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Adhesion after a tendon injury is one of the major problems following upper extremity surgery. In the present study, we evaluated a new material that is clinically usable as an adhesion barrier. Twenty-four male Wistar albino rats were used in the study. These rats (48 legs) were divided into three groups: sham, control, and experimental. No surgical intervention was performed in the sham group. After making a full-thickness cut through the right Achilles tendon, the tendon was repaired using the modified Kessler technique in the control group, while bovine collagen matrix was wrapped around the surgically repaired tendon using the modified Kessler technique in the experimental group. Two months after surgery, the operated and non-operated tendons were resected and analyzed through biomechanical, macroscopic, and histopathological examinations. The results of the biomechanical testing did not differ significantly between the control and experimental groups. Macroscopic examination of the adhesions revealed less adhesions in the experimental group but this difference was not statistically significant. Moreover, the results of the histopathological examination, which was performed based on five criteria, did not differ significantly between the two groups. Our study's results indicate that a bovine collagen matrix can be used to prevent tendon adhesion; however, larger studies are needed to verify these findings.

Maksillofasiyal kırıkların epidemiyolojisi ülkeden ülkeye değişir. Nüfus yoğunluğu, yaşam tarzı, kültürel arka plan ve sosyoekonomik durum maksillofasiyal yaralanmaların prevalansını etkileyebilir. Bu nedenle bu çalışmada, yatan hastalarda maksillofasiyal kırıkların epidemiyolojisi ve tedavi planlarını daha iyi politika oluşturma stratejileri için faydalı olacak şekilde değerlendirdik. Bu retrospektif çalışmada, hastaneye yatış ve maksillofasiyal yaralanma nedeniyle opere edilen 50 hastanın tıbbi kayıtları değerlendirildi. Yaş, cinsiyet, kırık tipleri, nedenleri, tedavi planları ve tedavi sonrası komplikasyonlar kaydedildi. Hastaların çoğu erkekti (% 78). Olguların çoğu 21-30 yaş aralığındaydı. Kırıklara çoğunlukla düşme (% 40) ve kazalar (% 38), özellikle de motosiklet kazaları neden olmuştur ve en sık tutulum yeri, mandibula'nın parasemfiz bölgesidir. Tedavi planı olarak ORIF + IMF (% 63) tercih edildi. Çalışmamızın bulguları, maksillofasiyal kırıkların neden ve insidansının her ülkede farklı olduğu görüşünü desteklemektedir. Birçok gelişmiş ülkenin aksine, düşme ve trafik kazaları maksillofasiyal kırıkların en yaygın nedenidir., The epidemiology of maxillofacial fractures varies from country to country. Population density, lifestyle, cultural background, and socioeconomic status can affect the prevalence of maxillofacial injuries. Therefore, in this study, we evaluated the epidemiology and treatment plans of maxillofacial fractures in hospitalized patients in a way that would be beneficial for better policymaking strategies. In this retrospective study, medical records of 50 patients who were operated for hospitalization and maxillofacial injury were evaluated. Age, gender, fracture types, causes, treatment plans, and post-treatment complications were recorded. Most of the patients were male (78%). Most of the cases were in the 21-30 age range. Fractures were mostly caused by falls (40%) and accidents (38%), particularly motorcycle accidents, and the most common site of involvement was the parasymphysis region of the mandible. ORIF + IMF (63%) was preferred as a treatment plan. The findings of our study supported the view that the cause and incidence of maxillofacial fractures were different in each country. In contrast to many developed countries, falls and traffic accidents are the most common cause of maxillofacial fractures

