[Show abstract][Hide abstract] ABSTRACT: Delayed sural flap based on the vascular axis of the sural nerve has been advocated for coverage of diabetic foot ulcers. In this study we compared the survival of neurovenous and standard inferior epigastric island flaps in diabetic and non-diabetic rats. VEGF concentrations and electrolyte balance of the flaps were also investigated during elevation and on the fifth day to explore the possible mechanisms that influence ischaemia of the flap during the hyperglycaemic state. There were no statistical differences in area surviving between diabetic and control rats for either flap. The VEGF concentrations were also similar in the two flaps in the two groups during elevation. On the fifth day, VEGF concentrations had decreased significantly in all of the flaps. Electrolyte balance paralleled VEGF concentrations. We conclude that flaps based on the vascular axis of a superficial nerve deserve further experimental and clinical attention as potential options for reconstruction of ulcers on diabetic feet.
Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery 02/2007; 41(1):22-5. · 0.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Perforator flaps increasingly find acceptance and use in the field of reconstructive surgery due to their decreased donor-site morbidity and increased like-tissue coverage. Nevertheless, they are more prone to vascular compromise, especially when the meticulous technique they require is not employed. Pedicle twisting is a condition occasionally encountered in flap procedures, sometimes inadvertently, sometimes inevitably. In this study, circulatory comprise induced by twisting of the pedicle on a true perforator flap in a rat model is investigated.Thirty-eight Wistar-Albino rats were randomized into 4 groups, and cranial epigastric artery true perforator flaps were elevated on a single perforator. The flaps were returned as they were in the control group (n = 9), and with 90 degrees , 180 degrees , and 270 degrees of torsion in groups 2 (n = 9), 3 (n = 10), and 4 (n = 10), respectively. The flaps were evaluated by their flap survival area, weight, and histopathological appearance by the end of the first week. The mean flap survival ratios for groups 1, 2, 3, and 4 were 97.78 +/- 4.41%, 72.22 +/- 44.10%, 73.50 +/- 30.46%, and 30 +/- 30.18% (mean +/- SD), respectively. The degree of degenerative changes in group 4 was found to be statistically significant (P < 0.016).Our histopathological examinations indicate that vascular compromise was moderate in group 3 and severe in group 4. Our findings suggest that under normal conditions, the pedicle of a true perforator flap must not be twisted more than 180 degrees .
Annals of Plastic Surgery 02/2006; 56(2):186-9. · 1.46 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This article describes a pedicle-lengthening procedure (the Y-V-I principle) that reverts a Y-shaped vascular structure into an I-shaped vascular structure, and its application to the latissimus dorsi muscle. If the Y-shaped vascular structure is divided proximal to the branching point and ligated, it becomes a V-shaped vascular structure. To obtain a linear I-shaped vascular structure, the V is opened, and the length of the vascular pedicle will become equal to the combined length of both limbs of the V. This report indicates that the latissimus dorsi flap may be transferred based on the circumflex scapular artery or the serratus branch.
Journal of Reconstructive Microsurgery 05/2005; 21(3):173-8. · 1.01 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objective of this study was to examine the effects of the standard surgical delay in the flaps based on the cutaneous branches of the vascular axis around a superficial sensory nerve. The delay procedure was experimentally tested in rats and subsequently used in patients. In the experimental study, the survival of a delayed inferior epigastric neurovenous flap was compared with that of a nondelayed inferior epigastric neurovenous flap. One type of clinically applicable delay pattern (standard bipedicled technique) was employed. A 3 x 3 cm flap was raised in 20 female Wistar rats assigned randomly to 2 groups. Each group consisted of 20 flaps. The standard bipedicled delay pattern increased the percentage survival of the delayed inferior epigastric neurovenous flap. The survival percentage of the delayed flaps was 59.8 +/- 185.0 (P < 0.5). The histologic findings of the skin revealed that our delay procedure enhanced the perfusion of the flap by dilating the arterial network. Stimulated by our experimental findings, we used the island bipedicled surgical flap delay or combined strategic-standard delay in the distally pedicled sural flap successfully on 9 cases.
Annals of Plastic Surgery 12/2004; 53(5):481-7. · 1.46 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The authors report the application of subcision surgery to ear deformities for crosscutting and weakening of the deformed cartilage. The subcision techniques for correction of a deformed cartilage are divided into two groups. With the first method, termed "horizontal subcision," a 18-gauge needle is inserted horizontally through a puncture in the skin surface, and multiple passes are made. With the second method, termed "vertical subcision," a sweeping motion of the needle is used for crosscutting of the deformed cartilage. An experimental study was conducted using 10 rabbits (20 ears) to test the authors clinical observations. On the basis of histologic analysis, the authors hypothesized that with the horizontal subcision technique, the sharp edge of the needle damages the perichondrium and weakens the cartilage by creating multiple irregular microincisions. With regard to the vertical incision technique, gross examination showed partial or complete cuts of the cartilage. Subcision surgery was successfully used in eight cases.
Aesthetic Plastic Surgery 07/2004; 28(4):239-44. · 1.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Reconstruction options for columellar defects together with membranous septum, nasal base, and upper lip are restricted. We present a case successfully treated with bilateral cheek advancement flaps with upper medial, perialar skin flaps to reconstruct the upper lip, columella, nasal base and membranous septum in a single session. This method provides adequate tissue with minimal cosmetic deformity in a single stage for repairing such compound defects.
British Journal of Plastic Surgery 05/2003; 56(3):291-2. · 1.29 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: For practice in microsurgery, animal models and microsurgical instruments are required. The use of some synthetic and non-animal materials such as human placenta and other tissues have also been suggested for practicing. The other material that is needed is microsuture. These materials are expensive and often not easily obtained. To meet this requirement, the authors present human hair as a microsuture material for microsurgical practice.
Journal of Reconstructive Microsurgery 02/2003; 19(1):37-40. · 1.01 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Despite the many methods described for correction of the deviated nose, it still continues to be one of the most challenging problems in rhinoplasty. It is obvious from the literature that the deformities present in the deviated nose can be quite different from patient to patient and that there is no one method that should be used for every deviated nose. Although unilateral osteotomy technique is not a new concept, so far it has not received the interest of plastic surgeons. Shorter operation time, lessened surgical trauma to the nose, lessened intraoperative bleeding, lessened postoperative edema, and lessened recurrence of the deviation are distinct features of the unilateral osteotomy technique that should be considered when planning surgery on such a complex deformity. We present our experiences with unilateral osteotomy and recommend it for patients who have a deviation related to only one side of the nose.
Aesthetic Plastic Surgery 01/2002; 26(6):413-5. · 1.19 Impact Factor