Hair tourniquet syndrome of toe.

INTRODUCTION: Hair tourniquet syndrome (HTS) is a rare surgical emergency caused by a hair or thread wrapping around an appendage. We aimed to present our clinical experience with HTS of toes and attract physicians' attention to this rare entity. METHODS: Between January 2012 and September 2022; 26 patients (25 pediatric and one adult case) were treated for HTS. All pediatric cases were treated surgically under loop magnification. The adult patient was treated nonsurgically. The patient's age, gender, affected appendage and side, duration of symptoms, and postoperative complications were recorded. RESULTS: Thirty-six toes of 25 patients (13 boys, 11 girls, and a male adult) were included in the study. The mean age of pediatric patients was 126.6 days. The third toe was the most affected (n:16), followed by the fourth (n:8). In seven patients more than one was affected. CONCLUSION: HTS should be treated as soon as possible when diagnosed to prevent further complications including appendage loss.

Basal cell skin cancers: Retrospective analysis of 67 cases.

BACKGROUND: Basal cell carcinoma (BCC) is the most common skin cancer and originates from the basal layer of the epidermis. It is most common in the head and neck region. It usually grows slowly and rarely metastasizes. The gold standard treatment is surgical excision. AIMS: In this study, it was aimed to discuss the demographic and medical data of patients treated with the diagnosis of BCC. PATIENTS/METHODS: Sixty-seven tumors of 55 patients who were operated for BCC in our clinic between 2016 and 2020 were retrospectively analyzed. Demographic and medical data were analyzed. RESULTS: The tumor was most commonly localized to the nose. The most common (50%) histological type was the nodular type. Recurrence occurred in one of our patients (1.5%). Surgical margin positivity was observed in six patients. CONCLUSIONS: Basal cell carcinomas are most common in the head and neck region. Its frequency increases with age and is more common in men. In our patients, 98.5% of the tumors were located in the head and neck, and 89.5% were over 60 years of age. Nodular is the most common type of BCC, and the most common nodular type was detected in our study. Surgical margin positivity is observed between 9% and 37.2% after surgery, and the recurrence rate is around 5%. In our study, surgical margin positivity was 9% and recurrence was 1.5%. Evaluating the excision margins carefully in a well-lit environment and taking into account cosmetic concerns, obtaining an adequately intact surgical margin in one go may lead to the ideal treatment result.

Acro-ischemic lesions in COVID-19 patients: A case series.

COVID-19 is a systemic disease characterized by vascular damage, increased inflammation, and hypercoagulability. Acral ischemic lesions occur as a result of increased inflammation and cutaneous thrombosis. Skin lesions can sometimes be the only symptom of COVID-19. In this respect, recognizing acro-ischemic lesions, which are skin lesions, may help in the early diagnosis of the disease and in predicting the prognosis. In patients with skin lesions without typical symptoms, the diagnosis of COVID-19 should be kept in mind. Herein, we describe five patients affected by COVID-19 which developed acro-ischemic lesions.

Factors Affecting Patient Satisfaction in Breast Reduction Surgeries: A Retrospective Clinical Study.

BACKGROUND: Breast reduction surgeries increase the individual's comfort of life by eliminating the problems caused by breast hypertrophy. We aimed to evaluate the effects of patients' demographic and operational data on satisfaction by using Breast-Q Questionnaire. METHODS: Breast-Q Questionnaire breast reduction module was applied to patients who had undergone breast reduction surgery by a single surgeon between 2016 and 2020 and who agreed to participate in the study. Demographic and operational data and Questionnaire results were analyzed with the help of SPSS Statistics V21.0 program by considering p < 0.05 as significant. RESULTS: Of the 94 patients who had undergone surgery, 52 who agreed to fill in the questionnaire were included in the study. Mean age was 39 and mean body mass index was (BMI) 28.6 kg/m2. Forty eight (92.3%) patients had undergone surgery for noncosmetic reasons. Significant differences were found between the physical well-being scores of the participants whose BMI was <25 and those whose BMI was >30. It was found that physical well-being (p= 0.001) and the amount of tissue removed increased with the increase in BMI (p = 0.018). No association was found between the tissue removed, the change in bra sizes and satisfaction. Satisfaction with outcome of surgery was found as 84.51% ± 24.28. Linear association was found between pre-information given and Breast-Q scores (p < 0.001). CONCLUSIONS: In our study, it was found that the tissue removed, breast size and the change in bra size had no effect on patient satisfaction. Being informed was found to be directly related to satisfaction. Providing sufficient information, understanding the expectations and obtaining the desired cosmetic results is important. Although physical complaints are at the forefront in the decision of surgery, aesthetic appearance is more effective in being satisfied with the surgery. A breast the weight of which is reduced through breast reduction and which looks aesthetically beautiful can only please the patient. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The use of 4% hydroquinone, 0.1% tretinoin, and 0.1% betamethasone creams to prevent hyperpigmentation of split-thickness skin grafts in Long-Evans rats.

