A Novel Method for Patients With Ear Keloid: Enucleation and Fat Grafting.

BACKGROUND: Keloid is a dermal fibroproliferative disease unique to humans. Due to the ambiguity in its pathophysiology and the frequent recurrence of keloid, there is no clear consensus on the treatment of keloid and there are many treatment methods defined. In order to benefit from the positive effects of fat grafting on pathological scars, we applied fat grafting to patients who underwent keloid enucleation. METHODS: Fifteen ear keloid patients included in the study. All patients underwent the same surgical procedure by the same surgeon. Routine follow-ups and examinations were performed to evaluate the results and in addition, the Patient and Observer Scar Assessment Scale (POSAS) survey was used. RESULTS: In the study, 15 patients were followed for a median (IQR) period of 21 (13-28) months. No recurrence was observed in any patient during follow-up, which occurred for a median of 21 (13-28) months. In the questionnaire filled out by the patients, the preoperative median value was found to be 48 (IQR: 12), whereas the postoperative median value was found to be 14 (IQR: 8). According to the patients, there was a statistically significant ( P < 0.05) positive improvement after surgery. CONCLUSIONS: Historically, surgical procedures were avoided because the surgical recurrence rate was very high, but today, recurrence rates are decreasing with combined treatments. These treatment combinations may require more than one intervention and require frequent clinical follow-ups. With our technique of fat grafting after enucleation, the treatment was completed with a single operation and no additional intervention was required.

An Alternative Method to Prevent Frey Syndrome After Resection of Huge Masses in Parotis: De-epithelialized Skin Flap Use.

Frey syndrome is still a significant problem in postparotidectomy patients 6 to 18 months after surgery. The most accepted theory of the pathogenesis of Frey syndrome is the aberrant regeneration theory. Creating a barrier between the remnant parotid gland and the overlying skin prevents Frey syndrome. A 51-year-old female patient who developed pleomorphic adenoma in the parotid gland was operated. After superficial parotidectomy, a barrier between the underlying postganglionic parasympathetic nerves in the deep parotid gland and the overlying cutaneous tissue was created with a local skin flap to prevent Frey syndrome. The patient was successfully treated, and she was followed up to 5 years. No postoperative complications were observed. No signs of Frey syndrome were found in follow-up. This case highlights that local skin flaps can be an innovative natural method as it is a quick and simple method to create this barrier in the presence of expanded skin.

Relationship between surgical rhinoplasty and Demodex infestation: a case-control study.

Background/aim: Human Demodex mites are parasites that live in the pilosebaceous unit and can cause demodicosis. While demodicosis may occur as a primary skin disease, it may also result from immunosuppression and topical or systemic immunosuppressive therapies. Surgical rhinoplasty is one of the most commonly performed cosmetic procedures, and it is the cause of a variety of cutaneous complications, particularly acne, as it affects the skin's adnexal structures. Thus, this study aimed to investigate whether the cutaneous changes in surgical rhinoplasty patients render them vulnerable to Demodex infestation. Materials and methods: Individuals who had undergone rhinoplasty (patients) and age- and sex-matched healthy volunteers (controls) were included in this prospective case-control study. To determine the Demodex density, samples were collected from the malar and nasal regions of both the patients and controls using the standard superficial skin biopsy method. Results: A total of 50 rhinoplasty patients and 50 healthy controls were enrolled in the study. The Demodex density on the nose was significantly higher in the rhinoplasty patients (p = 0.0001). Furthermore, the frequency of xerosis and pustules was significantly higher in the rhinoplasty patients compared to the control group (p = 0.046 and p = 0.001, respectively). Conclusion: Surgical rhinoplasty may be a risk factor for demodicosis, and patients will recover faster after surgery with proper diagnosis and treatment.

An idea for bringing the recipient pedicle of cross leg free flap closer: Fasciocutaneous flap above pedicle.

BACKGROUND: Cross leg free flaps are one of the salvage methods used for free tissue transfer in large tissue defects in the absence of recipient vessels. The fasciocutaneous flap above the posterior tibial artery can be harvested to protect the pedicle and to advance a distance to wound, which is equal to the length of fasciocutaneous flap. METHODS: Patients who were operated with cross leg free flap with the supporting fasciocutaneous flap on unwounded side were included in the study between years 2010 and 2020. Age, sex, location and size of the defects, arterial patencies, flap choices, fascio-cutaneous flap size, duration of operation, cross flap separation timing, complications, and time to return to work were evaluated. RESULTS: There were six patients with the etiology of high-energy electrical burns and trauma. There was only one arterial refilling for three patients and no refilling for others. Latissimus dorsi skin muscle flap was used in all but one patient. The mean defect size was 6.6×14.8 cm. The mean size of fasciocutaneous flaps was 4.08×5 cm. The mean operation time was 360 min. There was no complication except one dehiscence and one marginal necrosis and infection which were healed with wound care. Average time to return to work was 9 months. CONCLUSION: In similar cases, as wounded lower extremities with one or no artery refill, harvesting a fasciocutaneous flap with recipient vessels will be useful before considering the option of using a bridge free flap in medium to moderate sized defects.