Amaç: Nicolau sendromu (NS), bazı ilaçların enjeksiyonlarını takiben gelişen ve yaklaşık bir perforazomu kaplayan boyutlara ulaşan yumuşak doku ve ciltte nekroz gelişmesi durumudur. Bu çalışmada klinikte sık karşılaşılmayan diklofenak sodyum enjeksiyonu sonrası gelişmiş bu nadir patolojiye yönelik klinik yaklaşımımız ve tedavi alternatiflerinin sunulması amaçlanmıştır.Gereç ve Yöntemler: Bu geriye dönük çalışmada diklofenak sodyum enjeksiyonu sonrası enjeksiyon yerinde NS gelişen 16 hastaya yaklaşımımız değerlendirildi. Hastaların demografik verileri, eşlik eden hastalıkları, nekrozun yerleşimi ve boyutları ve cerrahi teknikler tarandı. Postoperatif komplikasyonlar, hastanede kalış süresi ve sonuçlar değerlendirildi.Bulgular: Toplam 16 hasta mevcut olup bunların 14'ü kadın 2'si erkek idi. Ortalama yaş 60±14,4 yıl ve ortalama vücut kitle indeksi (VKİ) 33±1,4 kg/m2 idi. En sık eşlik eden hastalık diyabetes mellitus, daha sonra primer hipertansiyon olarak gözlendi. Ortalama nekroz boyutu 8x8x5 cm olarak saptandı. Tüm 16 nekroza da cerrahi debridman uygulandı. Nekrozun cerrahi debridmanı sonrası 8 hastanın defekti primer kapatılırken 6 hastada fasyokutan flep yapıldı ve 2 hasta ise bir hafta sonra gecikmiş primer olarak onarıldı. Hastaların tümü sorunsuz olarak tamamen iyileşti.Sonuç: Yüksek VKİ, diyabetes mellitus ve primer hipertansiyon gibi komorbid özellikler taşıyan hastalara diklofenak sodyum enjeksiyonu yapılırken çok dikkatli olunmalıdır. İşlem sırasında, iğnenin kas tabakasına kadar ulaştığından ve perforatör bir damara denk gelmediğinden emin olunmalıdır. Enjeksiyon sonrası nekroz gelişmesi durumunda erken dönemde cerrahi debridmanı takiben rekonstrüksiyon etkili bir tedavidir., Aim: Nicolau syndrome (NS) is the necrosis of skin and subcuticular tissue, following injection of many drugs, which covers nearly a perforasome. This study aims to unveil our clinical approach and treatment alternatives against this rare pathology subsequent to diclofenac sodium.Material and Methods: In this retrospective study, our approach to 16 patients who developed NS at the injection site after diclofenac sodium injection was evaluated. Patients’ demographic data, concomitant diseases, location and size of necrosis, and surgical techniques were collected. Post-operative complications, hospitalization period and results were evaluated.Results: There were total of 16 patients, 2 of which were male and 14 were female. The mean age was 60±14.4 years, and the mean body mass index (BMI) was 33±1.4 kg/m2. The major concomitant comorbidity was diabetes mellitus, followed by primary hypertension. The mean defect size was 8x8x5 cm. Surgical debridement was applied to all 16 necrosis. Following the surgical debridement of necrosis, 8 patients were reconstructed with primary closure, 6 patients with fasciocutaneous flaps and 2 patients with delayed primary closure after a week. All patients heal completely without complications.Conclusion: Utmost care must be given when performing diclofenac sodium injections to the patients with comorbidities, such as high BMI, diabetes mellitus, and primary hypertension. The caregiver must be certain that the needle is in the muscular plane and no perforator vessel to be harmed during this procedure. In case of a post-injection necrosis, an early intervention with surgical debridement and reconstruction is an efficient treatment.

Rhinoplasty is a frequently performed surgical procedure. Besides an aesthetically successful outcome, determination of additional nasal pathologies and making a simultaneous intervention on these are also essential for a successful functional outcome. This study aims to determine the rates of accompanying nasal pathologies in patients undergoing rhinoplasty and reveals whether any additional interventions were performed during operation.In this cross-sectional study, 496 Caucasian Turkish patients who underwent rhinoplasty at the Plastic, ReconstructiveAesthetic Surgery and Otorhinolaryngology clinics of our research hospital between 2015 and 2018 were retrospectively examined. Among them, the results of 271 patients who had preoperative paranasal computerized tomography scans were evaluated.The mean age of the 271 patients was 28.8 years (Range: 17-55). Among them, 156 (57%) were female and 115 (42%) were male. The numbers of patients with septal deviation, inferior concha hypertrophy, unilateral/bilateral concha bullosa, nasal polyp, mucosal thickening, and retention cysts at the Otorhinolaryngology clinic were found to be 126 (82%), 77 (50%), 20 (13%), 10 (6.5%), 77 (50%), and 41 (27%), respectively, and these numbers were respectively 97 (82%), 60 (51%), 11 (9.3%), 2 (1.7%), 57 (48%), and 17 (14%) at the Plastic, ReconstructiveAesthetic Surgery clinic. A statistically significant difference was found in terms of the presence of retention cysts between the clinics (95% CI -0.11% to 0.16%; P=.014; P.005), and the presence of retention cysts was significantly higher at the Otorhinolaryngology clinic. A total of 18 (12%) patients were found to have additional surgical interventions.This study showed that additional nasal pathologies were frequently present in patients undergoing rhinoplasty operations. Hence, for a successful operation, it is essential to have Otorhinolaryngology consultation and detect accompanying pathologies in rhinoplasty cases which will be performed by Plastic, ReconstructiveAesthetic Surgery specialists.4.

