Posterior Arm Perforator Flap for Axillary Reconstruction After Hidradenitis Suppurativa Excision.

INTRODUCTION: Hidradenitis suppurativa (HS) is a chronic inflammatory disease arising from the hair follicles in apocrine gland-rich areas. It is also one of the most common indications for axillary surgery. Reconstruction of the axillary region after such surgery must be performed meticulously due to its critical location and crucial content. In this report, we present our experience of reconstruction of axillary defects with posterior arm perforator flaps (PAPF) following radical excisions. METHODS: A total of 14 patients (9 male, 5 female) aged between 16 and 49 years who had presented with HS in the axillary region and, after surgery, underwent reconstruction with either island or skin bridge posterior arm flap between January 2015 and October 2016 were included in the study and evaluated retrospectively. All of the defects were reconstructed with PAPF following wide excision. RESULTS: Five of the flaps (over 4 patients) were designed as flaps with skin bridges, while the remaining 12 flaps in 11 patients were raised as island flaps. The flaps had areas ranging from 20 to 84 cm2 (mean 39.5 cm2), depending on the size of the defect after excision. The mean follow-up time after the operation was 6 months. Wound dehiscence was detected in one patient, and another patient developed marginal necrosis during the postoperative period; no other complications were observed. CONCLUSION: Posterior arm perforator flaps can provide sufficient amounts of soft tissue to cover axillary defects and should be considered as the flap of choice in axillary reconstruction.

INTRODUCTION: La maladie de Verneuil (MV), ou hidrosadénite suppurée, est une maladie inflammatoire chronique qui touche les follicules pileux situés près des glandes apocrines. C'est également l'une des indications les plus courantes de chirurgie axillaire. Il faut procéder à une reconstruction méticuleuse de la région axillaire après l'opération en raison de son emplacement difficile et de son contenu crucial. Dans le présent rapport, les auteurs présentent leur expérience de reconstruction des anomalies axillaires à l'aide de lambeaux perforants du bras postérieur (LPBP) après des excisions radicales. MÉTHODOLOGIE: Au total, 14 patients (neuf hommes, cinq femmes) de 16 à 49 ans atteints d'une MV dans la région axillaire qui ont subi une reconstruction par lambeau en îlots ou par pont cutané prélevé sur le bras postérieur entre janvier 2015 et octobre 2016 ont participé à l'étude et fait l'objet d'une évaluation rétrospective. Les chirurgiens ont reconstruit toutes les anomalies à l'aide de LPBP après une large excision. RÉSULTATS: Cinq des lambeaux (sur quatre patients) étaient sous forme de ponts cutanés, et les 12 autres (sur 11 patients) ont été prélevés en îlots. Les lambeaux étaient d'une taille de 20 à 84 cm2 (moyenne de 39,5 cm2), en fonction de la dimension de l'anomalie après l'excision. Le suivi moyen était d'une durée de six mois après l'opération. Un patient a présenté une déhiscence de la plaie et un autre, une nécrose marginale pendant la période postopératoire. Aucune autre complication n'a été observée. CONCLUSION: Le LPBP peut fournir une quantité suffisante de tissus mous pour couvrir les anomalies axillaires. Il faut le considérer comme le lambeau de première intention lors d'une reconstruction axillaire.

Results of Surgical Treatment of Patients with Malignant Eccrine Poroma.

OBJECTIVES: Malignant eccrine poroma is a rare cutaneous malignancy. This study was a review of a series of patients with malignant eccrine poroma who underwent surgical treatment conducted in order to evaluate the management techniques and outcomes of treatment modalities. METHODS: All cases of surgically excised malignant eccrine poroma performed in a single clinic between 2012 and 2018 were included in the study. The details of patient age, gender, anatomical location of the tumor, histopathological features, and treatment modalities were analyzed. RESULTS: The average tumor size was 2.53 cm (range: 0.3-7 cm). The average tumor thickness was 3.06 mm (range: 2.5-4 mm). The mean clean tumor margin after the first excision was 1.28 mm and the mean tumor margin after the second excision was 8.83 mm. No recurrence or distant metastasis was detected in any of the patients during the follow-up period. CONCLUSION: Unlike frequent skin cancers, rare skin cancers, like malignant eccrine poroma, don't have definite treatment algorithms constituted from randomized trials. The findings of patient series are very useful to guide physicians in these cases.

