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This study evaluated the potential of Wharton's jelly mesenchymal stem cells with high tolerogenic properties in reducing immunosuppressive dosage and related adverse effects.A 4- to 6-week-old, 30-40 g weight, male inbred CD57BL/6 mice were used as skin allograft donors, whereas Balb/c mice with similar characteristics were used as recipients. Wharton's jelly stem cells were obtained from a commercial kit sourced from human umbilical cord. Skin allografts were performed from CD57Bl6 to Balb/c mice (day 0). Group 1 (control) received no treatment. Group 2 received 15 mg/kg cyclosporin A on days 0 to 30. Group 3 received 5.7 × 10 6 and 10.3 × 10 6 cell/kg Wharton's jelly stem cells on days 0 and 3, respectively. Groups 4, 5, and 6 received a combination of 15, 10, and 5 mg/kg per day cyclosporine A (days 0 to 30) with the same stem cell dose with group 3, respectively. Graft rejection was evaluated with digital photography and thermal imaging, histopathology (Banff grading, epithelialization scores, dermoepidermal dissociation), immunochemistry (Ki-67 and Bcl-2), and biochemical methods (interleukin 10, interleukin 2, interferon γ, tumor necrosis factor α) (day 10). Cumulative adverse effects of cyclosporin A occurring in the groups were revealed by histopathological evaluation of kidney and liver (a modified semiquantitative method of infiltration of inflammatory cells around the portal area and lobular region in liver; modification of the Banff rating of proximal tubules and hypertrophia of juxtaglomerular apparatus cells in kidney) (day 30).There was no rejection in groups 2, 4, and 5 until the end of study. These were statistically different versus groups 1 (day 10 ± 0.71), 3 (day 11 ± 0.82), and 6 (day 11 ± 0.58) (all P 's0.05). Groups 4 and 5 have exhibited statistically similar findings in histopathological (4 epithelization score: 3.7 ± 1.3; 5 epithelization score: 3.5 ± 0.5; 4 Banff grading score: 0.8 ± 0.6; 5 Banff grading score: 1.0 ± 0.5; both P 's = 1.00), immunohistochemical (4 Bcl-2 score: 3.5 ± 0.5, P = 0.618; 5 Bcl-2 score: 3.4 ± 0.5, P = 1.00; 4 Ki-67 score: 3.7 ± 0.4, P = 1.00; 5 Ki-67 score: 3.5 ± 0.5, both P 's = 1.00), and levels of cytokines (both P 's = 1.00) versus group 2. Adverse effects on kidneys and liver were lowest and statistically similar in groups 3, 5, and 6 (all P 's = 00) versus group 1.Wharton's jelly mesenchymal stem cells alter bioavailability of cyclosporine, albeit at much lower doses and with fewer systemic adverse effects.

The objectivity of physical and electrodiagnostic tests is limited in detecting carpal tunnel syndrome and its recurrence. Predicting the median nerve blood supply using superb microvascular imaging will allow exact diagnosis and a good follow-up system. The aims of this study include using superb microvascular imaging to correlate with electromyographic diagnosis, and to determine the impact of surgery on improvement in superb microvascular imaging.Between July of 2019 and January of 2020, 32 wrists of 21 patients were evaluated prospectively. After preoperative electrodiagnostic studies and vascular index measurement with superb microvascular imaging, open carpal tunnel release was performed by a single surgeon, and 3 months later standardized superb microvascular imaging was performed. Preoperative vascular indexes were compared with the mild, moderate, and severe electrodiagnostic study results. Preoperative and postoperative vascular index results were compared.The average of the preoperative and postoperative imaging groups was 2.77 and 1.48, respectively, and there was a statistically significant difference between the two groups (p0.05). Although no significant difference was found between preoperative and postoperative vascular index values in patients presenting with mild carpal tunnel syndrome (p0.05), there was a significant decrease in vascular index values in patients presenting with moderate and severe carpal tunnel syndrome after surgical decompression.Superb microvascular imaging is emerging as a groundbreaking, new, and reliable technique. Evaluation of the median nerve blood supply is a reliable method that would be helpful for early diagnosis, planning treatment, determining the severity of carpal tunnel syndrome, and postoperative follow-up.Diagnostic, IV.

Amaç: Yarık damak sebebiyle ameliyat edilen hastaların yaklaşık %30’u velofarengeal yetmezlik(VFY) sebebiyle ek müdahelelere ihtiyaç duyarlar. Ameliyat öncesi planlama için radyolojik değerlendirme kesinlikle gerekirken ameliyat sonrası değerlendirmede de oldukça faydalıdır. Bu çalışmada, velofaringeal yetmezlik sebebiyle opere edilen hastalarda velofarinksin dinamik manyetik rezonans(MR) ile değerlendirilmesi ile ilgili tecrübelerimizi paylaşmayı planladık. Hastalar ve Yöntem: Nisan 2014- Mayıs 2020 tarihleri arasında VFY ile başvuran ve postoperatif dinamik MR ile değerlendirilen 17 hasta çalışmaya dahil edildi. 7 hastaya faringeal flep, 7 hastaya posterior duvar augmentasyonu (2 kıkırdak, 5 yağ grefti) ve submukoz yarık mevcut 3 hastaya myomukozal onarım yapıldı. Ameliyat öncesi ve ameliyat sonrası 3. ayda tüm hastalara dinamik MRG yapıldı. Ameliyat sonrası sonuçlar dinamik MR ile değerlendirildi. Bulgular: Bu çalışmaya ortalama yaşı 13± 2.5 (9-29) olan, 11 (%65) kadın ve 6 (%35) erkek hasta dahil edildi. Posterior duvar yerleşimli greftlerin ikinci servikal vertebra seviyesinde ve yaşayabilir oldukları görüldü. Posterior faringeal fleple onarım yapılan hastalarda sagital planda nazal hava kaçağı görülmezken, aksiyel dinamik görüntülerde hava yolu için gerekli açıklık gözlendi. Submuköz kleftli hastalarda levator kas seyrinin normal düzleme geldiği gözlendi. Nazal hava kaçak alanı tüm tekniklerde preoperatif ölçümlere göre belirgin azalmıştı(p

