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Keles, Musa K/0000-0003-1915-079X WOS: 000402945600013 PubMed: 28571070 Among aesthetic surgery procedures, rhinoplasty is one of the most common. Preoperative simulations have become increasingly commonplace through the recent years along with a controversy regarding their use. Although capable of building a solid rapport between the surgeon and the patient by visualizing the end result, it can also prove to be a liability for a surgeon who is not confident about delivering the result which has been put on screen. The objective of this study is to evaluate the outlook of the surgeons and patients on preoperative simulations. Plastic surgeons who perform rhinoplasty and individuals who consider rhinoplasty were surveyed via an online questionnaire system. Their opinions about the practice of simulation were questioned and they were asked to distinguish between simulated and actual postoperative results. Statistical analyses were performed using SPSS software. Major factors influencing the decision-making process of patients were the availability of preoperative simulation, being shown appealing results of the surgeon's previous work and a personal reference from a patient with an appealing result. Within the health care professionals, it has been observed that experienced surgeons are more confident about using simulations, while inexperienced ones are daunted by being bound with a visual contract (p < 0.05). However, it has been noted that the preference of withholding the simulation or providing a copy to the patient was similar in all experience levels (p > 0.05). In conclusion, our findings suggest that the patients' self-consciousness regarding preoperative simulations seem to grow faster than the surgeons' confidence in their use. Level of evidence is Level V.

Introduction This article aims to expand the microsurgical treatment options for extremity degloving injuries with perforator artery repairs of the specific degloved angiosomes in upper and lower extremity. Methods Fourteen perforator arteries were repaired in seven patients. Four of them had circumferential degloving and 3 of them have non circumferential degloving injury. All had repair of the perforator arteries of the specific degloved segments. Four patients had additional vein repairs but none of the patients had AV shunts. Results All perforators provided adequate arterial supply to their specific angiosomes with some necrotic areas in neighboring angiosomes. Conclusions Perforator artery repair within the degloved tissues provides a direct arterial supply successfully even if one could not find an intact venous plexus.

In addition to soft tissue and bone tissue injuries as a result of high-energy trauma against the lower extremities, serious tissue losses may occur following tumor surgeries. For the reconstruction of this region, there are various options. The preferred methods of reconstruction vary with respect to the experience and knowledge of the surgeon. In this case, the mega prosthesis used following a tibia tumor resection by virtue of local flaps is discussed. [Hand Microsurg 2016; 5(2.000): 92-95]

No surgical procedure is free of complications; however, some of these complications are unintentional. Plastic surgeons may be unfamiliar with certain complications after rhinoplasty operations. In this study, we aimed to present four unintentional complications that have occurred in our patients and review the literature related to these complications. In this study, we conducted a review of 1400 patients who were operated on from 2007 to 2015. The medical recordings of all patients were investigated. Four patients with unintentional complications after rhinoplasty operations are presented and the related literature was reviewed. Cases 1 and 2: These patients included a 26-year-old woman and a 30-year-old man who developed herpes simplex virus (HSV) infections after a primary septorhinoplasty. Case 3: This was a 25-year-old woman who developed periorbital emphysema after a primary rhinoplasty operation. Case 4: This was a 22-year-old woman who developed a second-degree burn on the nasal dorsum. All patients healed without sequel or scars. Many unexpected complications have been reported in the literature. Some of these complications include bleeding disorders, allergic reactions, dermatitis, visual loss, gastric bleeding, benign paroxysmal positional vertigo, false aneurysm after rhinoplasty, pneumocephalus, Tapia’s syndrome, cavernous sinus syndrome, and skin reactions to prolene. Meticulous patient histories, consistent surgical routines, careful radiologic examinations, and frequent patient visits can help surgeons control these types of complications. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Case: A patient sustained a high-energy trauma that resulted in amputation of the middle and ring fingers, along with injuries to the thumb and the index finger. The amputations were not clean; therefore, heterotopic replantation of the best amputated part of the finger to the most functional stump was undertaken. Transarticular replantation was done at the level of the proximal interphalangeal joint without osseous fixation. Early active motion was initiated the next day. The replanted finger had excellent function. Conclusion: Whenever possible, designing a heterotopic transarticular replantation can minimize the functional drawbacks resulting from the prolonged immobilization often associated with fracture fixation. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

Background There are many variables that influence nose tip harmony. Even in a rhinoplasty that appears successful in profile, one may see nostril asymmetries, alar retractions, or irregularities in the soft triangle, and patients express their dissatisfaction with these simple deformities. Objectives In this study, we define the ratio of caudal and cephalic excess of the lower lateral cartilage. We evaluate whether it is possible to eliminate nostril asymmetries and alar retractions by means of supporting the facet polygon with the help of a lower lateral cartilage auto-rim flap, a technique we have developed in our rhinoplasties. Methods The auto-rim flap was used successively on 498 primary rhinoplasty patients on whom the same surgeon operated between May 2013 and June 2015, performing marginal incisions. Results Of the 498 patients in the series, only 1 of the first 10 required a revision due to tip asymmetry related to the auto-rim flap. A minimal nostril asymmetry that did not require intervention occurred in 10 patients. In none of the patients could an increased alar retraction be seen postoperatively. All patients exhibited alar cartilage in the anatomically correct position. Conclusions With the auto-rim flap technique, a part of the caudal excess of the alar cartilage remains as a flap in the facet region; therefore, there is no need in the cephalic region to perform more of an excision than what is strictly necessary. Level of Evidence 4![Graphic][1] Therapeutic [1]: /embed/inline-graphic-1.gif

