Plastic Surgery

Traction vasculogenesis: Experimental vessel elongation by traction in rat model Cagil Meric Erenoglu, Yigit Ozer Tiftikcioglu, Yigit Uyanikgil, Turker Cavusoglu Turkish Journal of Plastic Surgery 2019 27(2):44-48 Background: Microsurgeons may face inadequate vessel length in traumatic or post-resection vascular defects and flap surgery. As tissue regeneration by mechanical forces is possible like in tissue expansion and distraction osteogenesis, we questioned the effect of traction forces on isolated vessels, generated by an internal maxillary distraction device to overcome such problem. Methods: 30 Wistar-Albino rats were randomized in two groups as control and traction. By an internal maxillary distraction device placed subcutaneously to abdominal region, femoral artery and vein of traction group were applied daily traction for 10 days perpendicular to their course. Control group received the same procedure but no traction was applied. Vessel length, blood flow and histologic and microangiographic changes were evaluated on postoperative 11th day. Results: Final length of vessels was found to be higher in the traction group (21.93 mm) compared to control group (12.86 mm). (P = 0.000) Blood-flow patency rate of artery and vein was found 100 % in control group (n = 15) and 80 % in experiment group (n = 12). Microangiographic study showed patent blood flow in both control and traction groups. Histologic evaluation showed vascular wall thickening, perivascular adipocyte and neutrophil infiltration and vein lumen enlargement compared to control group. Conclusion: The preliminary “traction vasculogenesis” technique is found to be a promising technique to gain vessel length in vascular shortness problems. With further studies and refinements this technique may be carried to clinical applications in cases of vascular inadequacy.

The effects of different amounts of thrombin application on fat graft viability in rats: An experimental study Caner Kacmaz, Kaan Gideroglu, Emre Guvercin, Gaye Taylan Filinte, Mehmet Bozkurt, Deniz Filinte Turkish Journal of Plastic Surgery 2019 27(2):49-55 Aims: The most important disadvantage of fat graft, which is also a late-term complication, is graft resorption. The aim of this study is to evaluate the effect of thrombin, which is reported to increase the tissue regeneration and angiogenesis in many areas, to viability of fat graft. Settings and Design: Twenty Wistar-Albino type adult male rats were used in the study. They were divided into four groups as one control group and three experimental group. Subjects and Methods: Inguinal fat pads were excised and reduced to 500 mg (±1 mg) in all animals. To obtain thrombin, 3 animals were sacrificed. One percent amount of 0.25 mg lidocaine hydrochloride was injected to the scapular regions of the animals. Afterward, subcutaneous cavities were formed there to place the fat tissue inside. After placing the graft, varying proportions of thrombin were injected to the animals in the experimental groups. No thrombin was not injected to the control group. After 90 days, the experimental animals were sacrificed, and the fat grafts were removed. Statistical Analysis Used: The data obtained from control and experimental groups were analyzed using SPSS software (version 20.0; SPSS Inc., Chicago, IL, USA). Normal fat ratio, cyst or vacuole development, inflammation, fibrosis, microvascular density, apoptosis, and weight score differences between groups were compared using Kruskal–Wallis test. To compare two groups with different scores, Mann–Whitney U test was used. The statistical significance level was accepted as 0.05 (P = 0.05). Results: Macroscopic, histological, and statistical evaluations showed that thrombin has reduced the weight and volume loss on fat graft, increased viable fat cell amount and reduced inflammation on receptive area. Conclusion: The positive effects of thrombin on the viability of fat graft have given us courage to use it in further studies. Longer follow-ups are necessary and more studies are required to use it in clinical practice in combination with fat grafts.

Flap based reconstruction for the defects of Fournier's gangrene Utku Can Dolen Turkish Journal of Plastic Surgery 2019 27(2):56-61 Background: Fournier's gangrene is necrotizing fasciitis of the perineal area caused by mixed aerobic and anaerobic bacteria. It is a devastating disease that requires serial debridement besides intravenous antibiotic therapy. It often results with extensive and disfiguring soft tissue and skin loss. Plastic surgeons are always consulted for coverage of the defects. Wound coverage varies from simple wound care to free-flap reconstruction. Most of the cases require regional or distant flaps. Vacuum-assisted closure might be a good option until definitive coverage, but its application is quite difficult due to genital organs and anus. In this review article, flap-based reconstruction of the perineogenital area is discussed rather than the pathophysiology or primary treatment of the Fournier's gangrene. Methods: Literature review is performed on Pubmed and Google Scholar in Turkish, English, and French languages. Conclusion: Eradication of the infection and supportive patient care are the most important initial steps in the treatment of the Fournier's gangrene patient. This is followed by functional and aesthetic reconstruction of the resultant defect. The reconstructive ladder, from simple wound care to free-flap surgery, guides the reconstructive decision-making process.

