A New Modification of Fan Flap for Large Lower Lip Defects

Background and Aims: The reconstruction of the lower lip defects which may result from malignancy, trauma, and burn is necessary for mastication, oral competence, salivary retain, articulation, and aesthetic appearance of the face. While small (30% of the lower lip) and medium (30%-80% of the lower lip) size defects are reconstructed using primary repair and local flaps, reconstruction of the large defects including total and near-total of the lower lip is very challenging entity. We introduce a new modification of the fan flap named extended fan flap for reconstruction of the total and near-total lower lip defects. Material and Methods: The extended fan flap was used for 12 patients with defects involving more than 80% of the lower lip due to squamous cell carcinoma excision. Most of the patients were males (80.9%) with an average age of 66.8 years (range, 47-82 years). Results: No major complication is observed in the postoperative period. The functional and aesthetic results were satisfactory. The sphincter function for normal mastication, eating, and salivary retain was reestablished. No microstomy was seen and insertion of artificial dentition was possible for patients. Conclusion: We believe that the unilateral extended fan flap is a reliable and safe option with satisfactory functional and aesthetic results for total and near-total (more than 80%) lower lip defects

Surgical treatment and functional outcomes of multicomponent soft tissue injuries of the wrist

The aim of this study was to emphasize the importance of early surgical treatment of multicomponent soft tissue injuries of the wrist. A retrospective review was performed on 156 patients with multicomponent soft tissue injuries of the wrist who were treated between July 2007 and July 2015. All the patients included in the study were operated within the first 36 hours of the injury and were hospitalized after the surgery based on the extent of their injury. The patients were evaluated in terms of age, gender, etiology, injured structures, total number of damaged structures, mean follow-up time, complications and reoperation. The results were evaluated based on tendon function, opposition, intrinsic muscles, deformities and sensation. According to these criteria, excellent results were obtained in 81.6% to 88.8% of the patients. Poor results were found in less than 4 percent of the patients. In conclusion, we believe that early surgical management of multicomponent soft tissue injuries of the wrist, a meticulous approach and regular physical therapy are required to achieve good functional outcomes. (C) 2018 SFCM. Published by Elsevier Masson SAS. All rights reserved

Changing nodule activity with time on Tc-99m pertechnetate thyroid scintigraphy

A patient with a diagnosis of malignant melanoma was found to have a multinodular goiter on routine examination. Thyroid function tests revealed normal free T4 and TSH levels. A multinodular goiter was confirmed by thyroid ultrasonography with the dominant nodule located at the isthmus. Tc-99m pertechnetate thyroid scintigraphy did not reveal nodule activity. Delayed imaging was performed for localization of the dominant nodule with a marker. Surprisingly, the nodule was found to be hyperactive. The nodule was normoactive on I-131 thyroid scintigraphy. Fine needle aspiration biopsy confirmed a colloid nodule with follicular epithelial cells