Effects of different scar types on flap viability in a skin flap model: an experimental study.

BACKGROUND: The purpose of this study was to investigate the use of tissues with multiple traumas, scarred pedicles, and medial scarring as a flap. METHODS: Forty-eight rats were randomly divided into four equal groups. The modified McFarlane flap was chosen as the flap model. In Group 1 (control), a dorsal skin flap was elevated and then sutured back into original position. In the other groups, a two-phase procedure was used. In Group 2 (pedicle incision), scar tissue was created with a skin incision at the prospective pedicle site of the flap and then sutured to its original site. In Group 3 (preconditioning), multiple full-thickness traumas were performed along the entire flap body, and in Group 4 (middle incision) scar tissue was created with a skin incision at the prospective middle region of the flap. Then, after 45 days, dorsal flaps were raised in all rats and then sutured back into position. Seven days later, flap survival was evaluated through microangiography and histological evaluation of flap segments. Histopathological examination included assessment of the number of vessels, necrosis, infiltration with polymorphonuclear leukocytes, edema, fibrosis, inflammation, increase in fibroblast activity, and neovascularization. RESULTS: The flap survival rates were 66.78% in Group 1, 68.05% in Group 2, 68.5% in Group 3, and 60.01% in Group 4. The flap survival rate was significantly lower in Group 4 (p < 0.05). There was no significant difference in flap survival between Groups 1, 2, and 3. On microangiographic examination, the vascular network extended more distally and was densest around the scar line in Group 2. Vascularization was poorest in Group 4. On histological examination, the number of vessels tended to be greatest in Groups 3 and 4 but this was not significantly different between groups (p < 0.05). DISCUSSION: The study findings showed that it may be possible to raise a flap from a previously mutilated site secondary to scar formation and multiple full-thickness traumas along the flap body. However, distal necrosis may occur in situations when the scar is positioned in the middle region of the prospective flap.

Is it safe to harvest a proximally fractured fibula as an osseocutaneous anterograde pedicled flap for proximal tibial reconstruction in subacute period? A case report and literature review.

Osteoseptocutaneous fibula flap is commonly used as the workhorse flap for bone reconstruction. However, the use of previously fractured fibula as a free or pedicled flap for bone reconstruction has a limited knowledge in the literature. There is not any data in the literature about a case with proximal level of fibula fracture which was used as an anterograde pedicled osteocutaneous fibula flap for composite tibial reconstruction after high-energy injury. Based on a patient in whom the composite defect of the proximal tibial region was reconstructed with osteocutaneous fibula flap after a gunshot injury, it was tried to show that the fibula with a proximal level fracture could be used with anterograde flow in the subacute period and it is thought that the usability of this flap should be kept in mind. It is possible to harvest the pedicled fibula flap even in the subacute period with the evaluation of CT angiography preoperatively and with the checking the patency and flow direction of peroneal artery perioperatively. The success of the procedure may be increased through total dissection of inflammatory areas of pedicle which would extend into the injury zone during the subacute period.

Synchronous Pseudomonas Infection in Nose and Maxillery Sinus After Septorhinoplasty.

ABSTRACT: A 50-year-old patient who underwent secondary rhinoplasty 1 year after the operation presented with signs of localized infection on the postoperative twentieth day. An abscess due to Pseudomonas aeruginosa was detected in the nose and maxillary sinus. The infection regressed after surgical debridement combined with intravenous antibiotic therapy.Pseudomonas infection has been reported in only six patients after septorhinoplasty. Rhinoplasty was combined with other aesthetic procedures in three patients. The mean time of onset of complaints was 33.25 days. The most common complaint was pain. The mean time to complete regression of complaints after treatment was 44.5 days.Pseudomonas infection risk is especially increased in patients with combined surgical procedures and complicated revision rhinoplasty surgery. Careful examination of the patient, early and aggressive therapy, and surgical debridement are essential. The treatment of infection is incision and drainage of the affected areas. Antibiotic therapy followed by sensitivity-specific regimens should be administered."

