A severe form of Volkmann contracture is associated with loss of flexor and extensor compartment muscles. An 11-year-old boy with Volkmann contracture was admitted to our clinics with flexion contracture of the wrist joint and total loss of flexor and extensor muscle functions. Split latissimus dorsi free flap was used for reconstruction. The muscle was split based on the branching of thoracodorsal nerve and artery within the muscle so that each part of the muscle is nourished and innervated by a branch of thoracodorsal nerve and artery. No complication has occurred, and the patient can now grasp objects, although he cannot achieve full range of motion of the fingers. We performed a single muscle transfer for reconstruction of both the extensor and flexor compartments in severe form of Volkmann contracture and omitted the use of a second muscle transfer, thus greatly decreasing the operative time, cost, and morbidity.

Child↗

PubMed2006

Clinical experiences with a new tourniquet device.

Cessation of blood flow to the extremity improves the comfort of the surgeon. So pneumatic tourniquets are commonly used to obtain a bloodless field during upper- and lower-extremity surgery despite the several problems that tourniquet pressure may lead to. In this paper, we present our clinical experiences with a new tourniquet device called S-MART (OHK Medical Devices, Haifa, Israel) and compared the device with the traditional pneumatic tourniquet in terms of efficacy and complications. A total of 30 patients were included in the study. Preoperative systolic blood pressure measurements were obtained, and patients with a systolic blood pressure >190 mm Hg were excluded. S-MART was used in stead of pneumatic tourniquet in half of the patients in group 1. Pneumatic tourniquet was applied to the patients in group 2. The patient groups were compared. No major complications were observed in either group. But it was observed that S-MART was unsuccessful to maintain a bloodless field during the whole operative procedure in some of the cases. In conclusion, application of S-MART is practical, provides bloodless field for a certain time, and does not increase the complication rate related with the pressure applied to underlying tissues, but it is not a suitable tourniquet device for long surgical procedures.

Adult↗

PubMed2006

Vascular anatomy of the lateral pterygoid muscle.

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Hemodynamics↗

PubMed2006

An alternative dressing material for the split-thickness skin graft donor site: oxidized regenerated cellulose.

The split-thickness skin graft (STSG) donor sites have been treated with various and plenty of dressing techniques and materials. An ideal STSG donor site dressing should have antibacterial, hemostatic, and promoting epidermal healing properties. We have performed a prospective study to evaluate the effect of the oxidized regenerated cellulose on STSG donor site healing. Between January 2002 and January 2005, 40 patients who were operated in any kind of reconstructive operations with STSG donor sites were included in the study. One half of the wound was covered with oxidized regenerated cellulose and the other half of the same wound of the same patient was covered with fine mesh gauze treated with Furacin (nitrofurazone). The patients were grouped into 2 depending on the dressing technique: group I, semiclosed and group II, closed. The wounds were evaluated for healing time, infection, pain perception of the patient, and final esthetic results. The oxidized regenerated cellulose side of the group I was healed in a mean of 6.5 +/- 0.51 days; in group II, 5.4 +/- 0.50 days (range, 5-6 days). The fine mesh gauze treated with Furacin in group I was healed in a mean of 9.9 +/- 0.97 days (range, 8-11 days); in group II, 8.4 +/- 0.99 days (range, 7-10 days). There was a statistical significance between the oxidized regenerated cellulose side and the fine mesh gauze side (P < 0.001) in group I and group II separately. The difference between group I and group II was statistically significant in the oxidized regenerated cellulose side (P < 0.001), and the difference between group I and group II was statistically significant in the fine mesh gauze side (P < 0.005). The antibacterial, hemostatic, and absorbable property of the oxidized regenerated cellulose could ensure the utilization as an alternative STSG donor site dressing, especially because the positive influence over the wound healing was proven.

Absorption↗

PubMed2006

Flexor pollicis brevis adductorplasty: an alternative method in ulnar nerve paralysis.

Loss of pinch power associated with loss of coordinated movement of thumb and index fingers is the major disability in patients with ulnar nerve paralysis. Several tendon transfer methods utilizing different donor muscles have been used to restore adductor pollicis muscle function in ulnar nerve paralysis. In this paper, we discuss the transfer of flexor digitorum brevis muscle to the tendon of adductor pollicis muscle as an alternative method to restore key pinch in ulnar nerve paralysis. The technique was applied to 4 patients with ulnar nerve paralysis. Before clinical application, an anatomic study was carried out in 6 cadaver hands. In cadavers, radial and ulnar arteries were injected with latex and arterial pedicles of flexor pollicis brevis muscle were dissected under 4x magnification. Also, motor branches from the median nerve were shown at the entrance point to the muscle. In surgical practice, the superficial head of the muscle is detached from its insertion and the minor pedicle of the muscle is cut. Muscle is dissected proximally up to two thirds of its length. The dominant pedicle of the muscle originating from superficial palmar arcus is preserved, and the muscle is sutured to the tendon of the adductor pollicis muscle close to its insertion. Patients were evaluated in terms of key pinch strength preoperatively and at the postoperative sixth month using a pinch meter (Chattanooga Group, Inc). Key pinch strengths were recorded and expressed as percentage of the strength of the contralateral uninvolved hand. Mean key pinch strength of our patients was 29.7%. In conclusion, we believe in that flexor pollicis brevis adductorplasty may be an alternative method for restoration of adductor pollicis muscle function in ulnar nerve paralysis.

Adult↗

PubMed2006

Unusual and giant tumors of head and neck region.

