Scoring Systems in Major Extremity Traumas

In the emergency room, every mangled extremity presents with its unique features. Each case requires a different approach and special care, while a surgeon has almost always the same facilities and armamentarium in her/his own setting. Thanks to the advancements in the bone fixation technologies and microsurgical field, the attempts to salvage mangled or even amputated limbs have increased. However, it is still controversial how the decision should be made for salvage or amputation. That is why several scoring systems have been proposed based on retrospective analysis of this group of patients in order to generate a systematic approach and to optimize the outcome. Although they help the surgeon to decide salvation over amputation, or vice versa, the same scores in different patient populations should be interpreted meticulously, and the treatment plan should be established accordingly. The ultimate success is being able to make the most accurate decision possible, and this can be only achieved with experience and extensive knowledge along with sufficient surgical skills

Bare dorsal thoracic fascial flap for esophageal defects: an experimental study with dogs

Background Reconstruction of esophageal defects has challenged reconstructive surgeons for a long time. Problems that affect the continuity of the orogastic tract influence the patient's quality of life and general health. Bare free fascial flaps are used to restore soft tissue defects of the oral cavity because they provide thin, pliable tissues with a high capacity for epithelialization to preserve the local anatomy. An experimental study was planned to investigate reconstruction of anterior cervical esophageal defects using a pedicled dorsal thoracic fascial flap

The Effect of Very Low Concentrations of Ethanol on Microvascular Artery and Vein Anastomosis: An Experimental Study

Objectives This study investigated the effect of very low concentrations of ethanol on artery and vein anastomosis. Also, it was aimed to determine the appropriate ethanol concentration to be used in vasospasm. Methods Rats were divided into five groups of eight rats, each group, as follows: Group i: saline; Group ii: 2.5% ethanol; Group iii: 5% ethanol; Group IV: 7.5% ethanol; and Group V: 10% ethanol. During the femoral artery and vein anastomosis, 1ml of the agent was used for irrigation in each group. Vessel diameters were measured before the anastomosis, at the fifth and 15th minutes, and the third week after the anastomosis. Histopathological samples were taken in the third week. Results In Groups ii and iii, the mean vessel diameters were found to increase 15th minute. Also observed was an increase in mean vessel diameter that continued in the third week. Although acute vasodilation was detected in Groups IV and V, arterial and venous thrombosis was observed in the third week. Intima and media thickness decreased in Group ii, while it increased in Group iii. Perivascular inflammation and fibrosis increased as the ethanol concentration increased. Conclusion 2.5% ethanol causes acute and prolonged vasodilation and does not cause endothelial cell damage, perivascular inflammation, and fibrosis. 2.5% ethanol will be a powerful alternative use in many situations that occur with vasospasm

Functional Sharing of the Upper Orbicularis Oris Muscle for the Reconstruction of the Lower Lip

The lip reconstruction is a very controversial topic in plastic surgery and many flaps have been described for this purpose. Despite all of the interventions, some patients still have problems such as drooling and gingival show that decrease their quality of life. In this study, the authors report a patient whose lower lip was resected totally for squamous cell carcinoma. His lip was reconstructed with radial forearm flap and the patient was referred to our clinic with the aforementioned complaints. A portion of the orbicularis oris muscle of the upper lip was designed as a bipedicled flap, and it was transposed to the lower lip to make the initial flap functional. After the operation, the sphincteric function of the lip was better, and the problems as drooling and gingival show were absent. In conclusion, this flap can be a good option to make the initial nonfunctional flaps (such as radial forearm flap), functional in the aspect of lower lip reconstruction. It has a function, and it is concordant with the principle of reconstructing like with like. The native muscle tissue of the upper lip can be transferred partially to maintain physiologic oral competency

The effects of locally applied procaine on wound healing

Objective: The goals of this study were: (1) To determine the efficacy of 2% procaine (the most commonly used concentra- tion) in wound healing; and (2) To determine the proper open wound injection site. Materials and Methods: Thirty adult male Sprague-Dawley rats weighing between 250 and 350 g were used. Two full thickness defects were made on two sides of the midline 1 cm away from midline. The skin wound areas were approxi- mately 1.5 cm and times; 1.5 cm. The animals were randomly divided into three groups: Group 1 (control group, n = 8), Group 2 (injection directly into the base of wound, n = 8), and Group 3 (injection into healthy skin around the peripheral margins of the wound, n = 8). Mechanical analyses of wound tensile strength of were evaluated in all groups. Results: Wound closure was first seen in Group 3 on day 14. Mean wound healing times were 18.25 days, 16.25 days, and 15.62 days, and mean tensile strength was 777.13 cN, 988.25 cN, and 1068.25 cN in the Groups 1, 2, and 3 respectively. Conclusions: Procaine did not cause any necrosis around the wound, did not retard wound healing, did not cause circu- lation deficiency, and did not reduce the breaking strength of the wound. Therefore, it can be safely used to reduce pain around the wound and to accelerate the healing process of slow-to-heal wounds. [Arch Clin Exp Surg 2015; 4(1.000): 41-45

Does Wide Excisional Biopsy in Skin Cancer Prevent Finding The Real Sentinel Lymph Node?