Ankle fractures are among the most common orthopaedic surgical procedures. Skin-related complications of these surgeries are difficult to reconstruct due to the inadequacy of soft tissue in the region. Although free flaps are generally considered as the first choice in reconstruction of this area, free flaps may not be a suitable option especially in patients with advanced age and comorbidities. Perforator flaps offer a fast and safe alternative in lower extremity reconstruction. In the literature, there are a limited number of studies using perforator flaps in managing the postoperative complications of the lower extremity trauma surgeries. In our study, we report our experience with reconstruction of soft-tissue defects of medial malleolar region using posterior tibial artery perforator flap for postoperative complications of ankle fracture-related surgeries.

Extracorporeal perfusion of organs has a wide range of clinical applications like prolonged vital storage of organs, isolated applications of drugs, bridging time to transplant, and free composite tissue transfer without anastomosis, but there are a limited number of experimental models on this topic.This study aimed to develop and evaluate a human extracorporeal free flap perfusion model using an extracorporeal membrane oxygenation device. Five patients undergoing esthetic abdominoplasty participated in this study. Deep inferior epigastric artery perforator flaps were obtained abdominoplasty flaps, which are normally medical waste, used in this model. Deep inferior epigastric artery perforator flaps were extracorporeally perfused with a mean of 6 days. The biochemical and pathological evaluations of the perfusions were discussed in the article.

Aim: Gynecomastia is a benign enlargement of the breast in males. Surgical treatment options include liposuction, glandular excision and the combination of liposuction and glandular excision. In this study, it was aimed to evaluate 65 consecutive gynecomastia patients who were operated using different techniques and to present the treatment approach, and results and complications related to surgical techniques.Material and Methods: Sixty five patients who underwent gynecomastia operation in our clinic between June 2016 and January 2019 were included in this study. Demographic data, preoperative and postoperative photographs, clinical classification, perioperative details, postoperative results and complications were evaluated retrospectively.Results: Fifty five (84.6%) patients had bilateral gynecomastia and 10 (15.4%) patients had unilateral gynecomastia. Of the 120 breasts operated, 91 (75.8%) were Grade II, 20 (16.7%) were Grade III and 9 (7.5%) were Grade I, according to the Simon classification. Twenty-eight (43.1%) patients underwent liposuction and glandular excision, 35 (53.8%) patients underwent liposuction alone, and two (3.1%) patients underwent glandular excision only. Skin excision was performed for two patients at the first operation. Only two patients, one for inadequate reduction and the other for skin excess, were demanded revision surgery.Conclusion: Surgical treatment options for gynecomastia patients can be determined according to clinical evaluation of breast tissue and skin excess. In young patients with good skin quality, skin excision can be left for a second session. Although there was no significant difference between the methods used in this study, more complications were found with the excisional technique., Amaç: Jinekomasti erkeklerde görülen iyi huylu meme büyümesidir. Cerrahi tedavi seçenekleri arasında liposakşın, glandüler eksizyon ve liposakşın ve glandüler eksizyon kombinasyonu yer almaktadır. Bu çalışmada farklı teknikler kullanılarak ameliyat edilen ardışık 65 jinekomasti hastasının değerlendirilmesi, tedavi yaklaşımının ve cerrahi tekniklerle ilgili sonuçların ve komplikasyonların sunulması amaçlanmıştır.Gereç ve Yöntemler: Bu çalışmaya Haziran 2016 ve Ocak 2019 arasında kliniğimizde jinekomasti ameliyatı yapılan 65 hasta dahil edildi. Demografik veriler, preoperatif ve postoperatif fotoğraflar, klinik sınıflandırma, perioperatif detaylar, postoperatif sonuçlar ve komplikasyonlar retrospektif olarak değerlendirildi.Bulgular: Elli beş (%84,6) hastada iki taraflı jinekomasti ve 10 hastada (%15,3) tek taraflı jinekomasti vardı. Simon sınıflamasına göre, ameliyat edilen toplam 120 memenin 91 (%75,8)’i Evre II, 20 (%16,7)’si Evre III ve 9 (%7,5)’u Evre I idi. Yirmi sekiz (%43,1) hastaya liposakşın ve glandüler eksizyon uygulandı, 35 (%53,8) hastaya sadece liposakşın yapıldı ve 2 (%3,1) hastaya sadece glandüler eksizyon uygulandı. İlk ameliyatta iki hastaya deri eksizyonu yapıldı. Biri yetersiz küçültme ve diğeri ciltte fazlalığı için olmak üzere sadece iki hasta revizyon cerrahisi talep etti.Sonuç: Jinekomasti hastalarında meme dokusunun klinik değerlendirilmesine ve cilt fazlalığı derecesine göre cerrahi tedavi seçeneği belirlenebilir. Genç hastalarda deri kalitesi iyi ise cilt fazlalığı olsa dahi cilt ekzisyonu ikinci bir seansa bırakılabilir. Bu çalışmada kullanılan yöntemler arasında anlamlı bir fark olmamasına rağmen, eksizyonel teknikte daha fazla sayıda komplikasyon görülmüştür.

