Efficacy of Using Perichondrioadipodermal Flap With Combined Techniques in Prominent Ear Correction.

INTRODUCTION: Prominent ear is 1 of the most common congenital deformities of the ear. Incidence is reported as approximately 5%. This deformity can classically be the result of antihelix insufficiency, overprojection of concha or combination of both. Less frequently, folded or overprojectile ear lobule can aggravate the deformity. Surgical techniques can be aimed at concha, antihelix formation, lobule positioning. In our study, postoperative results for the combination of suture otoplasty and perichondrioadipodermal flap techniques in prominent ear surgery is discussed in light of the recent literature. METHODS: Forty-nine patients that were operated for prominent ear deformity in our clinic between 2010 and 2015 were evaluated. Anatomic structures that cause the anomaly was analyzed by photographing concha-scaphoid angle, antithetical fold absence or presence, position of the ear lobule, conchal depth, size of the auricula, and positioning Frankfort Plane parallel to the ground. The patients were photographed preoperatively, at postoperative first week and postoperative sixth month, respectively. Comparison of age, surgical technique, surgical complications, necessity for revision surgery, additional procedures, follow up time, preoperative, and postoperative helix-mastoid bone distance were evaluated. RESULTS: Forty-nine patients have been evaluated. Thirty-one of these patients were female, whereas 18 were male. Age of these patients ranged between 6 and 37. Operations were performed in 47 right side ears, and 44 left side ears (97% bilateral and 7% unilateral otoplasty). Preoperative helix-mastoid bone distance ranged between 21 and 33 mm (mean 26.77), whereas postoperative helix-mastoid bone distance was measured between 12 and 22 mm (mean 16.26). Compared to the preoperative values, helix-mastoid distance difference was statistically significant (P < 0.05). CONCLUSIONS: Asymmetry and recurrence are the most common late complications of prominent ear surgeries. Perichondrioadipodermal flap can be safely added to the combined surgical techniques protecting the cartilage support, therefore, reducing complication rates, with satisfying results.

Effect of Rosmarinic Acid and Alcohol on Fat Graft Survival in Rat Model.

BACKGROUND: Autologous fat grafting is a common procedure performed for cosmetic and reconstructive purposes. Unpredictable graft survival is a major drawback, and a variety of improvements on technique such as using antioxidants have been reported to increase retention. The authors examined whether a natural rosemary plant extract known with antioxidant properties, rosmarinic acid, could improve the survival of the adipose tissue. METHODS: Inguinal fat pads were harvested from 24 Sprague Dawley rats and implanted to the parascapular area. Rats were divided into three groups: rosmarinic acid and ethanol as solvent (RA), ethanol (E), and serum physiologic (C). These substances were administered intraperitoneally daily for 1 week and once a week for 7 weeks. Volume and weight measurements, blood specimens, weight and volume records, and histopathologic examinations were performed and analyzed. RESULTS: The RA group demonstrated lower TOS, TGF-beta, TNF-alpha, and MDA values compared to E and C groups. TGF-beta increase was statistically insignificant, but TOS, TNF-alpha, MDA decrease was found statistically significant. Weight and volume losses were lower in the RA and E groups compared to the C group. The difference between the RA and E groups in terms of weight and volume loss was statistically insignificant. Histopathologically fat necrosis, inflammation, and fibrosis were less in the RA group compared to the E and C groups (p < 0.05). CONCLUSION: Rosmarinic acid increased the fat graft volume retained and decreased cyst formation and abscess formation in the rat model. Further studies can be undertaken to investigate rosmarinic acid's local application as a tumescent and safety in humans. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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.

A classification system for ulnar polydactyly and clinical series.

PURPOSE: To describe a modified classification that includes both complicated ulnar polydactyly and ulnar polydactyly with bifid or duplicated proximal phalanx and to apply it to a clinical series. METHODS: A total of 42 patients with ulnar polydactyly were admitted to our outpatient clinic between January 2004 and January 2014 and were included in the study. Patients' clinical and radiological data were evaluated retrospectively and organized into 5 different subgroups. RESULTS: There were 20 bilateral and 22 unilateral patients with polydactyly. These were composed of 32 supernumerary digits represented as type I, 7 as type II, 9 as type III, 12 as type IV, and 2 as type V. Nine patients had bifid or duplicated proximal phalanges (types IIIA and IIIB) and 2 were of the complicated type (type V). We identified 5 types based on morphology, level of duplication, and other complicating features. CONCLUSIONS: Complicated ulnar polydactyly and ulnar polydactyly with bifid proximal phalanx are 2 important types of ulnar polydactyly with surgical implications, both separately included in the Pritsch classification system and Rayan and Al-Qattan classification systems. None of the current classification systems include both types. We believe our modified classification system will help to better define diagnosis and treatment plans for bifid proximal phalanx and complicated type ulnar polydactyly. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic III.

The effects of resveratrol on tendon healing of diabetic rats.

OBJECTIVE: The aim of this study was to determine the effects of resveratrol on the tendon healing process of streptozotocin-induced diabetic rats. METHODS: The study included 16 male Sprague-Dawley rats. Streptozotocin was administered to induce diabetes and bilateral tenorrhaphy of the Achilles tendons was performed. Intraperitoneal resveratrol was injected in the experimental group (n=8) and saline in the control group (n=8) during the postoperative period. Rats were sacrificed at the 14th day. Right side tendons were evaluated biomechanically and left side tendons histologically. RESULTS: Difference in mean tendon tensile strength was not statistically significant between groups (p>0.05). Histologic evaluations of the repair zones showed greater configuration of the newly synthesized collagen in the experimental group. The ratio of the newly synthesized collagen area to the healing region area was significantly higher in the experimental group then the control group (p<0.01). CONCLUSION: Resveratrol appears to have a positive impact on the process of tendon healing in diabetic conditions in the first 14 days.