"Modified" Penile Inversion Vaginoplasty: First Case Series of a Turkish Single Center.

Purpose: The aim of this study was to share our outcomes, including complications and their management, of a "modified" penile inversion vaginoplasty (PIV) technique applied to transgender individuals, which we presume to be the first reported case series of a single center from Turkey. Methods: A cross-sectional study, including adult transgender cases who underwent male to female gender-affirming surgery in our institution, between January 2015 and December 2019, was planned. The same "modified" PIV technique, in which the spatulated urethra was incorporated to the penile skin flap, was applied to all cases. Demographic data including case characteristics, medical history with prior operative details, and complications detected during follow-up examination were collected prospectively. Results: The mean age of 30 cases included in the study was 31.03±7.05 years. The mean length of hospitalization after the surgical procedures was 10.13±2.24 days. The mean vaginal depth measured at postoperative 1st year follow-up examination was 14.2±2.95 cm. Satisfactory neovaginal moistening was reported by 24 (80%) cases. In 8 (26.6%) of 30 cases, no complication was reported at all. Intraoperative (rectal injury) and postoperative (meatal stenosis, vaginal narrowing, scars, infections, etc.) complications occurred in 22 (63.4%) cases. Postoperative satisfaction rates including mental, physical, and social health in general were found to be 81.84% (66-98%). Conclusion: The "modified" PIV can be used as a preferred technique showing high satisfactory outcomes, especially in cases with short penile skin or circumcision, due to the achievable lubricity and vaginal width/depth.

Effects of Hyalobarrier gel and Seprafilm in preventing peritendinous adhesions following crush-type injury in a rat model.

BACKGROUND: In the present study, the aim was to evaluate the effects of Hyalobarrier gel (Anika Therapeutics S.r.l., Abano Terme, Italy) and Seprafilm adhesion barrier (Genzyme Corporation, Cambridge, MA, USA) in the prevention of peritendinous adhesions following a crush-type injury. METHODS: Twenty five female Wistar Albino rats, weighing 230 to 270 g and 7 to 9 months of age were randomized into 5 groups. Group 1 was the control group, Group 2 comprised the Hyalobarrier gel group, Group 3 was made up of the Seprafilm-treated subjects, Group 4 was the tendon repair and Hyalobarrier gel group, and Group 5 was the tendon repair and Seprafilm group. Two gastrocnemius muscle tendons of each animal, a total of 50 tendons, were used. The animals were sacrificed with the administration of a high dose of anesthetic on postoperative day 40. Macroscopic evaluation of adhesions was classified by 2 blinded researchers according to Tang's adhesion grading system. The number of fibroblasts and the density and formation of collagen fibers were noted for histopathological examination. RESULTS: None of the subjects in Group 2 was determined to have a severe adhesion, and moderate or severe adhesions were detected in Groups 3, 4, and 5. There was no statistically significant difference between Group 2 and the control group (p=0.737). Groups 3, 4, and 5 demonstrated fewer adhesions than Groups 1 and 2 (p<0.05). Groups 4 and 5 had fewer adhesions than Groups 2 and 3 (p<0.05). There was no statistically significant difference between Groups 4 and 3 (p=0.342). The histopathological findings were consistent with the macroscopic findings. CONCLUSION: Seprafilm was found to be effective in the prevention of peritendinous adhesions following a crush-type injury with or without repair of the tendon fibers. In contrast, Hyalobarrier gel was found to be effective only following repair of the tendon fibers.

The effect of magnetic field therapy and electric stimulation on experimental burn healing.

OBJECTIVES: : In this study, we aimed to compare morphological and histological differences between magnetic field and electric stimulation therapies in an experimental burn injury model in rats. MATERIALS AND METHODS: Between February 2011 and July 2011, a total of 21 Sprague-Dawley female rats were used in this study. Second-degree burns were induced on the back areas of the rats. All rats were equally divided into three groups including seven in each: the first burn group was treated with antibacterial pomade (Group 1, control group); the second group was treated with both antibacterial pomade and pulsed electromagnetic field therapy (Group 2); and the third group was treated with antibacterial pomade and electric stimulation for 14 days (Group 3). RESULTS: Earlier re-epithelialization, wound area contraction, reduction of edema, and hyperaemia were observed on gross examination in the pulsed electromagnetic fields and electric stimulation therapy groups compared to the control group. Neovascularization, collagen density, granulation tissue formation, cell proliferation, and inflammatory cell response of the pulsed electromagnetic fields and electric stimulation group increased, compared to the control group, in the histopathological evaluation (p<0.05). CONCLUSION: Our study results showed the positive healing effects of electric stimulation and pulsed electromagnetic fields on burn injury. Pulsed electromagnetic fields therapy produced more positive signs of healing than the electric stimulation group.

