Single and double injection paravertebral block comparison in reduction mammaplasty cases: a randomized controlled study

Background This study compares the analgesic effects and dermatomal blockade distributions of single and double injection bilateral thoracic paravertebral block (TPVB) techniques in patients undergoing reduction mammaplasty. Methods After obtaining ethics committee approval, 60 patients scheduled for bilateral reduction mammaplasty were included in the study. Preoperatively, the patients received one of single (Group S: T3–T4) or double (Group D: T2–T3 & T4–T5) injection bilateral TPVBs using bupivacaine 0.375% 20 ml per side. All patients were operated under general anesthesia. The T3–T6 dermatomal blockade distributions on the midclavicular line were followed by pin-prick test for 30 min preoperatively and 48 h postoperatively. All patients received paracetamol 1 g when numeric rating scale (NRS) pain score was ≥ 4, and also tramadol 1 mg/kg when NRS was ≥ 4 again after 1 h. The primary endpoint was NRS pain scores at postoperative 12th h. The secondary endpoints were dermatomal blockade distributions and NRS scores through the postoperative first 48 h, time until first pain and the analgesic consumption on days 1 and 2. Results Fifty-two patients completed the study. The NRS pain scores at 12th h were similar (right side: P = 0.100, left side: P = 0.096). The remaining NRS scores and other parameters were also comparable within the groups (P ≥ 0.05). Only single injection TPVB application time was shorter (P < 0.001). Conclusions The single injection TPVB technique provided sufficient dermatomal distribution and analgesic efficacy with the advantages of being faster and less invasive

The utilization of diced cartilage-fascia (DC-F) graft in the augmentation rhinoplasty of a case with Binder syndrome

The Binder syndrome is a congenital anomaly mostly seen in females characterized by a flat facial profile and flat nose with absent nasal spine, short columella, flat nasal dorsum, hypoplastic lower lateral cartilages (LLC) and septum, class-III malocclusion, and cleft lip and palate. A 26-year-old female patient with a Binder syndrome was referred to the clinic with a flat nasal dorsum, hypoplastic LLC, deformed nostrils, and hypoplastic columella. She had a history of bilateral cleft lip and palate, ocular strabismus, hypothyroidism, and growth retardation. An augmentation rhinoplasty with an open approach was performed in January 2019. The seventh costal cartilage and the rectus fascia were preferred as autologous grafts. An extended columellar strut graft was prepared and fixed to the nasal spine. Two lateral crural strut grafts was prepared and placed. The hypoplastic LLC were fixated to these grafts. A dorsal onlay graft was settled. Then, the diced cartilage-fascia (DC-F) graft was prepared and it was settled in over the nasal dorsum. A smaller and spherical DC-F graft was constructed to be placed over the extended columellar strut graft for increasing the tip projection. One-year postoperative results of this case confirm that the DC-F graft conserved its volume and shape. The growth retardation has not been described in Binder syndrome in the current literature, and this is the first case of nasal augmentation with DC-F graft in Binder syndrome. DC-F graft is a reliable alternative for the augmentation of the nasal dorsum in Binder syndrome. Level of evidence: Level V, therapeutic study

Calf restoration with asymmetric fat injection in polio sequelae

Background: Many things cause leg asymmetry and sequelae seen after poliomyelitis infections are still a cause of leg deformities. In this study, lipofilling and liposuction combinations are performed on patients with poliomyelitis sequelae. Volume deficiency is not the only leg problem with polio sequelae, leg length is also a problem. For this reason, the length deficiency must be addressed in order to achieve the desired symmetry. The aim of this study is correcting limb asymmetry by a method addressing both limb length deficiency by heel raise and volume deficiency by injection of fat based on corrected limb length

GENDER ASSIGNMENT SURGERY

In the treatment of sexual identity disorders, a series of surgeries are performed according to the need to change the body appearance and physical functions of the patients in order to obtain a similar appearance to the physical characteristics of the desired gender. It is necessary to have general information about these surgeries, to inform patients, to make treatment plans and guide them. This article summarizes general information about gender reassignment surgeries

