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ABSTRACT: BACKGROUND: There are lots of ways to close a defect according to the reconstruction ladder. In this article, we would like to share our experience with V-Y rotation advancement flap on different parts of the body. PATIENTS AND METHODS: Between 2006 and 2009, we performed V-Y rotation advancement flap on 68 patients (average age, 50 years). We performed this flap for decubitus and neuropathic ulcer on 33 patients, for defect reconstruction after tumor removal on 29 patients, and for trauma on 6 patients. RESULTS: The sizes of the defects ranged between 2 × 2 and 26 × 16 cm. All flaps survived without any major complications. Patients were satisfied with their scar appearance, and no sensory impairment was seen. CONCLUSIONS: V-Y rotation advancement flap restores the defect with a perfect color match and leaves an aesthetically acceptable scar. With its surgical flexibility and durability, this flap disappoints neither the surgeon nor the patient.
Annals of plastic surgery 11/2012; · 1.29 Impact Factor
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ABSTRACT: Fingertip amputation is the most common type of injury in the upper limb. Goals in fingertip amputation reconstruction are covering the defect, establishing maximum tactile gnosis, keeping the length of the finger, protecting the joint function, acquiring a well-padded pulp tissue, providing a bed for growing nail, obtaining a satisfactory cosmetic appearance and allowing the patient to return to work as soon as possible. Adjacent skin and soft tissue are the best covers for fingertip injuries. However, local homodigital flaps lack enough tissue to cover the defect. To solve this problem, we used V-Y rotation advancement flap bilaterally in fingertip amputations which meets all the reconstruction goals. Rotation besides advancement makes this flap more mobile and easier to cover larger defects in all amputation planes.
Between 2007 and 2009, we performed bilateral V-Y rotation advancement flap on seven male patients' pulpa (average age, 37.6 years) whose fingertips were not replantable.
Fourteen flaps were made on 7 fingers. There was neither total nor partial flap loss. Patients had neither cold intolerance nor scar hypersensitivity. Stiffness of the PIP joint did not occur. No obvious hooked nail occurred in patients who have remaining nail matrix. Because flaps contain neurovascular bundle, there was no difference in sensation and perfusion between the finger's pre-operative and post-operative status. The result was satisfactory with painless pinching.
In addition to the various and versatile fingertip reconstruction methods, we want to present V-Y rotation advancement flap as a quick, reliable and aesthetic method.
Hand 03/2012; 7(1):79-85.
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ABSTRACT: Proanthocyanidins are potent natural antioxidants which belong to a class of polyphenols. Proanthocyanidin-rich extracts are prepared from grape seeds. The effect of grape seed proanthocyanidin extract (GSPE) on the viability of abdominal skin flaps exposed to warm ischaemia and subsequent reperfusion were studied in 40 male Wistar rats. In the control group (group I; n=20), rats were fed with standard, non-purified rat diet, and the study group received GSPE 100 mgkg(-1) per day 1 week prior to surgery and 1 week following surgery. Abdominal island flaps were elevated in both the groups and subjected to 8h of warm ischaemia, followed by reperfusion. Mean flap survival areas in groups I (control group) and II (treatment group) were calculated to be 58.3%+/-11.72 and 81.0%+/-11.88, respectively. Flap survival on day 7 was significantly higher in group II compared to group I (p<0.01). Histopathological semi-quantitative analysis of the specimens revealed infiltration by polymorphonuclear leucocytes, oedema formation and necrosis in group I, whereas neo-vascularisation and fibrosis were the prominent findings in group II.
Journal of Plastic Reconstructive & Aesthetic Surgery 02/2009; 63(4):705-10. · 1.49 Impact Factor
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ABSTRACT: For head and neck reconstruction after tumor ablation surgery, free flaps are mostly the chosen treatment modality for most of the centers. Coping with venous insufficiency and increasing venous outflow of the flap during this process increases the success rate. To increase venous outflow, triple-lumen central venous catheter is inserted to one of the donor veins of the flap that has venous insufficiency and one intact vein anastomosis.
The Journal of craniofacial surgery 12/2008; 19(6):1645-7. · 0.81 Impact Factor
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ABSTRACT: The digital fibroosseous pulley system is essential for optimum function of the flexor tendons and the continuation of normal hand functions. Different materials have been used for pulley reconstruction in the literature but the ideal material is still controversial. In this study, after the excision of the A2 pulley, pulley reconstructions were performed by using acellular dermal matrix, solvent dehydrated bovine pericardium, fascia lata, and free tendon graft in the rabbit model. The animals were killed at the 8th and 12th weeks and subjected to biomechanical testing. Tendon excursion and work of flexion values were calculated for each digit of the rabbits. As a result, all the reconstructed pulleys were functioning well without a statistically significant difference between the experimental groups. Pulleys reconstructed with acellular dermal matrix and solvent-dehydrated bovine pericardium appear to have the potential to function as effective pulley substitutes.