Purpose/Aim: The presence of nodal metastasis is an important prognostic factor for malignant melanoma and causes a 50% decrease in survival. Patients found not to have lymph node metastasis as a result of sentinel lymph node biopsy but develop regional lymph node metastasis in the follow-up period are called false negative sentinel. The hypothesis of this study was that excisional biopsy in patients with large lesions may change the lymphatic pathway and therefore cause false negative results. Materials & Methods: A total of 40 Sprague-Dawley rats were divided into 4 groups: the control group, Group 1 (10 mm excision), Group 2 (15 mm lesion excision), and Group 3 (20 mm excision). Sentinel lymph nodes were found via imaging with nanocolloidal albumin including 99mTc and indocyanine green (ICG) before the excision and at 3 weeks after the excision. Evaluations were performed to determine whether or not they were the same nodes. Results: The false sentinel node detection rate in Group 3 was significantly higher than in both the control group and Group 1 (p < 0.05). No significant difference was detected between Group 2 and 3 according to false sentinel node detection rate. There were differences between preoperative and postoperative detection of sentinel lymph nodes found by radioactive and ICG methods but no significant difference was detected in the Kappa agreement coefficient. Conclusion: It can be suggested that incisional biopsy is performed on large lesions initially, followed by wide excision combined with SLNB at the second stage. This can help to prevent changes in the lymphatic pathway and therefore to decrease false negativity rates caused by the previous surgery

The Keystone, Scroll Complex, and Interdomal Area of the Nose: Histologic and Anatomical Observations

Comprehensive knowledge of nasal anatomy is essential for obtaining aesthetically and functionally pleasing results in rhinoplasty. In this study, the authors described the anatomy, histology, and clinical relevance of the interdomal region, keystone, and scroll complex. The current study examined these areas in 26 fresh cadaver heads. All cadavers were fresh, and no conservation or freezing processes were applied. All dissections were performed by the first author. It was determined that the structure that connected the middle crura in the interdomal region actually came together in the transverse plane and contained abundant capillaries within. It was observed that chondroblasts with high regenerative potential were present in the keystone area, and there was very tight attachment between periosteum and perichondrium. The scroll complex was found to be more flexible and thin and had fewer regenerative cells compared to the keystone region. With its unique anatomy and histology, the keystone acts as a transition area between the flexible and fixed units of the nose. The scroll complex should be taken into consideration during rhinoplasty because of its effects on fixation of the skin in the lateral supratip area and functional effects on internal and external nasal valves. The interdomal ligament, in contrast, acts as a transition between both middle crura rather than a real ligament

Neutrophil Elastase Inhibitor Increases Flap Survival in Experimental Degloving Injuries

Dagdelen, Daghan/0000-0002-2523-9195WOS:000542499100006PubMed: 32617053Objectives: Degloving hand injuries have generally been viewed as among the most difficult of injuries to manage due to the extensive nature of associated damage. The traditional approach to the circumferentially degloved segment of problematic flap viability has been to resuture the flap and to wait and see. However, the waiting period or the specific hemorheological protocol remains uncertain. This study aims to acknowledge if Sivelestat, known to ameliorate ischemia-reperfusion injury, enhances the survival of avulsed flaps in a hind limb degloving model of rats and to compare Sivelestat's effects to Pentoxifylline. Methods: In this study, total flap area (cm2), area of necrosis in the flap (cm(2)), and the ratio between the necrotic and total areas (percentage) were determined. Angiogenesis among the groups was documented with CD31, anti-PECAM staining. TUNEL assay was performed to allow the visualization of cell nuclei containing fragmented DNA, a typical feature of apoptosis. Results: The findings obtained in this study showed that Sivelestat administered at 10 mg/kg/hour dosage will inhibit the ischemia-reperfusion injury more pertinently than Pentoxifylline, which exerts only hemorheological effects. Conclusion: The anti-inflammatory effects of Sivelestat will be beneficial for decreasing the early complications of degloving injury, such as inflammation, sepsis, and edema, better than Pentoxifylline, which exerts only hemorheological effects