Introduction: Rhinoplasty constitutes an example wherein the various types of filling materials are used for nasal dorsal deformities. In this study, we took the advantage of a simplified procedure and used fibrin isolated from the coagulated peripheral blood of the experimental animal. Durability and viability of diced autologous cartilage grafts adhered to each other and formed using fibrin extracts were assessed experimentally in a rabbit model. Subjects and Methods: Diced cartilage graft (Group 1), block cartilage (Group 2), and fibrin adhered 0.5 mm diced cartilage graft (Group 3) were placed into subcutaneous pockets in the frontoparietal region of the same experimental animal. The grafts were excised at the end of 16 weeks. The excised grafts were macroscopically evaluated, and the final volumes and weights were measured. These measurements were compared to the initial values before implantation. Finally, the specimens were evaluated the histopathological examination. Results: In Group 1, 165% increase in weight and 56% increase in volume; in Group 2, 131% increase in weight and 81% increase in volume; finally in Group 3, 184% increase in weight and 68% increase in volume were seen. Although histological examination did not reveal any difference with regard to chondroid matrix score, metachromasia, vascularization, fibrosis, and inflammation we observed significantly higher cartilage proliferation score in Group 3. Conclusion: The results indicate that these grafts can be used efficiently, particularly in rhinoplasty procedures to correct nasal deformities.

WOS: 000384271100055 PubMed ID: 27607117 Background:Prominent ear deformity (PD) is an unacceptable condition of pinna that affects 5% of the population and is associated with emotional stress, behavioral disturbances, and social restrictions in relationships. Conchal hypertrphy, inadequate formation of antihelical fold, earlobe placement ahead than it should be, or various combinations of these changes are main characteristics of PD. Many surgical techniques have been described for the PD.The authors' aim was to present laterally based postauricular dermal flap combination with cartilage-sparing methods and effectiveness of this technique in suture extrusion prevention and reducing the rate of recurrence with long-term results.Methods:Forty-one patients had bilateral and 6 patients had unilateral PD, a total of 47 patients with a mean age of 14.48 were operated by using this combined procedure. A laterally based supraperichondrial dermal flap was prepared from a deepithelized elliptical postauricular incision. Mustarde and Furnas suture techniques were used solely for PD correction. The dissected laterally based dermal flap was fixed to the mastoid bone with sutures in stretched position after reshaping the auricular cartilage with sutures.Results:The average helix-mastoid distance was (mm) 16.282.36, concha-mastoid angle was 25.71 +/- 0.96 degrees on 12-month measurements. The helix-mastoid distance showed an increase of 1 to 3mm, in the concha-mastoid angle measurements of 1 degrees to 2 degrees. Statistically significant changes were observed between the average preoperative, postoperative 1. month, postoperative 12. month helix-mastoid distances (mm), and month concha-mastoid angle (degrees) measurements (P=0.0001).Conclusions:The laterally based postauricular dermal flap technique is an effective method to prevent suture extrusion and recurrence which are the most important complications of otoplasty procedure and easy to apply.