BACKGROUND: The increase in the pigmentation of skin grafts during the healing process is a cosmetic problem. There are a variety of medical and surgical treatment options for skin graft darkening. AIMS: The aim of this study was to investigate the effects of topical hydroquinone, tretinoin, and betamethasone application on hyperpigmentation of skin grafts. METHODS: A skin defect was created on the backs of 17 Long-Evans rats, and a 2 × 2 cm split-thickness skin graft was sutured. After 15 days, eight rats in the treatment group were treated with application of hydroquinone, tretinoin, and betamethasone cream, while nine rats in the control group were not treated. Visual evaluation was performed on days 45 and 75 using the Melasma Severity Scale (MSS), and histological evaluation was performed on day 75 using S100 and Masson Fontana (MF) staining. The Mann-Whitney U test was used for statistical analysis. RESULTS: Mean MSS values of the treatment group on days 45 were significantly lower compared to the control group (P = .036). On day 75, the mean MSS score of the treatment group was also lower; however, the difference was not statistically significant (P = .302). Histological evaluation of S100 and MF staining scores of the treatment group showed fewer melanocytes and fewer pigments in epidermis (P = .009 and P = .002, respectively). CONCLUSIONS: This study showed that topical application of hydroquinone, tretinoin, and betamethasone reduced the hyperpigmentation, number of melanocytes, and melanin pigment intensity that developed on the rat skin graft models. Clinical studies are needed to assess whether a similar effect could be observed with human skin grafts.

Hair tourniquet syndrome of toes and fingers in infants.

OBJECTIVE: Hair tourniquet syndrome is an uncommon condition characterized by strangulation appendages by a hair or thread. The aim of this study was to evaluate the results of hair removal and antibiotic therapy in our patients with hair tourniquet syndrome. METHODS: Between January 2012 and August 2018, 16 patients (8 boys, 8 girls; mean age: 118.5 [range: 20 to 380] days) were treated surgically for hair tourniquet syndrome. All patients were treated surgically under local or general anesthesia in the pediatric emergency department or in the operating theater using magnifying loupes. The age, gender, affected fingers or toes and the affected sides of the patients and the duration of symptoms until presentation were recorded. RESULTS: A total of 24 toes and fingers were treated for hair tourniquet syndrome. The right side was affected in 12 patients, the left side was affected in three, and both sides in one. The second toe was affected in three patients, the third toe in eleven, the fourth in six, and the fifth in two patients. Both the thumb and the second finger were affected in one patient. The average duration of the symptoms (excessive crying, swelling, redness) was 1.5 (range: 1 to 2) days. All patients healed without any complications. CONCLUSION: Hair tourniquet syndrome should be kept in mind as an etiology in infants with toe and finger strangulation. These patients should be examined undressed. Immediate removal of hair is an effective treatment method to save appendage. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

Awful face of the war-impacted smoke bomb capsule in the face and systemic toxicity: reports from the conflict in Syria.

In this study, a rare kind of injury due to smoke bomb capsule impaction to midface and under the cranial base is presented, and maneuvers to reduce mortality are discussed. Three male patients were presented with impacted smoke bomb capsules into the midface and under the cranial base structures. Midface structures, anterior cranial base, and, in 2 patients, unilateral eye were severely damaged. Two patients died after the initial emergency operations because their lung disease progressed to acute respiratory distress syndrome. One of the patients lived, and soft tissue reconstruction was achieved by using temporal transposition and cheek advancement skin flaps with split-thickness skin graft from donor site. However, craniofacial destruction is important in these patients; a multidisciplinary approach is needed for the treatment of direct smoke bomb injuries because the patients experienced chemical burn and acute trauma. The timing of maxillofacial reconstruction is also a question in these specific patients.