Tension suture technique for skin graft fixation. A novel alternative to tie-over dressing.
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Biomedical subjects
Publications and source records attributed to Onder Tan.
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PURPOSE: Postburn scar contractures are fairly often seen in many parts of the body, and are still a considerable problem for reconstructive surgeons. Although the mild to moderate contractures can easily be managed by numerous surgical methods, serious contractures usually require more comprehensive surgical solutions including multiple Z plasties and rhomboid flaps, each of which have disadvantages. We used a new method called "double opposing V-Y-Z plasty" in this study. This technique is a combination of V-Y plasty with Z plasty in double opposing fashion, both ensuring primary donor site closure. MATERIALS AND METHODS: The technique was applied to 21 postburn scar contractures in 14 patients (9 males and 5 females). The localization most often seen was in the hand. RESULTS: The mean follow-up time was 7.6 months. All flaps healed uneventfully. An adequate lengthening and functional recovery were achieved in all cases. The donor site scars were acceptable in all cases. None of the patients developed contracture recurrence in our series. CONCLUSIONS: Double opposing V-Y-Z plasty, as a good alternative to multiple Z plasties and multiple rhomboid flaps, is a very useful technique to insure more lengthening and to prevent recurrence in the treatment of serious postburn scar contractures.
BACKGROUND: The reconstruction of columellar defects is still a challenging procedure because of limited local and regional flap options and the characteristics of the anatomy of this site. Although a number of methods are available to repair nasal columella defects, no treatment of choice ensuring an excellent texture- and color-matched tissue in one stage has been determined to date. METHOD: In this case, we used a reverse-flow submental island flap prefabricated with the costal cartilage for the reconstruction of a complex columellar defect. RESULT: The flap survived completely with reversible venous congestion. The cosmetic result and nasal respiratory function were acceptable during the follow-up time of 6 months. CONCLUSION: We propose that the prefabricated reverse submental flap may be an alternative among the surgical options for columellar defects. This flap may also be considered in the reconstructive repertoire of other composite defects of the head and neck region.
BACKGROUND: A 16-year-old boy with penilurethra anomaly was admitted to our clinic. This is a case description of a hypospadiac congenital urethrocutaneous fistula of the anterior urethra. METHODS/RESULTS: After the chordee was corrected by removing dysgenetic tissue in urethral plate, urethral defect was repaired with tranverse preputial island flap. CONCLUSIONS: Congenital urethrocutaneous fistula is rare. Thirty-two cases of urethrocutaneous fistula have been reported previously. Embryological events that cause anterior urethrocutaneous fistula are unclear. We reported a case with hypospadiac congenital urethrocutaneous fistula of the anterior urethra treated with tranverse preputial island flap.
INTRODUCTION: Grafts and flaps have been widely used to reconstruct scrotal defects due to Fournier's gangrene. Controversy still exists concerning the use of grafts and flaps because of the low protection provided by the grafts and the high volume of the flaps. We describe the use of an expanded groin flap for scrotum reconstruction. TECHNICAL CONSIDERATIONS: Three patients were treated for total scrotal tissue loss using this method. An expander was installed through an incision from the inferolateral aspect of the groin, and superthin flaps obtained after 3 weeks were dissected starting from the medial side. Care was taken during dissection, because the skin was thin on the lateral side, and dissection was performed in a subfascial fashion. Finally, the defect was covered with the lateral part of the expanded flap and the donor site was primarily closed. CONCLUSIONS: To cover the testes, both the aesthetic and functional state should be taken into consideration. Therefore, a thin and durable cover is required for scrotal reconstruction. The expanded superthin groin flap possesses these features and is a good option.
Macrodactyly is a rare congenital anomaly of the extremities. Some treatments such as debulking, epiphysiodesis, stripping or resection of the digital nerve, shortening of the fingers, amputation, and angulation osteotomy have been tried. We describe a patient with a giant digit in the hand, and present middle phalangectomy as a suitable treatment.
OBJECTIVE: In bilateral cleft lip, there is a characteristic deformity called cleft lip nose characterized by short columella and prolabium with a pressed nose. Although lots of surgical techniques were described for columella lengthening and correction of the nose deformity, no technical method was suggested for prolabium lengthening. STUDY DESIGN: In this paper we propose a simultaneous bilateral cleft lip repair and lengthening of the prolabium, and describe a new technique called "Turkish tulip" for this aim. PATIENTS AND METHOD: Eleven patients (6 males and 5 females) with bilateral cleft lip were treated using this method. Patients' ages ranged from 3 months to 17 years at the time of operation. Five patients had incomplete and six had complete bilateral cleft lips. The patients were evaluated in terms of functional and aesthetic results in postoperative period. RESULTS: : The average follow-up time was 8 months (ranged from 4 months to 15 months). There were no postoperative complications. The prolabium was lengthened adequately in all patients. No notch and whistle deformity was seen in our series. The patient or parent satisfaction was good or perfect in all cases. CONCLUSIONS: To avoid the disadvantage of the long time course required to correct the nose deformity and to lengthen the prolabium, we propose the "Turkish tulip" technique with the primary repair of bilateral cleft lips simultaneously. With this technique it is possible to lengthen the columello-prolabial complex with cleft lip repair in the same session without any intervention to any part of the nose including the columella. As a preliminary study, according to the early results, this new technique seems to have good cosmetic outcomes.