WOS: 000219518000044 PubMed ID: 26225082 Ameloblastoma is the second most common odontogenic tumor of the oral cavity with the primary site being the mandible. The ratio of maxillomandibular involvement however is 5:1 in favor of the mandible. The most common complaint is a painless swelling over the mandibular area. Despite its benign nature, ameloblastoma has a high local recurrence rate, with the most recurrences seen within 5 years after operation. Biopsy and radiological evaluation may be helpful in differentiating the subtypes of ameloblastoma. Differentiation is important because some subtypes are more aggressive than the others. Preoperative planning may be done according to this classification, which can help decrease the recurrence rate. In our case, a 26-year-old female patient with recurrent ameloblastoma which developed on the fibular flap is presented. The free fibular flap and the left parasymphyseal part of the mandible were totally excised. Ameloblastoma was confirmed on pathological examination. We reconstructed the left mandibular site with a reconstruction plate and recurrence was not seen during follow up period.

UNLABELLED Sarcoidosis is a multisystem inflammatory disease that manifests as noncaseating granulomas, commonly in the lungs and intrathoracic lymph nodes. Subcutaneous manifestations of sarcoidosis that are caused by granulomas are referred to as specific for sarcoidosis, whereas other lesions are considered nonspecific. The authors present "sarcoidosis nodule formation on the lateral nasal osteotomy lines" in a sarcoidosis patient undergoing rhinoplasty surgery as a rare patient. LEVEL OF EVIDENCE V.

Frontal sinus fractures constitute 5% to 15% of maxillofacial fractures, and isolated anterior table injuries account for 33% of frontal sinus fractures. The treatment strategy of frontal sinus fractures should be individualized according to the extent of the injury. Endoscope-assisted repair without any fixation method for the treatment of mildly and moderately displaced (1-5 mm) and closed isolated anterior table frontal sinus fractures is a good alternative technique for treatment.Between April 2010 and December 2011, 5 patients with mildly and moderately displaced isolated anterior table fractures were treated. There were no lacerations in forehead skin of the patients. Preoperatively, the patients showed forehead depression at the fracture site, and computed tomography scan was taken to determine the extent of the frontal sinus fracture. Endoscope-assisted closed reduction treatment was applied to all patients.All fractures were reduced successfully. None of the patients needed to undergo conversion to traditional incision techniques. No patients required fixation materials. Cosmetic deformity was corrected in all patients perfectly.In the standard treatment modality of frontal sinus fractures, repair is best performed by a coronal approach. However, bicoronal incision has many disadvantages. Several authors have recently described some endoscopic and closed approaches to these injuries. The main disadvantages of these methods are poor visualization or fixation requirement with exogenous materials.Endoscopic reduction of mildly and moderately displaced closed isolated anterior table frontal sinus fractures without fixation is feasible. It results in a good clinical outcome in selected cases.

Background Fingertip amputations are among the most common injuries seen in the hand. According to the geometry of the amputation, it may be classified as transverse or oblique (dorsal, volar, or lateral type). Although numerous repair techniques have been described in the literature, there are few alternatives suitable for lateral oblique type fingertip amputations. Methods Between 2012 and 2016, we operated on 16 patients with simple rotation flap from the remaining part of the pulpa in a rotation and advancement manner for the reconstruction of lateral oblique type fingertip amputations. Results All but two of the flaps healed completely with full flap survival. Superficial distal flap necrosis was observed in two patients. They healed by secondary intention. No obvious hooked nail occurred in patients. Cold intolerance was observed in one patient; joint stiffness or hypersensitivity was not observed in any of the patients. Stiffness of the proximal interphalangeal joint did not occur. Two point discrimination test results were found to be normal. Conclusion This technique is simple, rapid, and free from relatively major complications. This flap allows for anatomical reconstruction of the fingertip by using a similar tissue in cases of lateral oblique fingertip amputations, where only a few flap options can be successful.

Constricted ear deformity was first described by Tanzer and classified it into 3 groups according to the degree of constriction. The group IIB deformity involves the helix, scapha, and antihelical fold. The height of the ear is sharply reduced, and the soft tissue envelope is not sufficient to close the cartilage framework after expansion and reshaping.This study describes expanding the cartilage and increasing the height by advancing the helical root superiorly and repairing the skin-cartilage defect with a superior auricular artery chondrocutaneous flap in Tanzer group IIB constricted ear deformity.Six ears of 6 patients were treated with this technique during the past 3 years. All patients were satisfied with the appearance of their corrected ears, and the increase in height was maintained through the follow-up period.The described technique does not have the disadvantages and possible complications of harvesting a costal cartilage graft. Moving and fixing the root of helix to a more superior position provide the auricle with additional length. The superior auricular artery chondrocutaneous flap not only provides adequate soft tissue for primary closure of the anterior portion of the auricle but also aids in repairing the cartilage defect resulting from the superior advancement of the helix as well.

