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ABSTRACT: A case diagnosed as Bardet-Biedl syndrome with polydactyly and hypertension has been presented here. Bardet-Biedl syndrome is an autosomal recessive disorder, which includes renal dystrophy, dystrophic extremities (often polydactyly), obesity, hypogenitalism, renal disease, and mental retardation. It was first described by John Z. Laurence and Robert Moon. The basic components of the syndrome were established by George Bardet in 1920 and Arthur Biedl in 1922. Although it is still referred to as Laurence-Moon-Bardet-Biedl in some reports, it has recently acquired the name Bardet-Biedl syndrome. Patients were generally lost due to renal insufficiency at young ages.
Annals of plastic surgery 12/2008; 61(5):511-2. · 1.29 Impact Factor
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ABSTRACT: A case diagnosed as Bardet-Biedl syndrome with polidactily and hypertension has been presented here. Bardet-Biedl syndrome is an autosomal ressesive disorder, which includes renal dystrophy, dystrophic extremities (often polydactily), obesity, hypogenitalism, renal disease, and mental retardation. It was first described by John Z. Laurence and Robert Moon. The basic components of the syndrome were established by George Bardet in 1920 and Arthur Biedl in 1922. Although it is still referred to as Laurence-Moon-Bardet-Biedl in some reports, it has recently acquired the name Bardet-Biedl syndrome. Patients were generally lost due to renal insufficiency at young ages.
Annals of Plastic Surgery 10/2008; 61(5):511-512. · 1.32 Impact Factor
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ABSTRACT: As most of the skin lesions tend to grow in a circular pattern, the resultant defects after surgical removal of these lesions are often circular. Although a number of local flap procedures have been described, alternative techniques are still needed for the closure of circular defects.
Here, a new surgical technique for the closure of circular skin defects is presented. This technique basically uses the extra skin relaxation gained with an unequal Z-plasty maneuver in favor of the defect closure. The procedure is named as "the reading man" because its surgical design resembles the silhouette of a man who is reading a book held in his hand.
In this technique, 2 flaps designed in an unequal Z-plasty manner are used. The first flap is transposed to the defect area whereas the second flap is used for closure of the first flap's donor site. For 3 years, this technique has been used for closure of the circular skin defects in 27 patients (19 men and 8 women) aged from 2 months to 68 years. The defect size was ranging between 1.5 and 14 cm in diameter.
A tension-free defect closure was obtained in all patients. All flaps healed with no complications. There was no patient with dog ear formation. A mean follow-up of 15 months (6 months-3 years) revealed an esthetically acceptable scar formation in all patients.
The reading man procedure was found to be a useful and an easy going technique for the closure of circular skin defects located on various anatomic regions. It enables surgeon to obtain a tension-free closure of considerably large skin defects with minimal scarring and additional healthy skin excision.
Annals of Plastic Surgery 05/2008; 60(4):420-5. · 1.32 Impact Factor
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ABSTRACT: Although several techniques have been described for total lower-lip reconstruction, it is still a major reconstructive challenge, which often requires lengthy and risky microsurgical procedures.
Here, we present a new local procedure, namely, bilateral musculocutaneous unequal-Z procedure for functional reconstruction of total lower-lip defects.
In this technique, 2 musculocutaneous flaps including the depressor anguli oris and platysma muscles, respectively, are used in an unequal Z-plasty manner on each side of the defect. The lip defect is closed by the means of extra tissue relaxation provided with bilateral Z-plasty maneuver. The oral sphincter is reconstructed by suturing the depressor anguli oris muscles to each other at the midline. The mucosal coverage is provided with mucosal flaps obtained from the buccal areas bilaterally. Over 2 1/2 years, this new technique was used in 8 patients, aged between 47 and 83 years, with total lower-lip defects resulted from excision of squamous cell carcinomas.
All patients healed uneventfully. At 6 months, physical and electromyography (EMG) examinations revealed an intact oral sphincter with a normal sensitivity. One patient died because of lung metastasis at 8 months after surgery. A mean follow-up of 2 years revealed a functionally and cosmetically acceptable lower-lip reconstruction in all surviving patients.
As a nonmicrosurgical local procedure providing an esthetically acceptable, sensitive, and functional lower lip, this new technique seems to be a useful alternative to the microsurgical procedures in total lower-lip reconstruction.
Annals of Plastic Surgery 03/2008; 60(2):162-8. · 1.32 Impact Factor
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ABSTRACT: Silicones are widely used materials in many fields of medicine and largely are believed to be biologically inert. However, some investigators have reported that silicone implants are associated with an increased incidence of autoimmune disorders. In this study, we evaluated the capsular tissue of silicone implants and the sera of implant patients and controls for antisilicone antibodies and nonspecific immunoglobulins (IgG, IgA, IgM, and IgE). Our study group included 15 patients (eight men and seven women) undergoing reconstructive procedures for burn scars, in whom we used silicone implants, and 15 sex-matched controls undergoing reconstructive surgery for burn scars without using silicone implants. By immunofluorescence, we discovered strong capsular binding of IgG and weak capsular binding of IgM; antisilicone antibody levels were significantly higher in capsular tissue than elsewhere. Serum IgE also was higher in patient vs control subject sera. In conclusion, silicone materials do lead to an immune response consisting of antisilicone antibodies most evident immediately adjacent to the implant itself.
