Utility of J-Shaped Scar Tissue-Based Flap for Secondary Bilateral Cleft Lip Repair: A One-Stage Procedure with Successful Outcomes on Correction of Vermilion Border, Volume Deficiency of Lip, and Muscular Function.

This study aimed to evaluate the utility of J: -shaped scar-tissue-based flap as a new technique in secondary bilateral cleft lip reconstruction in patients with challenging secondary deformities. A total of 52 patients, comprising 38 males and 14 females with a mean age of 21.0 years (range: 16-42 years), who underwent secondary bilateral cleft lip repair operation via the J: -shaped scar tissue flap technique in our clinic between 2014 and 2019 were included. Postoperatively, patients were followed up for an average of 2 years (range, 6 months to 5 years) to assess the outcomes regarding vermilion border, philtrum symmetry, function of the orbicularis muscle, and lip volumetric symmetry, based on the Global Aesthetic Improvement Scale (GAIS), patient-reported outcomes, and independent plastic surgeons' examinations. After an average follow-up of 2 years, outcomes regarding vermilion border, philtrum symmetry, function of the orbicularis muscle, and lip volumetric symmetry were successful, and none of the patients experienced new notch formation, muscular functional loss, lip volume loss, or asymmetry. Owing to good muscular function preventing the stretching, the postoperative scars become more acceptable to the patients. The technique has proven to be safe and successful through the GAIS objective assessment, as also confirmed by the examinations of the three independent surgeons, while the majority of patients reported an exceptional improvement in the appearance alongside a more than 95% satisfaction rate with the operation. In conclusion, our findings revealed successful functional and aesthetic outcome of using J: -shaped scar tissue flaps in secondary repair of cleft lips. The technique was associated not only with the correction of significant secondary deformities yielding an improved and symmetrical lip volume, correction of vermilion notch, and prevention of notch re-formation but also with the restoration of orbicularis oris muscle function and thus integrity of the lip with minimal scarring.

Extended Superolateral Cheek Lift With a Short Preauricular Scar: A Local Anesthesia-based Practicable Technique for the Correction of Moderate-degree Facial Aging Signs.

An ideal technique applicable to middle-aged individuals with a moderate degree of facial aging signs has not yet been established. This study aimed to evaluate the utility of an extended superolateral cheek lift with a short preauricular scar technique for the correction of facial aging signs. A total of 200 female patients (mean age: 43 y, range 27-56 y) who underwent a local anesthesia-based extended superolateral cheek lift for the correction of facial aging signs confined to the malar and nasolabial area, lower eyelid, jawline, and neck were included. Data on the Global Aesthetic Improvement Scale, patient-reported outcomes, and complications were recorded at 1, 6, 12, and 24 months postoperatively. The Global Aesthetic Improvement Scale scores revealed exceptional improvement in 90% of patients along with no complications at month 24. None of the patients developed a depressed scar, skin necrosis, breaking of the superficial musculoaponeurotic system plication sutures, asymmetry, or facial nerve problems. At postoperative month 24, the appearance was reported to be very much improved by 90% of patients, and 94% of patients reported that they were very satisfied with the treatment and that they would recommend this treatment to friends and acquaintances. Our findings revealed the potential utility of an extended superolateral cheek lift with a short preauricular scar as a local anesthesia-based practicable technique for the correction of facial aging signs in middle-aged patients, offering a favorable postoperative outcome, lack of complications and high patient satisfaction in addition to invisible scars and a short-term postoperative recovery.

Tissue Coverage and Functional Reconstruction Outcomes With Use of Serratus Osteomusculocutaneous Free Flap in Lateral Malleolar Reconstruction: A Case Report.