Background and Aim: The injuries due to gunshot can form extensive defects. The management of these defects is required in multistage procedures, and the treatment achievement should be evaluated in many aspects. In this study, a methodology was tried to be developed to reveal the path to be followed in the management of maxillofacial defects caused by high-energy close-range gunshot injury. In addition, similar cases were analyzed retrospectively, and the functional and social successes of the treatment were evaluated. Subjects and Methods: Five patients with high-energy gunshot injuries were retrospectively analyzed. The tissue requirements of the patients were identified. The technical and quantitative details of the treatment were recorded. The facial disability index was used to evaluate the patient's social and motor functions in the 1st year after the operations were completed. Results: The patients' mean age was 31 (17–45), and all of them were male. The mean follow-up time was 25 months (14–26), and the mean operation amount was 7.6 (3–11). Four mandibular, one maxillary, and five soft-tissue defects were detected. It was detected that these defects were managed in basic four steps. Satisfactory, functional, and social results were obtained in four patients in the postoperative 1 year. Conclusions: The management of this group of patients comprises complicated procedures. First, the patient should be stabilized vitally. Definitive reconstruction should be carried out after the wound is stabilized. To increase treatment success, the patient's mental status should be stabilized during the treatment period. Providing social function is important along with physical function.

Aim: Adding platelet-rich plasm (PRP) or mesenchymal stem cells are the most accepted methods to increase fat graft’s permanence. However, there is no consensus on timing and whether the effect of stem cells or PRP is observed more in the recipient area or in the donor area.It is aimed to present the application method and localization of PRP to be combined with fat graft to increase the survival.Material and Methods: in vitro part: Fat grafts were kept in a medium containing PRP. Cell output from the fat graft to the Petri dishes was examined every day. The time to recruit the maximum number of stem cells to the medium was determined (day 10). in vivo part: Eight group of rats were received PRP in different concentrations either to recipient or donor areas of fat grafts. After ten days, fat grafts were transferred to the recipient area. Ninety days after the transfer, histopathological examination and immunohistochemical staining were performed.Results: The group which had received the full-dose PRP to the recipient area showed the highest cellular integrity and vascularity (p< 0.05). Vascularity was superior in the half-dose PRP group compared to the control group (p< 0.05); cellular integrity did not increase. Donor site groups did not show increase in cellular integrity.Conclusion: Although PRP starts to increase fat graft permanence by increasing vascularity, it acts by preserving the cellular integrity of the fat cells as the concentrations increase. The PRP injection to the recipient area 10 days before fat grafting may provide higher survival rates., Amaç: Yağ greftinin kalıcılığını artırmak için trombositten zengin plazma (PRP) veya mezenkimal kök hücre eklenmesi en çok kabul gören yöntemlerdir. Ancak zamanlama ve bölge açısından kök hücrenin mi yoksa PRPnin mi etkisinin daha çok gözlendiği konusunda bir fikir birliği yoktur.Sağkalımı artırmak için yağ grefti ile kombine edilecek PRP'nin uygulama yöntemi ve lokalizasyonunun sunulması amaçlanmaktadır.Gereç ve Yöntem: in vitro çalışma: Yağ greftleri PRP içeren besiyerinde tutulmuştur. Yağ greftinden Petri kaplarına hücre çıkışı her gün incelendi. Ortama en fazla sayıda kök hücre alma zamanı belirlendi (10. gün). in vivo çalışma: Sekiz grup sıçana, yağ greftlerinin alıcı veya verici alanlarına farklı konsantrasyonlarda PRP uygulandı. On gün sonra alıcı bölgeye yağ greftleri transfer edildi. Transferden doksan gün sonra histopatolojik inceleme ve immünohistokimyasal boyama yapıldı.Bulgular: Alıcı alana tam doz PRP uygulanan grup en yüksek hücresel bütünlük ve damarlanma gösterdi (p< 0.05). Yarım doz PRP grubunda vaskülarite kontrol grubuna göre daha üstündü (p< 0.05); hücresel bütünlük artmadı. Alıcı alan grupları, hücresel bütünlükte artış göstermedi.Sonuç: PRP damarlanmayı artırarak yağ grefti kalıcılığını artırmaya başlasa da konsantras-yonlar arttıkça yağ hücrelerinin hücresel bütünlüğünü koruyarak etki eder. Yağ greftlemesinden 10 gün önce alıcı bölgeye PRP enjeksiyonu daha yüksek hayatta kalma oranları sağlayabilir.

