Agarose Gel: An Overview of the Dermal Filler and a Clinical Experience With 700 Patients.

Background: Dermal fillers currently in the market have several advantages and disadvantages over each other. Agarose gel (AG) is a unique material due to its special rheological characteristics and gel-forming capability. Objectives: The authors aimed to share their clinical experience on AG for a variety of facial augmentation procedures and its long-term results. Methods: The study population consisted of 700 patients (532 females; 168 males) aged 18 to 52 years. Follow-up visits were at 1, 3, 6, 12, and 24 months after the injections. Patient satisfaction was evaluated on a scale from 0 to 10 using a survey and clinical improvement was evaluated using the Global Aesthetic Improvement Scale (GAIS) by 2 independent plastic surgeons before the injection and at 1-year follow-up. Results: Eighty-two percent of the patients scored 1 or 2 (exceptional or great improvement) on GAIS. Eighty-five percent of the patients scored 8 or above (very satisfied). Most patients experienced at least 80% persistence of effect at 1-year follow-up. Conclusions: AG appears to be suitable for a variety of facial augmentation and contouring applications, as it is safe and has long-lasting favorable cosmetic efficacy.

Hybrid Nasal Filler: Combining Agarose Gel and Hyaluronic Acid for Nonsurgical Rhinoplasty.

Given its structural properties, it would be a mistake to assume that a single type of filler fits perfectly to each anatomical region of the nose in nonsurgical rhinoplasty procedures. Therefore, we aimed to develop a hybrid treatment model by applying two different structural types of fillers. Hyaluronic acid (HA), a hydrophilic material, and agarose gel (AG), a nonhydrophilic and high G-prime material, were used in the study according to their advantages and disadvantages. Methods: Patients who presented to the office desiring filler treatment for nonsurgical correction of the nose in a 2-year period were enrolled in the study. HA was used intradermally 0.1 ml per each point in the tip defining points and supratip. Injections of 0.4-0.7 and 0.4-0.6 ml AG were used supraperiosteally in the radix and nasal spine, respectively. Clinical improvement was evaluated two weeks later using the Global Aesthetic Improvement Scale from 1 to 5 (1: exceptional improvement; 5: worsened patient). Patient satisfaction was evaluated on a scale from 0 to 10 (0: not satisfied; 10: very satisfied). Results: A total of 32 patients (mean age: 27 years) were enrolled in the study. Mean score of patient satisfaction was 9.09 of 10 after injection and 9 of 10 after 2 weeks. Clinical evaluation scores after injection were 1.72 of 5 and 1.69 of 5 on the Global Aesthetic Improvement Scale. No major complication was observed. Conclusion: The HA and AG filler hybrid concept applied in different anatomical locations represents a safe and convenient option for nonsurgical rhinoplasty procedures.

Effectiveness of Different Surgical Flap Delay Methods and Their Systemic Toxicities.

OBJECTIVE: The surgical flap delaying has been shown to be effective in preventing partial flap loss or in preparing larger flaps. However, there is no gold standard flap delay method in the literature. In this study, the authors aimed to compare 3 types of surgical delay methods to determine which model would increase more flap survival. The authors also investigated the effect of delay methods on circulating mononuclear leukocytes as a parameter of DNA damage. METHODS: Twenty-four Sprague-Dawley male rats were divided into 4 groups. All subjects had a 10 × 3 cm modified McFarlane flap. Surface area measurements, biopsies, and blood samples were taken on the day of sacrification; 7th day for the control group and 14th day for delay groups. RESULTS: Between incisional surgery delay groups, a significant difference was found in necrosis and apoptosis in the bipedicled group, and only necrosis in the tripedicled group compared to the control. In terms of DNA damage, it was found higher in all experimental groups than in the control group. CONCLUSIONS: Both incisional surgical delay procedures' results were meaningfully effective when only incisions were made without the elevation of flaps. In conclusion, bipedicled incisional surgical delay seems to be the most effective method in McFarlane experimental flap model whereas two-staged surgeries may increase the risk of systemic toxicity.

Recommendations for management of diabetic foot ulcers during COVID-19 outbreak.

COVID-19 pandemia began in Wuhan, China, in December 2019. A total of 1 878 489 people were infected and 119 044 people were lost because of the disease and its complications by 15 April. Severe morbidity and mortality complications are mostly seen in elderly and patients having comorbidities. Diabetic foot ulcers (DFUs) are one of severe complications of diabetes mellitus and it may require urgent surgical interventions. In this paper, we aimed to create a management algorithm to prevent the unexpected complications that may occur in the patients and health care workers during the evaluation of COVID-19 in DFU patients who require urgent surgical intervention. We advise the use of thorax computerised tomography for preoperative screening in all DFU patients with severe signs of infection and especially those requiring urgent surgery for both the detection of the possible undiagnosed COVID-19 in the patient for the need for close follow-up and protection of the surgical and anaesthesiology team.

Revisiting the Limberg flap for central midface reconstruction in elderly patients.

To present the use of Limberg flap in the central midface reconstruction as an useful flap in elderly patients. A retrospective review of a total of 13 cases who underwent Limberg flap procedure to reconstruct various sizes of midfacial defects. Etiology, size, location, surgical procedures, outcomes, and complications, final evaluation according to the tumor-free survival and patient satisfaction in terms of aesthetic appearance were analyzed, the latter was evaluated by visual analog scoring system. The mean follow-up period was 11.53 months (2-22 months). The mean age of cases was 68 years (between 49 and 81 years). Average defect size was 7.76 cm2 (between 2.25 and 25 cm2 ). All operations were performed under local infiltration anesthesia. All patients were discharged on the same day of the operation. All the flaps survived with uneventful wound healing according to the patient satisfaction scores that were reliable and high. No any early or late recurrence was detected. Limberg flap is a safe and rapid option that could be applied in small- and medium-sized cutaneous defects in the central midface reconstruction in elderly patients.