When there is no suitable vessel in the injured leg for microsurgical transfer, cross-leg free flaps can be considered for lower extremity reconstruction. This report describes patients who experienced lower extremity trauma and underwent reconstruction with cross-leg free flaps with preserved blood flow in the recipient artery. Anterolateral thigh flap is preferred for small to moderate defects. The descending branch of the lateral femoral circumflex artery was dissected 2 cm proximally and distally and was prepared in a T-shape. The branches of the T were anastomosed to the recipient artery in the contralateral leg in the first session of the cross-leg free flap procedure. After 3 weeks, the flap artery was separated from the bifurcation. For large defects, the latissimus dorsi flap was chosen. The thoracodorsal artery was anastomosed to the contralateral posterior tibial artery in the first session. After 3 weeks, to provide recipient vessel integrity, the thoracodorsal artery was transected from the flap and anastomosed to the distal stump of the posterior tibial artery. Between January 2017 and January 2019, 8 defects were reconstructed using an anterolateral thigh flap; the remaining 4 defects were reconstructed using a latissimus dorsi flap. All flaps survived without complications. Anterograde flow distal to the anastomosis was confirmed in all recipient arteries via Doppler ultrasound. In cross-leg free flaps, the continuity of the recipient artery can be established to prevent diminished blood flow to the recipient extremity.

Background The aim of this study is to evaluate the frequency of flexor pollicis longus (FPL) tendon rupture and factors leading to this rupture during the follow-up of patients who underwent volar plate fixation because of distal radius fracture. Patients and Methods A total of 109 distal radius fractures of 102 patients treated with volar plate fixation and periodically followed up for at least 1 year between January 2013 and May 2018 were evaluated. Fractures were categorized according to the AO Foundation/Orthopaedic Trauma Association (AO/OTA) Fracture-Dislocation Classification and Soong's grading was used for classifying volar plate position. All patients operated were inquired retrospectively in terms of flexor tendon rupture. Results Gender distribution revealed 45 females and 57 males. Mean age was 47.9 (range: 17–88) years. Mean period of follow-up was 27 months. Distribution of fractures in accordance with the AO/OTA distal radius classification was 6, 8, 7, 12, 24, 33, 11, and 8 patients with types A2, A3, B1, B2, B3, C1, C2, and C3, respectively. When volar plate positions were analyzed with Soong's classification, it revealed that 79 (72.4%), 23 (21.1%), and 7 (6.5%) plates were grade 0, 1, and 2, respectively. In total, evaluating the three patients with FPL rupture, it revealed that the volar plate was positioned distally during fixation because the fracture line had advanced to the distal of the watershed line, the distal portion of the plate had lost complete connection with the bone, and at this portion, it was observed that the pronator quadratus muscle was not covering the plate entirely (Soong's classification grade 2). Patients did not have additional flexor tendon injury. Conclusion FPL tendon rupture is a rare but serious complication of volar plate fixation performed for distal radius fractures. We believe that appropriate choice of implant and careful surgical technique, along with the close follow-up of patients, with Soong's classification grade-2 volar positions would help in preventing this complication. Level of Evidence This is a Level 3a, differential diagnosis/symptom prevalence study.

Many techniques for nasal reconstruction have been described to achieve aesthetically and functionally favorable results. Local tissues, specifically the forehead flap, provide the best tissue match with the nose. However, when local tissue donor sites are limited, alternative options such as free tissue transfers should be considered.Herein, we describe a case of a 72-year-old male patient who had a total nasal and left malar defect reconstructed with a two-staged, pre-laminated, super-thin anterolateral thigh (ALT) flap. The patient's nasectomy was performed 15 years ago.

Background: Blepharoplasty is one of the most common procedures performed. To achieve optimal results in periorbital rejuvenation, a systematic approach to patients that addresses all the problems in the periorbital region is important. The aim of this study is to analyze blepharoplasty patients according to preoperative deformities and postoperative results and to create a basic algorithm for periorbital aesthetic surgery. Methods: Patients who underwent periorbital aesthetic surgery were examined retrospectively. Patients’ medical records and preoperative and postoperative photographs were analyzed. Preoperative and postoperative photographs were analyzed for 6 main criteria: brow position, blepharoptosis, canthal tilt, excess skin or deficiencies, excess subcutaneous tissue or deficiencies, and periorbital skin rhytides. After the anatomical analyses, researchers rated the results as optimal or suboptimal. Results: In total, 176 patients’ medical records were analyzed. Among them, 154 were women and 22 were men. The mean age was 43.8 years. No comorbid situation was detected in 133 of these patients. The postoperative result was evaluated as suboptimal in 151 patients (86%) and optimal in 25 patients (14%). An algorithm was proposed for the systematic evaluation of periorbital surgery patients to achieve satisfactory results. Conclusions: A simple 6-step checklist is designed to define periorbital deformities and to achieve the optimal youthful appearance.

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Achieving aesthetic and functional results in rhinoplasty requires meticulous techniques, and postoperative edema, ecchymosis, and pain can deteriorate the desired outcomes. Different osteotomy techniques are defined to have optimal outcomes while reducing edema, ecchymosis, and pain. In this study, the authors compared conventional and power-assisted surgical burr osteotomy techniques in terms of early postoperative complications. Patients who underwent primary open septorhinoplasty were included in the study and were divided into 2 groups. The first group had lateral endonasal osteotomy with conventional guided osteotomes, and the second group had lateral osteotomy with surgical round burr. Edema and ecchymosis scoring systems were used on the postoperative first, third, and seventh day to evaluate postoperative edema and ecchymosis, and the visual analog scale was used to evaluate pain severity on the postoperative period. Out of 70 patients who had undergone septorhinoplasty, 36 received conventional osteotomy and 34 received surgical round burr osteotomy. Periorbital ecchymosis scores were significantly lower in the second group on the postoperative first, third, and seventh days. The periorbital edema scores were significantly lower in the second group on the first postoperative day but no difference was found between postoperative days 3 and 7. Also, the pain scores were significantly lower in the second group. Osteotomy with surgical round burr yields less ecchymosis, edema, and pain in the early postoperative period than conventional osteotomy in primary septorhinoplasty patients.

Objective: To describe a single suture technique for the simultaneous repair of cutaneous and subcutaneous wounds. Method: Skin and subcutaneous wounds of >3cm in size were repaired using a single suture technique. Different suture sizes were chosen for different wounds. Timing of suture removal was decided according to body area and wound healing status. Results: A total of 78 patients were treated (41 women and 37 men). Mean age was 31.7 years (range: 14–72 years). At one month postoperatively, 56 patients attended a follow-up visit and 27 patients attended at six months postoperatively. Local infection was observed in one patient and wound dehiscence observed in two patients after suture removal. Resulting scars were similar to those of other types of suture techniques. Conclusion: This study describes a single suture technique for the simultaneous repair of cutaneous and subcutaneous wounds. It is easy to learn and perform. This technique reduces the risk of infection, cost and procedure time.

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