The aim of abdominoplasty is to restore a normal abdominal contour, with minimal signs of the surgery. The purpose of this study was to determine the feasibility, safety, and advantages of en block removal of a skin island before upper abdominal dissection during abdominoplasty. Five hundred-forty female patients who underwent abdominoplasties between January 2004 and December 2018 were retrospectively analyzed. In these cases, the planned skin resection was initially made en block, as done with an elliptic skin excision. In this way, symmetric skin removal is achieved. After the removal of this skin, epigastric skin undermining was easily achieved. The mean age of the patients was 41.4 y, and the mean body mass of index was 27.3 kg/m2. The mean operative time for abdominoplasty only was 98 min. Eight patients had minor skin problems, 22 patients needed aspiration for seroma formation, and 7 patients needed scar revision surgery. There was only one hematoma postoperatively. The final position of the scar from the upper vulvar commissure was 8.9 cm. The results obtained were comparable to those of classical abdominoplasty, suggesting that en block removal of the skin before upper flap dissection is a safe maneuver. En block removal of skin island at the start of the surgery has the added advantage of a reduced operative time and acceptable aesthetic outcome, without an increase in complication rates. In cases of planned abdominoplasties, we suggest that removal of the abdominal skin at the beginning of the operation is a safe and feasible procedure.Abbreviation: PDS: polydioxanone.

Alveolar cleft reconstruction is important to increase the quality of life of cleft lip and palate patients. Usually, alveolar clefts can be reconstructed using bone grafts. However, bone grafting can be insufficient, and other alternatives may be necessary in wide and recalcitrant clefts. The medial femoral condyle (MFC) flap may be the solution for alveolar clefts that are impossible to reconstruct with bone grafting. In this study, the reconstruction of alveolar clefts in the pediatric cleft lip and palate population, using the MFC flap, is described. This study examined 9 pediatric patients whose alveolar clefts were reconstructed prospectively using MFC flap in 2015 and 2019. The age, gender, follow-up times, independent parameters, and existence of concomitant vestibulonasal fistulas of the patients were recorded. Computerized tomography images of the patients were evaluated to detect defect characteristics and evaluate the volume of flap postoperatively. Flap viability was confirmed with bone scintigraphy, and donor area morbidity was evaluated with the Dynamic Gait Index (DGI) in the postoperative period. The study included 7 male and 2 female patients. The mean age of the patients was 13. In addition to an alveolar cleft, 6 patients also had vestibulonasal fistula. It was observed that the volume of the flaps had not changed one year after the operation. The DGI score of all the patients was 24. Existing techniques may be inadequate in the reconstruction of wide and recalcitrant alveolar clefts. MFC flap may be the start of a new era for the treatment of alveolar clefts.

Introduction : The recovery of recurrent motor branch of the median nerve might be delayed in high level median nerve injuries due to the long reinnervation distance. The aim of this study is to define a novel nerve transfer to restore the opposition and pinch. Methods : Two fresh frozen hand cadavers were used for the study. The motor branch of the first palmar interosseous muscle of the ulnar nerve was identified and dissected. Thenar branch of the median nerve was dissected from its insertion site. The motor branch of the first palmar interosseous muscle of the ulnar nerve was transferred to the thenar motor branch of the median nerve. Axon counts were examined histopathologically. Clinically this nerve transfer was performed for two female patients with a high-level median nerve injury. Mehta opposition scores were 21 and 20, respectively and the results were satisfactory six months after the surgery. Discussion : Although exploration and repair are recommended as the first treatment for median nerve injuries, the waiting time until the motor branch is reinnervated is critical in high level lesions. Nerve transfers become very important for fast recovery. Conclusions : This new nerve transfer proposal may be an important step in nerve transfer surgery.

AmaçPrimer dudak damak yarığı (DDY) onarımı, yaşam boyu en kritik aşamadır. DDY ameliyatı, ameliyata ve anesteziye bağlı komplikasyon risklerini içerir. Bu çalışmada, primer DDY cerrahisi sonrası erken dönemde meydana gelen komplikasyonların değerlendirilmesi ve bu durumları tetikleyen erken dönemdeki faktörlerin belirlenmesi amaçlanmıştır.Gereç ve YöntemBu çalışmaya 271 DDY hastasının 328 ameliyatı dahil edildi. Komplikasyonlar, ilk 3 günde ortaya çıkan ateş gibi komplikasyonlar minör komlikasyon olarak sınıflandırıldı. Palyatif bakımla tedavi edilemeyen veya yoğun bakıma transfer edilmesi gereken komplikasyonlar ise majör komplikasyonlar olarak kabul edildi. Erken komplikasyonların epidemiyolojisi ve nedensel bağlantısı istatistiksel olarak değerlendirildi.BulgularDudak damak yarığı nedeniyle ameliyat edilen tüm olguların %19'unda (n: 63) erken komplikasyonlar görüldü. Bunlar arasında minör komplikasyon oranı %9 (n: 25) idi. Anestezinin uzamasının ağızdan beslenmede yetersizlik gibi minör komplikasyonların artmasına neden olduğu belirlendi. Majör komplikasyonlar %11 (n: 38) oranında görüldü. Bu majör komplikasyonlar, bilateral dudak yarığı olanlarda, sendromik olgularda, damak yarığı olanlarda ve erkek hastalarda daha sıktı. Komplike vakaların ortalama hastanede kalış süresi 3.35 gündü. Komplike olmayan vakalarla karşılaştırıldığında hastanede kalış süresinde artış vardı (p, AimPrimary cleft lip and palate (CLP) repair is the most critical stage throughout lifetime. CLP surgery involves risks of surgery and anaesthesia related complications. In this study, it was aimed to evaluate complications occurred in early period after primary CLP surgery and to determine early factors that trigger these conditions.Materials and MethodsIn this study 328 surgeries of 271 CLP patients were included. Complications were classified as minor complications such as fever occurring within first 3 days. Complications that cannot be treated with palliative care or required transfer to intensive care were considered as major complications. Epidemiology and causal link of early complications were statistically evaluated.ResultsEarly complications were seen in 19% (n: 63) of all cases that operated for cleft lip and palate. Among them rate of minor complications were 9% (n: 25). It was determined that prolongation of anaesthesia lead to rising of minor complications such as deficiency in oral feeding. Major complications were observed in 11% (n: 38). These major complications were more common in bilateral cleft lip, syndromic, palate and male patients. Mean hospitalisation of complicated cases were 3.35 days. When compairing to noncomplicated cases there was increasing in hospitalisation time (p