Annals of plastic surgery 08/2008; 61(2):215-20. · 1.29 Impact Factor
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ABSTRACT: This paper presents the details of an experimental study of arterial anastomosis, combining suture with the cyanoacrylate tissue adhesive. At the distal end of the vessel, two parallel incisions were made, 180 degrees apart from each other, and two sutures were placed passing from the proximal end to exit from the most distal part of the longitudinal incisions. The tissue adhesive was then applied to the proximal vessel, and the full-thickness vascular 'lid' flap was closed over it on anterior and posterior surfaces. Eighty anastomoses were carried out at the left and the right femoral arteries of 40 Wistar rats. For all of the animals, conventional end-to-end anastomosis was carried out on the left side, and the lid technique was used on the right side. There was no statistically significant difference between the patency rates of the groups (two non-patent in control and two in the study group) (P>0.05), whereas significantly reduced operation time (mean 16.2 and 10.7 min in control and study groups, respectively) (P<0.0001) and bleeding time (median 1.5 and 0.5 min in control and study groups, respectively) (P<0.0001) were documented in the study group. Histopathological evaluation of both the patent and non-patent vessels at day 21 revealed no signs of tissue toxicity or intraluminal adhesive leakage. In view of these data, it was concluded that the technique provides an effective and simple method for end-to-end anastomosis of small-calibre arteries.
Journal of Plastic Reconstructive & Aesthetic Surgery 06/2008; 62(9):1205-9. · 1.49 Impact Factor
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Dermatologic Surgery 12/2007; 33(11):1380-3. · 1.80 Impact Factor
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ABSTRACT: Pinocchio or Cyrano nasal tip deformity is a rare situation that develops secondary to the soft tissue tumors underneath. In literature, there is only one case reported with Pinocchio nasal deformity secondary to cavernous lymphangioma. In this study, we present a Pinocchio or Cyrano nasal deformity with skin involvement secondary to lymphangioma circumscriptum.
Journal of Craniofacial Surgery 12/2007; 18(6):1473-5. · 0.82 Impact Factor
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ABSTRACT: Reattachment of the amputated fingertips as composite grafts has been performed for distal levels in children, with high rates of good outcome, but the majority of the reports emphasized that this procedure had success rates only up to 50% in adults. Several techniques to enhance composite graft take in adults have been defined. In this study, a technique to enhance nonmicrosurgical replantation of amputated fingertips as composite grafts is presented.Twenty-three patients were treated with this technique, 20 of which were adults. An area of skin on the amputation margin of the stump was deepithelized, and the amputated part was defatted to reattach the piece as a cap composite graft and to increase the contact area. The patients were evaluated after the operations regarding functional and esthetic outcome. Success rates of 86.95% in total and 85% in adults were achieved, with acceptable sensibility (with a mean value of 7.26 mm for the 2-point discrimination), minimal shortening (a mean value of 6.80 mm), and satisfactory esthetic outcome using this technique.
Annals of Plastic Surgery 12/2006; 57(5):545-51. · 1.32 Impact Factor
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ABSTRACT: Mallet finger deformity is a common disability that causes discomfort and inconvenience to the patient. Although numerous operative techniques have been described, surgical management remains controversial.
Between 2002 and 2004, 19 patients with an unsuccessful splinting regimen history, chronic deformities of tendinous origin (>3 months after the injury), or fractures involving 30 percent or more of the articular surface underwent surgical treatment. In 11 patients, chronic mallet finger deformity with tendinous origin was present, whereas eight patients presented with mallet fractures involving more than 30 percent of the articular surface. Open reduction with internal "pull-in" sutures and distal interphalangeal joint immobilization with Kirschner wire was accomplished. Active motions of the proximal interphalangeal and metacarpophalangeal joints were not restricted. After removal of the Kirschner wire at week 6, active flexion exercises were commenced immediately, and daily activities were not restricted. Full activity was allowed at day 7. Goniometric measurements, radiographs, and patient satisfaction were evaluated during the follow-up period.
The mean follow-up period of the patients was 16 months (range, 4 to 28 months). Mean extensor lag of the distal interphalangeal joint was 2 degrees (range, 0 to 6 degrees). The mean flexion of the distal interphalangeal joint was 74 degrees (range, 60 to 90 degrees). According to Crawford's evaluation criteria, 14 excellent and five good results were obtained. Apart from radiologically documented mild degenerative changes or joint narrowing in six patients, no complication was encountered.
