Plastic Surgery

Amlodipine improves skin flap viability in rats exposed to nicotine Fatih Irmak, Isil Akgun Demir, Selami Serhat Sirvan, Soysal Bas, Semra Karsidag, Aysim Ozagari Turkish Journal of Plastic Surgery 2019 27(3):93-97 Background: A recent series of experimental and clinical studies have demonstrated the negative effects of nicotine such as ischemia and necrosis of skin flaps. In order to overcome the negative effects of nicotine numerous studies have been conducted with various agents and methods. In this study, we investigated the effects of amlodipine (AML) on flap survival in nicotinized rats. Materials and Methods: Thirty Sprague Dawley rats were randomly divided into three groups: Group A nicotine; Group B nicotine + AML; Group C control group. The rats in Group A and B have received nicotine for 4 weeks before the surgical intervention. At the end of the 4th week, MacFarlane flaps were elevated and adapted back by suturing in all groups. In Group B, AML has been administered to the rats after the surgery and continued for 10 days. All the flaps were visualized with fluorescein angiography and underwent histopathological assessment. The necrotic areas of the flaps were measured as well. Results: The necrosis rate in Group A was found to be significantly higher compared to Group B (P< 0.001). The perfusion rates in Group B were found to be significantly higher when compared to Group A (P < 0.05). Vascular proliferation was found to be significantly higher in Group B compared to Group A and C (P < 0.05). Vasodilation rates were significantly higher in Group B and C (P < 0.05). Conclusions: AML was found to be useful to enhance flap survival in nicotinized subjects. Its clinical use might be promoted in the future with the help of further studies supporting our findings.

First dorsal metacarpal artery flap a workhorse for reconstruction of selected small defects of the hand Shende K Nilesh, Puri Vinita, Patil Chaitanya, Patil Deepak, Palsule Shilpshree Turkish Journal of Plastic Surgery 2019 27(3):98-103 Background: The first dorsal metacarpal artery (FDMA) flap is used mainly for reconstruction of thumb defects. We share our experience of this flap for various defects of thumb and also its use to cover other defects. Materials and Methods: Case records of 15 patients with FDMA flap between October 2015 and February 2018 at our center were analyzed retrospectively. Data were analyzed for etiology, associated comorbidities, interval between injury and operation, site of defect, harvesting technique, and inclusion of dorsal interossei muscle cuff, complications, donor-site morbidities, and postoperative sensory recovery. Results: Of 15 patients, 13 were male and 2 were female. Eleven patients had a posttraumatic defect, 2 had post-electric burn defect, 1 had a firecracker injury, and 1 had a post snakebite defect. Of 15 patients, 12 patients had thumb defects, 1 patient with defect of first web space, 1 on volar aspect of palm, and 1 on the dorsum of hand over the head of third metacarpal. All patients showed protective sensations and 6 patients with 12-month follow-up showed minimum of 9 mm of two-point discrimination with no donor-site morbidity. Conclusions: The FDMA flap has a constant anatomy, easy dissection, and shows good functional and esthetic results. FDMA flap is the first treatment of choice for defects of the thumb, but it can be used for selected small defects of hand due to its wide arc of rotation.

Ellipsoid modification of extended soft triangle graft for the treatment of alar retraction and soft triangle deficiency Sevgi Kurt Yazar, Memet Yazar Turkish Journal of Plastic Surgery 2019 27(3):104-106 Background: Alar notching, retraction, or soft triangle deformities have an important impact on rhinoplasty outcome. In this paper, we present the results of an anatomical graft used to correct alar notching and the deformity in the soft triangle region. Patients and Methods: Twenty-four patients were included in the study (10: Female, 14: Male). Following the open rhinoplasty steps, the harvested cartilage grafts were reshaped in an ellipsoid fashion with a width of 0.5–1 mm, a height of 4–6 mm and a length of 1.5–2 cm. These prepared grafts were placed under the intermedial crus and caudal part of the lateral crus. Results: In all patients except one, alar notching and soft triangle deficiency were successfully treated. In one patient, minimal notching persisted following the surgery and the patient did not want any revision surgery. We did not encounter gross absorption, graft exposure, graft visibility, or recurrence of deformities in any patient. Conclusion: We think that this technique can be used in alar notching and soft triangle deformities whether for prophylactic or therapeutic purposes.