Transsexual Mastectomy: Selection of Appropriate Technique According to Breast Characteristics.

BACKGROUND: Subcutaneous mastectomy for female- to-male transsexuals is usually the first surgical pro- cedure in sexual reassignment. The main objective of subcutaneous mastectomy is to create an aesthetically pleasing male chest contour by removing all glandular tissue while minimizing chest wall scars. AIMS: In this paper, we present our experience with subcutaneous mastectomy performed in female-to- male transsexual patients. The authors recommend their point of view to aid in selecting the most suitable subcutaneous mastectomy technique depending on breast characteristics. STUDY DESIGN: Retrospective cross-sectional study. METHODS: Between March 2011 and December 2014, 52 patients underwent bilateral subcutaneous mastec- tomies (total of 104 mastectomies), performed using the following four techniques: Webster semicircular, concentric circular, vertical, and apron flap. The tech- nique decision depended on the breast size, degree of skin excess, skin elasticity, chest width, nipple areolar complex size and position. RESULTS: Seventeen patients (32.7%) were operated with Webster semicircular, 7 patients (13.5%) with con- centric periareolar, 12 patients with vertical (23%); and 16 patients (30.8%) with the apron flap technique. The overall postoperative complication rate was 13.4%. All patients were satisfied with the aesthetic results of their subcutaneous mastectomies within the follow-up period. CONCLUSION: To obtain higher patient satisfaction with aesthetic results and lower postoperative complication rates, breast characteristics are evaluated in a detailed fashion, while choosing the ideal technique of Female-to-Male (FtM) subcutaneous mastectomy. The presented surgical new algorithm facilitates the selection of the most reliable surgical technique.

Bilateral congenital absence of the opponens pollicis muscle: a case report.

BACKGROUND: Thumb hypoplasia and thenar muscle anomalies are complex congenital conditions that are associated with other congenital anomalies or syndromes. Congenital absence of the opponens pollicis muscle is very rare and is associated with the absence of other muscles. METHODS: A 6-year-old male was referred to our clinic with a provisional diagnosis of carpal tunnel syndrome because electromyography findings at the referring hospital were consistent with this diagnosis. He was unable to oppose his thumbs to his other fingers or grasp objects. All physical examination, electromyography, and magnetic resonance imaging findings were consistent with bilateral absence of the opponens pollicis muscle. RESULTS: The patient underwent bilateral transfer of the extensor indicis proprius tendon. At 1 year after surgery, he had satisfactory thumb opposition on both sides. CONCLUSIONS: Differentiation between congenital muscle anomalies and carpal tunnel syndrome is very important in order to avoid performing unnecessary surgical procedures. We present a case of bilateral congenital absence of the opponens pollicis muscle, which has not previously been reported, and review the literature regarding congenital muscle anomalies of the hand.

Reconstruction of hypoplastic glans and subglanular stricture with fat transfer and release.

Circumcision is a common minor surgical procedure. However, if it is performed by untrained individuals, it may cause serious complications. In this case report, we describe an unusual circumcision complication with subglanular stricture and hypoplastic glans, which we named "exclamation mark deformity," its treatment that involved glans augmentation by fat injection, and results together with further treatment options.

Intraorbital wooden foreign body: clinical analysis of 32 cases, a 10-year experience.

BACKGROUND: We aimed to describe herein the clinical features, diagnosis and treatment of intraorbital wooden foreign body injuries. METHODS: A case series review of orbital injuries managed at Trakya University Faculty of Medicine between 2002 and 2012 was performed retrospectively. The clinical analysis of 32 intraorbital wooden foreign body injuries was reviewed. RESULTS: Among the 32 cases, injuries in 16 were caused by a tree branch, in 10 by a pencil, in 5 by a stick, and in 1 by a bush. With respect to preoperative vision, postoperative vision was improved in 69% of patients. Time lapse from injury to presentation was correlated with the size of the foreign body. The subjects were comparable in etiological factor, and distribution of injury according to orbit was as follows: superior 28%, medial 25%, lateral 22%, inferior 16%, and posterior 9%. Computerized tomography (CT) for foreign body was definitive in 72% (n=23) and suggestive in 28% (n=9). CONCLUSION: The diagnosis of orbital wooden foreign body is difficult because it may be missed clinically and from the imaging perspective. If a foreign body is suspected, optimal patient management should be done. Prior to the surgery, imaging modalities should be maximally utilized. A careful preoperative evaluation, imaging studies, which are event-specific, a high index of suspicion, and rigorous surgery and postoperative care are the keys in the management of orbital wooden foreign body injuries.