Reconstruction of Large Meningomyelocele Defects with Bipedicled Fasciocutaneous Flaps: Technical and Clinical Points.

AIM: The aim of this study was to evaluate the bilateral vertical bipedicled procedure for the closure of large meningomyelocele defects and to emphasise some technical and clinical considerations. MATERIAL AND METHODS: This procedure was used to close large meningomyelocele defects in ten patients (six males and four females) between January 2016 and August 2020. Eight of the patients were operated on within the first 24 hours of birth, and the remaining two were operated on between 1-7 days from birth. The average defect size was 6 x 9 cm (5 x 7 and 8 x 13 cm). The location of the lesions was thoracolumbar in two patients and lumbosacral in eight patients. Patient demographics, including sex, gestational age, birth weight, age at operation, defect size, duration of the operation, intraoperative-postoperative blood transfusion, length of hospital stay and complications, were evaluated. RESULTS: In all patients, closure was successful. Two patients required reoperation because of wound dehis-cence, and healing was uneventful, without any complications. No patient experienced late breakdown of the wound during a mean follow-up period of 14.9 months (12-18 months). CONCLUSION: Bipedicled fasciocutaneous flaps can be used as an alternative method to repair large meningomyelo-cele defects due to their simple and reliable nature, which also causes less haemorrhage, and can be used in selected patients.

A Novel Method for Correction of the Tethered and Contracted Facial Scars: The Three-Dimensional Subcutaneous Z-Plasty.

OBJECTIVE: Scar revision is 1 of the basic surgery in the field of plastic and reconstructive surgery. The classic treatment of the scar is excision scarless tissue, wide undermining and suture by planes. This method has had unsatisfying results on contracted and tethered scars. The aim of this study is to present the three-dimensional subcutaneous z-plasty technique for correction of tethered facial scars without scar lengthening. MATERIALS AND METHODS: Twenty tethered scars were corrected using this technique. All scars were located on the face. Objectively, the final result was evaluated by using the Stony Brook Scar Evaluation Scale. Subjectively, patients' overall satisfaction was assessed 1 year after the surgical operation. In addition, the information on the age, gender, etiology, scar location, scar length, type of anesthesia, and follow-up period were examined. RESULTS: This procedure was used in nineteen patients (8 males and eleven females). The mean follow-up period was 15.3 months. There was a mean increase of 2.85 points increase in the Stony Brook Scar Evaluation Scale value. The overall success rates for the procedure, as assessed by the patients, were: very satisfied in 12 patients, satisfied in 5 patients, and slightly satisfied in 2 patients. One patient had minimal wound dehiscence. No complications including hypertrophic scar, infection, hematoma, and suture reaction were observed in any patients. CONCLUSIONS: The three-dimensional subcutaneous z-plasty technique is a procedure that uses only basic plastic surgery principles. It offers a good solution for the correction of tethered and contracted scars without recurrence. This technique combines the advantages of elliptical excision and z-plasty by enabling the augmentation of the depressed area without extending the scar length.

Giant exophytic tumor of the leg: A case report of amyloidoma with literature review.

Amyloidosis is a heterogeneous group of diseases with the most common form being systemic distribution. The least common type of the disease is tumor formation due to deposition which is called "amyloid tumor (amyloidoma)". Although such tumors can occur in any region of the body, extremity localization is fairly seldom. Here, we report the clinical and histopathological features of amyloidoma in an 81-year-old female patient who presented with a large rapidly growing mass in the left lower extremity.

A Simple Solution for Infractured Lateral Nasal Osteotomy Lines During Revision or Primary Rhinoplasty: Osseos Stabilization With Polydioxanone Sutures.

ABSTRACT: In addition to precautions taken with perioperative surgical techniques, nasal packing and external nasal splinting are frequently employed to ensure the stability of the nasal bones following osteotomies performed during rhinoplasty. However, despite these precautions, nasal bone fragments, generally caused by trauma or healing problems, can approach the midline, progress in a posterior direction and heal with malunion in an infractured manner. Since cavities on the infractured side can result in asymmetries and/or airway narrowing, revision osteotomy is required to correct these problems. Subsequent potential recurrent infractures caused by nasal fragments can easily be prevented with late-absorbed sutures passing through the neighboring holes and opening near the osteotomy lines. This technique would be useful for both primary and secondary rhinoplasty, but especially in secondary rhinoplasty operations. (Level of Evidence: Level IV).