Patient Reported Quality of Life and Aesthetic Satisfaction with Latissimus Dorsi Flap in Immediate Partial and Delayed Total Breast Reconstruction.

OBJECTIVES: Latissimus dorsi (LD) muscle flap can be used as an alternative to abdominal flaps for autologous breast reconstruction. The aim of the present study was to present the results of the quality of life and aesthetic satisfaction of breast reconstruction surgeries with LD flap and implants. METHODS: Sixteen patients who had undergone LD flap breast reconstruction were included in the study. Patients were surveyed on the quality of life and aesthetic satisfaction 12 months following breast reconstruction. RESULTS: There were no major complications observed following surgeries. All of the patients included in the study were highly satisfied with the final aesthetic results. There was no difference in satisfaction rate between partial versus total reconstructions and between reconstruction with or without implant. CONCLUSION: LD flaps can be a good alternative to abdominal flaps for autologous breast reconstruction for both partial and total breast reconstruction and can achieve similar aesthetic results.

Preoperative subcutaneous sildenafil injection increases random flap survival in rats.

PURPOSE: To investigate the effect of subcutaneous sildenafil on random flap survival. METHODS: Fourteen Wistar rats, which were divided in to two groups, were used for this experimental study. Rats in the sildenafil group received subcutaneous sildenafil injections daily for seven days before flap elevation. At the end of the treatment period, 9x3 cm dorsal skin flaps were elevated and reinserted back into their place in all of the animals. Necrotic and whole flaps areas were recorded on graph papers. Seven days after the flap elevation samples for histological examination were taken and angiographies were performed to visualize the flap vascularization. RESULTS: The calculated average percentage of necrotic flap areas were 18.29% and 42.26% in the sildenafil and control group respectively.(p=0.0233). In selected angiography images, vessels were found to be more prominent in the sildenafil group. The average number of capillary formations under light microscopy was higher in the sildenafil group (p= 0.0286). CONCLUSION: The subdermal high dose sildenafil has a positive effect on flap survival.

Preoperative subcutaneous sildenafil injection increases random flap survival in rats

Abstract Purpose: To investigate the effect of subcutaneous sildenafil on random flap survival. Methods: Fourteen Wistar rats, which were divided in to two groups, were used for this experimental study. Rats in the sildenafil group received subcutaneous sildenafil injections daily for seven days before flap elevation. At the end of the treatment period, 9x3 cm dorsal skin flaps were elevated and reinserted back into their place in all of the animals. Necrotic and whole flaps areas were recorded on graph papers. Seven days after the flap elevation samples for histological examination were taken and angiographies were performed to visualize the flap vascularization. Results: The calculated average percentage of necrotic flap areas were 18.29% and 42.26% in the sildenafil and control group respectively.(p=0.0233). In selected angiography images, vessels were found to be more prominent in the sildenafil group. The average number of capillary formations under light microscopy was higher in the sildenafil group (p= 0.0286). Conclusion: The subdermal high dose sildenafil has a positive effect on flap survival.

Oncoplastic Breast Conserving Surgery: Aesthetic Satisfaction and Oncological Outcomes.

OBJECTIVE: Oncoplastic breast conserving surgery (BCS) involves radical excision of tumors while maintaining the natural breast contours. In this study, we present the results of the oncoplastic BCS surgeries performed in our clinic. MATERIAL AND METHODS: 13 breast cancer patients who had undergone oncoplastic BCS were included in this retrospective study. Postoperative photographs and retrospective chart reviews were used to evaluate the results. Aesthetic satisfaction level was verbally obtained from the patients. RESULTS: Oncoplastic BCS was performed using superomedial, superolateral, superior and inferior pedicles. All the patients were highly satisfied with the final aesthetic results and tumor free at the postoperative 12 months. CONCLUSION: Oncoplastic BCS can achieve favorable results regarding the final aesthetic appearance and tumor control.