Effect of lidocaine on reducing injury in a rat electrical burn model.

Electrical injuries induce progressive tissue loss. We evaluated the effect of lidocaine on tissue necrosis after electrical burn injuries. Forty-two male Wistar albino rats (250-300 g) were divided into 3 groups [Group A (n=6), control group without an electrical burn injury; and Groups B (n=18) and C (n=18), electrical burn injury groups without and with lidocaine therapy, respectively]. Three separate analyses were performed at different time points on 6 of 18 rats from Groups B and C at each time point. Electrical burns were induced by applying 220 V AC between the left upper and right lower extremities for 10 seconds. Myeloperoxidase and malondialdehyde levels were measured in skin and muscle biopsy specimens after the first hour, fresh and dry weight differences in the amputated extremities were calculated after 24 hours, and live and necrotic tissue areas were measured at 7 days after burn injury. We found that lidocaine reduced edema, the number of neutrophils, and neutrophil damage in tissues. We conclude that lidocaine decreased the amount of necrotic tissue caused by electric injury.

Fucoidin, a neutrophil rolling inhibitor, reduces damage in a rat electrical burn injury model.

BACKGROUND: Electrical injuries induce progressive tissue loss caused by free oxygen radicals released from neutrophil aggregates. Fucoidin, a potent inhibitor of L-selectin function, reduces the aggregation of neutrophils. The aim of this study was to evaluate the effect of fucoidin on tissue damage in rat electrical burn injury model. METHODS: Forty-two male Wistar albino rats (250-300 g) were divided into 3 groups (Group A (n=6), control group without electrical burn injury; Groups B (n=18) and C (n=18), electrical burn injury groups without and with fucoidin therapy, respectively). Three separate analyses were performed at different time points on 6 out of 18 mice from Group B and C at each time point. Biochemistry (myeloperoxidase and malondialdehyde levels) and histopathology (number of neutrophils) of the skin and muscle biopsies at 1st hour; tissue edema (ratio of wet weight/dry weight of extremities) at 24th hour; and necrotic areas at 7th day after electrical injury were evaluated. The electrical burn was induced by exposing rats to 220 V AC between their left upper extremity and right lower extremity for 10 s. Fucoidin was administered as 25 mg/kg intravenous bolus injection at 15 min after electrical burn injury. RESULTS: Myeloperoxidase and malondialdehyde levels, number of neutrophils, tissue edema, and necrotic area were significantly less in fucoidin-applied rats than the group without fucoidin therapy. CONCLUSIONS: Fucoidin inhibits tissue damage induced by electrical burn injury in rats by reducing necrotic area, edema and number of neutrophils.

The effects of thermal injury on immature rat ear cartilage.

The purpose of this study was to research regeneration and growing properties of an immature rat ear cartilage and its adjacent tissue after a thermal injury. Fifteen 30-day-old male Sprague-Dawley rats were used. Burn wounds were created by applying a heated plaque. All the rats, based on their tissue sampling day, were placed in two groups for histopathologic evaluation. In group I (n = 5), the burned right auricles were amputated on the first day,and the left auricles were amputated as a control at the same time. In group II (n = 10), the burned right auricles were amputated on the 30th day, and the left auricles were amputated as a control at the same time. Epithelization of skin was completed in period ranging between 12 and 15 days in all burned ears. The skin appendages were few throughout the affected area.Chondroid tissue regenerated from perichondrium and increased capillary vessels were observed.On the first day of the burn injury, electron microscopic findings were karyopyknosis, karyorrhexis, and karyolysis of the nucleus, and there were also signs of necrosis. New chondroblasts were formed around the collagen fibrils in the scar tissue on the 30th day. CD-31 immunohistochemical staining showed increased capillary vessels in the burned ear. The peripheral nerve fibers decreased and regenerative signs of nerves were shown with the use of S-100 immunohistochemical staining. Differentiation of chondroblasts to chondrocytes occurs in the burned immature ear, and new cartilage tissue regenerates from perichondrium. In addition, regenerative signs of nerves appear.

Anthropometric breast measurement: a study of 385 Turkish female students.

