Reconstruction of Scrotal Skin Defects Using Bilobed Pudendal Flap.

Background: Due to its unique cosmetic appearance and functioning, scrotal skin offers a major clinical challenge in terms of reconstruction. Thus, successful reconstruction of scrotal skin should include both provision of pliable texture and protection of testicular functions. Skin grafts and flaps are important options for such reconstruction; however, they both have unique features that bring about specific limitations and specific problems. Aims and Objectives: In the light of the negativities related to the widely used skin grafts and flaps, this study aims to discuss the use of bilobed pudendal flap-a simple, uniform, and pliable tissue-for the first time in the related literature for the reconstruction of scrotal skin defects caused by Fournier's gangrene. Materials and Methods: This study was performed using the single-step method of scrotal skin reconstruction on eight patients who had developed scrotal skin defects and underwent reconstruction by using three-dimensional bilobed pudendal flaps (defect and reconstructive tissues planned on different planes) from December 2016 to August 2019. Results: No complication such as infection, bleeding, hematoma, partial or complete flap loss, scar contraction, urinary problem, erectile dysfunction or discomfort, or sensation loss was observed in seven out of eight study patients. The only complication to have developed in one patient was minimal dehiscence, which was then corrected by restoration. Conclusion: Repair of scrotal skin defect using a three-dimensional bilobed pudendal flap enabled an elastic scrotal repair acceptable in sensorial and visual terms.

Potential Risk of Benign Paroxysmal Positional Vertigo Due To Traumatic Effect of Osteotomy in Septorhinoplasty Patients.

PURPOSE: We investigated the effect of osteotomy on the vestibular system in septorhinoplasty patients and determined the potential risk of benign paroxysmal positional vertigo (BPPV) in these patients. PATIENTS AND METHODS: In the present prospective study, 47 primary septorhinoplasty patients were evaluated as the study group and 50 septoplasty patients as the control group. Osteotomy was performed in all septorhinoplasty patients. No hammer and osteotomes were used in the control group. All patients underwent static balance tests (tandem stance test, 1-leg standing test, and Romberg test), dynamic balance tests (tandem walking test and Fukuda test), positional balance tests (Dix-Hallpike test and supine roll test), head impulse test, and the adult dizziness handicap inventory (ADHI) preoperatively and during the first postoperative week. RESULTS: No significant differences were found between the 2 groups in terms of the static balance tests, dynamic balance tests, positional balance tests, or head impulse test results. The postoperative ADHI scores were significantly worse in the septorhinoplasty patient group than in the control group. Posterior semicircular canal BPPV was observed in 2 patients in the septorhinoplasty group but none in the control group. CONCLUSIONS: BPPV is one of the possible early postoperative complications of rhinoplasty. In patients with vertigo after rhinoplasty, surgeons should evaluate the semicircular canals using the Dix-Hallpike and supine roll tests. To avoid the traumatic effect of osteotomy reflected on the inner ear, attention should be given to the applied force, and sharp osteotomes should be used.

Z-plasty as an alternative choice for the treatment of recurrent local sternal wound infections.

OBJECTIVE: Sternal wound infections after sternotomy are associated with high morbidity, high mortality, and prolonged hospital stay. The recurrence rate of sternal wound infections after single-stage closure is greater than expected. The aim of the study is to present our results of a consecutive series of Z-plasty for the treatment of recurrent sternal wound infections. METHODS: Between March 2015 and March 2017, a total of 9 patients were referred to our clinic with a recurrent sternal wound infection due to sternotomy with or without osteomyelitis. All patients previously underwent one or more surgical procedures for sternal infection. Negative pressure wound therapy and several debridement methods were performed before reconstruction. Two triangular double-transposition fasciocutaneous flap techniques as Z-plasty under local anesthesia was performed for all of the patients. RESULTS: The flaps survived completely without any tissue loss. There were no major postoperative complications. One patient had recurrent infection after the flap procedure and was treated with antibiotic therapy. At 6 months of follow-up, all of the patients were able to return to normal activities of daily living with a high patient satisfaction rate. CONCLUSIONS: Local sternal wound reconstruction is an effective, rapid, and simple with Z-plasty associated with low recurrence risk. We believe that Z-plasty can be used for recurrent local sternal wound infections as an alternative treatment option for selected patients without mechanical dehiscence.

Endoscopic-Assisted Treatment Combined With Transoral and Transbuccal Approach to Mandibular Subcondylar Fractures.

