Reconstruction of Head and Neck Region with Supraclavicular Artery Flap.

Abstract: Although frequently used head and neck reconstruction methods are perforator flaps and free flaps, supraclavicular artery (SCA) flaps are newly used in skin defect reconstructions. In this study, we shared the experience of the SCA flap to evaluate whether there is a strong option in the head and neck. This prospective clinical cohort study of 28 patients, including 11 men, 12 women, and 5 children was performed between 2016 and 2020 years in the patients who were planned with SCA flap for burns, tracheostomy, or after malignant skin tumor of head and neck region. Seventeen of our patients were burnt, 8 malignant skin tumors, and 3 were used to repair the wound that did not heal after tracheostomy. In one patient, the tissues could not be closed primarily because the skin lost its elasticity due to a burn in the surrounding tissues. No flap necrosis dehisens or any other complications were seen and our patients were discharged with complete recovery. While only two patients stated moderate satisfaction orally, the other patients liked the result very much. On the other side, all the patients declared no loss of functionality following this SCA flap surgery. The SCA proved itself as a strong reconstructive flap for the head and neck, and has consistently demonstrated a reliable flap to provide a perfect color match. Level of Evidence: II, Randomized clinical cohort study.

A strong reconstruction option for tissue loss on hand and wrist due to firearm injury in the Syrian war: Reverse posterior interosseous flap.

ABSTRACT: All of the injuries were the open injuries with bone or tendon structures in the hand and wrist region as a result of the firearm injury (FI) in the Syria. In the study, we assessed the outcomes of the posterior interosseous flap (PIF) on hand and wrist that we used for the Syrian injured people including civilians and soldiers in this War. PIF was applied to 77 patients who composed of 43 female and 34 male that all patients were evaluated for tissue loss resulting from gunshot wounds and injured in the War between 2014 and 2020 years with tissue loss in hand and wrist as a result of FI. The flap survival rate was 100% for all the patients. The dimensions of flaps ranged from 4.1 cm × 2.2 cm to 9cm × 5.4 cm with 0.51 ±â€Š0.12 cm thickness. The mean pedicle length was 6.33 ±â€Š1.08 cm. The surgery for PIF took 68.8 ±â€Š22.1 minutes, while blood loss was 60 ±â€Š24 mL. We observed no palsy conditions including the posterior interosseous nerve. The donor sites were treated by primary intention in the patients. We found the superiority of PIF with the postoperative follow-up comfort, ease of fracture healing, easy and fast, easy-to-apply method and no second additional session requirement in FI patients. We did not detect flap necrosis in any patient or observe a flap-related complication. As a result of the present study, it strongly supports the thesis that PIF is the best option in these cases.

Alternative Methods to Local Flap Applications in Large Tissue Losses Caused by Gunshot Injuries in the Syrian War.

PURPOSE/OBJECT/BACKGROUND: In gunshot injury (GSI), the distance, ballistic properties, and the site of injury of lead or scattering gain importance. The authors investigated alternative methods to local flap applications in large tissue losses on facial regions caused by GSI in the Syrian War at the light of our approaches and outcomes. MATERIALS AND METHODS: The study was designed as a cross-sectional retrospective clinical cohort analyze. The authors analyzed data describing the distribution and comparisons of 187 Syrian patients who injured in the war due to GSI and transferred to our medical center from Jan 2011 and June 2018. The study included data of the patients with demographics, mechanisms of a war injury, clinical data, treatment, and outcomes. RESULTS: 131(70%) of all the patients were soldiers, while the rest 56 was civilians. 58% (n = 108) of the GSI was female while remaining was males (42%; n = 79). The rate for children was 32% in all the patients as the most common soft tissues of the face were around the maxilla-zygoma (38.4%), orbita-nose region (29.3%), mandibula-teeth (18.5%). The authors performed a fascio cutaneous transposition flap that was planned from the cervical region (58%), interpolation flap that was planned from the frontotemporal region (28%), and forehead rotation flap (14%). The authors did not lose any patients due to plastic reconstruction. CONCLUSION: The fasciocutaneous transposition flap, interpolation flap, and forehead rotation flap that The authors apply to these patients are extremely rare flaps today. These flap applications have achieved tremendous outcomes, even without any sign of necrosis in war surgery.

Shrapnel Injuries on Regions of Head and Neck in Syrian War.

