Late Correction of Traumatic Nasal Deformities: A Surgical Algorithm and Experience in 120 Patients.

BACKGROUND: Traumatic nasal deformities have a wide spectrum of presentations, which further complicates their management and preoperative planning. Although many methods and algorithms have been proposed for management of specific posttraumatic nasal deformities, such as twisted, deviated, saddle, or short nose, these algorithms usually focus on a specific deformity in isolation from the remainder of the nose. OBJECTIVES: The aim of this study is to present an algorithm for traumatic nasal deformities and to evaluate the functional and aesthetic outcomes of this new algorithm by a preoperative and postoperative quality-of-life questionnaire. METHODS: Patients with traumatic nasal deformity were operated on according to our surgical algorithm. Preoperative and postoperative Rhinoplasty Outcome Evaluation (ROE) scores, which is a rhinoplasty outcome survey, were evaluated. RESULTS: A total of 120 patients were included in the study. The mean preoperative ROE score was 3.3 ± 1.9 and mean postoperative ROE score was 20.4 ± 3.2. There was a statistically significant difference between preoperative and postoperative ROE scores (P < 0.001). There was a negative, mild to moderate, statistically significant correlation between preoperative scores and benefit (difference between postoperative and preoperative scores) (r = -0.465, P < 0.001), which means patients with lower scores had more improvement from the surgery. During the follow-up period, relapse of deviation, hypertrophic inferior turbinate, and intranasal synechia were found in 9% (n = 11), 6.6% (n = 8), and 3.3% (n = 4) of patients, respectively. CONCLUSIONS: In this study, a comprehensive surgical algorithm applicable to all traumatic nasal deformities is suggested, and the results of 120 patients with traumatic nasal deformities are presented.

The effect of in vivo created vascularized neurotube on peripheric nerve regeneration.

INTRODUCTION: Creating vascularized nerve conduits for treatment of nerve gaps have been researched, however, these methods need microsurgical anastomosis thereby complicating the nerve repair process. Thus, the concept of vascularized nerve conduits has not popularized up till now. The aim of this study is to evaluate the effects of vascularized and non-vascularized biological conduits on peripheral nerve regeneration. MATERIAL AND METHODS: Following ethical board approval, 15 Sprague-Dawley rats were used in the study. The rats were equally divided into three groups. In group I, a silicon rod was inserted next to the sciatic nerve of the rat and connective tissue generated around this rod was used as a vascularized biological conduit. In group II, a silicon rod was inserted into the dorsum of the rat and connective tissue generated around this rod was used as a non-vascularized biological conduit. In group III, autogenic nerve graft was used to repair the nerve gap. The contralateral sciatic nerve is used as a control in all rats. Macroscopic, electrophysiological and histomorphometric evaluations were performed to determine the nerve regeneration. RESULTS: There was no statistically significant difference between groups, in terms of latency. However, the mean amplitude of group I was found to be higher than other groups. The difference between group I and II was statistically significant. Myelinated axonal counts in group I was significantly higher than groups II and III. CONCLUSION: Our results showed that vascularized biological conduits provided better nerve regeneration when compared to autografts and non-vascularized biological conduits. Creation and application of vascularized conduits by using the technique described here is easy. Although this method is not an alternative to autogenic nerve grafts, our results are promising and encouraging for further studies.

Use of a fibrovascular tube in creation of neo-urethra during penile reconstruction.

INTRODUCTION: There are several techniques employed in the surgical treatment of total or partial penile reconstruction, hypospadias surgery, and urethral stricture. Urethral reconstruction is performed in different ways applying these techniques. OBJECTIVE: We evaluated use of a fibrovascular sheath to create a neo-urethra formed around a silicon tube. MATERIAL AND METHODS: We used nine male New Zealand rabbits for this study. In the first step, we placed a silicone tube under the skin in the lower abdomen of the rabbits and waited for the formation of a fibrovascular sheath to totally surround the tube. In the second step, the silicone tube was removed and the formed fibrovascular sheath was anastomosed with penile urethra over a silicone 8F Foley catheter. Ten days after the second step, the silicone Foley catheter was removed. Twenty days after the second step, we evaluated the newly created neo-urethra with a retrograde urethrogram. Thirty days after the second step, the rabbits were sacrificed and the bladder, urethra, and neo-urethra were removed for histopathological examination. RESULTS: Six of the rabbits completed the study. After the first operation, in the third month, formation of the fibrovascular sheath was observed around the silicon tube. After anastomosis and removal of the silicon Foley catheter, urine was seen to pass through the neo-urethral meatus. Urethrocystography showed that the neo-urethra and penile urethra were aligned and urine flow was regular. Histopathological evaluation showed that the structural integrity of the newly formed urethra was comparable with the structure of the regular urethra (Table) and the calibration did not change over time, although the newly formed urethra was not covered with uroepithelium. CONCLUSIONS: In this study, we achieved promising results with use of a newly formed fibrovascular sheath as a neo-urethra.