Background High-pressure injection injuries of the hand are rare severe injuries. This study aimed to present a retrospective analysis of current and possible prognostic factors, treatment modalities and evaluation criteria. Methods Ten patients who had high-pressure injection injury to their upper extremity between 2005-2018 were included in this study. All patients were evaluated for the compartment syndrome; if exists fasciotomy and wide debridement were performed. After the first debridement, the second debridement was considered within the first 24 hours. Results In this study, 10 patients (mean age: 30) were evaluated retrospectively. The injected materials were the animal vaccine, thinner, oil, diesel, water, plastic and paint. Preoperative and postoperative mean WBC levels were 14.73 K/µL and 9.62 K/µL, respectively. Preoperative and postoperative mean neutrophil levels were 11.4 K/µL and 6.49 K/µL, respectively. Conclusion Early and serial debridement and compartment syndrome evaluation are required. Despite these cautions, amputation may occur. Material, injection force and the time elapsed are the main determinants in prognosis. Aggressive debridement is required in high-pressure injection injuries. However, the adequacy of debridement should be evaluated because it is mostly impossible to completely clean the tissue from diesel or thinner. According to the experience of 10 cases in our series, when clinical and macroscopic debridement adequacy was observed, a decrease in WBC and neutrophil levels was observed simultaneously. For this reason, WBC and neutrophil levels may be an indicator of the adequacy of debridement, although these injuries are very rare, larger series are needed for this interpretation.

WOS: 000500336000002, PubMed: 31799405, Objectives Better healing results of any tissue or area is closely linked with a well-blood supply in reconstructive surgery. Peripheric nerve healing is closely related to blood supply as well. We aimed to assess whether there was any difference between digital nerve healing with and without extrinsic blood supply. Methods We assessed 48 patients with unilateral digital nerve injury at zone 2. Twenty-four of them had unrepairable arterial injury and other 24 had no arterial injury. The 24 patients in the "unrepaired artery group" (UA) and 24 patients in the "intact artery group" (IA) were compared. Results Mean follow-up time was 17.7 months. The mean two-point discrimination (2PD) was 5.29 mm in IA group and 5.37 mm in UA group. One neuroma in IA group and two neuromas in UA group were determined. We found no statistically significant difference between these groups in terms of neuroma, 2PD, and cold intolerance. The results of British Medical Research Council sensory recovery clinical scale were comparable for these two groups. Conclusion Digital nerve healing is related to numerous factors. We hypothesized that blood flow may be one of these factors; however, at this zone digital artery repair is not the foremost determinant for digital nerve healing. Further researches should be done for upper injury levels. Despite this result, we argue not to leave the digital artery without repairment and we propose to repair both artery and nerve to achieve the normal anatomical integrity and to warrant finger blood flow in possible future injuries.

WOS: 000480728400010, PubMed: 30994490, Introduction: Hand photography is effective and advantageous for assessing functional deficits and improvements related to surgery. In this study, it is aimed to investigate whether the correct active range of motion (ROM) is masked by the passive ROM in a wrist joint. Method: Eleven patients who were treated for unilateral wrist fractures were included in the study. Photography was performed in all patients by the same surgeon according to the conventional hand surgery photography approach and the active ROM photography approach. Differences between the noninjured side and injured side were assessed. Results: No differences were found between the active ROM and passive ROM during the extension and flexion movements in the noninjured side group. However, in the injured side group, the results from the photographs obtained with the conventional method were significantly better than the results from the photographs obtained when the wrist was actively moved. Conclusion: These findings suggest that photographs of wrists during passive motion may affect the results of a treatment or study by showing false positivity. We propose obtaining images of active ROM instead of passive ROM in hand photography.