Demir, Ahmet/0000-0002-8820-3122 WOS: 000415085100083 PubMed: 27258706 Nasal tip support is critical to achieve a lasting result in rhinoplasty. In this article, the authors compared the effects of strut grafts (SG) and caudal septum-based nasal tip supporting techniques (CSB-T) in terms of reaching the desired tip projection. Included in this study were 40 patients (24 women and 16 men) who underwent primary open rhinoplasty via transcolumellar incision between January and June 2012. To achieve a good nasal projection, SG and CSB-T were used for 15 and 25 of these patients, respectively. Certain anatomic landmarks were identified on preoperative, simulative, and 1-year follow-up photos. With these landmarks, certain angular and proportional values were calculated. In the SG, the authors found no statistically significant difference in between simulative goals and postoperative results regarding bending angle. Postoperative nasolabial angle (NLA), tip angle, subnasal-tip/subnasal-radix (SnT/SnR) ratios were significantly lower than the simulation values; radix angle and supratip index values were significantly higher. In the CSB-T group, the authors found no statistically significant difference in between preoperative values and postoperative results regarding NLA, tip angle, bending angle, (SnT/SnR) ratio values. Postoperative supratip index and radix angle measurements were found to be significantly higher than the simulation values. With these findings, the authors concluded that CSB-T support is superior than the SG for supporting the nasal tip in noses that also need shortening in caudal length. In noses that do not need caudal shortening, nasal tip projection can again be supported by the caudal septum by just forming a bridge between lower lateral cartilage and quadrangular septum using a wider SG that mimics septal extension grafts.

Demir, Ahmet/0000-0002-8820-3122; Keles, Musa K/0000-0003-1915-079X WOS: 000374761200010 PubMed: 26967097 Maxillofacial traumas with long-barreled guns may sometimes cause catastrophic results by means of smashing in facial structures. In these patients, reconstruction strategies of both fragmented/lost soft and hard tissues still remain controversial. In their clinic, the authors treated 5 patients with severely injured face after failed suicide attempt between 2008 and 2013. In this study, the authors aimed to present their clinical experiences on these severely injured maxillofacial gunshot traumas and offer a treatment algorithm to gain a result as possible as satisfactory in terms of functionality and appearance.

Keles, Musa K/0000-0003-1915-079X; Demir, Ahmet/0000-0002-8820-3122 WOS: 000374509700003 PubMed: 26919381 Background Epigallocatechin gallate (EGCG) is a substance abundant in green tea. In this study, the effects of EGCG on, perforator flap viability were investigated. Methods A total of 40 rats were assigned to four groups of 10 each. In each subject, a 4 x 6 cm abdominal skin flap was raised and adapted back onto its place. In the control group, no further procedures were taken. In the flap group, 40 mg/kg/d EGCG was injected into the flap. In the gavage group, 100 mg/kg/d EGCG was given through a feeding tube. In the intraperitoneal group, 50 mg/kg/d EGCG was injected intraperitoneally. On the 7th postoperative day, flaps were photographed and the viable areas were measured and compared via a one-way analysis of variance. Results The ratios of viable and contracted flap area were 9.15/12.01, 4.59/16.46, 11.56/11.20, and 11.65/10.77 cm(2) for the control, flap group, gavage group, and intraperitoneal group, respectively. While the flap group yielded the worst results in the sense of flap contraction and viability (p < 0.001), the gavage and intraperitoneal groups were significantly better than those of the control group (p = 0.03). Histologically, epidermal, papillary dermal, and capillary tissue volumes were evaluated. In comparison to the control group, the flap group yielded significantly increased epidermal and dermal volumes (p = 0.03), however, these values were significantly decreased (p = 0.04) in the gavage and intraperitoneal groups. Capillary volumes were significantly decreased in EGCG treatment groups (p < 0.01). Conclusion Our experiment has shown that oral and intraperitoneal administration of EGCG increases the perforator flap viability when compared with controls, while direct injection decreases the viability. Ondokuz Mayis University Faculty of Medicine Scientific Research Projects FoundationOndokuz Mayis University [PYO.TIP.1904.13.028] The grant for the study was granted by the Ondokuz Mayis University Faculty of Medicine Scientific Research Projects Foundation (grant no. PYO.TIP.1904.13.028).