BACKGROUND: Perforating and cutting injuries to the head and neck due to shrapnels are largely life-threatening and require immediate medical attention. In the present article, the surgical conditions in the war-related head and neck injuries were presented in terms of war surgery with mortality rates. MATERIALS AND METHODS: The study was designed as a retrospective clinical case-control study including primarily 179 head and neck injuries that occurred due to shrapnels in the Syrian Civil War. The records of 2015-2019 years were analyzed according to demographics, injury types, injury location, plastic surgery approaches and postoperative outcomes. RESULTS: Injury mechanism of all wounds was penetrating type, which was commonly secondary to an explosive device, collapse due to shrapnels of the explosion, gunshot or grenade. While 43(24%) of the wounded were soldiers, 136 (76%) were civilians. Considering the reason for the shrapnel injury, 83% was due to the explosion and 17% was due to gunshot injuries. The 32% showed facial fractures. As the most common fractures of the face were around the maxilla-zygoma (28.4%), orbita (22%), and teeths (18.5%). Considering neck injury zones, region-2 was mostly affected by the region. The third zone had the lowest rate of injury with 10%. In 89 (49%) patients, the authors preferred primary, while 15 gained secondary reconstruction (8%). The authors used Limberg flap for 24 (32%) patients, rotation flap for 39 (52%) patients, and bilobe flap for 12 (16%) patients. CONCLUSION: The most important cause of mortality was not the destruction, tissue loss caused by shrapnel injury, or experience of the surgeon, but the severe states of sepsis or multiple different trauma when brought for treatment from long range from the war zone.

Surgical restoration of drop-hand syndrome with tendon transfer in patients injured in the Syrian civil war.

BACKGROUND: The radial nerve is one of the most common war-related injury sites due to penetrating cutting tool injuries or gunshot wounds, resulting in drop-hand syndrome. The aim of this study was to evaluate the outcomes of tendon transfer in patients with drop-hand syndrome who had been injured in the Syrian Civil War. METHODS: This level-II, prospective, comparative study included 13 civilians injured in the Syrian Civil War 2015 and 2017. The palmaris longus tendon was used for transfer to the extensor pollicis longus for thumb extension. The pronator teres was transferred to the extensor carpi radialis brevis for wrist extension. The flexor carpi radialis was transferred to the extensor digiti communis for 2nd, 3rd, 4th, and 5th finger extension. All outcomes of thumb abduction and extension, wrist extension, wrist flexion, and finger extension were assessed. RESULTS: There was a high level of radial nerve injury in all patients included in the study. The time from injury to treatment ranged from 1.5 months to 9 months. The mechanism of injury most commonly observed was a gunshot wound, which was observed in 8 patients (61.5%), followed by a penetrating cutting tool injury (n = 3; 23.1%) and humerus fracture (n = 2; 15.4%). CONCLUSIONS: In radial nerve injuries, successful results can be achieved with tendon transfer. All patients regained thumb abduction of up to approximately 60°. All the patients were able to bend the wrist, grip, and extend the fingers while in wrist flexion, neutral wrist and wrist extension positions. Although the reason for the radial injury varied, the postoperative outcomes were good for all patients, and the rehabilitation period progressed successfully in patients who underwent tendon transfer repair within 90 days of injury.

Surgical Evaluation of Flame Burn Injuries in Syrian Civilians.

The aim of the current study was to evaluate the severity and location of flame burns and the mortality rate of civilians affected by these in the Syrian Civil War and to present the surgical treatment outcomes of the injured civilians to be able to provide recommendations. This was a prospective hospital-based observational cohort study involving 573 patients with data collected from 2011 to 2018. All of these patients were Syrian civilians, and their flame burn injuries were related to the Syrian conflict. All burns were divided into four subgroups according to TBSA and compared. The groups of TBSA were compared as 0 to 25% (n = 97), 25 to 50% (n = 257), 50 to 75% (n = 135), and >75% (n = 84) (P = .413). Almost all had a second (n = 331; 57.7%) and third (n = 189; 32.9%) degree deep burns. The median burn size was 47% TBSA in the patients. The burn mechanism was mostly the flame type of burn (n = 467; 81.5%) as a result of fuel oil explosions, followed by bomb-related burns (n = 106; 18.5%) (P < .001). Mortality was seen in 223 (39%) due to the high surface area and reaching hospital too late at 1 to 8 days (P = .187). The findings of this study indicate that war-related flame burns result in an extremely high mortality rate and time is lost, which could protect against life-threatening outcomes.

Incidence and Severity of Maxillofacial Injuries During the Syrian Civil War in Syrian Soldiers and Civilians.

PURPOSE: The aim of this study was to assess the maxillofacial injuries (MFIs) and our surgical approaches in the Syrian Civil War that emerged during the spring of 2011, among Syria's government and Syrians. PATIENTS AND METHODS: The present study is a prospective clinical study of injured patients at Turkey's Border Hospitals during the Syrian Civil Conflict. Patients' data cover to all emergency and plastic surgery hospitals throughout Turkey. We assessed the patients' data according to location of trauma, duration of hospitalization, the severity and etiology of MFIs with the Injury Severity Score. RESULTS: MFIs were found in 112 of the 956 wounded. The injuries occurred in 69 civilians (61.6%) and 43 soldiers (38.3%). The mean age ranged from 8 to 66 (mean: 29,1 ±â€Š12). Eighty-two percent or higher rates of the injuries needed >4 days' hospitalization. We observed the mortality at a rate of 13.3% for the MFIs. Majority of the MFIs were accompanied by >3 concomitant injuries (n = 59; 52.6%). Most of the facial injuries were located at Mandibula (n = 75; 66.9%), Maxilla (n = 69; 61.6%) and orbitofrontal (n = 52; 46.4%) regions. CONCLUSIONS: Severity and incidence of MFIs were extremely high compared with previously published studies of other wars, especially affecting the civilians in the Syrian Civil War. The high rates of LeFort III fractures exhibit its devastating damages on civilians.