Epidermoid inclusion cyst in palmar localization is very rare. We present an unusual case of palmar epidermoid inclusion cyst which causes Dupuytren-like contracture in hand. A 32-year-old male patient was complaining of the traction feeling of the mass. The mass was excised surgically, it was a hairy nodule like structure and reported as epidermoid inclusion cyst. Cystic lesions are very common masses. However epidermoid inclusion cysts in the palmar region are important because they may arise from the eccrine ducts and may be relevant with HPV infections. Thus, HPV screening should also be done in such a case. [Hand Microsurg 2018; 7(3.000): 170-172]

WOS: 000434152500003 PubMed ID: 28972286 IntroductionThe deep inferior epigastric perforator (DIEP) flap is one of the most commonly utilized flaps of reconstructive surgery. Although the horizontal flap design is the most commonly used, this flap can be vertically designed to avoid drawbacks such as excessive tissue dissection, relatively reduced flap perfusion, and scarification of the contralateral flap opportunity. The aim of this report is to present our case series for foot and ankle reconstruction with vertical designed DIEP flap. Patients and methodsThe free vertically designed DIEP flaps (VDIEP) were used in eight patients (7 male, 1 female) whose age is in a range of 20-66 years for soft tissue reconstructions in the ankle and foot region over a five-year period. The range of defects' size was from 8 x 5 cm to 15 x 7 cm and the causes were electrical burn, trauma and diabetic foot infections. ResultsFlap dimensions varied from 10 x 6 cm to 17 x 9 cm. All the flaps had two or more perforators, and all flaps survived completely. There were no early or late complications. We followed up the patients for 10 months in average. We observed no functional problems, especially in main motions of foot and ankle like eversion, inversion, flexion or extension except one patient. Donor site scars were acceptable in all patients. ConclusionsThe VDIEP flap may be an option for selected lower extremity soft tissue reconstructions, and it may be an alternative to classically designed abdominal flaps.

WOS: 000429251300009 PubMed ID: 28220716 Objective: Coronoid process hyperplasia (CPH) of the mandible is a rare condition that can be defined as an abnormal bony elongation of histologically normal bone with the symptoms of progressive, painless difficulty in opening the mouth. The purpose of this study is to evaluate the outcomes of five patients with CPH treated by coronoidectomy, relative to post surgery jaw function. Methods: Five patients with CPH were included in this study. The diagnosis of CPH was confirmed by radiographic and clinical examination of the mandible. All five patients underwent bilateral intraoral coronoidectomy under general anesthesia. The mean maximum interincisal mouth opening for the patients was determined by measurements taken pre-surgery, intraoperative, and at longest follow-up. All five patients underwent postsurgical physical therapy directed towards jaw function. Results: All the patients with limited mouth openings presented with a preoperative maximum interincisal mouth opening of 12.4 mm (range 9-20.3 mm), which was increased to 37 mm (range 22-52 mm) in the operating room after bilateral intraoral coronoidectomy and 42 mm (range 32-52 mm) during the late follow-up. Conclusions: Patients with limited jaw function related to bilateral CPH can benefit by undergoing bilateral coronoidectomies and physiotherapy.

In reconstructive hand surgery, flaps and therefore microsurgical techniques are inevitable to provide the best functional and aesthetic results. There are various complications of defect repair with microsurgical methods. We aimed to classify subacute and late unexpected complications that develop after defect repair by microsurgical methods and to present the management. Patients who underwent microvascular flap surgery for upper extremity tissue defects between 2014-2018 were included in the study. Complications other than total flap loss were retrospectively investigated and recorded. 8 patients (6 Male, 2 Female) were included to the study. 5 left and 3 right hand defects were detected. 3 fingers, 3 hand dorsum, 1 wrist and 1 forearm defects were detected. 2 marginal necrosis, 2 partial flap loss, 1 venous insufficiency, 1 nonunion, 1 skin contracture and 1 burn were the determined complications. Most defects present with different traumas in hand. The trauma zone is almost always close to the area of microvascular repair, moreover the recipient artery may not always be intact. How the bone fixation is performed is very important, covering the bone should be provided with well-blooded tissues. While providing all these, this coverage should not be bulk and should not restrict the range of motion in the hand. Having grasping function necessitates a repair that puts the function in the foreground compared to other areas in the body. Subclinical infections of hand in patients presenting with post-traumatic defects may cause nutritional problems, which may impair wound healing. Such a problem can also be confused with the arterial deprivation of the flap. The absolute sense requirement distinguishes the hand area from the reconstruction of many areas. All these are challenging difficulties in choosing flap for defects in the hand. [Hand Microsurg 2021; 10(2.000): 116-126]

Hypothenar hammer syndrome (HHS) is a rare traumatic vascular disease, which is characterized by pain and cold insensitivity in the areas fed by ulnar artery. Computerized tomography angiography (CTA) is the gold standard for the accurate diagnosis of it. Less invasive tests that are used to make decisions regarding the application of angiography, which is an invasive imaging method, have been reported in the literature. In this study, an indocyanine green-enhanced near-infrared fluorescence imaging system is used for the diagnosis of a patient with HHS who was not properly diagnosed with CTA. Although CTA is still considered as the gold standard for the diagnosis of upper extremity vascular insufficiencies, indocyanine green-enhanced fluorescence imaging, being an easily applicable and lacking of radiation exposure, should be considered first before CTA.