Venous ulcers are characterised by longstanding and recurrent loss of skin integrity. Once occurred, healing is slow and recurrence is high because of inappropriate conditions of the wound bed. This study involves 20 patients with chronic venous ulcers at least 6 weeks of duration treated with negative pressure wound therapy (NPWT). Patients underwent a radical debridement of all devitalised tissues in the first operation. After adequate haemostasis, silver-impregnated polyurethane foam was applied. Once the wounds were determined to be clean and adequate granulation tissue formation was achieved, split-thickness skin grafts were applied. Black polyurethane foam was applied over them. All wounds completely healed without the need for further debridement or regrafting. The mean number of silver-impregnated foam dressing changes prior to grafting was 2·9 (one to eight changes). The mean number of NPWT foam changes was 2·6 after skin grafting (two to five changes). Two patients who did not use conservative treatments for chronic venous insufficiency (CVI) after discharge from the hospital had recurrence of venous ulcers in the follow-up period. Application of NPWT provides quick wound-bed preparation and complete graft take in venous ulcer treatment.

Blepharoptosis (ptosis) is one of the most common eyelid disorders encountered in ophthalmology. Several procedures have been developed to correct ptosis. The most common complications of ptosis surgery are well defined in the literature. Herein, we report a rare complication of superior rectus muscle paralysis following levator resection surgery for a blepharoptosis. Surgeons may well be aware of its occurrence.

Objective: The aim of this study was to evaluate the use and efficacy of digital artery perforator (DAP) flaps in fingertip reconstruction.Methods: From 2007 to 2011, 7 fingers of 5 patients (4 male, 1 female) underwent fingertip reconstruction with extended DAP flaps following traumatic fingertip amputation. Average flap size was 4.25 cm2.Results: All flaps survived except one case in which partial skin necrosis was observed and treated with wet-dressing. Donor sites were closed with full-thickness skin grafting in 5 and primarily in 2 fingers. We did not observe hypersensitivity or cold intolerance in repaired fingers.Conclusion: The DAP flap is a reliable, free-style perforator flap that can be used for all types of fingertip injuries., Amaç: Bu çalışmanın amacı parmak ucu rekonstrüksiyonunda dijital arter perforatör (DAP) fleplerinin kullanımı ve etkinliğini incelemekti.Çalışma planı: Travmatik parmak ucu ampütasyonu sonrası, 2007 ila 2011 yılları arasında 5 hastanın (4 erkek, 1 kadın) 7 parmak ucunun genişletilmiş DAP flebi kullanılarak rekonstrüksiyonu yapıldı. Ortalama flep boyu 4.25 cm2 idi.Bulgular: Bir hasta haricinde bütün flepler yaşadı. Bu hastamızda gözlenen parsiyel deri nekrozu ıslak pansuman ile tedavi edildi. Beş parmakta verici alana tam kalınlıkta deri grefti kondu, diğer iki hastada verici alan primer olarak kapatıldı. Onarım yapılan parmakların hiçbirinde hipersensitivite ya da soğuk intoleransı gözlenmedi.Çıkarımlar: Dijital arter perforatör flep güvenilir bir serbest-stil perforatör flep olarak tüm parmak ucu yaralanmalarında kullanılabilir.

Prominent ear is the most common deformity of the external ear. The major causes can be an underdeveloped antithetical fold, concha hypertrophy, and prominence of the ear lobule. Since Ely’s first aesthetic correction of the prominent ear in 1881, more than 200 different techniques have been described, but the choice of procedure still remains the surgeon’s preference. This report presents the laterally based posterior auricular dermal flap technique as an adjunct to the conventional cartilage-sparing otoplasty. An elliptical skin incision was planned according to the classic prominent ear correction technique. Instead of the excision, skin was deepithelialized. From the inferior border of the incision, the dermal flap was incised and elevated in a medial-to-lateral direction. The posterior auricular dermal flap was used to support and cover the suture material. This method was used in the treatment of 17 consecutive patients. After a follow-up period of 6–32 months (mean 16 months), the patients were evaluated in terms of the recurrence and suture line problems. No suture line problems or recurrences were observed at the end of the follow-up period. Use of the posterior auricular dermal flap both prevents suture extrusion and decreases recurrences. Level of Evidence V This journal requires that authors assign a level of evidence to each article. 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 .