Currently, there is no ideal method defined in the repair of complex lateral malleolar defects, and the existing methods (i.e., bone repair, soft tissue or free flap closure) are far from producing functional results in terms of the ultimate recovery of ankle movements. Herein, an operative technique for soft tissue, ligamentous, and osseous reconstruction of fibular defect, using a free vascularized serratus anterior osteomusculocutaneous flap for reconstruction of a fibular deficit and the sixth costa for soft tissue coverage, was described in relation to tissue coverage and functional reconstruction outcome in a 31-year-old male patient with soft tissue and distal fibula defects in the lateral malleolus region caused by a traffic accident. Ankle movement was regained to almost full extent. No complications requiring further intervention was encountered in the donor site or ankle. In conclusion, the described operative technique enabled the repair of functional ligaments of the ankle joint in addition to repair of the soft tissue, lateral malleolus bone and skin defects in one session without the need for further additional operative intervention. Hence, the use of serratus osteomusculocutaneous free flap as a lateral malleolar reconstruction method seems to enable not only the tissue coverage but also to assist with functional reconstruction.

Comparative Analysis of Using Bone Graft, Hydroxyapatite Coralline (Biocoral®) and Porous Polyethylene (Medpor®) Implants for Cranioplasty in a Rat Model of Cranial Bone Defect.

AIM: To compare the efficacy of bone graft, hydroxyapatite coralline (Biocoral®), and porous polyethylene (Medpor®) implants for cranioplasty in a rat model of cranial bone defects. MATERIAL AND METHODS: Two parietal bone defects were created in each of 16 male Sprague-Dawley rats. One was repaired with a bone graft using bone removed from the contralateral defect, and the other was filled with either Medpor® or Biocoral® (each n=8, with the repair on the left in four and the right in the other four). The rats were sacrificed at either 4 or 8 weeks, and implant stability, volumetric changes, and histological parameters were compared between the three materials. RESULTS: At 8 weeks, scores for bone formation (p=0.003), healing of the defects (p=0.008), and material resorption (p=0.010) were higher for the bone grafts than for Biocoral® and Medpor®, whereas the fibrosis scores were significantly higher for Medpor® and Biocoral® than for the bone grafts (p=0.004). The other parameters were similar between the three materials at 8 weeks, except for significantly higher inflammatory cell infiltration with Medpor® than with Biocoral® and bone grafts (p=0.005). CONCLUSION: Implant stability scores were similar for the three implant materials. However, there was better bone formation and healing of the defects with bone grafts, a lower risk of resorption and greater fibrosis induction with Medpor® and Biocoral®, and less volumetric reduction with Medpor®.

Upper extremity replantation results in our series and review of replantation indications.

BACKGROUND: Upper extremity amputations are usually not life-threatening, but they negatively affect the life quality of the victim. In addition to the functional disabilities of upper extremity amputation, disfigurements frequently cause psychological and social debilitations. METHODS: Between 2007-2015, fourteen cases were admitted to emergency with total major amputation of the upper extremity. All cases were male (22-45 years of age. Mean age: 29.6). Replantation was applied to all except three cases with multileveled crush injuries. RESULTS: All replantations were successful. Additional interventions were needed in four cases with replantation at elbow level and replantation at the distal arm level. The postoperative functional results were evaluated. The patient's overall satisfaction, the recovery of flexor and extensor mobility, the extent of the active motion of digits, the recovery of thumb opposition, active movements of wrist and elbow joints, recovery of sensitivity in the median and ulnar nerve, the ability of the surviving hand and/or forearm to perform daily works are all evaluated. The results were satisfactory in hand replantations. However, some ulnar nerve distal motor problems were encountered in three cases with replantation at elbow level, and one case with replantation at the distal arm level with a crush injury, acceptable and excellent results were obtained in other cases. CONCLUSION: Despite the availability of prostheses, cadaveric upper extremity replantations, replantation of the native extremity is still the most appropriate treatment for amputated cases. However, surgeons should realize that the ultimate goal is not merely to save the viability of the extremity through replantation, but rather to preserve the life quality by improving the function.

Combination of Lipofilling With Liposuction in the Correction of Pseudo Genu Varus Deformity.

