The new reconstruction technique in the treatment of the skin cancers located on the eyelid: Posterior temporalis fascia composite graft

BACKGROUND: Difficulty of reconstruction of the eyelids arises from the need to reconstruct different supporting and covering structures in a single operation. Defects in the anterior lamella of the eyelids can be readily repaired with skin grafts or flaps but posterior lamellar reconstruction needs more complex applications. METHODS: We performed posterior lamellar eyelid reconstruction with posterior parts of the temporalis fascia, since their anatomical and histological features are very similar to the defects. Nine patients with skin tumors located on the periorbital region were treated with local skin flaps and deep layer of the temporalis fascia. RESULTS: Grafts were harvested very easily. There was no complication related with graft or donor site. Biopsy was performed in three cases and normal conjunctival elements were seen. Functional and acceptable aesthetically results were achieved in all patients. CONCLUSION: Ideal reconstructive material for replacement of the posterior lamina is still lacking. Tarsal reconstruction can be made with deep temporalis fascia with success since the thickness of the both tissues are very similar and also since the loose areolar layer of the temporalis fascia is very thin and highly vascularized, this layer can be used in reconstruction of the conjunctiva. According to our knowledge this is the first report of using of the posterior part of temporalis fascia as a composite graft in the literature

Cutaneous horns: are these lesions as innocent as they seem to be?

BACKGROUND: Cutaneous horns (cornu cutaneum) are uncommon lesions consisting of keratotic material resembling that of an animal horn. Cutaneous horn may arise from a wide range of the epidermal lesions, which may be benign, premalignant or malignant. PATIENTS AND METHODS: In this respective study, we describe our experience of eleven patients with cutaneous horn treated at our centre between January 2000 and January 2004. The clinical, pathological and treatment details were extracted from the case records. Data is presented as frequency distribution. RESULTS: There were 8 male and 3 female patients with a median age of 57 years. Most of the lesions were located on the ear, hand and scalp. Surgical resection was carried out in all the lesions. There were two cases of squamous cell carcinoma, and one case of basal cell carcinoma, other 8 cases were benign. None of the lesions recurred and no adjuvant treatment was given to any of the malignant lesions. CONCLUSION: Cutaneous horn is a clinical diagnosis that refers to a conical projection above the surface of the skin. The lesions typically occurs in sun exposed areas, particularly the face, ear, nose, forearms, and dorsum of hands. Even though our 60% of the cutaneous horns are benign possibility of skin cancer should always be kept in mind

Vaginal reconstruction with neurovascular pudendal thigh flap in seven cases

Vulva, vajina ve perine rekonstrüksiyonu plastik cerrahlar, jinekologlar, çocuk cerrahları, ürologlar ve genel cerrahlar için yönetimi en güç klinik durumlardan biridir. Sıklıkla vajinal agenezi nedeniyle olsa da bu alandaki onkolojik problemlerden sonra da rekonstrüksiyon gereksinimi doğar. Bu bölgenin rekonstrüksiyonunda pek çok yöntem tanımlanmıştır. Nörovasküler pudendal uyluk flebi ile vajina rekonstrüksiyonu yapılabilmektedir. Biz çalışmamızda primer amenore nedeniyle başvuran ve doğumsal vajina agenezisi tanısı alan toplam yedi bayan olguda uyguladığımız nörovaskuler pudendal uyluk flebi sonuçlarımızı sunduk. Hiç bir olgumuzda erken yada geç dönemde bir komplikasyon gelişmedi. 3 olguda yeni oluşturulan vajina içinde kıl gelişimi gözlense de bu durum olgularda hiç bir şikayete yol açmadı.Tümolguların post-operatif 6. ayındaki kontrollerde duyusal ve seksüel fonksiyonu tam olan yeni vajina oluşturulduğu görüldü. Bu flep; uygulamasındaki kolaylık, donör alanda kabul edilebilir ve gizlenebilir iz yaratması, postoperatif dönemde stent kullanma gerekliliği olmaması, dayanıklı, güvenilir bir flep olması ve hem kozmetik hem de fonksiyonel olarak istenilen sonuçların elde edilmesinden dolayı vajina rekonstrüksiyonundaki en ideal yöntemlerden biri olduğu sonucuna vardıkReconstruction of the vulva, vagina and perineum is still a challenge for the plastic and reconstructive surgeons, gynecologists, pediatric surgeons, urologists and general surgeons. The major indications for the reconstruction of the vagina are vaginal agenesis and post-oncological surgery. Many techniques have been described for the reconstruction of this anatomical region. The neurovascular pudendal thigh flap is one of these. In this report we presented the results of the neurovascular pudendal thigh flap in seven female patients with primary amenorrhea secondary to congenital vaginal agenesis. There were no early or late complications in our series. Only hair growth was observed in three patients but this caused no complaints. Satisfactory functional, sensory and cosmetical results were achieved in all patients within the post-operative six months. We concluded that neurovascular pudendal thigh flap is one of the most ideal techniques in reconstruction of the vagina due to its relatively simple technique, acceptable scar formation in donor area, lack of need for a stent in post-operative period, durable and reliable characteristics of the flap and successful functional and cosmetical results

