A new local flap technique for closing long-axis skin defects: the cyclist flap procedure.

BACKGROUND: Local flaps are commonly used during the treatment of skin tissue defects. Although there are many available procedures for the closure of triangular, circular and rhomboid-shaped defects, long-axis elliptical skin defects lack treatment options. To address this problem, a new local flap design called the cyclist flap procedure (CFP) was developed, so called because it resembles the silhouette of a person riding a bicycle. METHODS: The CFP was performed in 29 patients aged 9-81 years in 2021-2022. The defects were localised in the sacral region (1), upper extremities (3), lower extremities (3), and head and neck regions (22). Closures of skin defects due to pressure ulcers (one patient) and after tumour excision (28 patients) were performed, and the patients were followed up for 12-20 months. RESULTS: Only minor complications were observed in two patients. During follow-ups, no secondary surgery was required due to dog-ear, trapdoor, recurrence or revision. Furthermore, the aesthetic results related to the skin lines and scar size were acceptable. CONCLUSION: The CFP is a new, easy-to-apply and advantageous procedure for the closure of long-axis elliptical and oval skin tissue defects.

Effectiveness of Fasciocutaneous Superomedial Thigh Flap in Reconstruction of Fournier Gangrene Defects.

Background: Fournier gangrene (FG) is a necrotizing fasciitis involving perianal and abdominal regions. It progresses quickly and requires urgent intervention. With the use of vacuum-assisted closure (VAC) treatment applied during clinical follow-up and the use of superomedial thigh flap in the region, the treatment is completed with an effective, functional, and rapid approach. This study examines the clinical details of this method for reconstruction. Methods: The study included 15 patients who underwent superomedial thigh flap in VAC treatment reconstruction for tissue defect after FG debridement from 2016 to 2020. The patients were examined in the form of clinical evaluation with hospital admission and surgical evaluation in the postop process. Results: In patients with wound maturation and sufficient granulation, superomedial thigh flap application followed by VAC treatment soon after shortened the operation time, shortened the postop drain time, and provided effective treatment of dead space. An aesthetic and functional result was obtained with the proximity of the flap to the area. In addition, due to the sensory branches present in the flap, a sensory result was obtained according to the ratio of flap size. Conclusions: Superomedial thigh flap provides a practical, effective, and fast solution to the tissue defect that occurs after FG debridement. Effective results can be obtained when combined with VAC therapy.

Effects of taurine and apocynin on the zone of stasis.

BACKGROUND: Among the zones of coagulation, hyperemia and stasis that occur in the burned area, the most intense metabolic process and the highest sensitivity to recovery with treatment is the zone of stasis.This metabolic process is related to how well the tissues in the zone of stasis can cope with oxidative stress. If the tissues in the zone of stasis are saved, the burn area will potentially heal faster and with less scar. In this study, we examined the effects of taurine amino acids and apocynin molecules on saving the tissues in the burn zone of stasis. METHODS: The study was conducted with 48 rats. The burn zone of stasis was created according to the pattern previously described in the literature as comb burn model. In the 21-day study, biopsies were taken for histological examination on the 3rd, 7th and 21st days of the study. In addition, macroscopic photographic analysis was performed. Biopsies were taken for biochemical analysis on the 21st day. Histologically, inflammation, reepithelialization, and collagenization were evaluated, and the CD34 immunoreactivity was analysed. Biochemically, CAT, SOD, tGSH, TAS, TOS, MDA and PPC values were determined. RESULTS: In the histological examination, on the 3rd, 7th and 21st days, inflammation was found to be reduced in the groups given taurine and apocynin on the 3rd day. On the 7th day, better reepithelialization and collagenization were observed in the group given taurine. Significant reepithelialization, collagenization and hair follicle development were observed in the groups given taurine and apocynin on the 21st day. In the biochemical analysis, the effects of apocynin on antioxidant enzymes were determined to be prominent. While we found no significant difference on the 3rd and 7th days in the photographic analysis, taurine and apocynin were observed to act synergistically on the 21st day and significantly reduced the burned areas. CONCLUSION: On the 3rd day, taurine and apocynin prevented inflammation, the effects of taurine in the zone of stasis in the early period (7th day) are more pronounced, the effect of apocynin on antioxidant enzymes is more pronounced. In the late period (21st day), taurine and apocynin were found to be more effective in saving the zone of stasis by creating a synergistic effect.

Wrapping degloved fingers with a distal-based radial forearm perforator flap: A repair method for multiple digital degloving injury.

Degloving hand injuries present challenging situations to hand surgeons as they present with difficulties in reconstructive microsurgery, particularly in multiple digital injuries. Time is a limiting factor when multiple degloving finger amputations are present. Thus, we proposed a repair method for multiple degloving finger injuries that involves coverage with a distal-based reverse forearm flap of all injured fingers in a two-stage procedure. Early vigorous physical therapy after pedicle division of the flap at postoperative third week eliminates joint stiffness problems at wrist and metacarpophalangeal joints.