Clinical Rheumatology 03/2008; 27(2):147-50. · 2.00 Impact Factor
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ABSTRACT: We report a sporadic case of congenital lateral cleft palate and lateral palatal synechiae and suggest that its mechanism is embryonal. This is the first published case that we know of with cleft palate-lateral synechiae syndrome including the lateral cleft palate.
Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery 02/2008; 42(6):325-7. · 0.94 Impact Factor
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ABSTRACT: Although small meningomyeloceles may be amenable to direct closure by undermining of the surrounding skin, the closure of large meningomyelocele defects is a challenging reconstructive problem.
Here, we present a new surgical procedure for the closure of large meningomyelocele defects.
In this procedure, after neurosurgical repair and closure of the placode, the defect is surgically converted to a triangle in shape. Then, the triangular defect is closed by transposition of 2 skin flaps designed in an unequal z-plasty manner. Over 3 years, this new technique, namely Mutaf triangular closure procedure, was used for the closure of large meningomyelocele defects in 5 patients, aged between 2 days to 6 weeks. The defect size was 10.4 x 7.5 cm on average.
In all patients, a tension-free 1-stage closure was obtained. Except one with a minimal hematoma, all patients healed with no complication. There was no patient with late breakdown of the wound during 2 years of mean follow-up.
Besides the 2 major advantages of short operative time and minimal blood loss, our technique provides a well-vascularized soft tissue padding over the neural tissues, and no suture line overlies the cord closure. With these advantages, this new technique seems to be a useful and safe solution for closure of large meningomyelocele defects.
Annals of Plastic Surgery 12/2007; 59(5):538-43. · 1.32 Impact Factor
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ABSTRACT: The unfavorable temporoauriculomastoid region is a serious clinical problem that makes total ear reconstruction a real challenge. In patients who have it, all local flap solutions to provide skin coverage to the cartilage frame are precluded because of loss and/or severe scarring of the regional skin in association with loss of the axial vascularity of the region. In the current literature, all available techniques for these patients are lengthy and risky free flap procedures that can provide a poor quality of skin coverage with no aesthetic harmony at best. In this article, the authors describe the use of the bilobed cervical flap as a new technique for providing skin coverage in total ear reconstruction for patients with an unfavorable temporoauriculomastoid region.
Over a period of 6 years, the technique was used in seven patients between the ages of 19 and 52 years. In all patients, the entire skin of the temporoauriculomastoid region was either lost or badly scarred. Moreover, use of the ipsilateral temporoparietal fascia was not possible because of impaired axial vascularity of the region.
Except for mild venous congestion at the distal part of the primary flap, the flaps healed uneventfully in all patients. The patients were followed up for 1 to 4 years. The results were excellent in all patients.
Providing a thin, pliable, hairless, and well-vascularized skin cover with a perfect color match, the bilobed cervical flap seems to be a useful solution to overcome the skin coverage dilemma in patients with an unfavorable temporoauriculomastoid region.
Plastic and reconstructive surgery 10/2006; 118(3):652-62. · 2.74 Impact Factor
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ABSTRACT: A new nonmicrosurgical technique for one-stage total phallic reconstruction is presented. In this procedure, an innervated anterolateral thigh (ALT) flap including the medial half of the fascia latae is combined with a sartorius perforator flap. Both flaps are elevated together as an island chimeric flap based on the lateral circumflex femoral vessels and tunneled to the recipient area. The neourethra is created with thin and hairless skin of the sartorius perforator flap, while the ALT flap is used to construct the shaft and glans of the neophallus. The rigidity was provided with a penile prosthesis covered with a neotunica albuginea created with vascularized fascia latae for the first time in the literature. The lateral femoral cutaneous nerve of the ALT flap is coapted to the pudendal nerve to provide erogenous sensibility. Here, a 15-year-old male in whom this new procedure was used for one-stage total phallic reconstruction is presented. Two years of follow-up revealed that an esthetically acceptable and functional neopenis with a nonhairy competent urethra, erogenous sensitivity, and a proper rigidity was achieved with no complication. This new technique, namely, the "Istanbul on the thigh" flap, is a one-stage, safe, and timesaving technique which fulfills all essential goals of phallic reconstruction but does not require microsurgical equipment and expertise. Moreover, the donor scar is located at an unexposed area, easy to conceal. Although more clinical experience is needed, this new procedure seems to be a useful alternative in phallic reconstruction.
Annals of Plastic Surgery 08/2006; 57(1):100-6. · 1.32 Impact Factor
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ABSTRACT: We studied 73 repairs of cleft palate (48 cleft lip and palate and 25 isolated cleft palate) done during a 7-year period (January 1996-October 2002) by the same plastic reconstructive surgeon. Two-flap or four-flap palatoplasty techniques were used to provide tension-free, three-layer repairs for patients with cleft palate. Their ages ranged from 10-244 months (mean 27). The postoperative follow-up period ranged from 6 to 60 months (mean 21). There was a palatal fistulation rate of 7% (5/73). There were two fistulas after two-flap palatoplasty (5%, 2/39), and three fistulas after four-flap palatoplasty (9%, 3/34). The mean diameter was 7.8 mm (range 5.1 to 13). There was no significant difference between the two techniques.
Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery 02/2005; 39(5):287-9. · 0.94 Impact Factor