Oculoauriculofrontonasal Dysplasia Syndrome With Additional Clinical Features.

Oculo-auriculo-vertebral spectrum and frontonasal dysplasia are two well-known examples of dysmorphology syndromes. Oculoauriculofrontonasal syndrome (OAFNS) is a clinical entity involving the characteristics of both OAVS and FND and is thought to be a result of the abnormal development of structures in the first and the second branchial arches, including the abnormal morphogenesis of maxillary processes. Herein we report a case of OAFNS with cliteral hypertrophy, premaxillary teeth, and inguinal hernia, features not previously reported in the literature.

Hot-press hand injury caused by roller type ironing machine.

Thermal crush burn injury due to roller type ironing press machine is relatively rare and can cause destructive effects with significant morbidity. These injuries can be avoided by taking some basic precautions. Early debridement after admission and definitive treatment after the extent of injury are delineated and these are the preferred approaches in the management. We present a case of thermal crush injury of the hand caused by laundry roller type ironing press machine.

Sequential Use of Hyperbaric Oxygen, Synthetic Skin Substitute and Skin Grafting in the Treatment of a Refractory Vasculitic Ulcer.

Cutaneous leukocytoclastic vasculitis (CLCV) is a disorder characterized by the inflammation of the small vessels of the skin. CLCV may cause recurrent, drug-resistant, non-healing ulcers. Herein, we present a patient with a recalcitrant ulcer caused by CLCV, who was successfully treated with hyperbaric oxygen therapy and skin grafting. There is not any particular therapy/product that will heal all type of wounds. We can achieve better results provided that wound care products and advanced treatments are used at the right time.

Radial bone graft usage for nasal septal reconstruction.

BACKGROUND: Although various techniques have been described for correction of crooked and saddle nose deformities, these problems are challenging with high recurrence and revision rates. Conventional septal surgery may not be adequate for nose reconstruction in crooked and saddle nose deformities. MATERIALS AND METHODS: Between December 2005 and October 2009, six patients with crooked nose and five patients with saddle nose deformities underwent corrective surgery in our clinic. All patients were male, and the mean age was 21 years (range, 19-23 years). We used rigid radial bone graft to prevent redeviation and recurrence following corrective nasal septal surgery. RESULTS: The mean follow-up period was 28 months, ranging from 18 to 46 months. Mean operation time was 4 hours (3-4.5). All patients healed uneventfully. None of the patients required secondary surgery. CONCLUSIONS: We believe that radial bone grafts offer a long lasting support in treatment of challenging cases with crooked and saddle nose deformities.

Distally based venous flap: a new technique for the correction of syndactyly without skin graft in adult patients.

Skin grafts and local flaps are conventional methods for repairing simple syndactyly. Skin grafts usually leave unsightly appearance and contracture formation. In this study, unipedicled distally based venous flap were raised from third or fourth metacarpal area of the hand for syndactyly treatment. The distally based venous flap was to provide skin coverage to one side of the finger, in order to avoid complications arising from using skin graft. Nine patients' syndactylies (5 simple incomplete and 4 simple complete syndactyly) were treated using this method. The mean follow-up period of the flaps was 14 months, ranging from 12 to 16 months. Mild edema and venous congestion occurred in all flaps. Superficial necrosis involving two flaps did not affect flap survival. All flaps survived completely. In this article, we have described a new surgical technique for the correction of syndactyly in a single surgical procedure that utilizes a distally based venous flap to provide skin coverage without skin graft.

Distally based venous flap for proximal phalangeal soft tissue burn defect and web space burn contracture.

Flap choices for the coverage of the proximal phalangeal soft tissue defects of the finger and web space burn contractures are limited. A unipedicled distally based venous flap was raised from the third or fourth metacarpal area of the hand for proximal phalangeal soft tissue defects of the finger and web space burn contracture. For clinical use, we operated seven male patients using this venous flap. Superficial necrosis involving two flaps did not interfere with flap survival. Mild edema and venous congestion occurred in all flaps. All flaps survived completely. The mean follow-up period of the flaps was 6 months, ranging from 3 to 14 months. A well-planned distally based venous flap is an useful option for the coverage of the proximal phalangeal soft tissue burn defects of the finger and web space burn contracture of the hand.

Frontal parosteal lipoma.

Parosteal lipoma of the head and neck is very rare, and there is no reported case of parosteal lipoma in the frontal region. We present the case of frontal parosteal lipoma in a 20-year-old man who was referred for a forehead mass causing a cosmetic problem. Computed tomography revealed an osseous projection with cortical irregularity and soft tissue enlargement. Excision of the lesion revealed a 7 x 4.5-cm lobulated, encapsulated, yellow tan mass. Histopathologic examination revealed mature adipose tissue, and pathologic diagnosis of lipoma was made. Here, we present the first case of parosteal lipoma in the frontal region.