Enhancement of Tissue Expansion by Calcium Channel Blocker: A preliminary study

BACKGROUND: Reconstruction of the defects after surgical resection of tumors is one of the important issues in surgical oncology. It is essential that the defect should be covered with a tissue quite similar to the original one and is best achieved by harvesting tissue from an area adjacent to the defect. Tissue expansion is one of the most frequently used reconstructive techniques. A number of studies evaluated blood circulation, capsule formation, tissue tolerance, histomorphological changes and complications of expander placement. However, only a few attempted to enhance tissue expansion. This study we aimed to evaluate verapamil, a calcium channel blocker, to enhance tissue expansion. MATERIAL AND METHOD: Twelve New Zealand rabbits weighing between 900 gm and 1200 gm were assigned into study and control groups. High volume expanders (100, 200 or 300 cc) were placed into the subcutaneous tissue. Rabbits in the study group received verapamil. Expanders in the control group were inflated every three days to achieve same pressure as the study group. The size of the flaps was assessed by applying pressure on tip of the flap to demonstrate the contraction. Histopathological examinations were performed. RESULTS: By administering liquid earlier and more quickly less flap retraction was observed in the study group. In the control group expanders were exposed in two rabbits while no complication occurred in the study group. Following extraction of the expanders, the flaps were elevated and less retraction was observed in the study group compared to controls. CONCLUSION: Verapamil is safe when used topically and provides less retracted flaps. It can be suggested that verapamil acts on the myofibroblasts in the capsule around tissue expanders and thus increases efficiency of the expanders

Giant inframuscular lipoma disclosed 14 years after a blunt trauma: A case report

<p>Abstract</p> <p>Introduction</p> <p>Lipoma is the most frequent benign tumor of the soft tissue. This lesion is often asymptomatic except in cases of enormous masses compressing nervous-vascular structures. Although the diagnosis is mostly clinical, imaging tools are useful to confirm the adipose nature of the lesion and to define its anatomic border. Sometimes, lipomas may be the result of a previous trauma, such as in this patient.</p> <p>Case presentation</p> <p>A 45-year-old man presented at our institution with a giant hard firm mass in the upper external quadrant of the right buttock disclosed after a weight loss diet. Subsequent magnetic resonance imaging showed a giant adipose mass developed beneath the large gluteal muscle and among the fibers of the medium and small gluteal muscles. When questioned on his medical history, the patient reported a blunt trauma of the lower back 14 years earlier. He underwent surgery and histological examination confirmed a giant lipoma.</p> <p>Conclusion</p> <p>Lipomas might result from a previous trauma. It is hypothesized that the trigger mechanism is activated by cytokine and growth factors released after the trauma. We herein present an exceptional case of a giant post-traumatic lipoma which caused a painful compression on the right sciatic nerve.</p