Despite scaphoid fractures are common, simultaneously bilateral scaphoid fractures are rare cases. Most fractures of the scaphoid, especially the nondisplaced fractures of the waist and distal part, are able to heal spontaneously with proper casting. Although the scaphoid fracture is commonly seen among patients who fell on their outstretched hands, those with a history of falling on both hands are rarely seen and bilaterality should not be overlooked. It may be necessary to review the treatment plan once again in bilateral cases. A 48-year-old male patient was referred to our hand surgery clinic with below elbow thumb spica cast on his right hand 3 days after trauma. When the detailed history was questioned, it was observed that the patient fell from a height of 8 meters, there was pain in his right hand when he was in the emergency room, and pain in his left hand began after he had left the emergency room. The patients X-ray and CT images for his both hands were obtained. Bilateral acute simultaneous nondisplaced scaphoid waist fractures were diagnosed and bilateral compression screw fixation was planned. However, patient didnt accept the operation and bilateral below elbow thumb spica casts were applied. Complete union and normal wrist range of motion were achieved. The major challange of this case is the treatment because applying bilateral cast causes difficulties in performing his daily activities besides loss of work hours. Although, most of nondisplaced waist fractures can be treated with proper casting in bilateral cases surgical treatment is considered one step ahead from casting. [Hand Microsurg 2021; 10(2.000): 164-168]

Background Lidocaine and epinephrine could potentially decrease adipocyte viability, but these effects have not been substantiated. The phosphorylation status of perilipin in adipocytes may be predictive of cell viability. Perilipin coats lipid droplets and restricts access of lipases; phospho-perilipin lacks this protective function. Objectives The authors investigated the effects of tumescent solution containing lidocaine and epinephrine on the phosphorylation status of perilipin in adipocytes. Methods In this in vitro study, lipoaspirates were collected before and after tumescence from 15 women who underwent abdominoplasty. Fat samples were fixed, sectioned, and stained for histologic and immunohistochemical analyses. Relative phosphorylation of perilipin was inferred from pixel intensities of immunostained adipocytes observed with confocal microscopy. Results For adipocytes collected before tumescent infiltration, 10.08% of total perilipin was phosphorylated. In contrast, 30.62% of total perilipin was phosphorylated for adipocytes collected from tumescent tissue ( P < .01). Conclusions The tumescent technique increases the relative phosphorylation of perilipin in adipocytes, making these cells more vulnerable to lipolysis. Tumescent solution applied for analgesia or hemostasis of the donor site should contain the lowest possible concentrations of lidocaine and epinephrine. Level of Evidence 5![Graphic][1] Therapeutic [1]: /embed/inline-graphic-1.gif

Tuberculosis (TB) is a disease that mainly affects the lungs and is primarily caused by Mycobacterium tuberculosis bacteria. However, the hand involvement is extremely rare. Diagnosing the tenosynovitis due to the tuberculosis is the main challenge for the surgeons. It is aimed to present a case of Mycobacterium tenosynovitis of the hand and outline the treatment protocol for its diagnosis. 46-year-old male patient was presented with swelling in his right hand. Physical examination revealed no pathology except for swelling in the right thenar region. Magnetic resonance imaging (MRI) revealed chronic tenosynovitis. Synovectomy was planned for the patient, and following the thenar incision, mass formations in the form of pale-yellow rice grains were found inside the thickened sheath of the flexor pollicis longus. Since these formations suggested TT intraoperatively, the intraoperative wound culture, samples for acid-resistant staining, TB DNA, and TB culture, as well as pathology samples, were taken. Intraoperative suspicion of TT is extremely important in order to prove the diagnosis. Although TB that affects the hand is rare, it is an element of tenosynovitis that must be kept in mind in areas where TB is endemic. Rice bodies are important guiding agents for intraoperative diagnosis and subsequent treatment.

WOS: 000428237600009, PubMed: 29350367, Our objective was to compare the outcomes of dorsal hand defect reconstruction using a posterior interosseous artery flap (PIAF) and a reverse adipofascial radial forearm flap : From 2008 to 2013, 23 patients who underwent hand soft tissue defect reconstruction with PIAF (11 patients) and patients) were included in this retrospective study. Reconstruction methods were compared in terms of functionality with disability of the arm, shoulder, and hand (DASH) score and range of motion (ROM) and aesthetically with scar assessment. Operation times, length of hospital stay, and donor site problems were compared. RESULTS: We found no statistically significant differences between PIAF and RARFF in terms of ROM, DASH score, and length of hospital stay. Statistically significant differences were found in operation time, scar assessment, and donor site problems between PIAF and RARFF patients. : RARFF showed better results than PIAF in dorsal hand defects, but in RARFF, the major arteries of the hand are sacrificed., Bu çalışmadaki amacımız el dorsumundaki defektlerin posteriyor interosseöz arter flebi (PİA) ve ters akımlı adipofasyal radial önkol (RRÖF) ile onarım sonuçlarını kıyaslamaktır.Geriye dönük olarak dizayn edilen bu çalışmaya 2008–2013 yılları arasında, PİA ile (11 hasta) ve RRÖF ile (12 hasta) el dorsumundaki yumuşak doku defektleri onarılan 23 hasta dahil edildi. Onarım yöntemleri fonksiyonel olarak kol, omuz ve el sorunları anketi (DASH) skoru, eklem hareket açıklığı (ROM) ile; estetik olarak skarın görünümü ile değerlendirildi. Ameliyat süreleri, hastanede kalış süreleri ve donör alan problemleri kıyaslandı. Posteriyor interosseöz arter flebi ve RRÖF arasında ROM ve DASH skorları ve hastanede kalış süresi açısından istatistiksel açıdan fark saptanmadı. Ameliyat süreleri, skar değerlendirmesi ve donör alan problemleri açısından ise istatistiksel açıdan fark saptandı.Dorsal el defektlerinde RRÖF sonuçları PİA’dan daha iyidir, ne varki RRÖF elin ana bir arterini sakrifiye etmektedir.