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OBJECTIVE: : Melkersson-Rosenthal Syndrome (MRS) is a rare granulomatous disease characterized by a triad, including orofacial swelling, facial palsy and lingua plicata with usually recurrent or progressive course. Orofacial swelling, the most often sign of MRS, leads to the both esthetic and functional deformities. Because of its unknown etiology, a rational treatment is difficult and management of MRS still remains symptomatic, aiming at to remove orofacial swelling mainly. Although the many nonsurgical therapies have been mentioned in the literature, none has been proved uniformly and predictably successful to date. In this paper, we present different surgical procedures and their outcomes in a series of 4 cases with MRS. The procedures including mucosa, submucosa and tangential muscle resection, crescent shaped commissuroplasty, and facial liposuction may be considered in surgical armamentarium when orofacial swelling becomes persistent. We think that the plastic surgeons may act more effectively in the management of the syndrome in the future.
BACKGROUND: Closure of large meningomyelocele defects presents a challenging problem. In this paper, the procedure and outcome of bilobed fasciocutaneous flap closure of large meningomyeloceles have been discussed. MATERIALS AND METHODS: Bilobed fasciocutaneous flap was used in 20 patients with large meningomyelocele defects, the largest of which was 77 cm2. A fasciocutaneous dissection was performed and the defect area was covered by tension-free closure. RESULTS: In the follow-up period of 6 weeks, partial flap loss in a patient and cerebrospinal fluid leak inferior to the flap in another 2 were observed. These patients recovered by dressing without flap loss. CONCLUSIONS: Utilization of bilobed flaps for closure of large meningomyelocele defects seems to be an effective and reliable procedure, with advantages of decreased operative time, minimal bleeding, the suture lines for dura and flap not superimposed, and low morbidity.
The main aim of this study is to evaluate the advantages, disadvantages, and aesthetic results of the total lower eyelid reconstruction with paranasal flap. The other reconstruction methods are also revisited.Ten patients, who were operated for the reconstruction of total lower eyelid defects between November, 1999 and April, 2005 in our department were included in this study. The total lower eyelid defects of all patients were reconstructed using paranasal flap for anterior lamella and chondromucosal, chondrocutaneous or mucosal graft for posterior lamella. Follow-up time was ranged between 3-35 months. The advantages, disadvantages and complications were defined and aesthetic results of the patients were also evaluated by using a questionnaire which was filled by patients at third month after reconstruction. All flaps and grafts survived, partial or total necrosis was not encountered but one patient with ectropion had a secondary reconstructive procedure. The aesthetic results of the patients were also satisfactory. The paranasal flap is very reliable and safe method for total lower eyelid reconstruction.
Cutis verticis gyrata (CVG) is a very rare morphological condition of the scalp characterized by ridges and furrows resembling the surface of the brain. Primary or idiopathic CVG occurs in the absence of underlying soft-tissue abnormalities and is often associated with neuropsychiatric disorders. Secondary CVG occurs as a result of a local inflammatory or neoplastic process of the scalp or a systemic illness that produce pathologic changes in the scalp structure. The choice of treatment of CVG is surgical repair which depends on the size and location of the lesion, the underlying disorder, and the wishes of the patient, including primary repair, serial excision, skin grafting, local flaps and tissue expansion. In this case report, we describe the first female patient in the published work with primary essential CVG that appeared at 30 years of age. Because the patient had no cosmetic or functional complaint, no surgical intervention was attempted. Primary essential CVG, a very uncommon disorder, may be encountered in females after the third decade. The classification of CVG is essential to properly diagnose and treat patients who present with these unusual scalp lesions.
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The management of soft-tissue defects in the lower third of the leg and foot presents a considerable problem because of composite tissue defects, inadequate and tight local tissue for reconstruction, and poor circulation. Although the reverse sural flap is frequently preferred and is fairly reliable, some complications arising from the circulation may be encountered in large flaps or in diabetic patients. In the present study, we developed a new modification by supercharging the sural flap to reduce venous congestion and edema and to increase the reliability of the flap. We treated 3 patients (2 men and 1 woman) by utilizing a supercharged reverse sural flap. All flaps survived and healed uneventfully. We also suggest a new and more distinctive classification for supercharging and turbocharging, which defines the vessel type to be anastomosed and the relationship of the vessel to be anastomosed with the main vessel to the flap.
Melanotic neuroectodermal tumor of infancy (MNTI) is an uncommon, fast-growing, pigmented neoplasm of neural crest origin; it primarily affects the maxilla of the infants during the first year of life. Approximately 200 instances of this tumor are reported in the medical literature. We present a case of newborn with MNTI on the left maxillary alveolar ridge. The patient underwent complete surgical resection without maxillectomy. There has been no recurrence in a follow-up period of 1 year. The diagnostic features and management alternatives of MNTI are discussed.
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