The pull-in technique allows accurate realignment of the tendon-bone unit without any specific instrumentation or intraoperative fluoroscopic imaging methods.
Plastic and reconstructive surgery 10/2006; 118(3):696-702. · 2.74 Impact Factor
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ABSTRACT: Rhinoplasty has become one of the most frequently requested and performed surgical procedures for both functional and aesthetic purposes. As an attention-attracting prominence, even the slightest disfigurement of the nose causes serious disturbance to the patient before or after the operation. Functional problems also cause discomfort. For these reasons, postrhinoplasty complications are regarded as challenging problems for both for the patient and the surgeon. Some cases necessitate grafts for better aesthetic or functional outcome, but there is still controversy over the preference for autogenous or allogenous grafts, both for primary and secondary cases. Evaluation of autogenous and allogenous grafts implanted in the nose is quite challenging for several reasons, including the possibility of unpredictable complications leading to catastrophic disfigurements, the impossibility of obtaining pathologic specimens, and the need for a long follow-up period for stable results. An experimental model for rhinoplasty, fulfilling the need for precise evaluation, was planned and performed after anatomical observation of the noses of rabbits.
Fifteen adult New Zealand rabbits were used, five for the anatomical evaluation and 10 for the rhinoplasty model. Computed tomographic images and measurements were obtained before and after the surgical processes.
This experimental model for rhinoplasty has not been reported in any previous studies. This study demonstrates the surgical anatomy of the rabbit in detail and constitutes a guide for researchers as a convenient experimental model for rhinoplasty, with all stages similar to those performed on humans.
Plastic and reconstructive surgery 06/2006; 117(6):1851-9. · 2.74 Impact Factor
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ABSTRACT: Gluteal artery perforator flaps have gained popularity due to reliability, preservation of the muscle, versatility in flap design without restricting other flap options, and low donor-site morbidity. Today, free or local flaps based on the perforating arteries of the gluteal region are among the most commonly used procedures for the management of lumbosacral defects and autologous breast reconstruction. An anatomic study was carried out to investigate localization, dimension, and distribution of the perforator arteries in 16 gluteal regions of 8 formol-fixed cadavers. The total number of perforators in each gluteal region was 13-20 (mean 17 arteries). Mean vessel diameter and mean vessel length were 1.1 mm (range 0.7-1.7 mm) and 6.4 cm (range, 5.2-9.1), respectively. Topographic analysis of the perforators revealed that the gluteal region can be divided into 3 parts in terms of vessel density. The majority of the perforators were localized in superior zone, whereas the middle zone was documented to be the poorest region. Data derived from this analysis were also confirmed by individual analysis of each cadaver.
Annals of Plastic Surgery 05/2006; 56(4):409-12. · 1.32 Impact Factor
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ABSTRACT: In clinical practice, there are many ways to reconstruct nasal defects. Despite this fact, achieving a desirable image and better functional results is still a problem. Banner, bilobed, and dorsal nasal flaps have recently been used to reconstruct defects up to 2 cm. For defects larger than 2 cm, flaps raised from the frontal region and face are used. The major disadvantages of these flaps are the visible scar and the frequent need for a second session.
The authors used orbicularis oculi musculocutaneous flaps raised from the lower eyelid, containing branches of the angular artery and the infraorbital artery in its pedicle, to reconstruct nasal tip and supratip defects. Between February of 2002 and March of 2004, reconstruction with orbicularis oculi musculocutaneous island flaps raised from the lower eyelid was performed on 15 patients (eight men and seven women) with nasal tip and supratip defects. Thirteen defects were secondary to basal cell carcinoma and two were secondary to congenital melanocytic nevus. The diameter of the defects ranged between 2.1 and 3.1 cm (average diameter, 2.5 cm). Patients were between 25 and 72 years old (average age, 52 years).
Patients were followed up for an average period of 6 months (range, 1 to 12 months). In two patients (13.3 percent), postoperative venous problems were seen but resolved in 3 days. Partial necrosis developed in one patient (6.6 percent). In one patient (6.6 percent), minimal scleral show was seen in tolerable ranges. Neither ectropion nor other eyelid deformities were seen.
The authors believe that this flap is a good alternative for reconstruction of nasal defects because of its advantages, namely, the need for only a single session, minimal donor-site morbidity, better color and thickness match, and easy and faster surgery.