PURPOSE: Endoscopic treatment of maxillofacial fractures is a different way of performing open reduction and internal fixation. This report presents a case series of mandibular subcondylar fractures performed with combined endoscopic transoral and transbuccal approaches and the results. MATERIALS AND METHODS: Sixteen patients with mandibular condylar fractures were preoperatively assessed for risk and underwent open reduction and internal fixation with the endoscope-assisted transoral approach. Duration of hospital stay was recorded and patients were followed for an average of 17 months for possible complications. RESULTS: No major complications were encountered in any patient. Minimal angulation was observed in 3 patients. One patient had late complaints of temporomandibular joint pain. CONCLUSION: Endoscopic-assisted mandibular condylar fracture repair includes special surgical equipment and manipulation not used in classic methods. With this approach, subcondylar fractures can be more readily manipulated through a transbuccal puncture with appropriate fixation achieved.

Reverse Adipofascial Radial Forearm Flap Surgery for Soft-Tissue Reconstruction of Hand Defects.

Objective: The reverse radial forearm flap has been used for soft-tissue hand defect surgical procedures worldwide. One of the major drawbacks of this flap, however, is donor site morbidity, as the donor site is closed with a skin graft. Problems with skin graft donor areas include adhesion, contracture, and wound-healing complications. In this study, only the adipofascial component of a reverse radial forearm flap was used to prevent these problems; in addition, a skin graft was applied over the flap instead of over the donor site. Methods: Between January 2011 and December 2013, a total of 13 hand defects were reconstructed with a reverse adipofascial radial forearm flap. Patients were evaluated for functional results using total active motion criteria and disability of the arm, shoulder, and hand scores, operation time, hospitalization time, and patient satisfaction. Results: All flaps and grafts placed on flaps survived completely and donor sites healed without complications. The total active motion criteria and the disability of the arm, shoulder, and hand score demonstrated that the functional outcomes were successful. Patient satisfaction scores using the visual analog scale had a mean of 88.3 (SD = 2.95) mm. Operation time for the flap surgery was 126.1 (SD = 21.80) minutes, and patients were discharged at an average of 6.3 (SD = 1.44) days. Conclusion: Use of an adipofascial component in reverse radial forearm flap surgery is appropriate for reducing problems with donor site skin grafts. Patients' functional outcomes denoted that the reverse adipofascial radial forearm flap is a reliable and effective method to cover soft-tissue defects of the hand. Level of Evidence: IV.

The worth of sound recording as evaluation criteria of response to surgery in non-reduced anterior disc dislocation.

AIM: The objective of the present study was to examine whether joint sounds are objective criteria for evaluating the success of surgery for non-reduced anterior disc dislocation. METHOD: Twenty-seven patients (age, 35.6 ± 10.6 years; female/male, 22:5) with non-reduced disc dislocation, as confirmed by MRI, were included in the study. Temporomandibular joint (TMJ) sounds were assessed and digitized by custom-made device. As a surgical treatment, all patients underwent "disc plication technique". The success of surgery was evaluated with maximal interincisial opening (MIO), pain, patient satisfaction scores, MRI examination, and TMJ sound intensity. Recording of sounds of TMJ and pain and satisfaction scores were repeated again at postoperative 12 months and compared to preoperative results. RESULTS: Mean preoperative sound intensities with jaw opening and closing and left-right movement were 79.37 ± 3.52 dB and 81.0 ± 4.99 dB, respectively. Mean postoperative sound intensity with jaw opening and closing was 64.81 ± 4.54 dB whereas that with left-right movement was 65.6 ± 5.38 dB. Examination of preoperative and postoperative sounds showed that decreased volume level related with clinical improvement and postoperative replaced disc image in MRI. MIO values increased from 25.89 ± 1.76 mm to 34.26 ± 1.403 mm. Postoperative pain scores were lower than preoperative period and patient satisfaction improved markedly. CONCLUSION: The results of this study showed that patients who underwent plication for non-reduced disc dislocation had clinical improvement, which was related with the decreasing volume level of the click sound, reducing the pain, improving satisfaction, and replacing the disc to normal position in MRI.

An easy way for congenital symmastia correction.

UNLABELLED: Congenital symmastia is described as a connection between the breasts without macromastia. In this condition, there is accumulation of fat and glandular tissue between the breasts, which produces a unified appearance of the breast tissue across the chest. We report a case of congenital symmastia in a 21-year-old woman with normal-sized and -shaped breasts. We achieved satisfying aesthetic results using suction-assisted lipectomy and the patient's complaint was resolved without scar or major surgery. LEVEL OF EVIDENCE V: 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 .