WOS: 000492876500001, PubMed: 31667349, Foreign bodies are common entities found in hand surgery practice. However, they are a very rare cause of the acute cubital tunnel syndrome. A 48-year-old male patient was consulted for cubital tunnel symptoms after 2-day unconscious state in the intensive care unit. The ulnar nerve was explored, a piece of glass was removed inside the cubital tunnel, and the nerve was repaired. However, compression neuropathy symptoms due to the acute trauma are interesting. Nerve laceration with a foreign body should be considered in acute-onset cubital tunnel syndrome, in which the foreign body history of a trauma patient cannot be determined explicitly.

WOS: 000403052800007 PubMed ID: 29026811 Background:There is a need for improved methods and storage media to sustain the tissue viability of autologous skin grafts.Objective:To compare histological changes in human skin grafts stored in platelet-rich plasma (PRP) with those of grafts stored in saline.Methods:Eight circular, 3-mm full-thickness skin graft samples were harvested from the abdominal skin of each of 5 patients scheduled to undergo an abdominoplasty procedure. Four of these graft samples were stored in saline, and the other 4 were stored in saline mixed with PRP prepared from the patient's own venous blood. Histological assessment of the microscopic appearance of the samples was performed on days 5, 8, 11, and 14. The integrity of the epidermal-dermal junction, number of keratinocytes with perinuclear halos, collagen organization, and number of fibroblasts per field were assessed. The cellular apoptosis rate was also measured on these same days.Results:On day 5, significant differences were observed microscopically between the PRP-and saline-stored grafts (P < .05). The grafts preserved in saline exhibited early marked cellular and nuclear swelling with pleomorphism, as well as early nuclear halo formation. The cell viability rate of the PRP group was significantly higher than that of the saline-stored group on day 8 (P < .05).Conclusion: Platelet-rich plasma and its inherent growth factors supported longer graft survival; however, its effect lasted only until day 8. Platelet-rich plasma may be beneficial if grafts need to be stored for delayed application(s). Historique : Il faut am´eliorer les m´ethodes et les milieux de conservation pour maintenir la viabilit´e des greffons autologues de peau. Objectif : Comparer les changements histologiques des greffons de peau humaine conserv´es dans du plasma riche en plaquettes (PRP) a ` ceux des greffons conserv´es dans un solut´e physiologique. M´ethodologie : Les chercheurs ont pr´elev´e huit ´ echantillons de greffons circulaires de trois millime `tres de peau pleine ´epaisseur sur la peau de l’abdomen de chacun des cinq patients qui devaient subir une abdominoplastie. Quatre d’entre eux ont ´ et´e conserv ´ es dans un solut´e physiologique et les quatre autres, dans un solut´e physiologique m´elang´ea ` du PRP pr´epar´ea ` partir du propre sang veineux du patient. Les chercheurs ont proc´ed´ea ` l’´evaluation histologique de l’aspect microscopique des ´echantillons les cinquie `me, huitie `me,onzie `me et quatorzie `me jours apre `s le pr ´ ele `vement. Ils ont examin´e l’int ´ egrit´e de la jonction dermo´epidermique, le nombre de k´eratinocytes dot´es de halos p´erinucl´eaires, l’organisation du collage `ne et le nombre de fibroblastes par champ. Les mˆemes jours, ils ont mesur´e le taux d’apoptose cellulaire. R´esultats : Le cinquie `me jour, les chercheurs ont observ´e des diff´erences microscopiques significatives entre les greffons conserv´es dans le PRP et ceux conserv´es dans un solut´e physiologique (P

Background One of the clinical aspects characterizing gynecomastia is the enlargement of the nipple-areolar complex (NAC) due to hypertrophic breast glands, and the excessive fatty tissue underneath. Objective The purpose of this study was to quantify the reduction of the areolar diameter after ultrasound-assisted liposuction (UAL) of the male breast. Methods The horizontal diameters of the NACs of 30 men who underwent UAL were measured before surgery, 1 month after surgery and 6 months after surgery in a standard fashion. Those patients with surgical gland removals of any kind were not included in this study. Results The mean age of the patients was 27.9 years, and all of the patients had bilateral grade I, II, or III gynecomastia. The mean diameter of the NACs before surgery was 35.36 mm (range, 26-55 mm), and after surgery, the mean diameter of the NACs was initially reduced to 28.8 mm (range, 23-44 mm) and later to 28.57 mm (range, 23-42 mm). The mean volume of breast tissue aspirated was 382 mL per breast, and the percentage of reduction was 17.3%. The reduction of areola diameter was statistically significant after first month. A significant positive correlation was identified between the liposuction volume and areolar diameter reduction. Conclusions In cases of gynecomastia, the removal of the glandular and fatty tissue underneath the areola releases the expanding forces and pressure that enlarge it. In many cases of gynecomastia, UAL alone is effective in reducing the size of the NAC and allows the surgeon to avoid placing scars on the breast.