Radiofrequency: Review of literature Metin Gorgu, Ali Gokkaya, Jehat Kizilkan, Ertugrul Karanfil, Ali Dogan Turkish Journal of Plastic Surgery 2019 27(2):62-72 Background: Radiofrequency (RF) devices have widespread use in skin rejuvenation. Although they are used noninvasively, recently minimally invasive RF devices are being added to the inventory to increase their efficiency. Because RF devices do not operate on a light basis, their effects are independent of skin color and type. Therefore, they have a broader spectrum of patients compared to other noninvasive and minimally invasive devices. Skin rejuvenation with RF devices will continue to be important for plastic surgeons to pursue the nonsurgical operations. With RF application, heat is generated at different levels and different degrees under the skin. Methods: Shrinkage and denaturation of the collagen with temperature increase the likelihood of desired rejuvenation effects. The degree of temperature increase in RF applications depends on the frequency of the devices, the power of the devices used, and the characteristics of the headers. Today, different types of RF devices are offered by manufacturers. Heating with an RF device in a therapeutic dose of the skin is possible if appropriate frequency and adequate power are provided. When the therapeutic temperature is close to the complication limit, the user needs to know the device well, be aware of the skin structure at the application site and skin thickness, as well as can adjust the application doses well to get better therapeutic results. Conclusion: The wide variety of RF devices has led to the development of different application methods for users. In this article, RF devices, mechanisms of action, methods of use, clinical practice techniques, and results are reviewed. Even though the results are good, RF applications are not an alternative to a surgery.

Does the patient satisfaction correlate with sensorial recovery after primary repair of digital nerves and flexor tendons? Egemen Ayhan, Abdurrahman Ciftaslan, Melih Bagir, Metin M Eskandari Turkish Journal of Plastic Surgery 2019 27(2):73-76 Background: We aimed to evaluate the correlation of patients' satisfaction with sensorial evaluation results after primary repair of digital nerves and flexor tendons. Materials and Methods: In total, 31 fingers of 25 patients that underwent primary repair for clear-cut digital nerve and flexor tendon injuries were included in this retrospective study. The mean age of the patients was 34.8 ± 9.4 years. Patients' gender, age at admission, trauma date, and injured finger were obtained from patients' folders. We called the patients for the last follow-up and used two-point discrimination (2PD) and Semmes–Weinstein monofilament (SWM) tests to evaluate sensorial recovery. Patients were interviewed for hand dominance, cold intolerance, and if they were satisfied. Visual analog scale (VAS) was used to evaluate the satisfaction of patients related to the injured finger. We analyzed correlations between VAS score and age, follow-up period, 2PD score, SWM score, cold intolerance score, gender, hand dominance, and the injured finger. Results: Patients' satisfaction was significantly correlated only with cold intolerance score. There was no significant correlation between patients' satisfaction and age, follow-up period, gender, hand dominance, injured finger, 2PD score, and SWM score. Conclusion: Our study revealed that patients' satisfaction was not only correlated with sensorial recovery scores but also significantly negatively correlated only with cold intolerance, and novel modalities to treat this phenomenon are required. Moreover, patients' satisfaction was not related to age, gender, hand dominance, and the injured finger; hence, surgeons should focus on meticulous repair of digital nerves in any age, for any gender, and any finger of patients.

Herbo-medicinal formulation; Marham-e-raal: A potent ointment for acute and chronic wounds – A review Waseem Ahmad, Saiyad Shah Alam, Zareena Aquil Turkish Journal of Plastic Surgery 2019 27(2):77-83 The wound is a break in continuity of skin and mucus membrane. It may arise owing to multiple causes such as mechanical, chemical, and thermal injuries. There are number of treatments available for the acute and chronic wounds but each having its own drawback from the point of view of the reach of below poverty line and common people. Many of them are so much costly that it becomes difficult to adopt them as a mode of treatment, and few others have lesser potency in terms of cure. The aim of this review is to elaborate the properties, pharmacological actions, phytochemical studies, and mechanism of action of the contents of Marham-e-raal which is easily available and affordable. We have taken a deep insight into the Marham-e-raal by collecting and studying the meaningful and scientific data in favor of the same; and made an essential conclusion that it possesses antimicrobial, antiviral, antiseptic, rubefacient, and wound healing properties.

A rare location and unusual development: Antecubital leiomyoma Alper Ural, Fatma Bilgen, Mehmet Bekerecioglu, Sevgi Bakaris Turkish Journal of Plastic Surgery 2019 27(2):84-86 Leiomyomas are benign soft tissue neoplasms which are originated from smooth muscle cells. Leiomyomas rarely occur in the upper extremity. To our knowledge, there have been no reports of a leiomyoma of the forearm which occured after intravenous catheterisation in Turkish literature. Herein, we report such a case of antecubital leiomyoma in a 52-year-old man. The case is presented due to its rarity and the risk of tumor misdiagnosis. Leiomyomas should be considered in the differential diagnosis of solitary masses of the extremities.

Congenital deficiency of the medial crus Suphan Tunc, Oguz Kayiran Turkish Journal of Plastic Surgery 2019 27(2):87-90 Congenital deficiency of lower lateral cartilages is rarely observed. Moreover, congenital lack of medial and/or lateral crus is extremely rare. Here, a case having nasal tip asymmetry with lack of nasal tip support, hence, the atrophy of medial crus is presented. Reconstruction of the medial crus was appropriately established with a septal cartilage graft. Supportive grafts were also used to enforce the tip and columella. The patient was extremely satisfied from the surgery. The practitioners must be aware of the deformities and deficiencies of the nasal cartilages as well as suitable reconstructions.

Sinuses: Another diagnostic marker of malignant transforming pressure ulcer BA Ramesh, Satish Kumar Jayaraman, J Mohan Turkish Journal of Plastic Surgery 2019 27(2):91-92