Intravascular Papillary Endothelial Hyperplasia of the Foot.

A case of intravascular papillary endothelial hyperplasia is presented. This proliferation usually forms inside thrombotic processes. It is critical to be able distinguish these lesions from low-grade angiosarcomas because they can have similar pathologic findings.

Use of Turn-in Skin Flaps for Nasal Lining Reconstruction.

BACKGROUND: Reconstruction of the nasal lining is the most difficult part of complex nasal reconstruction because the mucosa has a unique texture and fineness. Many techniques, ranging from skin grafts to local flaps, have been applied for the reconstruction of the mucosa. In some cases, even free flaps have been used. OBJECTIVE: The aim of this study was to discuss the feasibility of using turn-in flaps in nasal reconstruction. MATERIALS AND METHODS: Seventeen patients with full-thickness nasal defects underwent reconstruction with turn-in flaps. In all the patients, the bone structure was formed using cartilage grafts, and the skin defects were reconstructed using paramedian forehead flaps. A rhinoplasty procedure was added in 10 of the patients. RESULTS: Necrosis was not observed in any of the flaps, and the results were satisfactory for all the patients. CONCLUSION: This technique provided enough support for the onlay cartilage grafts, and the flap was thin enough to avoid any nasal airway obstruction. In selected patients, this technique can also be used in conjunction with a rhinoplasty procedure.

Trichoblastic carcinoma of the scalp with rippled pattern.

Trichoblastic carcinoma (TC) is a rare type of malignancy which is derived from the hair follicles. In this paper, we report a case with TC on the scalp characterized with rippled pattern. There have been reports of rippled pattern in trichoblastomas, sebaceomas, and basal cell carcinomas. To the best of our knowledge, this is the first case in the literature to report a rippled pattern in TCs.

How were lipofilling cannulae designed and are they as safe as we believe?

BACKGROUND: Most practitioners in plastic surgery believe that blunt tipped cannulae are safer. Interestingly, there is no study about their safety, and the problem is exactly this. As the use of blunt tipped cannulae is somehow difficult, some surgeons try other extreme alternatives, such as sharp and cutting tipped injection needles. But, they can cause complications such as vessel damage. According to these hypotheses, we tried to design a cannula which would ease the application of lipofilling and which would minimise the trauma. Contrary to the injection needle, the tips of the cannula would be blunter, and trauma would be diminished. OBJECTIVES: After designing such a cannula, we compared it with the most frequently used Coleman type cannulae with regard to ease in utilisation, and safety. We also tried to evaluate the potential for trauma, of the regularly used cannulae. MATERIALS AND METHODS: In the first part, the penetration capacity of all cannulae was measured and compared, and in the second part, the tissue damage was evaluated in an experimental model. RESULTS: According to the statistical and histological findings, the pointed-tip cannulae, blunted to a certain degree, can be applied easily through the tissues. The surgeon works more comfortably and we have noted that these cannulae cause less tissue damage.

Functional Sharing of the Upper Orbicularis Oris Muscle for the Reconstruction of the Lower Lip.

The lip reconstruction is a very controversial topic in plastic surgery and many flaps have been described for this purpose. Despite all of the interventions, some patients still have problems such as drooling and gingival show that decrease their quality of life. In this study, the authors report a patient whose lower lip was resected totally for squamous cell carcinoma. His lip was reconstructed with radial forearm flap and the patient was referred to our clinic with the aforementioned complaints. A portion of the orbicularis oris muscle of the upper lip was designed as a bipedicled flap, and it was transposed to the lower lip to make the initial flap functional. After the operation, the sphincteric function of the lip was better, and the problems as drooling and gingival show were absent. In conclusion, this flap can be a good option to make the initial nonfunctional flaps (such as radial forearm flap), functional in the aspect of lower lip reconstruction. It has a function, and it is concordant with the principle of "reconstructing like with like." The native muscle tissue of the upper lip can be transferred partially to maintain physiologic oral competency.