BACKGROUND: Anthropometric measurements and proportions of the human body have made a significant contribution to the science of aesthetic and reconstructive plastic surgery. OBJECTIVE: The present study was performed to measure anthropometric breast values in Turkish female students and compare them with those of women in other nations. METHODS: The study included 385 female undergraduate student volunteers between the ages of 18 and 26 years with no physical or developmental deformity and with a body mass index between 20 and 26. A total of 19 parameters were measured in a standing position. The parameters measured were body weight, height, shoulder width, upper chest width, middle chest width, lower chest width, waist width, hip width, clavicle-nipple length, sternal notch-nipple length, nipple-nipple length, upper arm length, medial mammary radius, lateral mammary radius, nipple-inframammary fold length, nipple diameter, areola diameter, nipple projection, and mammary projection. Breast volume, breast ptosis, and retracted nipple rates were also assessed. RESULTS: The mean breast volume was determined to be 407.2 +/- 263.6 cc. The mean values of the right and left breast volumes were calculated as 415.2 +/- 264.5 cc and 399.1 +/- 265.5 cc, respectively; the right breast volume was significantly greater than the left breast volume (P < .001). The ideal external view of the breasts with equal volume for both sides and no ptosis was observed in 35.1% of the volunteers. The percentage of women with unilateral or bilateral retracted nipple was 2.6%. CONCLUSIONS: The results of the present study will help in comparing the anthropometric breast values of young Turkish women with those of women in other countries. They may also be useful either in planning aesthetic and reconstructive breast surgery or in designing breast augmentation accessories and clothing.

Late-onset pulmonary edema and disseminated intravascular coagulation due to latex anaphylaxis.

BACKGROUND: Anaphylaxis after the administration of tissue expanders has been reported. Late onset hypotension, thrombocytopenia, disseminated intravascular coagulation (DIC) and pulmonary edema due to the tissue expanders have not been reported. METHODS: In this case report, late onset hypotension, thrombocytopenia, disseminated intravascular coagulation and pulmonary edema due to the administration of tissue expanders were described. RESULTS: The authors report a 16-year-old girl with burn scar deformities scheduled for reconstruction of the scar contractures with insertion of tissue expanders in which the administration of latex tissue expanders was associated with late onset hypotension, thrombocytopenia, disseminated intravascular coagulation and pulmonary edema. Skin tests performed for latex demonstrated strong positive weal and flare reactions. CONCLUSION: Late onset anaphylactic reactions due to latex tissue expanders, an unusual unpredictable adverse reaction, must be kept in mind. Early recognition and proper emergent treatment are essential to reversing this complication.

Effect of verapamil on reduction of peri-implant capsular thickness.

Silicone is a material commonly used in reconstructive and aesthetic surgery, but capsular formation is a very frequent complication of silicone implants. This study aimed to investigate whether verapamil, a calcium-channel blocker, can reduce the thickness of the peri-implant capsule in rats when it is instilled into the subcutaneous pockets. For this study, 60 female Wistar albino rats were used, and cubes of silicone blocks (10 x 10 x 5 mm) were crafted. The rats were divided into five groups of 12 each, and the groups were distinguished according to the use of silicone and artificially created hematoma relevant to administration of a single dose of 5 mg verapamil (Isoptin). The control group was left without silicone. In two of the four silicone groups, hematoma was artificially created around the silicone by a 1-ml injection of blood. The implants were removed 6 months later, and capsulectomy was performed. Under light microscopic examination, no severe inflammation was observed in any of the capsule tissues. Additionally, the thickness of the capsule was measured and found to be significantly reduced statistically in all the verapamil-treated groups, including the groups with the artificially created hematoma. In conclusion, based on the statistically significant data obtained in this study, subcutaneous verapamil administration may be a useful adjunct for preventing formation of capsular contracture after silicone implantations. This preliminary work in rats should be confirmed with larger mammals before carefully controlled clinical trials are considered.

Reverse-flow retroauricular island flap in facial reconstruction.

BACKGROUND: Reconstruction of facial skin defects requires good-quality skin cover to satisfy aesthetic expectations of patient, especially when the skin defect is on the uncovered area of the face. Limitations in the available local tissue and donor-site morbidity restrict the options. OBJECTIVE: In an effort to solve these problems, we have begun to use a subcutaneous pedicled retroauricular reverse-flow flap. METHODS: Between January 1997 and December 2005, reverse-flow subcutaneous pedicled retroauricular island flap was used to cover facial defects in 12 patients who underwent surgical excision of skin tumor. The patients ranged in age from 44 to 81 years with a mean age of 58 years. RESULTS: Only one case experienced a superficial necrosis in the distal one-quarter part of the flap. The functional and aesthetic results were satisfactory for both patients and surgeons, and no tumor recurrence was observed during the 12 to 28 months (mean, 18.8 months) follow-up period. CONCLUSIONS: This flap can be used reliably for the reconstruction of facial skin defects of small and medium size. The preference of frontal branch pedicled flap enables more distal facial area defects to be covered, such as dorsal nasal, nasolabial, and upper lip, than flaps based on parietal branch.

