Background: Sacral pressure ulcer reconstruction is frequently applied in plastic surgery practice. Although perforator flaps are frequently used, recurrence is not uncommon in patients. For this reason, using the as little area as possible during the reconstruction is vital. Therefore, we aimed to describe a mathematically standardized bilobed perforator flap design for sacral pressure ulcer reconstruction with a certain proportion and angle relation between limbs.Methods: A total of 17 patients (5 female/12 male)were included in this report. The mean age of the patients was 50.4 years (Ranging from 32 to 79 years). The patients with grade 3-4 sacral pressure ulcers were included in the report. The patients have grade 1-2 sacral ulcers or the other areas of pressure ulcer excluded. The size of the defects ranged from 8 Â 14 cm to 5 x 16 cm. For ulcers in the sacral region, we used bilobed flaps that we mathematically standardized. The length of the first limb of the flap was planned 90 vertically oriented according to the distance between the perforator zone to the distal lateral border of the defect. The width of the first limb was kept equal to the length of the defect. The orientation of the second limb of the flap was designed 90 degrees horizontally according to the first limb. Therefore, the lengths of second limbs were calculated as half of the first limb's width, and the widths of second limbs were calculated as 3 /4 width of the first limb's width.Results: A total of 10 flaps were elevated based on superior gluteal artery perforators, and seven flaps were nourished by inferior gluteal artery perforators. The mean size of the first limb of the flaps was 14.7 Â 7.2 cm (Ranging from 8 to 20 Â 6 to 13 cm). The mean size of the second limb of the flaps was 6.7 Â 5.3 cm (Ranging from 5 to 12 Â 4 to 8 cm). The mean size of defects was 10.5 Â 7.3 cm (Ranging from 8 to 14 Â 5 to 16). The mean rotation angle was 91.7 (ranging from 90 to 100). In the early postoperative period, the hematoma was detected in three patients and evacuated in one patient, resulting in wound separation. Tip necrosis was seen in a patient that was healed by wound care. No total flap loss was encountered. No late-term recurrence was seen during the follow-up. The mean follow-up time was 13.1 months (Ranging from 4 to 24 months). Conclusion:Unilateral standardized bilobed perforator can reliably be preferred in medium to large size sacral pressure ulcer defects.
Nostril retainers are used in cleft lip nose surgery in the post-operative period to maintain alar diameter and resistance against contraction. Various custom made splints were described in the literature to mimic this function when nostril retainers cannot be used for economic or logistic reasons. The authors designed a nostril retainer made by silicone urinary catheter for adult age patients which can be prepared easily. The splint can be used in both unilateral cleft lip nose surgery and operations in the alar wing of the nose.
Background Chronic kidney disease (CKD) impairs osteoblast/osteoclast balance and damages bone structure with diminished mineralization and results in bone restoration disorders. In this study, we investigate the effects of adipose-derived stromal vascular fraction and platelet-rich plasma (PRP) on bone healing model in rats with CKD. Methods Sprague-Dawley rats were separated into 4 groups. All groups except group I (healthy control) had CKD surgery using 5/6 nephrectomy model. All groups had intramedullary pin fixation after receiving bone fracture using drilling tools. Group II rats were used as control group for CKD. Group III rats received PRP treatment on fracture site. Group IV rats received PRP and stromal vascular fraction treatment on fracture site. Weight loss and blood samples were followed at the time of kidney surgery, third, sixth, and 12th weeks. Bone healing and callus formations were compared, biomechanically, radiologically, histopathologically, and immunohistochemically. Osteoblastic transformation of stem cells was assessed with DiI staining. Results Negative effects of CKD on bone healing were reduced by increasing mechanical, histological, radiological, and biochemical properties of the bone with stromal vascular fraction and PRP treatments. Although thickness of callus tissue delayed bone healing process, it also enhanced biomechanical features and bone tissue organization. Conclusions Platelet-rich plasma and adipose-derived stromal vascular fraction treatments were effective for bone healing in animal model, which can be promising for clinical trials.
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