A novel soft tissue graft alternative in rhinoplasty: the buccal fat graft

Background Camouflage grafts are prepared from alar, auricular cartilages, deep-temporal, rectus, mastoid fascia, fat-dermofat tissue, and allografts. Rhinoplasty and bichectomy may be combined. This study aimed to introduce buccal fat as a graft alternative in rhinoplasty. Methods Patients who had rhinoplasty with utilization of buccal fat between January 2017 and March 2021 were included in study. Bichectomies were performed after bone/cartilage reconstruction of rhinoplasty and 3-5 cc buccal fat was extracted 0.5-1 cm cranial to Stenon orifice. Buccal fats were placed in serum filled 20 cc injector, and injector was placed in a sterile ice cubes. Before utilization, buccal fats were immersed in a serum-antibiotic solution. Buccal fat was sutured over dome for cartilage camouflage in majority of patients. For treatment of the glabellar depression (2 male pts, 25 and 32 years age), the suture was self-knotted, and fat was passed through suture till the knot. Then, the suture was passed through nasal dorsum, pierced out glabella, and fat was settled. For scar restoration (1 female pt, 34 years age), buccal fat was sutured beneath depressed scar over ala. Polydiaxonone 6/0 round suture was used for fixations. Results Forty-eight patients were operated with this technique. Thirty-six patients were female; twelve were male. The mean age was 26 years (18-41 years). In 45 patients, rhinoplasty-bichectomy was combined, and the buccal fat was used as a camouflage graft. In 3 patients, the buccal fat was used for pseudohump (2patients) and scar (1patient) restoration. Cartilage visibility was absent in all patients. Pseudohump restoration was satisfactory without fat absorption. Scar restoration was satisfactory. Conclusions In rhinoplasties combined with bichectomy, buccal fat pad may be utilized as a soft-tissue graft source. It also may be used as a soft-tissue graft in selected rhinoplasties without a planned bichectomy. Level of evidence: Level IV, therapeutic stud

Post-traumatic double crush pudendal nerve entrapment syndrome after fracture of the pelvis: A case report

Pudendal syndrome is primarily characterized by stress urinary incontinence, dysuria, sexual arousal syndrome, painful erections, and anal incontinence. The syndrome occurs when the pudendal nerve or one of its branches is compressed, stretched, or injured. Double crush is the compression of a peripheral nerve at two or more separate areas with various signs and symptoms. We, herein, aimed to introduce the case of a 42-year-old male who underwent the distal release procedure due to the diagnosis of "double crush pudendal syndrome" following a proximal release surgery previously performed elsewhere. The patient's history revealed a pelvic fracture with urethral injury 27 years ago. Throughout the years, the patient had been evaluated by various medical disciplines and undergone several treatments. In 2017, an orthopedic surgeon performed proximal pudendal nerve release using transgluteal approach, and then rectal pain and defecation complaints relieved. However, in 2019, the patient was referred to our clinic because of the persistence of erection and perineal complaints after the proximal pudendal nerve release. Based on a detailed clinical and laboratory assessment, the diagnosis of double crush neuropathy was established, and distal release of the pudendal nerve using transperineal approach was performed. To determine the efficiency of the surgical treatment, International Index of Erectile Function (IIEF) and Quality of Erection Questionnaire (QAQ) tests were used preoperatively and at the first postoperative year. Furthermore, to assess the perineal pain, erection pain, and pain during intercourse Visual Analog Scale (VAS) was used. The erectile dysfunction improved from the severe degree (9 points) to the mild degree (22 points) postoperatively. The patient's general and sexual satisfaction scores, and erection quality score improved compared to the preoperative baseline. According to VAS, the perineal pain, erectile pain,and pain during intercourse decreased postoperatively. (from 7 to 2 out of 10, from 8 to 3 out of 10, from 7 to 2 out of 10, respectively). When perineal and sexual complaints are encountered following pelvic trauma, the pudendal nerve-related problems, especially double crush syndrome, should be kept in mind in differential diagnosis. A multidisciplinary approach must be established in order to avoid any delay in diagnosis and treatment. Surgical intervention may provide a significant improvement in clinical and functional status

Investigation of the Differences between the Immunity of High- and Low-risk Anatomical Regions in Patients with Basal Cell Carcinoma: Is Neutrophil to Lymphocyte Ratio Associated with Regional Distribution of the Tumor?

OBJECTIV

Balancing the Anteroposterior Diameters of the Nostril Lengths in Cleft Rhinoplasty

Background Osteocartilaginous deformities in cleft rhinoplasties may be restored with numerous techniques. However, the anteroposterior (AP) diameter lengths of the nostrils may still be unequal and should also be addressed. A technique was designed to balance nostril AP diameter lengths and apical shapes