Myelomeningocele closure by unilateral lumbar artery perforator flap: Experience with thirty-eight patients.

BACKGROUND: Repair of large soft tissue defects in meningomyelocele is difficult and its morbidity is high. By applying unilateral lumbar artery perforator transposition flap for closing these defects, we aimed to investigate effects on the repair procedure, duration of surgery and recovery period, with the rates of bleeding and morbidity. PATIENTS AND METHODS: Our report was conducted in 38 patients between the years 2013 and 2017. All soft tissue defects were repaired with unilateral lumbar artery perforator flap (LAPF) in meningomyelocele. Fourteen patients were female and 24 patients were male. The youngest patient was a 5.5 month premature female baby and weighing 570 g. The oldest was weighing 3,700 g and at 1.5 months old. RESULTS: Mean flap size was 32 ± 29.4 cm2 (ranged: 4 × 3-8 × 7 cm2 ). The mean rotation angle was 126.7° (ranged: 90°-170°). Flap positions were separated as 9 (23%) thoracodorsal and 29 (77%) lumbosacral. None of the patients had flap necrosis, infection, or hematoma. The operation took 23 ± 5.3 minutes on average and bleeding was minimal as 16 cc. All patients were discharged within around 9 ± 2 days. The follow-up period of the patient ranged from 4 to 21 months. Flap survival was at the rate of 100%. There was no flap or postoperative complications. Final outcome for all patients were assessed as complete healing. All patients recovered fast with minimal blood lose, and satisfied the outcomes. CONCLUSIONS: As a result, unilateral lumbar perforator flap can be performed successfully in every center. This report suggests using LAPF for reconstruction of meningomyelocele by surgeons as a safe and reliable option, allowing surgeons strong results.

A Rare Case of Misdiagnosis: Recurrence of Dermatofibrosarcoma Protuberans That Was Treated Surgicallyas a Keloid.

AIM: In this report, we presented the patient with Dermatofibrosarcoma Protuberans (DFSP), removed by considering as the keloid scar in the general surgery clinic with misdiagnosis. CASE REPORT: The patient was a 19-year-old female student with no scar or previous trauma history in the lesion area. Pathology report of excisional biopsy revealed as a DFSP, reachedsubcutis and dermis. In staging by CT, there had been no distant metastases. There was a lesion with the size of 2x1.5x1.5cm. A large resection was made to include the entire mass and the lower fascia. The defect area was repaired with a Limberg flap. There was no tumor recurrence in the first 6 months following the operation with high-level aesthetics for patient satisfaction. CONCLUSION: DFSP should be remembered in cases of operative or spontaneous keloid scarring lesions. The surgical treatment is possible after extensive resection with flap or graft repair.

[An unusual Wohlfahrtia magnifica myiasis case localized in cutaneous and subcutaneous tissues in a patient with head-neck cancer]. / Bas Boyun Kanserli Hastada Kutaneöz ve Subkutaneöz Yerlesimli Siradisi Wohlfahrtia magnifica Vakasi.

Auricular tumors constitute 6% of all head-neck tumors. Malignant tumors of the auricula are generally squamous or basal cell carcinomas. Myiasis rarely occurs in healthy individuals. In general, it is a parasite that is seen in patients with mental retardation or psychiatric disorders, elderly individuals, those with poor self-care and hygiene, and those with immune system disorders. In humans, it is mainly seen in tropical and subtropical regions; however, in rare instances, it may be seen in other regions of the world. In the literature, there are limited numbers of myiasis cases reported from Turkey. In this study, we aimed to present a myiasis case (Wohlfahrtia magnifica) involving cutaneous and subcutaneous tissues with an underlying head-neck cancer, which, to the best of our knowledge, has not been reported before in the literature.

Orbitomaxillomandibular reconstruction with free osteomyocutaneous fibular flap and lower trapezius myocutaneous flap.

Several types of flaps and techniques have been used in the reconstruction of maxillomandibular defects. Myocutaneous flaps of the fibula, the scapula, the rib, the iliac bone, the radial forearm, the rectus abdominis, the anterolateral thigh, the latissimus dorsi, and the pectoralis major have been used either alone or in combination for this purpose.The aim of the current study was to discuss a 17-year-old patient with a gunshot injury who underwent orbitomaxillomandibular bone reconstruction using free fibular graft shaped as 3 pieces and soft tissue reconstruction using lower trapezius myocutaneous flap in conjunction with the surgical approach used.