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The Journal of craniofacial surgery 03/2013; 24(2):689. · 0.81 Impact Factor
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ABSTRACT: The thin-walled structure of veins leads them to stay collapsed during anastomoses, thereby the incidence of technical failures is more common than arterial anastomoses. In order to overcome this problem, we are introducing the use of viscoelastic material based on our experience on rats. Six rats were used in order to study the technical feasibility of the viscoelastic material during microsurgical vein anastomosis. End-to-end anastomoses were performed on rat jugular veins using 0.5-1 mL of the viscoelastic medium applied to the ends of the veins and surgical field under ×30 operating microscope magnification. Then 1.8% (n:3) and 3.0% (n:3) hyaluronic acid was used as a viscous medium in order to keep the vein lumens open during anastomosis. In conclusion, we have found that 3.0% hyaluronic acid viscoelastic medium facilitates microvenous anastomosis in rat. Studies involving human practice are needed for further evaluation of this technical refinement.
The Journal of craniofacial surgery 03/2013; 24(2):585-6. · 0.81 Impact Factor
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ABSTRACT: BACKGROUND: We present a technical modification of vertical reduction mammaplasty which provides a reliable pedicle that can be used in large and highly ptotic breasts with confidence when compared to vertical mammaplasty techniques without sacrificing conical breast shape and projection, in contrast to Wise pattern reduction techniques. METHODS: Thirty-two patients under general anesthesia were operated on using this modification between 2008 and 2012. The surgical technique is as follows: after general anesthesia induction and local anesthetic infiltration, skin incisions are made according to preoperative drawings. The breast meridian is prepared by superior and inferior plication of the vertical pedicle, including two dermal and one central attachment to the chest wall. Lateral and medial tissue resections are performed, thus preparing medial and lateral pillars after skin undermining. The pillars are sutured to the meridian to reconstruct a projectile conical breast shape. Inverted-T scar (87.5 %, n = 28) and vertical scar (12.5 %, n = 4) were used for closure. RESULTS: All patients were satisfied with the outcome regarding breast projection, shape, and size at 12 (n = 30) and 24 months (n = 15) after surgery except for 12 cases that needed reoperations: 2 cases for bottoming out and lower pole deformity, 2 cases needed more reduction by liposuction or re-excision, and 8 scar revisions. CONCLUSION: Early and late results (up to 2 years) regarding breast shape and projection were found to be satisfactory while providing a reliable pedicle with less postoperative drainage. 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 .
Aesthetic Plastic Surgery 02/2013; · 1.41 Impact Factor
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Injury 06/2012; · 1.98 Impact Factor
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Microsurgery 03/2012; 32(5):420-2. · 1.61 Impact Factor
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Injury 04/2011; 42(11):1387-8. · 1.98 Impact Factor
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ABSTRACT: The surgical anatomy of the dorsal branch of the ulnar nerve and artery on the dorsal aspect of the hand is important in design of neurocutaneous flaps for reconstructive surgery and serves as a donor site for nerve grafts. In this study, the course, location, and diameter of the dorsal branches of the ulnar nerve and artery were studied from anatomical and reconstructive perspectives.
Upper limbs of 14 (7 left and 7 right) and 22 formalin-preserved adult cadavers (15 left and 7 right) were dissected in two different centers.
The diameters of the ulnar nerve, artery, and their dorsal branches were measured at selected reference points. The distances to specific anatomical landmarks were also measured, during their courses from the proximal forearm towards the middle phalanges of the 4th and 5th fingers.
Our data may facilitate the design of neurocutaneous flaps nourished from the dorsal branches of the ulnar nerve and artery, and may aid in the harvesting of nerve grafts from the dorsal branch of the ulnar nerve, and provide a safe surgical approach to the dorsum of the hand.
Anatomia Clinica 04/2011; 33(3):229-33. · 0.93 Impact Factor
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ABSTRACT: In this clinical report, we are presenting the combination of demineralized bone matrix combined with bilateral galea frontalis flaps. Based on our 6-month results, this seems to be a reasonable combination to accomplish long-lasting restoration of forehead defects related to en coup de sabre linear localized scleroderma.