Plastic and reconstructive surgery 02/2006; 117(1):239-46. · 2.74 Impact Factor
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Burns 10/2005; 31(6):792-4. · 1.96 Impact Factor
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ABSTRACT: Although several different methods were described in the literature, closure of large meningomyelocele defects presents a challenging problem. Wound dehiscence may lead to devastating complications. In this paper, the efficacy of the bilateral modified V-Y advancement flap procedure was investigated in terms of simplicity, donor-site morbidity, and reliability.
The authors presented 10 neonates treated with a modified subcutaneous advancement procedure. Unlike the typical V-Y advancement techniques, the apical extensions of the "V" flaps were elevated based on the paraspinous perforators. A standard closure algorithm was not followed, as the well-vascularized apical extensions facilitated intraoperative decision making for the most appropriate adaptation pattern, depending on the size, shape, and localization of the defect. As well as that, transposition of these apical flaps to the defect site was further supported by the advancement of the V-Y flaps to decrease the tension along the closure.
Mean follow-up period was 13.6 months (range 3-37 months), and no complications that might be attributable to the operative procedure were observed.
Utilization of bilateral modified V-Y flaps for the closure of large meningomyelocele defects is a simple and effective procedure. Main advantages of the method described in this paper may be listed as follows: simplicity, reliability due to coverage of the defect with well-vascularized flaps, minimal bleeding, decreased operative time, and no donor-site morbidity.
Annals of Plastic Surgery 07/2005; 54(6):640-4. · 1.32 Impact Factor
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ABSTRACT: Currently, there are various surgical treatment modalities for ingrowing nail. None of these procedures are perfect to achieve esthetic results with low cost, recurrence, and complication rates. Eighty-seven toenails of 77 patients were operated in our clinic; 49 wedge matrix resections (WMR) and 38 partial matricectomy followed by lateral fold advancement flap (LFAF) were applied. Average follow-up period of the patients was 13 months. The recurrence rates, spicule formation, immobilization periods, and patient satisfaction for cosmetic result and discomforting symptoms were investigated. Nail, distal phalanx bone, soft tissue measurements were performed in the counterlateral healthy toe of 34 patients that we operated due to the unilateral ingrowing nail and 34 randomized individuals with no ingrowing nail by lateral and anteroposterior toe x-rays. There were no significant differences for age, sex, the side of the ingrowing nail, postoperative mobilization period, and the follow-up period between 2 groups that the techniques were applied to. There was no statistically significant difference in WMR (8.1%, 4 toes) and LFAF (none) for the recurrence rate. But there was significant difference between WMR (36.7%, 18 toes) and LFAF (5.2%, 2 toes) for the spicule formation rates (P < 0.05), and there was significant difference between WMR (20.4%, 10 toes) and LFAF (none) for the reoperation (P < 0.03). It was observed that patient satisfaction in cosmetic view was better in patient group treated with LFAF (P < 0.05). Phalanx heads were wider in patient group with ingrowing nail at the results of the measurements (P < 0.01). The fact that granulation and scarred tissues are removed instead of performing the great soft tissue excisions is more correct for both recurrence and cosmetics. Partial matricectomy and LFAF is a good alternative method for the treatment of ingrown nail, with less recurrence rates and cost and better cosmetic results.
Annals of Plastic Surgery 04/2005; 54(3):306-11; discussion 312. · 1.32 Impact Factor
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ABSTRACT: An experimental study has been performed on 30 New Zealand rabbits to compare autogenous cartilage harvested from the rabbits' auricles, bone graft harvested from the iliac crest of the rabbits, and the commercially available solvent dehydrated human costal cartilage (SDHCC) grafts, each measuring 1 x 1 cm. The grafts are divided into two groups, one group of grafts are inserted into pouches on the cranial bones subperiosteally and the other subfascially on the back of the animals. The grafts are evaluated on the 4th and the 12th weeks. No problems, such as dehiscence, hematoma, infection, erythema, flap necrosis, or graft exposition, occurred during the postoperative follow-up. SDHCC grafts are well tolerated and preserved by the host. They are infiltrated by the fibrous connective tissue and are firmly fixed to the surrounding structures. By the end of 12th week, the thickness of SDHCC grafts were not significantly different, compared with autogenous cartilage grafts, but both were thicker than the autogenous bone grafts. Viable chondrocytes and active cartilage development on SDHCC grafts were seen by the 4th week and chondrogenetic and osteogenetic activity on the 12th demonstrate the feasibility of clinical use of SDHCC grafts for soft and bony defects.
Journal of Craniofacial Surgery 02/2005; 16(1):89-94. · 0.82 Impact Factor
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Journal of Craniofacial Surgery 12/2004; 15(6):1060-2. · 0.82 Impact Factor