An Academic Picture of Plastic Surgery from Past to Present: Bibliometric Analysis of Turkish Plastic Surgery Literature in International Journals (1976–2018) Ahmet Demir, Tonguc Isken Turkish Journal of Plastic Surgery 2019 27(3):107-122 Introduction: In this study we aimed to analyze the international and Turkish contribution of the plastic surgery literature in the last 42 years and compare results to each other. Materials and Methods: Web of Science online library (v.5.30) was used as a database. Papers that published between 1976-2018 were analyzed for both international and Turkey separately in terms of distribution of papers according to the years, rankings of source countries, rankings of source organizations, publishing journals, numbers of citations and contributing authors. Results were presented as numerical data. Results: Rohrich RJ is in the first place with 743 publications in the field of plastic surgery history. In the ranking of countries contributing to the plastic surgery literature, Turkey ranks 4th standings. Conclusions: Publishing papers in highly populated journals would add on the papers itself is a false belief. In recent years Turkey's contribution to the international plastic surgery literature has as decreasing trend. Repeating of this type bibliometric analyze studies every five 5 year may aid to understand academical progresses and trends better for both international arena and Turkey.

Child injuries in the Syrian Civil War Ahmet Kahraman, Mustafa Ozkan, Muzaffer Durmus Turkish Journal of Plastic Surgery 2019 27(3):123-126 Objective: During wars, many soldiers and civilians either get injured or die. In civil wars, older people, women, and children are more vulnerable to injuries and traumas. The aim of this study is to reveal the demographic features and variety as well as the characteristicsof the injuries in children who were impacted from the Syrian civil war and underwent surgeries in the plastic, reconstructive and aesthetic surgery department. Patients and Methods: This is a retrospective study which initially included 121 children aged 0–18 years out of a total of 402 Syrian patients treated in the plastic, reconstructive and aesthetic surgery department between December 2011 and December 2016. Results: Of 83 children with war injuries treated in our clinic, 42% were female and 58% were male. Forty-one percent of the injuries were located in the head-neck region. 43.4% of the injuries were due to burns. Thirty-six percent of the injuries were located on the extremities. All the patients underwent a total of 242 surgeries. The mean number of surgeries per child was 2.9. The mean time of hospitalization was 17.12% days. Conclusion: The results of the study show that children are impacted just as much or more thanadults in the Syrian civil war and had more severe injuries than those effected by similar wars and terrorist attacks.

Perineoscrotal reconstruction following fournier's gangrene using the upper medial thigh perforator flap Fatih Irmak, Selami Serhat Sirvan, Mert Sizmaz, Sevgi Kurt Yazar, Arzu Akcal, Semra Karsidag Turkish Journal of Plastic Surgery 2019 27(3):127-131 Background: Fournier's gangrene (FG) is a synergistic necrotizing fasciitis that involves the genitalia, perineum, or anal region and can be life threatening and generally necessitates urgent surgical intervention. It often causes scrotal defects that require reconstruction after surgical debridement. The reconstruction of these serious scrotal defects poses certain challenges for surgeons. In this study, reconstruction of scrotal defects caused by FG with medial circumflex femoral artery perforator (MCFAP) flap evaluated. Patients and Methods: Seventeen patients with FG reconstructed using a MCFAP flap, admitted to our hospital between February 2003 and March 2017, are included in this study. Reconstruction with MCFAP flap results, mean debridement number, comorbid diseases, and length of hospital stay are analyzed together. Patients with FG reconstructed using techniques other than MCFAP were not included in this study. Results: Eighteen MCFAP flaps were performed in 17 patients. The mean duration of operation was 2 h 55 min. Diabetes mellitus was the most common comorbid disease. The mean days of hospital stay were 19.9. Total flap loss was not seen in 17 patients. Donor area of the flap is closed primarily, by V-Y advancement flaps or by split-thickness skin grafts. Acceptable cosmetic results and scrotal contours were obtained in all patients. No major complications were observed. Conclusions: Using a MCFAP flap, a method that has minimal donor site morbidity, requires single session surgery, provides good skin quality and color similar to the scrotum, is an easy-to-perform process, proving to be a reliable flap for scrotal reconstruction.

