An improvement in dorsal reverse adipofascial flap for fingertip reconstruction - Nail matrix preservation

WOS: 000230860100009PubMed: 16034245Dorsal reverse adipofiascial flap (DRAF) is one of the most reliable choices for reconstruction of fingertip amputations. A drawback of this method is matrixectomy, which is routinely performed in distal phalangeal amputations, even when the germinal matrix and some nail bed is intact. However, the nail is important for both functional and esthetic reasons and should not be killed. We described a new approach to DRAF, in selected cases, for preserving the nail. As a result, we obtained useful and esthetic fingertip with a nail unit

Surgical therapy for uncontrolled chronic hidradenitis suppurativa

Hidradenitis suppurativa (HS) is a recurrent, chronic inflammatory skin disease involving the axillary, inguinal, and anogenital regions that is manifested by abscesses, fistulae, and scarring. The exact etiology of this condition remains unknown. The aim of this study was to assess the consequences of uncontrolled chronic hidradenitis and to describe the long-term follow-up. The literature was reviewed to identify reliable information regarding the characteristics and treatment of hidradenitis. In addition, we evaluated long-term results of the patients with widespread chronic hidradenitis treated by us. The study group comprised three female and 11 male patients who were seriously ill. Multiple site disease was observed in all patients. The distribution of the inflammatory areas was noted: axilla (10), inguinal (5), perino-perianal (7), and other (7). Aggressive surgical treatment was performed on all patients. Good follow-up results were obtained with negligible recurrences. Since spontaneous resolution is rare and progressive disability the rule, early definitive surgical treatment of HS is advisable. © Springer-Verlag 2002

Maxillofacial morphology in children with complete unilateral cleft lip and palate treated by one-stage simultaneous repair

WOS: 000228884600007PubMed: 15861053Background: There is a common belief among the majority of surgeons occupied with cleft lip-cleft palate repair that early one-stage simultaneous repair of hard and soft palates affects maxillofacial development adversely. This proposition has not been proven with long-term clinical studies. In this study, the effects of one-stage repair on the maxillofacial development of children with complete unilateral cleft lip-cleft palate were investigated, and the results were compared with those of the cleft children treated with conventional two-stage repair. Methods: The study was designed as follows. Group 1 consisted of 19 children (mean age, 85.4 +/- 12.8 months) treated with a one-stage procedure. In this group, cleft lip, palate, and alveolus were repaired simultaneously at a single surgical session in the first 10 months of life (mean age at time of surgery, 6.8 +/- 1.2 months). Group 2 consisted of 22 children (mean age, 90.1 +/- 13.0 months) treated in two stages as follows: lip repair was performed at a mean age of 4.8 +/- 1.0 months and palate repair was performed at a mean age of 14.6 +/- 2.0 months. The follow-up period was approximately 6.3 years for both study groups. Group 3 (control) consisted of 27 children (mean age, 87.1 +/- 11.7 months) without cleft who were matched for age. Results: Compared with the control group, the children in both cleft groups revealed a greater maxillomandibular retrognathism, a more open palatal plane, larger anterior facial heights, and decreased posterior vertical maxillofacial heights. No significant difference was determined between study groups 1 and 2. Conclusions: Because both of the surgical treatment procedures give rise to similar maxillofacial development outcomes, regardless of the timing of surgery, the onestage procedure offers several important advantages, such as less psychosocial trauma, low cost, and possibly an improvement in speech results because of less scarred palatal fields and the low rate of palatal fistula

Dual preconditioning: Effects of pharmacological plus ischemic preconditioning on skin flap survival

To enhance skin flap viability, pharmacological and ischemic preconditioning methods were investigated intensively. This study was designed to determine whether combined local dexamethasone administration and pedicle clamping would result in an additive enhancement of skin flap survival in the rat model. Twenty-eight male Sprague-Dawley rats were included in dexamethasone injection, clamping, clamping plus dexamethasone injection, and control groups. A rectangular random skin flap (3 x 11 cm) was outlined as bipedicled on the back of the animals. The dexamethasone or saline injection points in the flap were standardized. In the dexamethasone injection group, after raising the flaps, a total of 2.5 mg/kg dexamethasone was injected into the flaps. In the ischemic preconditioning group, 1 hour after saline injection, the cranial pedicle was clamped for 20 minutes and then 40 minutes reperfusion was performed. The clamping-plus-dexamethasone injection group was the same as the clamping group except dexamethasone was injected instead of the saline. In the control group, saline was injected instead of dexamethasone. Regardless of the group, all flaps were cut at the cranial side at the end of the 2 hours and were sutured back. On day 7, the surviving area was significantly greater in all experimental groups compared with the control group (p < 0.05). Furthermore, the clamping-plus-dexamethasone group demonstrated the highest flap viability