BACKGROUND: The combined use of lipofilling and liposuction has not been reported for the correction of pseudo genu varus deformity. OBJECTIVES: The aim of this study was to evaluate the utility of combined liposuction and lipofilling for a bilateral correction of pseudo genu varus deformity based on a single-center experience over a 13-year period. METHODS: A total of 72 patients with pseudo genu varus deformity treated with combined liposuction and lipofilling were included. Data on postoperative complications, the need for additional rounds of lipofilling, and aesthetic outcomes over an average of 5 years (range, 1-9 years) were recorded. RESULTS: Fat harvested from the upper medial portion of the knee was sufficient for lipofilling in 12 (16.7%) patients, and additional donor sites were used in 60 (83.3%) patients. A second round of lipofilling (average, 20 mL; range, 15-50 mL) was required in 17 (23.6%) patients within 6 months to 1 year after the operation. The need for additional lipofilling or liposuction was not noted for any other patients. None of the patients developed major complications such as fat necrosis, infections, contour deformities, or medial concavities during knee flexion. CONCLUSIONS: The current findings strongly suggest that the combined use of liposuction and lipofilling for the correction of pseudo genu varus deformity is a feasible, effective, and safe alternative that seems to offer additional benefits compared with fat grafting alone, including a fast recovery, a low risk of complications, and an increased likelihood of a long-lasting correction of the calf contour.

Use of Muscle Graft Versus Fascia Flap as Interpositional Material in Prevention of Reossification in a Rat Model of Skull Bone Defect.

AIM: To investigate the utility of two different interpositional materials (muscle graft vs. fascia flap) for preventing the osseous reunion of skull bone defect including the coronal suture line in rats. MATERIAL AND METHODS: A total of 32 male Sprague-Dawley rats were divided into 2 groups (n=16 for each) after the formation of bilateral coronal bone defect, based on the interpositional materials used to prevent re-ossification; the rats were divided into the muscle graft (MG) group and the fascial flap (FF) group. In each group, the other side of the coronal suture served as the control. The rats were sacrificed at postoperative 4 weeks or 8 weeks for histopathological, radiological, and microbiologic investigations. RESULTS: At postoperative 8 weeks, there was partial reunion in the defects with bony tissue in both the groups; no obvious differences were noted between the groups on radiological examination.The defect content involved bone and fibrous tissue in the MG group and bony bridges and loose connective tissue in the FF group. New bone formation was moderate, marked, and extreme and the reduction in defect size was marked, moderate, and extreme in the MG, FF, and control groups, respectively. CONCLUSION: Our findings revealed that neither the temporal MG nor the temporal FF were able to achieve complete prevention of re-ossification of the skull bone defects including the coronal suture line; further, neither material was superior to the other.

[Donor site sequela of class III B vascular anomaly following reconstruction of the mandible with free osteoseptocutaneous fibula flap: a case report]. / Serbest fibula osteoseptokutan flep ile mandibula rekonstrüksiyonundan sonra verici sahada sinif III B vasküler anomaliye bagli sekel: Olgu sunumu.

Free transfer of the fibula for mandibular reconstruction provides desirable functional and aesthetic results. However, unexpected donor- and recipient-site complications may be encountered with most free flap transfer procedures. A 62-year-old woman underwent wide resection and segmental mandibulectomy for low-grade squamous cell carcinoma of intraoral location. Reconstruction of the defect was performed at the same session with an osteoseptocutaneous free flap from the right fibula. A class III B vascular malformation was detected intraoperatively at the donor site, which resulted in restriction of foot inversion and abduction, and of toe extension during the follow-up.

Comparison of different methods of circumferential tracheal reconstruction: an experimental study.

OBJECTIVES: This study was designed to compare different prefabrication models for circumferential tracheal reconstruction. MATERIALS AND METHODS: Thirty adult female New Zealand rabbits were divided into six groups for circumferential tracheal reconstruction with a different tissue combination. Prefabrication of neotrachea was performed without anastomosis. Lateral thoracic fascia or pectoralis major muscle were used for vascular supply. Polypropylene mesh, polytetrafluoroethylene (Gore-Tex), or cartilage rings were used for skeletal framework. Hairless epithelial skin graft was used for inner lining. The groups were compared in terms of viability of hairless epithelial graft, longitudinal flexibility, rigidity, flap wall thickness, internal diameter, and flap viability. RESULTS: Epithelial skin graft was almost totally viable (95%-99%) in the polypropylene mesh groups. Gore-Tex groups exhibited almost total necrosis (74%-71%). Longitudinal flexibility and rigidity were similar to the native trachea in Gore-Tex and polypropylene mesh groups. Neotrachea prefabricated with cartilage grafts showed more than normal longitudinal flexibility and collapsed easily. CONCLUSION: The prefabricated model with the use of polypropylene mesh for skeletal framework and lateral thoracic fascia for vascular supply seems to be the best alternative in the reconstruction of circumferential tracheal defects.