Head and neck tumors can reach to massive dimensions if patients are uneducated and ignorant about the disease. Resection of such giant tumors creates a significant functional and aesthetic loss due to proximity of vital structures in head and neck region. Reconstruction of these complex defects is a demanding procedure and postoperative results are not always excellent in terms of function and aesthetics. We have reviewed a group of patients with giant head and neck tumors treated in our department. Postoperative results were evaluated in terms of function and aesthetic appearance. Postoperative functional results were good in most of the patients and aesthetic results were acceptable. Early diagnosis and excision of the tumors in head and neck region decrease the morbidity of the disease. Treatment should be planned on individual basis. Most of the patients with head and neck tumors are elderly patients with additional medical problems so reconstructive procedures should be selected by taking this in consideration. Complex and long-lasting operations should be reserved for young patients.

Adult↗

PubMed2006

Two extreme conditions of xeroderma pigmentosum.

Two atypical cases of xeroderma pigmentosum are reported. One of these cases with lung metastasis of squamous cell carcinoma in the first decade of life and the other with late onset disease (XP) in fifth decade of life. Lung metastasis of squamous cell carcinoma in first decade of life in patients with xeroderma pigmentosum has never been reported in the literature to our knowledge. Late onset of the disease in fifth decade is also a rare condition. Clinicians should be more alert for the internal organ metastases to improve the survival of the patients and should never forget that xeroderma pigmentosum has got a wide range of clinical presentation.

Carcinoma, Squamous Cell↗

PubMed2006

Giant pleomorphic adenoma of soft palate leading to obstruction of the nasopharyngeal port.

Pleomorphic adenoma is the most common tumor of minor salivary glands, but it is rarely located in the soft palate. It is generally a small mass at the time of diagnosis, but if it is neglected it can rarely become larger, leading to obstructive symptoms such as snoring, hypernasal speech, and dysphagia. Surgical removal of the mass is curative. In this paper, we present a case of an unusually large pleomorphic adenoma of the soft palate leading to snoring and hypernasal speech. The defect that resulted from the excision of the mass is covered with a uvular flap.

Adenoma, Pleomorphic↗

PubMed2006

Epidermodysplasia verruciformis: an unusual presentation.

BACKGROUND Epidermodysplasia verruciformis (EV) is a rare autosomal recessive genetic disorder of the immune system manifested by increased susceptibility to cutaneous human papillomavirus (HPV) infection beginning from the early years of life, and compromising lesions resembling flat warts, especially on the distal extremities and the face; but malignant transformation occurs in sun-exposed areas within the third or fourth decade of life. OBJECTIVE We describe two case reports of epidermodysplasia verruciformis, one of which was onset and had more aggressive features than the usual presentation. METHODS Intermittent surgical excision of the tumoral lesions were performed in the first case, whereas only one surgical intervestion was sufficient in the second case. RESULTS The early onset case was more aggressive, and new tumoral lesions were seen, whereas the other patients was free of the disease for 2 years.CONCLUSION Epidermodysplasia verruciformis possess multi factorial etiologies, and the main prognostic factor of the behavior of the disease may be the family history and genetic susceptibility.

Adolescent↗

PubMed2005

An alternative method of vein anastomosis with fibrin glue.

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Anastomosis, Surgical↗

PubMed2005

Rhabdomyomatous mesenchymal hamartoma.

The authors report the case of a 6-month-old boy seen at Ankara Numune Hospital because of a papillomatous lesion centrally located on the chin. The lesion was excised under local anesthesia, and histologic examination revealed numerous eccrine glands and muscle bundles, neuronal tissues, and fatty tissue covered by stratified squamous epithelium. According to the histologic findings, the lesion was diagnosed as rhabdomyomatous mesenchymal hamartoma, which is known to be a rare lesion of childhood.

Adipose Tissue↗

PubMed2005

[Crush injuries of the hand.].

BACKGROUND: To carry out a pilot study on the epidemiology of the crush injuries of the hand in our country and to obtain valuable data that will be used for construction of a protective program in the future. METHODS: 124 patients with crush hand injuries were observed retrospectively based on medical records in terms of age, sex, field of work, parts of body affected by the injury, mechanism and underlying causes of the injury RESULTS: Most of the patients were in 0-18 year- age group and inserting the hand into the working machine was the leading cause of injuries. Eighty seven male (70,16% ) and 37 (29,84 %) female patients were included in the study. Most of the patients (44,1%) were working in wood industry at the time of the accident. Interestingly only one hand of all patients were injured. Most commonly injured finger was the middle finger. Most commonly encountered pathology was the tendon laceration in injured fingers. CONCLUSION: Most of the cases were due to lack of attention and education and could be prevented by simple precautions and by wide-spread work education programs leading to a marked decrease in health expenses and loss of man power.

Adolescent↗

PubMed2004

Phenol intoxication in a child.

Phenol preparations are used in dermatology and plastic surgery for the treatment of acne and during chemical face peeling. At this institution, phenol peeling is used in addition to mechanical dermabrasion for the elimination of subclinical premalignant lesions of patients having xeroderma pigmentosum. As the phenol peel is performed, most surgeons concentrate on skin results, ignoring systemic complications. Local histological changes and systemic toxicity have been seen during applications. Cardiac arrhythmias and even sudden death have been reported. The high incidence of cardiac arrhythmias after topical application of phenol preparations is demonstrated. The case of an 11-year-old boy with a diagnosis of xeroderma pigmentosum who underwent mechanical dermabrasion and chemical peeling with phenol and then developed severe cardiac arrhythmias is reported. A serious systemic toxic effect on cardiac rhythm from cutaneously applied phenol occurred in this case.

Arrhythmias, Cardiac↗