Congenital double lip deformity: presentation of eight cases

Dogumsal çift dudak nadir rapor edilen, ancak sık görülen bir anomalidir. Bu klinik durum sıklıkla izole bir deformite olarak görülse de, bir sendromun parçası da olabilir. Sıklıkla erkeklerde görülen ve patogenezi embriyolojik gelisimdeki defektlerle açıklanmaya çalısılan bu deformite ile ilgili olarak literatürde yirmiden az sayıda yayınlanmıs çalısma vardır. Bizim çalısmamızda, kadın erkek sayısı esit olup olguların hepsi estetik yakınmalarından dolayı doktora basvurmuslardır. Olguların hepsine lokal anestezi altında eliptik eksizyon yapılmıstır. Alınan cerrahi örneklerin patolojik incelemeleri normal dudak mukozası olarak rapor edilmistir. Olguların hiçbirinde post-operatif erken yada geç komplikasyon görülmeyip istenilen kozmetik sonuç elde edilmistir. Bir olguda parsiyel çift dudak deformitesi saptanmıs olup, bilgilerimize göre literatürde parsiyel çift dudak deformitesine ait bir yayın yoktur. Sonuç olarak bu çalısmada, dogumsal çift dudaga sahip toplam 8 olgu sunulmus ve bu deformitenin etyolojisi, görülme sıklıgı ve tedavi yöntemleri literatürdeki bulgular esliginde tartısılmıstır.Although congenital double lip deformity is not an uncommon condition, this deformity was presented rarely in the literature. Congenital double lip deformity may be present either as an isolated anomaly or a component of a syndrome. However less than twenty reports were presented in the literature, males were affected predominantly and pathogenesis of this deformity was explained by the embryological defects. In our study male to female ratio was equal and all patients were operated since the aesthetical reason. Elliptical excision was performed under the local anesthesia in all patients. All specimens were evaluated pathological and reported as “normal lip mucosa”. There were no early or late post-operative complication and aesthetical results were achieved in all patients. One case of our patients had partial congenital lip deformity, best of our knowledge; there was no data about the partial congenital lip deformity. Finally, in this study we present eight cases with congenital double lip and discuss the etiology, incidence and treatment modalities according to the data presented in the literature

Two staged salvage operation in hypospadias

Hipospadias Plastik ve Rekonstrüktif Cerrahide tedavisi oldukça güç olan anomalilerden biridir. Günümüze kadar hipospadias tedavisinde 600 den fazla teknik tanımlanmıştır. Genel olarak bu teknikler tek yada çok aşamalı olarak ikiye ayrılır. Her bir teknik kendine özgü avantaj ve dezavantajlara sahiptir. ılk defa opere olacak olgularda tek aşamalı teknikler tercih edilirken, daha önce pek çok defa ameliyat edilen olgularda “kurtarma” ameliyatı olarak seçilecek standart bir yöntem bulunmamaktadır. Primer olgularla karşılaştırıldığında daha önce opere edilmiş olgularda daha yüksek oranlarda komplikasyon söz konusudur. 1995- 2000 yılları arasında iki yada daha fazla sayıda başarısız hipospadias onarımı yapılmış 12 olguda Bracka'nın tanımlamış olduğu çift aşamalı teknikle kurtarma operasyonu yaptık. Olgulara birinci oturumda yeni üretra için kulak arkası veya yanak mukozasından alınan tam kalınlıktaki greftle dayanıklı ve geniş bir yatak oluşturuldu, 6 ay sonraki ikinci oturumda üretra oluşturulup ektopik meatus anatomik yerine çekildi. Üretra üzeri fleple kapatılarak su geçirmez şekilde yerine sütüre edildi. Bir olguda ilk oturum sonrası greftte enfeksiyona bağlı kısmi kayıp; ikinci oturum sonrası iki olguda (% 17) fistül gözlendi. Literatürdeki kurtarma ameliyatı verilerine göre oldukça düşük olan bu oranlarla kurtarma operasyonu gerektiren hipospadiaslı olgularda Bracka'nın tanımladığı iki aşamalı tekniğin iyi bir alternatif olacağı sonucuna vardık.Hypospadias is one of the most challenging anomalies in the point of reconstruction. More than 600 techniques have been described in the literature until now. These techniques can be considered as either single or multiple staged. Every technique has some advantages and disadvantages. Although one stage techniques are mostly performed in primary hypospadias, there is no consensus in management of secondary hypospadias for “salvage” operations. More complication rates have been reported in secondary cases. Between 1995 to 2000, we performed two stage hypospadias repair described by Bracka, in twelve patients who had history of two or more hypospadias repairs. Initially the patients were operated to create a bed for neo-urethra by a full thickness skin graft from retro-auricular region or buccal mucosa. Six months later, neo-urethra was created using this graft and the meatus was relocated to the anatomical region.To prevent fistula formation, waterproofing flap was performed to cover of neo-urethra. Partial graft loss seen as secondary to infection was observed in one patient after the first operation and fistulas were seen in two patients after the second operation. These complication rates were lower than the reported salvage hypospadias repair techniques found in the literature.We concluded that two-stage hypospadias repair of Bracka is a good alternative in salvage hypospadias repair

