Introduction: Hidradenitis suppurativa (HS) is a chronic inflammatory disease arising from the hair follicles in apocrine gland-rich areas. It is also one of the most common indications for axillary surgery. Reconstruction of the axillary region after such surgery must be performed meticulously due to its critical location and crucial content. In this report, we present our experience of reconstruction of axillary defects with posterior arm perforator flaps (PAPF) following radical excisions. Methods: A total of 14 patients (9 male, 5 female) aged between 16 and 49 years who had presented with HS in the axillary region and, after surgery, underwent reconstruction with either island or skin bridge posterior arm flap between January 2015 and October 2016 were included in the study and evaluated retrospectively. All of the defects were reconstructed with PAPF following wide excision. Results: Five of the flaps (over 4 patients) were designed as flaps with skin bridges, while the remaining 12 flaps in 11 patients were raised as island flaps. The flaps had areas ranging from 20 to 84 cm2 (mean 39.5 cm2), depending on the size of the defect after excision. The mean follow-up time after the operation was 6 months. Wound dehiscence was detected in one patient, and another patient developed marginal necrosis during the postoperative period; no other complications were observed. Conclusion: Posterior arm perforator flaps can provide sufficient amounts of soft tissue to cover axillary defects and should be considered as the flap of choice in axillary reconstruction.
Introduction In reconstruction of digital amputations of the upper extremity, composite tissue alternatives with similar features are limited for finger tip reconstruction. Among these alternatives, free perforator flaps elevated from the hypothenar region (HFPFs) are defined, but reluctancy goes on for utilization of these flaps. In this study, we aimed to highlight the sensory results of HFPFs when a neural repair is incorporated to the flap and also to justify their usage by presenting functional and aesthetic outcomes of the reconstructions performed with HFPFs. Methods This clinical study was conducted from June 2015 to June 2017. Twelve patients with acute finger tip amputations were examined. Distal amputation levels were subgrouped according to Ishikawa classification. Patient demographics and amputation etiology were listed. All fingertip defects were reconstructed with a neurotized HFPF. All perforator anastomoses were performed in an end-to-end fashion. During follow-up, 2-point discrimination and dynamometric test were conducted. In addition, the Michigan Hand Outcomes Questionnaire was carried out. Evaluation of the results from a cosmetic standpoint was also conducted, with 4 blinded, independent surgeons using the visual analog scale. Results Of 12 digital amputations reconstructed with neurotized HFPFs, 10 were totally viable during follow-up, whereas partial loss was observed in 2 flaps. The mean age was 38.8 ± 11.8 years. Most of the amputations were classified as Ishikawa subgroup 2 (50%). The mean dynamic 2-point discrimination was 3.2 ± 0.11 mm and slightly greater compared with contralateral digit (P = 0.003). Also minor decreases were measured in forced grip and pulp-to-pulp grip strengths (P = 0.003). Overall satisfaction was 92.7% in Michigan Hand Outcomes Questionnaire. Average visual analog scale score was 7.25 out of 10. Conclusions Hypothenar free perforator flaps, with incorporation of neural repair, give promising results for reconstruction of the fingertip. In addition to superior sensorial outcomes, HFPFs yield satisfying results from aesthetic and functional perspectives.
In patients with moderate lower lid laxity, the lower orbicularis oculi muscle becomes atonic or ptotic. Hence, in such patient populations, with periorbital fractures, additional vertical support endorsement either by lateral canthopexy or orbicularis oculi muscle suspension flap must accompany plate and screw fixations. In this report, we shared our experience in applying prophylactic suspension to the lower lid with turnover orbicularis oculi transposition muscle flap in zygomatic fractures treated by subciliary approach in 98 patients. Our results show that turnover orbicularis oculi muscle suspension flap avoids the rounding of the lateral canthal angle more successfully and prevents ectropion better than the resuspension orbicularis oculi muscle flap does. We advocate using this flap where zygomatic fractures are approached via the subciliary incision. We foresee that it is a reliable and easily executed technique especially in middle-aged patients with moderate lower lid laxity for the prevention of ectropion.
Introduction As the number of traffic and occupational accidents increases, crush and avulsion types of amputations of the limbs have started to be seen more frequently. Due to increased microsurgical experience and recent developments in microsurgical technique, the success rate of replantation has increased. However, with greater industrialization, more crush and avulsion type injuries are seen rather than guillotine type, which have comparatively higher replantation success rates. Venous insufficiency after replantation or revascularization procedures is one of the most common causes of limb loss in either the short or the long term (1). If venous anastomosis is not performed during a replantation procedure, the success rate will be <20% (2). The hypothesis of this study was that the use of arterial grafts may be more successful in repairing a gap between veins that occurred after a crush-avulsion type of injury. Therefore, a crush-avulsion type injury model was created in rat veins. The damaged veins were repaired either primarily or with an arterial or venous graft and the success rates were evaluated and compared. 2. Materials and methods Approval for this study was granted by the Üsküdar University Animal Research Ethics Committee. A total of 24 Sprague-Dawley rats, each weighing 250-300 g, were divided into 3 groups. Group 1 (8 rats) was designated as the control group, Group 2 (8 rats) the venous graft group, and Group 3 (8 rats) the arterial graft group. Anesthesia was administered intraperitoneally using ketamine hydrochloride at the dose of 50 mg/kg and xylazine hydrochloride at the dose of 10 mg/kg. The extremities of the rats were fixed to the operating table with tape, and the operative field was shaved and cleaned with an antiseptic solution. On each rat, a unilateral femoral incision was made and the femoral vein was dissected. To create a proper crush injury to the veins using a previously defined Background/aim: Venous insufficiency after replantation or revascularization is one of the most common causes of limb loss in either the short or the long term. The aim of this study was to evaluate the results of a new technique to overcome venous insufficiency. Materials and Methods: A crush-avulsion type of injury was formed in the femoral veins of rats of 3 separate groups. In the control group, primary repair was applied to the damaged veins and the remaining 2 groups were repaired with either an arterial graft or a vein graft. The success rates of anastomosis were then compared. Results: In the control group the patency rate was 25% in the 2nd hour, 12.5% on the 2nd day, and 12.5% on the 10th day. The patency rate in the vein group was 87.5% in the 2nd hour, 50% on the 2nd day, and 37.5% on the 10th day, whereas the patency rates in the artery group were 100% in the 2nd hour, 87.5% on the 2nd day, and 75% on the 10th day. Conclusion: Microsurgery requires experience and patience. It can be considered that the use of arterial grafts for venous repair in replantation after crush-avulsion type amput...
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