Lipoma removal with mini incision [5]

[No abstract available

Digital block with and without epinephrine during chemical matricectomy with phenol

BACKGROUND Digital block with epinephrine is safe in selected patients. Chemical matricectomy with phenol is a successful, cheap, and easy method for the treatment of ingrown nails. OBJECTIVE To determine the effect of digital block with epinephrine in chemical matricectomy with phenol. MATERIAL AND METHODS Forty-four patients with ingrown toenail were randomly divided into two groups. The plain lidocaine group (n=22) underwent digital anesthesia using 2% plain lidocaine, and the lidocaine with epinephrine group (n=22) underwent digital anesthesia with 2% lidocaine with 1:100,000 epinephrine. In the postoperative period, the patients were evaluated for pain, drainage, and peripheral tissue destruction and were followed for up to 18 months for recurrence. RESULTS The mean anesthetic volume used in the epinephrine group (2.2±0.4 mL) was significantly lower than the plain lidocaine group (3.1±0.6 mL). There was no statistically significant difference in postoperative pain and recurrence rates, but duration of drainage was significantly shorter in the epinephrine group (11.1±2.5 days) than in the plain lidocaine group (19.0±3.8 days). CONCLUSION Digital block with epinephrine is safe in selected patients, and epinephrine helps to shorten the postoperative drainage period. The authors have indicated no significant interest with commercial supporters. © 2010 by the American Society for Dermatologic Surgery, Inc

The effects of onion extract on hypertrophic and keloid scars.

To evaluate the therapeutic activity of topical onion extract in gel form on hypertrophic and keloid scars, focusing on problems such as elevation, redness, hardness, itching and pain. This comparative prospective study assigned 60 patients to three groups. Group I was treated with onion extract alone, group 2 with silicon gel sheet alone and 3 group with a combination of onion extract and silicon gel sheet. In the group comparisons, a significant difference was observed at the end of six months in the colour parameter between group I and group 2 and in the height parameter between group I and group 3 (ANOVA post-hoc Tukey's test, p<0.01 and p<0.05 respectively). The onion extract was more effective in relation to scar colour, while the silicon gel sheet was superior in decreasing the height of scar (paired sample t-test, p<0.001). In addition, the most effective therapeutic results were obtained when the silicon gel sheet treatment was combined with onion extract in group 3. Onion extract improved hypertrophic and keloids scars via multiple mechanisms. However, it was statistically ineffective in improving scar height and itching. For this reason, onion extract therapy should be used in combination with an occlusive silicon dressing to achieve a satisfying decrease in scar height

Complications of minor cutaneous surgery in patients under anticoagulant treatment

WOS: 000181079800016PubMed: 12621574Anticoagulant use is common in the elderly population. The role of these medications in the postoperative period is not well defined. We designed a prospective study to evaluate the incidence of postoperative complications in patients taking aspirin and warfarin. A prospective study was performed on 102 patients undergoing minor cutaneous plastic surgery. The number of subjects using regular aspirin, warfarin, and that of the patients with no anticoagulant medication were 37, 21, and 44, respectively. Complications were defined as minor, moderate, or major based on predetermined criteries. Of patients taking warfarin, 57% had some complication, significantly more than complications in the control group. The number of major complications in the warfarin group was significantly higher than those of the control and aspirin groups (p = 0.02). Also, the total number of complications in the warfarin group was significantly higher than the control group, but there was no significant difference between aspirin and control groups (p > 0.05). Cutaneous surgery in patients who receive warfarin is associated with a risk of major complication, but this risk does not exist in the patients receiving chronic aspirin treatment

A Training Model for Cutaneous Surgery

BACKGROUND. Training models are necessary for development of many skills in medical education. OBJECTIVE. To develop a training model for improvement of simple surgical procedure skills. METHODS. A convex, rectangular, smooth-surfaced wooden plate covered by first cotton material and then polyethylene stretch film was used. Skins of rats that had been used previously for experimental studies were attached on the wooden plate. In order to see efficacy of our model, we decided to use it in a cutaneous surgery workshop. Theoretical and practical information about surgical sutures, punch biopsy, excisional biopsy, rotational flap, and Z-plasty procedures was given to the participant physicians. Surgical skills of participants were scored before and after the practical part of workshop. RESULTS. Thirty-three physicians were enrolled voluntarily to the workshop. All participants showed statistically significant increase in scores (P < 0.05). CONCLUSION. The similarity to human skin and the easy setup make this training model an ideal teaching tool to improve the skills of physicians for simple cutaneous surgery