Demir, Ahmet/0000-0002-8820-3122; WOS: 000367303700001 PubMed: 26710014 Background: Early degradation is a common complaint for hyaluronic acid fillers. Although the combination of hyaluronic acid fillers with botulinum neurotoxin type A presented improved clinical results, objective measurement of hyaluronic acid volumes has not been previously assessed. Methods: In this study, the authors have split the calvaria of the rabbit to mimic the glabellar region in humans. In this model, the authors applied hyaluronic acid alone to one side and hyaluronic acid combined with botulinum neurotoxin type A to the contralateral side. Two days and 3 months after the filler injection, magnetic resonance imaging was performed to assess the filler volumes. Results: Average initial volume of filler only and filler combined with botulinum neurotoxin type A was 0.61 cm(3) on both sides, and there was no difference between initial volumes of the two sides (p = 0.735). At the end of 3 months, average degraded volumes of filler-only and filler combined with botulinum neurotoxin sides were 0.33 cm(3) and 0.19 cm(3), respectively, and the degradation difference was significant between the two groups (p = 0.001). End volumes for the filler-only and filler combined with botulinum neurotoxin sides were 0.28 cm(3) and 0.42 cm(3), respectively, and end volumes between two sides were also statistically significant (p < 0.001). Conclusion: This study showed that hyaluronic acid filler application in combination with botulinum neurotoxin type A significantly decreases the degradation process and increases the remaining volume of the hyaluronic acid fillers at the end of the paralyzed period. Ondokuz Mayis University Faculty of Medicine, Scientific Research Projects CouncilOndokuz Mayis University Ondokuz Mayis University Faculty of Medicine, Scientific Research Projects Council, funds this study.

WOS: 000292057600006 PubMed: 21594809 The replantation and revascularization of a distal finger following a crush injury or avulsion are difficult because of the shortness of the vessels after debridement. The success rate of the anastomoses may decrease when they are under tension. To address this, many maneuvers have been described, such as shortening the amputated part or proximal finger stump for tensionless closing, interposing a vein graft between the vessel ends, and vessel transfer from a neighboring finger. Regardless of which of these techniques is chosen, it is an additional drawback for the already traumatized hand or amputation stump. Y-V-I pedicle lengthening is a method for providing extra pedide length. This article presents a pediatric patient with a traumatic partial amputation at the fourth distal interphalangeal joint in whom the finger was salvaged by achieving anastomoses using the Y-V-I pedide-lengthening principle.

WOS: 000361410800015 PubMed: 26372718 …

Overlapping fifth toe is a congenital deformity and is characterized by an external rotation of the toe so that it overrides the adjacent fourth toe. Treatment of this condition aims to permanently reposition the fifth toe and includes conservative and surgical techniques. Here we present a case of severe overlapping fifth toe deformity treated with a combination of Z-plasty and a unilobed transposition skin flap technique over a limited surgical area, associated with low morbidity.

Keles, Musa K/0000-0003-1915-079X WOS: 000326421800009 PubMed: 24214785 BACKGROUND: We aimed to present the primary experience of one surgeon with a new surgical technique performed on the first 13 cases and to evaluate outcomes following an extraoral endoscopic approach to subcondylar fractures. METHODS: Fifteen subcondylar fractures in 13 patients, who were treated at Ondokuz Mayis University Hospital between January 2010 and June 2011, were included in this study. Patients were operated on using either endoscopic or open approach. RESULTS: Rigid plate fixation was completed endoscopically using extraoral approach in nine fractures, while six fractures were plated by conversion to a full-open approach. In all six fractures that could not be fixed endoscopically, the proximal fragments were medially displaced, whereas seven of nine fractures that were successfully fixed endoscopically were laterally displaced. CONCLUSION: An extraoral endoscopic approach for subcondylar fractures is feasible and can be carried out with decreased morbidity. This approach is recommended for those with limited experience in endoscopy to treat low laterally displaced subcondylar fractures as their initial cases.

Objectives: Treatments of long peripheral nerve defects are limited and a means to construct a vascularized nerve graft substitute has been sought. Material and Methods: An in vivo chamber bioreactor was designed with the White New Zealand rabbit's superficial inferior epigastric pedicle (SIEP) and using autologous Schwann cell (ASC) suspension, a tissue volume containing rich vascularization and a dense presence of Schwann cells was constructed. This construct was comparatively tried on 3 cm of a sciatic nerve defect. Results: A vascularized build with rich blood supply and an abundance of Schwann cells was engineered and utilized for nerve regeneration and transmission, axonal passage being displayed. Conclusion: According to the literature review, this is the first achievement of engineering a nerve graft substitute containing vascularized Schwann cells. Therefore, it is believed this study has yielded significant preliminary results, providing a basis for future studies. [Hand Microsurg 2016; 5(2.000): 62-69]

To the Editor: Vacuum-assisted closure (VAC) is a well-recognized minimal invasive treatment method for various acute and chronic wounds. If there are a number of wounds are present in a given anatomic region, a Y connector can be used to join 2 wound suction dressings together. As an alternative to the Y connector, some authors proposed bridging separate wounds with a piece of sponge after draping the intact skin between them. Thus, VAC can be performed using only 1 unit and 1 TRAC pad (KCI Medical Ltd, Kidlington, UK). We also frequently used the same method in our clinic; and have noticed no difference between the use of a Y connector and a bridging sponge in effectiveness of managing multiple wounds. The new VAC sponges are fashioned as flat coils that are amenable to being cut to size or unrolled and extended when needed (Fig. 1A). In this letter, we