The Journal of craniofacial surgery 01/2011; 22(1):257-8. · 0.81 Impact Factor
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ABSTRACT: In this report, we are presenting a case in which we have split the paramedian forehead flap, thus providing 2 axially perfused skin flaps for simultaneous reconstruction of the upper and lower lid structures after resection of basal cell carcinoma from the left medial canthal area. We found that split forehead flap seems to be a favorable option for simultaneous reconstruction of the upper and lower eyelid defects by enabling nicely vascularized and abundant amount of regional skin.
The Journal of craniofacial surgery 01/2011; 22(1):363-5. · 0.81 Impact Factor
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The Journal of craniofacial surgery 09/2010; 21(5):1662. · 0.81 Impact Factor
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ABSTRACT: In this article, we are introducing the use of galeal-frontalis flap to reduce hypertrophic sinus based on 1 case: a 25-year-old amateur boxer who had prominent frontal area due to hypertrophic frontal sinus. Three-dimensional reformatted computed tomography scans were obtained for evaluation of the hypertrophy and the morphology of the frontal sinus. Reduction of the hypertrophic frontal sinus was performed by resection and shaping of the anterior wall and obliteration of the frontal sinus by right-side galeal-frontalis flap excision via bicoronal approach. The trimmed anterior wall was inserted into the frontal sinus and secured with three 3.0 PDS sutures to the bone edges, and the incision was closed. The outcome was satisfactory without any complications during 1-year follow-up, and sixth-month computed tomography scans revealed no bone resorption. Here we are introducing a novel technique to reduce hypertrophic sinus based on a clinical report.
The Journal of craniofacial surgery 05/2010; 21(3):939-41. · 0.81 Impact Factor
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Microvascular Research 03/2010; 79(2):91-2. · 2.83 Impact Factor
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ABSTRACT: We describe herein a new technique for reconstruction of the orbital floor, using autologous nasal septal bone and report the surgical results achieved in maxillofacial trauma patients.Prior to its clinical surgical application, a cadaver practice was carried out on 5 formalin-fixed adult human cadavers to establish the feasibility and efficacy of the method. Fifteen patients with orbital floor fractures, operated between 2005 and 2008, using this technique, were included in the current study.Cadaveric practice revealed that an adequate and appropriate size of septal bone graft can be harvested for reconstruction of the orbital floor. All patients except one had satisfactory clinical and radiologic late results. One patient experienced persistent enophthalmos, possibly due to delayed repair and associated displaced zygomatic bone fracture.Autologous nasal septal bone as an orbital floor bone graft has many advantages, including low donor site morbidity, adequacy and appropriateness of size, and similarity of its bicortical morphology and histologic nature compared with the orbital floor bone. Our clinical results strongly support that this technique can become a satisfactory alternative to existing reconstruction methods.
Annals of plastic surgery 01/2010; 64(1):41-6. · 1.29 Impact Factor
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ABSTRACT: In this article, we present the use of triangulation for end-to-side microvascular arterial anastomosis. The classic end-to-side anastomosis starts by putting 2 sutures 180 degrees apart to the lateral arteriotomy aperture that is parallel to the longitudinal axis. We are performing triangulation in end-to-side microvascular artery anastomoses by putting 3 stay sutures, securing 2 of them to visualize vascular lumen and reduce the risk of passing suture from the back wall. We have been using this method for the last 5 years and found that triangulation seems to be a safer technique to teach and practice end-to-side microvascular anastomosis.