Reconstruction after Fournier gangrene: Our approaches and outcomes Bilgen Can Turkish Journal of Plastic Surgery 2019 27(3):132-136 Context: Fournier's gangrene is a necrotizing infection of the perianal region and scrotum. It progresses quite quickly and is fatal. Treatment involves debridement of the necrotized tissues, broad-spectrum antibiotherapy, and fluid replacement therapy. Delayed reconstruction can be planned after clinical stabilization. While there is a wide range of reconstruction options, no ideal method is applicable to all patients. Aims: By presenting our results for Fournier's gangrene reconstruction surgery at our center, we aim to discuss surgical approaches for the condition, and their pros and cons. Settings and Design: Retrospective analysis. Subjects and Methods: Sixteen patients who underwent Fournier's gangrene reconstruction in 2014–2018 at Balıkesir Atatürk City Hospital were analyzed retrospectively. The mean age, defect size and location, concomitant diseases, mean time to reconstruction, reconstruction method, hospital stay after reconstruction, and complication rates were reported. Results: All patients were male. The most common comorbidity was diabetes mellitus (75%). The mean time to reconstruction was 48.4 days. Scrotal flap alone was the most common reconstruction method (56.25%). Bilateral superomedial thigh flap was used in four patients with total scrotal defect (25%). Gracilis musculocutaneous flap was combined with scrotal flap for three patients (18.75%), with defect extending to the perianal region. The mean hospital stay after reconstruction was 8.6 days. Two patients (12.5%) developed wound dehiscence. Conclusions: No ideal method is applicable to all patients. Rather, the patient age, expectations, and general condition; defect characteristics; and the surgeon's experience determine the ideal method.

Giant Schwannoma of the ulnar nerve compressing ulnar artery Gokay Baykara, Galip Gencay Ustun, Koray Gursoy, Muzaffer Caydere Turkish Journal of Plastic Surgery 2019 27(3):137-139 Schwannomas are peripheral nerve tumors that have a relatively slow-growing pattern usually presenting with compressing symptoms. Treatment is excision of mass, but it is important to decide whether radical excision/nerve grafting or nerve-sparing surgery using intra/extracapsular approach should be performed. Besides that, scarification or preservation of nerve fascicles inside the capsule should be considered during surgery. A case with a giant Schwannoma of the ulnar nerve is presented. Tumor was excised using intracapsular approach enabling salvaging of ulnar artery and healthy ulnar nerve fascicles. Patient's early and late postoperative neurological examination did not show any decline compared to preoperative examination. Intracapsular excision makes preservation of healthy fascicles possible while allowing total excision of the mass. Scarification of the fascicles inside the neural sheath of the tumor results in no neurological deficit. The aim of this study is presenting a case diagnosed in the late course with accompanying neural and vascular pathologies, and reviewal of possible treatment methods for maximizing neurological outcome while minimizing relapse.

A case of a mandibular body fracture complicated with odontoid fracture Nilufer Bahadirli, Mustafa Hanci, Mustafa Keskin Turkish Journal of Plastic Surgery 2019 27(3):140-142 Mandibular fractures are the most common fractures of facial bones. If the fracture is detected and the occlusion is affected, surgery is the best option. Motor vehicle accidents and fall injuries are the most common reasons for combined injuries of maxillofacial and cervical spine (c-spine). The most common scenario is the cooccurrence of midfacial trauma and upper c-spine injuries. Despite the low incidence of the cooccurrence of spinal injuries and maxillofacial trauma, it is crucial to have guidelines that assess and manage this situation because of its severe outcomes.

A rare condition to keep in mind: Pyoderma gangrenosum after breast reduction Nilufer Bahadirli, Mustafa Sutcu, Mithat Akan Turkish Journal of Plastic Surgery 2019 27(3):143-146 Pyoderma gangrenosum is a rare inflammatory disease, characterized by ulcers with purple-colored borders and erythematous halo. Clinically, the patient has fever and severe local pain. Pyoderma gangrenosum can occur after any surgical procedure and the diagnosis is usually delayed. It is important for surgeons and infectologists to be watchful about this rare condition because if misdiagnosed, it has serious results including severely painful ulcerations, prolonged therapy, repeated hospitalizations, psychological trauma, and extensive scarring. The authors report a postsurgical pyoderma gangrenosum case after reduction mammoplasty. This report emphasizes on the importance of awareness about this uncommon disease and its diagnosis.