Background: The aim of gynecomastia surgery is to restore a normal chest contour with minimal signs of breast surgery. Objective: The authors examine the rate of complications in gynecomastia surgery when no closed-suction drains are placed. Methods: One hundred thirty-eight consecutive male patients who underwent gynecomastia surgery without drains were retrospectively analyzed to determine whether the absence of drains adversely affected patient outcomes. Patients were managed by ultrasonic-assisted liposuction both with and without the pull-through technique. Results: The mean age of the patients was 29 years, and the mean volume of breast tissue aspirated was 350 mL per beast. Pull-through was needed in 23 cases. There was only 1 postoperative hematoma. Conclusions: These results are comparable with previously published data for gynecomastia surgery in which drains were placed, suggesting that the absence of drains does not adversely affect postoperative recovery. Routine closed-suction drainage after gynecomastia surgery is unnecessary, and it may be appropriate to omit drains after gynecomastia surgery. Level of Evidence: 4 ![][1] [1]: /embed/graphic-1.gif

ulkay, muzaffer basak/0000-0002-0928-0462; keskin, ilknur/0000-0002-7059-1884; ESENER, Osman/0000-0001-9444-3598; Kaplan, Suleyman/0000-0003-1477-5002 WOS: 000351794000001 PubMed: 25485952 The potential ability of melatonin to protect against impairment of the fetal peripheral nerve system due to maternal consumption of diclofenac sodium (DS) was investigated. Eighty-four pregnant rats were divided into seven groups: control (CONT), saline administered (PS), DS administered (DS), DS with low-dose melatonin administered (DS + MLT10), DS with high-dose melatonin administered (DS+MLT50), low-dose melatonin administered (MLT10), and high-dose melatonin administered (MLT50). After the pregnancy, six male newborn rats from each group were sacrificed at 4 and 20 weeks of age. Their right sciatic nerves were harvested, and nerve fibers were evaluated using stereological techniques. Mean numbers of myelinated axons, axon cross-section areas and the mean thickness of the myelin sheet were estimated. Four-week-old prenatally DS-exposed rats had significantly fewer axons, a smaller myelinated axonal area, and a thinner myelin sheath compared to CONT group (p < 0.05). Although melatonin at both doses significantly increased axon numbers, only a high dose of melatonin increased the diameter of those axons (p < 0.05). At 20-weeks of age, myelinated axon number in the DS group was not only significantly lower than all other groups (p < 0.05) but also the cross-sectional area of these axons was smaller than all other groups (p < 0.05). There were no differences between the groups regarding the mean thickness of the myelin sheet. The current study indicates that prenatal exposure to DS decreases the number and the diameter of sciatic nerve axons and that melatonin prophylaxis can prevent these effects. (C) 2014 Elsevier Ltd. All rights reserved. Scientific and Technical Research Council of Selcuk UniversitySelcuk University [10102002] This work was supported by a grant from the Scientific and Technical Research Council of Selcuk University [Grant # 10102002]. The authors are grateful to Osman Akdag, MD for skillful technical assistance in the research laboratory; Ender Erdogan, MD, PhD for help with the histological analysis, and Sinan Canan, PhD for assistance during the preparation of the manuscript.

Introduction: Trichilemmal cysts (TCs) are common skin lesions that occur in hairy areas. A TC involving a fingertip has not been previously described in the literature. We herein report a case of a TC occupying a fingertip region. Case presentation: A 43-year-old woman presented with a 1.5 × 1.5 cm nodular lesion on the third fingertip. The lesion was completely excised, and histopathological examination revealed a TC. Conclusion: TCs may involve atypical locations, such as fingertips, where there are no hair follicles. After surgical excision, a careful histopathological examination should be performed to differentiate TCs from proliferating pilar tumors.

Subtotal and total reconstruction of the lower lip is a challenge for the plastic surgeon. Large defects extending to the chin area can be difficult to manage with only local flaps, and free flaps are better suited. In an attempt to restore the lower lip with the vermilion, the authors used the radial forearm free flap with anteriorly based ventral tongue flap in 5 patients. The tongue flap is used 3 months after the free flap procedure, and this flap is divided 3 weeks later. The tongue flap transfer, adaptation, and division are done under local anesthesia. In all patients, the aesthetic result was excellent compared with the complexity of the reconstructed defect. Patient compliance was uneventful. Although it is a 3-stage reconstruction, combination of radial forearm flap with the tongue flap offers functional and fine aesthetic results.

The soft tissue defect of the heel and the lateral malleolus region of foot and heel continues to be difficult for reconstructive surgeons due to limited available soft tissue, the flap size and the range of vascular pedicle, or the requirement for microsurgical equipment. Several techniques that have advantages and disadvantages have been reported in the literature. The superficial peroneal neurocutaneous island flap offers versatile and appropriate cover at this region with minimal morbidity and maximal reconstructive capacity. In this paper, an experience with the reversed superficial peroneal neurocutaneous island flap in reconstruction of a lateral heel defect was presented. [Hand Microsurg 2016; 5(2.000): 96-99]

Infantile myofibromas (IMs) are benign, congenital, soft tissue tumors that can present at birth or during infancy in solitary, multicentric or generalized forms. Infantile myofibromatosis is well described in the head and neck but rarely reported on the hand. The treatment is early surgical removal and histopathological evaluation. Allow rate of regression is reported. Visceral involvement and generalized forms are more serious conditions, therefore, it is important to perform radiologic examination to determine if there is distant dissemination of the disease. In this paper, we have presented a case of infantile myofibroma in a 20-day-old female who had a pedunculated skin lesion on the fifth digit of her right hand. This case was unusual in location of origin.