The Versatile Use of Temporoparietal Fascial Flap

Background: The pedicled or free temporoparietal fascial has been used in many areas, especially in head and neck reconstruction. This thin, pliable, highly vascularized flap may be also transferred as a carrier of subjacent bone or overlying skin

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

Idiopathic isolated clitoromegaly: A report of two cases

BACKGROUND: Clitoromegaly is a frequent congenital malformation, but acquired clitoral enlargement is relatively rare. METHODS: Two acquired clitoromegaly cases treated in Atatürk Training Hospital, Izmir, Turkey are presented. RESULTS: History from both patients revealed clitoromegaly over the last three years. Neither gynecological nor systemic abnormalities were detected in either patient. Karyotype analyses and hormonal tests were normal. Abdominal and gynaecological ultrasound did not show any cystic lesion or other abnormal finding. Computerized tomography scan of the adrenal glands was normal. Clitoroplasty with preservation of neurovascular pedicles was performed for the treatment of clitoromegaly. CONCLUSION: The patients were diagnosed as "idiopathic isolated" clitoromegaly. To the best of our knowledge, there has been no detailed report about idiopathic clitoromegaly in the literature

The creation of new rotation arc to the rat latissimus dorsi musculo-cutaneous flap with delay procedures

BACKGROUND: Latissimus dorsi musculocutaneous flap is one of the most frequently performed reconstructive techniques in surgery. Latissimus dorsi muscle has two arcs of rotation. It is classified as type V muscle. This muscle can be elevated on the thoracodorsal artery to cover large defects in the anterior chest and also, the muscle can be elevated on the segmental vessels to cover midline defects posteriorly. The aim of this study was to create a new arc of rotation on a vertical axis for the muscle and investigate effectiveness of vascular and chemical delays on the latissimus dorsi muscle flap with an inferior pedicle in an experimental rat model. We hypothesized that the latissimus dorsi muscle would be based on inferior pedicle by delay procedures. METHODS: We tested two different types of delay: vascular and combination of vascular and chemical. We also tried to determine how many days of "delay" can elicit beneficial effects of vascular and combination delays in an inferior pedicled latissimus dorsi musculocutaneous flap. To accomplish this, 48 male Sprague-Dawley rats were randomly subjected to vascular or combination delay (vascular and chemical). In addition, one ear of each rat was assigned into a delay procedure and the other ear was used as a control. Results were evaluated macroscopically, and micro-angiography and histological examinations were also performed. As a result, there was a significant difference in viable flap areas between vascular delay alone and control groups (p < 0.05). RESULTS: The higher rate of flap viability was obtained in seven-day vascular delay alone. However, there was no significant difference in the viability between seven-day vascular delay and five-day vascular delay (p < 0.05), so the earliest time when the flap viability could be obtained was at five days. The rate of flap viability was significantly higher in the vascular delay combined with chemical delay than the control group (p < 0.05). CONCLUSION: The combination of vascular and chemical delays increased the rate of viability. Nevertheless, there was no significant difference between vascular delay alone and combination of vascular and chemical delays. Chemical delay did not significantly decrease the delay period. Better histological and microangiographical results were achieved in delay groups compared to control groups. We concluded that the arch of the latissimus dorsi musculocutaneous flap can be changed and the flap can be used for various purposes with the delay procedures

Keloid formation after circumcision and its treatment

Circumcision is performed in many communities around the world for either medical, ethnic, or religious issues. It is a safe procedure when it is performed by a fully trained surgeon. However, complications such as bleeding, infection, diminished penile sensation, urethral injury and amputation of the glans are occasionally seen. Keloid is the result of excessive deposition of collagen in the dermis and subcutaneous tissues. It usually develops at the site of trauma or surgical injuries. Keloid formation on the penis is a very rare condition. In this study, we present a case of keloid formation after circumcision and review the related literature. (C) 2012 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved

The Versatile Use of Temporoparietal Fascial Flap

Background: The pedicled or free temporoparietal fascial has been used in many areas, especially in head and neck reconstruction. This thin, pliable, highly vascularized flap may be also transferred as a carrier of subjacent bone or overlying skin.Objective: The aim of this study is to report our experience in versatile use of temporoparietal fascial flap (TPFF) and discuss the surgical anatomy and technique.Patients and Methods: A total number of 57 TPFFs have been used in periorbital, mid-facial, auricular, and tracheal reconstruction due to tumor resection, trauma, and congenital ear deformities.Results: All the flaps were successfully transferred without any major complication. The cosmetic results were quite satisfactory to all patients.Conclusion: The advantages and minimal donor site morbidity of TPPF makes this flap a good choice in many reconstructive procedures.</p

Use of a perichondrial autograft on the peritendinous adhesion: an experimental study in rabbits

Objective: The aim of this experimental study was to evaluate the use of a clinically available perichondrium graft as an adjunct to surgical tendon repair