Sculpturing a fibular flap: combined horizontal/vertical osteotomy and ostectomy for reconstruction of complex craniofacial defects with one flap.

A fibular flap has great versatility in reconstructive procedures. Osteomies and ostectomies enable the flap to be used for variable defects. We used combined horizontal/vertical osteotomy and ostectomy for reconstruction of complex craniofacial defects with one flap in two patients. Vertical osteotomy transforms the tubular structure of a fibula into a flat bone that can be used for reconstruction of wider defects with less vertical height. Neither vertical osteotomy nor ostectomy had negative effects on viability and bony healing of the segments in our patients. We think that the fibular flap, thanks to its versatility, can be used for reconstruction of complex orbito-zygomatic and orbito-cranial defects successfully.

Brachioradialis transposition for elbow extension in obstetrical brachial plexus palsy.

Disorders of elbow extension occur following traumatic or neurologic injuries of the triceps muscle. Restoration of elbow extension is an integral part of the entire upper extremity surgical reconstruction to improve the following daily activities: bringing down an object from above, handwriting, using the hand in the supine position, steering a wheelchair, driving a car, and swimming. The transfer of the posterior head of the deltoid muscle to triceps (Moberg procedure) and the transfer of the biceps to triceps (Friedenberg procedure) are previously described procedures for the functional restoration of triceps function. In conditions where these procedures cannot be used, we describe a new technique for restoration of elbow extension. In 4 cases with obstetrical palsy sequela, where shoulder abduction was established with the latissimus dorsi and teres major transfer, restoration of elbow extension was planned to aid in activities performed while the hand is above the head. To achieve this goal, the brachioradialis muscle was transposed bipedically to the triceps muscle.

Circumferential trachea reconstruction with a prefabricated axial bio-synthetic flap: experimental study.

OBJECTIVE: The ideal method, in reconstruction of circumferential tracheal defects more than 50% of the total tracheal length, is still a question. Current methods lack either in epithelial lining or in skeletal framework. In this study, we designed an axial biosynthetic prefabricated flap to reconstruct the circumferential tracheal defects in rabbits. METHODS: Ten rabbits are used. The inner mucosal lining is substituted by hairless epithelium obtained from proximal ear. The tracheal cartilage is substituted by polypropylene mesh and the tracheal adventitia is substituted by lateral thoracic fascia as a vascular supply. The study is designed in three stages. Stage 1: Hairless epithelial graft is obtained by secondary healing of a full thickness skin defect in ear. Stage 2: Epithelial graft, polypropylene mesh and lateral thoracic fascia are tubed around a silicone catheter. This structure is dissected through its pedicle (lateral thoracic vessels and fascia) to the axilla and mobilized. The prefabricated neotrachea is carried on its pedicle to the cervical area through a subcutaneous tunnel formed superficial to the sternum and left there for 2 weeks. Stage 3: The silicone catheter is taken out and prefabricated neotrachea is adapted to the defect formed in native trachea and anastomized. Later the animals are evaluated for 4 weeks. The patency of the lumen, the viability of the epithelial graft and fascia, airtightness of the anastomoses and other features of the reconstruction are evaluated by radiological, macroscopical and histological examinations. RESULTS: Survival at 4 weeks was 70%. All of the prefabricated neotracheas and epithelial grafts were viable. The rigidities, longitudinal elasticities, diameters and wall thickness were similar to native tracheas. Occlusion of lumen is encountered only in one animal. There was no hair growth from the epithelial lining. CONCLUSION: The study defines a new method of circular tracheal reconstruction with successful substitution of inner lining, skeletal framework and vascular supply.