication by suturing the umbilical skin and the rectus fascia together to maintain the umbilical dimple, to place it at the vertical incision made in the abdominal skin at a predetermined point. Silk sutures are used for the abdominal fascial plication and neo-umbilical fixation. Liposuction from the neo-umbilicus to xiphoid along the midline of the upper abdomen creates a minimal superior sulcus. In each patient, a three-dimensional umbilicus with sufficient depression was obtained. All patients, including one case with complications, were pleased by the final aesthetic results.

Fournier's gangrene as a complication of varicella in a 15-month-old boy.

An inguinal and perianal localization of Fournier's gangrene (FG) in a 15-month-old boy as a complication of the varicella infection is discussed. This is the first presentation of the disease as a complication of the varicella rashes. There were already 57 pediatric FG cases resulting from other causes that had been presented in the medical literature.

Unilateral osteotomies for externally deviated noses.

Despite the many methods described for correction of the deviated nose, it still continues to be one of the most challenging problems in rhinoplasty. It is obvious from the literature that the deformities present in the deviated nose can be quite different from patient to patient and that there is no one method that should be used for every deviated nose. Although unilateral osteotomy technique is not a new concept, so far it has not received the interest of plastic surgeons. Shorter operation time, lessened surgical trauma to the nose, lessened intraoperative bleeding, lessened postoperative edema, and lessened recurrence of the deviation are distinct features of the unilateral osteotomy technique that should be considered when planning surgery on such a complex deformity. We present our experiences with unilateral osteotomy and recommend it for patients who have a deviation related to only one side of the nose.