Venous ulcers are characterised by longstanding and recurrent loss of skin integrity. Once occurred, healing is slow and recurrence is high because of inappropriate conditions of the wound bed. This study involves 20 patients with chronic venous ulcers at least 6 weeks of duration treated with negative pressure wound therapy (NPWT). Patients underwent a radical debridement of all devitalised tissues in the first operation. After adequate haemostasis, silver-impregnated polyurethane foam was applied. Once the wounds were determined to be clean and adequate granulation tissue formation was achieved, split-thickness skin grafts were applied. Black polyurethane foam was applied over them. All wounds completely healed without the need for further debridement or regrafting. The mean number of silver-impregnated foam dressing changes prior to grafting was 2·9 (one to eight changes). The mean number of NPWT foam changes was 2·6 after skin grafting (two to five changes). Two patients who did not use conservative treatments for chronic venous insufficiency (CVI) after discharge from the hospital had recurrence of venous ulcers in the follow-up period. Application of NPWT provides quick wound-bed preparation and complete graft take in venous ulcer treatment.
Cubital tunnel syndrome is the second most common peripheral nerve compression syndrome. It is the most common peripheral neuropathy of the ulnar nerve. The surgical treatment of the cubital tunnel syndrome is widely described in the literature, however the variations of the standard muscular anatomy in the medial humeral epicondyle region may create technical difficulties during surgical management. The epitrochleoanconeus muscle, which is an aberrant muscle of this region, is a rare cause of cubital tunnel syndrome. A case with ulnar nerve compression at the elbow caused by an uncommon etiological factor, hypertrophic epitrochleoanconeus muscle, and its surgical management is reported.
Lip carcinoma is one of the most common cancers of the head and neck region. Lower lips are more frequently affected. Squamous cell carcinoma accounts for more than 95% of the cases. The aim of treatment is to achieve the highest cure rates with adequate excision with clear surgical margins while leaving the smallest defect sizes behind for reconstruction. Excised tissue is known to shrink when removed, in relation with its retractile properties. In this study, the evaluation of the amount of shrinkage in excised lip cancer specimens and determination of the relation between surgical and histopathologic margins were aimed. The study included 21 consecutive excised lip specimens for the treatment of squamous cell carcinoma of the lip. The volume of the specimen, tumor length, and margin distance measurements were measured and recorded step by step from before surgical excision to histopathologic evaluation. Specimens were evaluated in a standardized fashion by the same pathologist after 48 hours of fixation. For data analysis, Number Cruncher Statistical System 2007 and Power Analysis and Sample Size 2008 Statistical Software (Kaysville, UT) were used. The surgical margins of the excised lip specimen shrink up to 41% to 47.5% from before excision to histopathologic evaluation. The most significant step was the excision step, followed by the formalin fixation step. The histopathologic process itself and the duration of formalin fixation did not result a significant change in surgical margins. The tumor tissue itself did not show a significant shrinkage.
Ameloblastoma is the second most common odontogenic tumor of the oral cavity with the primary site being the mandible. The ratio of maxillomandibular involvement however is 5:1 in favor of the mandible. The most common complaint is a painless swelling over the mandibular area. Despite its benign nature, ameloblastoma has a high local recurrence rate, with the most recurrences seen within 5 years after operation. Biopsy and radiological evaluation may be helpful in differentiating the subtypes of ameloblastoma. Differentiation is important because some subtypes are more aggressive than the others. Preoperative planning may be done according to this classification, which can help decrease the recurrence rate. In our case, a 26-year-old female patient with recurrent ameloblastoma which developed on the fibular flap is presented. The free fibular flap and the left parasymphyseal part of the mandible were totally excised. Ameloblastoma was confirmed on pathological examination. We reconstructed the left mandibular site with a reconstruction plate and recurrence was not seen during follow up period.
The laterally based postauricular dermal flap technique is an effective method to prevent suture extrusion and recurrence which are the most important complications of otoplasty procedure and easy to apply.
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