The Journal of craniofacial surgery 10/2009; 20(6):2225. · 0.81 Impact Factor
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ABSTRACT: Silent sinus syndrome is a clinical entity with the constellation of progressive enophthalmos and hypoglobus due to gradual collapse of the orbital floor with opacification of the maxillary sinus, in the presence of subclinical maxillary sinusitis. It occurs secondary to maxillary sinus hypoventilation due to obstruction of the ostiomeatal unit. In this paper, a 35-year-old woman with a complaint of asymmetry in her left eye and denting of upper eyelid was reported. In the left eye, upper sulcus was deepened and there was 3-mm hypoglobus. There was no diplopia or restriction of eye movements in any gaze positions. Hertel exophthalmometry revealed a 4-mm enophthalmos on the left eye. Computed tomographic scan of the orbita and paranasal sinuses showed left maxillary sinusitis, air-fluid level, and collapse of left maxillary sinus walls. In addition, inferior bulging in the left orbital floor was also reported. The treatment was a 2-stage operation. In the first stage, she underwent endoscopic septoplasty plus left maxillary antrostomy, and in the second stage, she underwent a subciliary orbital floor repair of the iliac bone resulting in the improvement of the enophthalmos and her cosmetic appearance. Regarding this case, the literature is also reviewed in detail.
The Journal of craniofacial surgery 10/2009; 20(6):2156-9. · 0.81 Impact Factor
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Plastic & Reconstructive Surgery 09/2009; 124(4S):72. · 3.38 Impact Factor
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ABSTRACT: In this paper, we are presenting a rare case of accidental middle turbinectomy, a complication of nasotracheal intubation. We have reviewed the literature and addressed important parameters on nasotracheal intubation to avoid damage to the turbinates and its possible serious complications.
The Journal of craniofacial surgery 04/2009; 20(2):566-8. · 0.81 Impact Factor
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ABSTRACT: In this article, we introduce the use of dental mirror during microsurgery. We have been using no. 4 dental mirror during microvascular anastomoses and nerve coaptations for the last 6 months successfully and found that, as a cheap and easily obtainable instrument, it has facilitated our practice. We are strongly recommending the use of dental mirrors in microsurgical practice and inclusion to every microsurgery instrument set.
The Journal of craniofacial surgery 02/2009; 20(1):201-2. · 0.81 Impact Factor
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ABSTRACT: Prominent ear deformity is a common congenital ear deformity. Prominent ear deformity includes components such as valgus of concha, failure of scaphal folding, conchal hypertrophy, and prominent lobule. The deformity and the elastic properties of the ear cartilage determine the method of surgical correction in each case. Concha-mastoid suture, conchal excision, and posterior auricular muscle excision are different treatment options for mild to severe cases of conchal hypertrophy and valgus deformity. In this article we present a method of conchal excision, combined with a posterior auricular muscle flap, to repair severe conchal hypertrophy or valgus deformity. Six patients (11 ears) were operated on using this method. The results obtained were satisfactory. Postoperative results at 6 months were satisfactory in all patients. The smoothness and the natural appearance of the conchal bowls were notable in all patients. In contrast to the early methods of utilizing the posterior auricular muscle by transposing to the scapha or excising, its usage as a muscle flap for conchal hypertrophy and valgus deformity may be a promising option for the future.
Aesthetic Plastic Surgery 11/2008; 33(4):527-32. · 1.41 Impact Factor
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ABSTRACT: In this study, we aimed to develop a new muscular neurotization technique, in which transection of the donor nerve is avoided. We investigated the outcome of insertion of the donor nerve within the denervated muscle following segmentary epineurectomy (lateral muscular neurotization). Thirty-five male Wistar rats were evaluated in five groups, including sham control, denervation control, denervation combined with segmentary epineurectomy, direct muscular neurotization, and lateral muscular neurotization. Electromyography, muscle weight measurements, and histological evaluations were performed at postoperative months 2 and 3. The denervation group was statistically successful for denervation as compared with the sham control group for all parameters. The lateral neurotization group was successful in preventing muscle atrophy and gaining reinnervation in electromyographic, histological, and weight parameters. The direct neurotization group was also successful in histological and weight parameters. Lateral muscular neurotization is promising because it does not interrupt the fascicular integrity and is successful in reinnervation; therefore, it seems to be a good alternative for direct muscular neurotization.
Journal of Reconstructive Microsurgery 09/2008; 24(6):435-42. · 1.43 Impact Factor