Microvascular anastomosis with minimal suture and Arista: an experimental study.

BACKGROUND: The conventional technique of microvascular anastomosis may cause trauma to the vessel wall. In addition, the technique is difficult for beginners and is time consuming. The duration of ischemia is an important limiting factor for muscle transfer. In the case of multiple-digit replantations, fatigue developed in the surgeon may also result in suboptimal results. This study was performed to establish an easier and shorter method of microvascular anastomosis using the Arista hemostatic agent. METHODS: In this study, 20 carotid arteries obtained from rats were equally divided into two groups. The arteries were then divided and repaired using three simple interrupted stay sutures with Arista powder. Evaluations were performed using the following three methods: (1) clamping time during the vessel anastomosis, (2) patency test (after 1 hour, 24 hours, and 28 days), and (3) light microscopic findings. RESULTS: The clamping time in the conventional suture anastomosis group was 21+/-4 minutes, whereas that of the minimal suture in the Arista group was 12+/-2 minutes; the difference between the two groups was statistically significant (P<.001). There was no significant difference between the patency rates of the two groups (P= .474). It was observed that the Arista group showed qualitatively less perivascular foreign-body giant cell reaction than the control group. There was no evidence of vascular mural fibrinoid necrosis, indicating that Arista was nontoxic for the vessel walls. CONCLUSIONS: The Arista-assisted microvascular anastomosis is an alternative to the conventional suture-only method because it reduces the anastomosis time significantly and does not cause narrowing of the vessel wall. We believe that this technique has the potential for improving the performance of microvascular anastomosis in clinical practice.

Predictive value of 99mTc-sestamibi scintigraphy for healing of extremity amputation.

PURPOSE: Although various non-invasive procedures have been proposed to determine the optimal level of amputation of limbs in patients who have vascular disease, currently there are no consistent criteria that can be applied before surgery. The purpose of this study was to determine whether (99m)Tc-sestamibi imaging can accurately predict the healing of amputation sites. METHODS: In a prospective study in 26 patients (21 men, 5 women; age range 23-94 years) presenting with ulcers or gangrene of the foot and hand, (99m)Tc-sestamibi imaging was performed preoperatively. The indications for amputation included gangrene (23 patients), electrical injury (2 patients) and trauma (1 patient) of extremities. Although the amputation levels were chosen according to clinical criteria and scintigraphic results, the final amputation level was defined by scintigraphic results. Two below-knee, one above-knee, 12 toe, 11 transmetatarsal, two phalanx, one finger and one thumb amputations and one shoulder disarticulation were performed. In four cases, the amputation defect was not suitable for coverage using a local dermal flap; rather, it was covered with free tissue transfer. Patients had clinical follow-up for 6-36 months (mean 11.69 months) to assess healing of the stump. Scan results were compared with clinical outcome to assess prediction of healing. RESULTS: There was healing in all amputations at the end of the follow-up period. When evaluated regarding preoperative (99m)Tc-sestamibi uptake pattern, there was no perfusion to the lesion site in 21 patients and perfusion to an area smaller than the extent of skin necrosis in four patients; thus, in these 25 patients, (99m)Tc-sestamibi scintigraphy suggested non-viable tissue in the extremities with clear-cut edges of perfused muscle tissue. Diffusely decreased uptake was seen below the left knee in one case. How scintigraphy changed management was analysed. The amputation levels proposed before scintigraphy were divided into two groups, "definite" (n=14) and "indefinite" (n=12), based on visual examination and Doppler findings. In nine patients in the definite group, the proposed amputation level before scintigraphy was not altered by the scintigraphic data. However, (99m)Tc-sestamibi scan enabled unnecessarily high amputation levels to be avoided in 12 patients in the indefinite group and in five patients in the definite group. Therefore, there was change in management of 65% of cases based on scintigraphic findings. CONCLUSION: Since healing of the stump was seen in all cases, outcome was correctly predicted by scintigraphy. This preliminary study supports the use of (99m)Tc-sestamibi scan in selecting the optimal amputation level consistent with subsequent stump healing.