Key and Keyhole Model for Dorsal Onlay Cartilage Grafts in Correcting Nasal Deformities.

BACKGROUND: The shaping of the cartilage and keeping it in place is very significant for patients who need nasal reconstruction with costal grafts at traumatic or secondary rhinoplasties. In this study, a template is prepared during the surgery that shows the dorsal defect in a 3-dimensional manner and acts as a guide while shaping the cartilage. METHODS: Seventeen patients who required secondary rhinoplasties because of trauma or previous operations were included in this study. The patients were operated on between the years 2009 and 2013. The mean age of the patients was 24 years (19-38 years). According to the surgical technique, bone wax was placed in a sheath prepared from the finger of a sterile nylon surgical glove before the dorsal reconstruction. It was placed to the nasal dorsum and shaped over the skin with digital maneuvers. Afterward, the bone wax was stripped off the nylon glove, and it was used as a template to shape the cartilage graft. RESULTS: No need for revision rhinoplasties was seen in any of the patients during the mean follow-up period of 19 months. The patients stated that they were satisfied by both the functional and the aesthetic results. CONCLUSIONS: The bone wax template and the defect fit in a key and keyhole fashion. It is supported by multiple points on the nasal bone and the septum. Thus, it does not slide and its warping is avoided. We think that it gives satisfactory results and it shortens the learning process.

Predicting skin deficits through surface area measurements in ear reconstruction and adult ear surface area norms.

Ear reconstruction is one of the most challenging procedures in plastic surgery practice. Many studies and techniques have been described in the literature for carving a well-pronounced framework. However, just as important as the cartilage framework is the ample amount of delicate skin coverage of the framework. In this report, we introduce an innovative method of measuring the skin surface area of the auricle from a three-dimensional template created from the healthy ear.The study group consisted of 60 adult Turkish individuals who were randomly selected (30 men and 30 women). The participant ages ranged from 18 to 45 years (mean, 31.5 years), and they had no history of trauma or congenital anomalies. The template is created by dividing the ear into aesthetic subunits and using ImageJ software to estimate the necessary amount of total skin surface area required.Reconstruction of the auricle is a complicated process that requires experience and patience to provide the auricular details. We believe this estimate will shorten the learning curve for residents and surgeons interested in ear reconstruction and will help surgeons obtain adequate skin to drape over the well-sculpted cartilage frameworks by providing a reference list of total ear skin surface area measurements for Turkish men and women.

Creating a neoconchal complex using the adjustable conchal sliding technique in prominent ear correction.

An oversized aural concha plays a significant role in prominent ear deformities and should be taken into consideration during preoperative examination. In the current study, we present a procedure known as the conchal sliding technique as an alternative to more disruptive methods. Twenty-four patients (9 females and 15 males; 47 ears in total) underwent a conchal sliding procedure between 2006 and 2010. During the surgery, a wide subperichondrial dissection is performed after a posterior elliptical incision. After the concha is exposed as a hemisphere, it is split along its long axis to reveal the medial and lateral cartilage segments. These segments are gently scrolled upon each other. Transposition of the lateral segment posteriorly to the medial segment replaces the whole ear toward the posterior direction. Three mattress sutures (4-0 polypropylene) reliably secure the repositioned and setback conchal bowl. If needed, an antihelix can be formed using neoconchal-scaphal mattress sutures. Median follow-up period was 24.3 months (range, 6-48 mo). A unilateral hematoma developed in 1 patient and an anterior step deformity occurred in another. No recurrence, infection, necrosis of the skin, distortion of the auditory canal, or formation of keloid was observed in any of the patients. The median cephaloauricular angle was measured as 46 degrees before the surgery and 26 degrees after the surgery, whereas the distance between the helix and the mastoid was 23 mm before the surgery and 11 mm after the surgery. All the patients were satisfied with the results. This technique provides stable and natural results by creating a safe neoconchal complex. It may be a safe and reliable solution to an oversized aural concha, enabling natural-looking and positive cosmetic results.