Dear Editor, Harvesting vein graft is a commonly performed salvage procedure in hand and reconstructive microsurgery when insufficient length of the vessels to be available or lack of a segment of the vessel[1]. Vein grafts are taken from superficial veins which are commonly present on extremity subcutune tissue. Although graft need can be predicted in some situations, it is mostly decided during the operation period. The consistency between the diameter of taken vein graft and applied vessels is wanted. We are using noncontact visualization system (AccuVein AV300, Cold Spring Harbor, NY) in our clinic; in order to determine the location of betaken vein graft. (Fig. 1). The main aim this device that belong to Anesthesia clinic; guiding anesthesia medical doctors in challeging cases and children for establishing vascular access. This device uses infrared and laser technology to help locate veins easily. When positioned about 8–15 cm above the skin, the device detects the difference in reduced hemoglobin concentration between the veins and surrounding tissue at about 0.7 cm depth from the surface of the skin and then instantly displays a map of the veins larger than 1 mm on the skin. [2, 3] Superficial blood vessels appears dark on a red background and no patient contact is required.[2, 3] So we can harvest vein graft through a very small skin incision on the correct location. As a disadvantage; this method may be insufficient for an applied tourniquet on extremity because of a hemoglobin dependent view. Fig. 1 Noncontact visualization system device(AccuVein AV300, Cold Spring Harbor, NY) (above left). When positioned about 8–15 cm above the skin(below left), superficial blood vessels appears dark on a red background and no patient contact is ...

AIM Large defects of the scalp, head and neck region are often encountered by plastic surgeons. The repair of such defects is dependent upon their location, size and depth. This study describes the use of large scalp flaps as a salvage procedure in the reconstruction of large scalp, head and neck region defects in elderly patients with poor general condition or advanced malignancy. MATERIAL AND METHODS The presented study includes 22 patients operated between 2007 and 2011 for the reconstruction of large defects of the hair-bearing skin and head/neck region with large scalp flaps. A defect exceeding 25 cm² area was classified as "large" as defined in the previous studies. The patients' medical records were analyzed. RESULTS Scalp flaps provided a satisfactory and durable reconstruction in the late follow-up term. All flaps were completely survived except in one case in which a partial necrosis in the distal margin occurred. Major complications were recorded in 4.5% of patients while minor complications were recorded in 13.5% of them. CONCLUSION In conclusion, large scalp flaps should be considered as a salvage procedure for reconstruction of large scalp, head and neck defects especially for palliative situations in elderly patients with significant comorbidities and advanced malignancies.

Background The long-term goal of cleft palate repair is to provide normal maxillary growth and speech capacity. However, most surgical repairs of cleft palate result in areas of bone denudation on lateral aspects of the hard palate. It is widely acknowledged that palatal bone denudation and subsequent scar contracture resulting from cleft palate surgery can inhibit maxillary growth. Method This study is designed to investigate the effect of the periosteum on growth patterns of the maxilla. A total of 32 three-week-old Sprague-Dawley rats were randomly divided into a control group and three experimental groups: a mucosa excision group, a mucosa-periosteum excision group and a periosteal graft group. Nine weeks postoperatively the skulls were prepared for study and palatal widths and lengths were determined. The experimental groups were investigated for various histological changes. Results There was no statistically significant difference for the maxillary measurements (palatal width and length) between the mucosa excision group and the periosteal graft group when compared with the control group. However, the mucosa-periosteum excision group compared to the control indicated a statistically significant decrease in the same measurements. There was also a statistically significant difference for the maxillary measurements between the periosteal graft group and the mucosa-periosteum excision group. It was demonstrated histologically that the density of the Sharpey's fibres and periodontal scar tissue showed a slight increase in the mucosa excision group and the periosteal graft group compared with the control group. In the mucosa-periosteum excision group, the density increased significantly as expected. Conclusions All of these findings testify that retaining the periosteum or replacement with a periosteum graft after surgery can prevent the inhibition of maxillary growth.