Evaluation of facial complications of hyaluronic acid fillers

Objectives: This study aims to evaluate facial complications of dermal fillers and to increase the public awareness about seriousadverse outcomes of these applications.Patients and Methods: Between January 2015 and June 2019, a total of 12 patients (2 males, 10 females; mean age 41 years; range,28 to 64 years) who experienced hyaluronic acid (HA) filler-related complications were retrospectively analyzed. Complications wererecorded using the hospital records.Results: The mean follow-up was 7 (range, 6 to 9) months. In one patient, livedo reticularis over the nose caused by the filler tothe nasolabial fold was seen. In another patient, livedo reticularis over the nose caused by the HA filler for tip augmentation wasobserved. Both patients were treated with heating and oral acetylsalicylic acid. In another two patients, cellulitic infections wereobserved. Oral antibiotics and topical antibiotic cream were applied. In two patients, infraorbital edema was seen caused by HAfiller application to the nasojugal folds. Hyaluronidase was applied for treatment. In two patients, a granuloma was seen at the rightinfraorbital region and at the left nasolabial region, respectively. Both of them were treated with hyaluronidase. In one patient, agranuloma and infectious abscess of the upper lip caused by the HA filler application for lip augmentation was observed. For thetreatment of the abscess, surgical drainage was used and hyaluronidase was applied for the treatment of the granuloma. In threepatients, bruising was observed which was treated with the Arnica cream.Conclusion: Our study results show that fillers are not completely innocent products. We recommend that these materials shouldbe used in experienced hands in accordance with the relevant regulations

An unusual variation of the median nerve: Double palmar cutaneous branch

Median sinirin palmar kutanöz dalı (PKD), elin küçük ama önemli bir siniridir. Bu sinirin travmatik veya iyatrojenik olarak hasarlanması, inerve ettiği bölgede paresteziye ve rahatsızlık verici nöroma oluşumuna yol açabilir. Palmar kutanöz dala ait varyasyonlar sıkça görülmekle birlikte, birden fazla sinirin varlığı ender bir durumdur. Burada, el bileğindeki bir kitlenin eksizyonu sırasında farkedilen, iki palmar kutanöz dala sahip bir olgu sunulmaktadır.The palmar cutaneous branch of the median nerve (PCBMN), is a small but important nerve for the hand. Traumatic or iatrogenic injury to this nerve may result in troublesome neuroma formation and paresthesia in the area supplied. Despite the usual occurence of variations in this nerve, the presence of more than one nerve is a rare incident. In this report, we present a case with two PCBMN's, which were diagnosed during excision of a mass in the wrist. The PCBMN's were dissected to their origin from the median nerve and were found to be arising separately from the median nerve

Human hsp 60 peptide responsive t cell lines are similarly present in both behçet's disease patients and healthy controls

Heat shock protein (HSP, 60/65 kDa) is investigated as a candidate autoantigen in Behçet's disease (BD), a systemic vasculitis of unknown origin, and a prominent response to ‘disease-specific epitopes’ of mycobacterial and human HSP60/65 is described in BD patients. In this study, long-term T cell lines from peripheral blood of BD patients (n=6) and controls (n=7) were stimulated with mycobacterial recombinant HSP and purified protein derivate (PPD) and expanded with IL-2. In the BD group, 15 out 27 and in the controls, 25 out of 35 PPD specific T cell lines have responded to the synthetic peptides of the human HSP60. Out of the primarily HSP-specific T cell lines, 17/23 in patients and 8/8 in controls did recognize a peptide of human origin. T cell lines specifically reactive to 136–150, 179–197, 244–258 and 336–351 could be raised with similar frequency in both groups. In contrast to a previous report, T cells also reacted to peptide 425–441 frequently in both groups. The results demonstrate that the human proliferative response to mycobacterial HSP may also target the self-protein in both BD patients and controls. However, the responsive T cells may have different effects depending on their functional features such as cytokine secretions

The effect of hyperbaric oxygen therapy (HBO) when used postoperatively in skin grafting over radiated tissue in the rat

Under conditions that may risk the success of flap surgery, free skin grafting may be an option for the reconstruction of the irradiated area. Clinical observations reveal that skin grafts applied to irradiated area undergo ulceration, resulting in chronic open wounds. The role of hyperbaric oxygen therapy (HBO) in problem wounds is to increase the tissue oxygen tension to optimize fibroblast proliferation and collagen synthesis, to enhance the oxidative killing capacity of the white blood cells and to stimulate angiogenesis. HBO has also been shown to stimulate angiogenesis in radiation-damaged tissue. In view of this data, an animal model is designed to investigate the effect of HBO therapy on the survival of a skin graft applied on a previously irradiated area. HBO therapy was started on the day of surgery and was continued for 20 days. Graft survival in each rat was calculated as a percentage of the total graft. There was no statistically significant difference between the mean value of the graft survival rate of HBO-treated and HBO-untreated groups

Favorable Outcome with Close Margins in Patients Undergoing Nipple/Skin Sparing Mastectomy with Immediate Breast Reconstruction: 5-year Follow-up

Background: Implant-based breast reconstruction after mastectomy has recently been reported to be the preferred type of surgery among breast-specific surgeons and plastic surgeons. Aims: To explore the significant clinicopathological factors associated with long-term outcome related to local recurrences of the nipple among patients who underwent immediate breast reconstruction with tissue expander or implant after mastectomy. Study Design: Retrospective cohort. Methods: From January 2007 to January 2013, 51 breast cancer patients who underwent immediate breast reconstruction with tissue expander or implant were retrospectively analysed. Patients’ demographic data, clinicopathological characteristics, and clinical outcome by disease-free survival and disease-specific survival analyses were determined. Results: The median follow-up was 64 (31-114) months. Of the 57 mastectomies, 41 were skin sparing mastectomy (72%) and 16 were nipple-areola sparing mastectomy (28%). Immediate breast reconstruction surgery included tissue expander (n=46, 81%) or implant (n=11, 19%) placement. The molecular subgroups of 47 invasive cancers were as follows: luminal A (n=23, 49%), luminal B (n=16, 34%), non-luminal HER2 (n=5, 10.6), triple negative breast cancer (n=3, 6.4%). The 5-years disease-specific survival, disease-free survival, and locoregional recurrence-free survival rates were 96.8%, 90%, and 97.6% respectively. Patients with luminal A cancer were found to have an improved 5-year disease-free survival time than other (luminal A; 100% vs. non-luminal A; 78%; p=0.028). Of the 14 nipple-areola sparing mastectomy, 13 had a close median tumour distance to nipple-areola complex (<20 mm) with a 5-year locoregional recurrence free survival of 100%. Conclusion: Immediate breast reconstruction with implant or tissue expander can be safely applied in patients undergoing skin sparing mastectomy or nipple-areola sparing mastectomy. Patients with luminal-A type show the most favourable outcome. During the 5-year follow-up period, patients even with close margins (<20 mm) to nipple-areola complex with nipple-areola sparing mastectomy have excellent locoregional and overall survival when treated by contemporary multidisciplinary oncological managemen