İs the vertical scarmammaplasty a safe procedure for reduction of heavy sized breasts?

Aim: The vertical scar mammaplasty is one of the most frequently performed operations among reduction mammoplasties. The technique has now been adopted by many surgeons for mastopexies and small reductions, but it has not been commonly used for large reductions because of the frequency of healing problems of the vertical scar. The best candidate for surgery is a patient with elastic skin, moderate hypertrophy (up to 800 g removed per breast), and a breast which is a mixture of fat and glandular tissue. Method: In this study, we present our late term results with vertical scar reduction mammaplasty in heavy sized breast with resection of 1000g or more per breast in eleven patients. Eleven patients with heavy sized 22 breasts in which more than 1000g of tissue was resected are evaluated. Results: Median age of the patients was 32 years (20-46 years) and the average amount of resected specimen was 1322g (1000-1780g) per breast. All patients were operated by the same team and senior surgeon. During the follow up period 2 major complications in the early period were observed: partial nipple-areola necrosis and hematoma. Secondary healing of a partial nipple areola necrosis in a heavy smoker patient resulted in periareolar hypertrophic scar. There were no late term complications. Conclusion: We think that the vertical mammaplasty technique can safely be applied to heavy breasts and large reductions over 1000 gr of tissue.Amaç: Dikey izli (vertikal skar) meme küçültme tekniği mevcut ameliyat teknikleri içinde sıklıkla kullanılan yöntemlerden biridir. Bu teknik, özellikle meme düzeltme ve çok büyük olmayan memelerin küçültülmesinde pekçok cerrah tarafından başarı ile uygulanmaktadır.Ancak aşırı büyük memelerde özellikle dikey izin iyileşme problemleri ile ilgili olarak kullanımı tartışmalıdır. Bu tekniğe en iyi aday hasta elastik derisi olan, orta derecede hipertrofik(800gr.danaz) veyağ vebez karışımından oluşan memelerdir. Yöntem: Bu çalışmada, 1000gr.danfazla miktarda doku rezeksiyonu yaptığımız toplam 11 hastadaki aşırı büyük memelerde uyguladığımız dikeyizli tekniğin erken ve geç dönem sonuçları sunulmuştur. Bulgular: Hastaların yaşları 20 ile 46 arasında değişmekte olup ortancası 32idi. Eksize edilen doku miktarı 1000 ile 1780 gr. arasında olup ortalaması 1322 gr. idi. Tüm hastalar aynı cerrahi ekip tarafından ameliyat edildiler. İzlem süresince olgularda erken dönemde iki komplikasyon gözlendi: parsiyel meme başı - areola nekrozu ve hematom. Aşırı sigara içimi öyküsü olan nekrozlu hasta hipertrofik skar ile iyileşti. Uzun dönem sonuçlarında hastalarda herhangi bir komplikasyon gözlenmedi. Sonuç: Sonuç olarak dikey izli meme küçültme yönteminin, 1000 gr. dan fazla rezeksiyon yapılacak aşırı büyük memelerde güvenli bir şekilde uygulanabileceği görüşündeyiz

Preemptive analgesic properties of ketamine on tonsillectomy surgery

Tonsillektomi/adenotonsillektomi operasyonlarında cerrahinin çesitli zamanlarında uygulanan ketaminin preemptif analjezik özelliklerini arastırmaktır. Tıp Fakültesi Etik Kurulu ve olguların/ailelerinin yazılı onamları sonrası, çalısma prospektif, randomize, çift kör olarak gerçeklestirildi.Yasları 5-15 arası, 90 çocuk 3 gruba ayrıldı. Preemptif grupta (Grup P, n=30) tosillektomi pozisyonununda, ketamin 0,5mg/kg intravenöz (IV) 2mL serum fizyolojik (%0.9 NaCl=SF) içinde uygulandı. Kanama kontrolüne kadar 6 g/kg/dak. ketamin infüzyonuna devam edildi ve kanama kontrolünde 2mLSF uygulandı. Ketamine grubunda (Grup K, n=30), tonsillektomi pozisyonu baslangıcında IV 2mLSF verildi. Sonrasında 10 mL/saat SF infüzyonuna devam edildi ve kanama kontrolünde 0,8 mg/kg ketamin 2 mL SF içinde IV verildi. Kontrol grubunda (Grup C, n=30) tonsillektomi pozisyonu, cerrahi boyunca ve kanama kontrolünde IV SF uygulandı. Postoperatif periyotta sözel agrı skoru (VPS)>3 oldugunda, ilk 6 saatte 1mg/kg IV tramadol, sonrasında 6 mg/kg oral parasetamol ile agrı sagaltımı yapıldı. Kardiorespiratuar sistem bulguları, anesteziden uyanma ve taburcu olma parametreleri tramadol ve parasetamole ihtiyaçı olan olgu sayısı, parasetamol doz sayısı ve komplikasyonlar kaydedildi. Bulgular: Anesteziden uyanma ve taburcu olma parametreleri ile kardiyorespiratuar sistem bulguları gruplar arasında benzerdi. Sözel agrı skoru preemptif grupta, erken postoperatif dönem ve 4. saatte diger iki gruptan daha düsükken, 6. saatte kontrol grubunda diger iki gruptan yüksekti (P<0,05). Parasetamol ve tramadol ihtiyacı olan olgu sayısı ve total parasetamol dozu preemptif grupta diger iki gruptan daha azdı. Cerrahi insizyon baslamadan önce kullanıldıgında, ketaminin tonsillektomi/ adenotonsillektomi operasyonu sonrası preemptif analjezik etkili oldugu ve postoperatif analjezik ihtiyacını azalttıgı kanısına varıldıThe aim was to evaluate the preemptive analgesic effects of ketamine was used in different stages of surgery. All of the patients/parents were informed and The Ethical Committee of the Medical Faculty approved the study. Ninety patients (ages, 5-15) divided into three groups. The pre-emptive group (Group P, n=30) received intravenous (IV) ketamine 0,5mg/kg in 2mL saline at tonsillectomy position, followed by a continuous infusion of ketamine 6 g/kg/min, and 2mLsaline was administered during homeostasis. In the ketamine group (Group K, n=30), 2 mL saline was given at tonsillectomy position, and saline infusion (10 mL/h) continued until homeostasis, and 0,8 mg/kg examine was given during homeostasis in 2mLsaline. In the control group (Group C, n=30) saline was given at all stages of study.WhenVPS is greater than 3; tramadol 1 mg/kg IV administered in the first 6 hours postoperatively, and after paracetamol orally, 40mg/kg was given. Cardiorespiratory system data, recovery from anaesthesia and discharging parameters tramadol and paracetamol requirement, total dose of paracetamol, and complications were recorded. Recovery from anesthesia and discharging parameters were similar between the groups. In the preemptive group, VPS scores were lower than the other two groups at the early postoperative period, and at 4 , hours. The VPS scores were higher in the control group than the other two groups at 6 hour (P< 0,05). Tramadol and paracetamol requirement, total dose of paracetamol were fewer than the other groups in the preemptive group.Total complication number was similar in all groups. Ketamine decreases postoperative analgesic requirement and has preemptive analgesic effect when used before surgery in tonsillectomy/adenotonsillectomy surger