In this study, the histological and vital effects of rotation on multiple and single based perforator flaps were evaluated. A 6 cm × 6 cm abdominal perforator flap model was used on 80 male rats; half of these received a single-pedicled flap, and the other half double-pedicled. The flaps of control subgroups were raised and sutured without rotation. In rotation subgroups 90-, 180-, 270-degree rotations were performed, and rotation effects on flap viability and histological changes were analyzed. Among single- and double-pedicled perforator flaps, respectively, mean survival area was 12.59 cm(2) and 27.84 cm(2) in non-rotated subgroups, 12.49 cm(2) and 17.06 cm(2) in 90-degree rotation subgroups, 5.96 cm(2) and 9.96 cm(2) in 180-degree rotation subgroups, and 1.45 cm(2) and 1.70 cm(2) in 270-degree rotation subgroups. While survival areas of double- and single-pedicled perforator flaps with the same rotation degree showed no statistically significant difference, non-rotated double-pedicled perforator flaps had a statistically larger survival area compared to single-pedicled perforator flap (P = 0.001). In the single-pedicled flap group, there were no statistical differences between survival flap areas of the non-rotated subgroup and the 90- and 180-degree rotation subgroups (P > 0.05), but the non-rotated subgroup had a statistically larger survival area compared to the 270-degree rotation subgroup (P = 0.003). In double-pedicled perforator flap group, the control subgroup had a statistically larger flap survival area compared to 90-degree, 180-degree, and 270-degree rotation subgroups (P = 0.004, P = 0.002, P = 0.001). Degenerative histological changes gradually increased in correlation with the rotation angle in both single- and double-pedicled groups. When double- and single-pedicled groups were compared; degenerative histology score displayed no statistical difference between control subgroups and rotated subgroups (P > 0.05). In this rat abdominal propeller perforator flap model, we found that double perforators without pedicle rotation could support larger flap survival when compared to the single pedicle. However, double perforators did not cause an increase of survival area when pedicles were rotated. In the single-pedicled perforator flap, the flap survival area did not significantly decrease until 180-degree pedicle rotation. In the double-pedicled perforator flap, the flap survival area decreased when the degree of rotation increased. The degenerative changes increased in correlation with the rotation degree in both single- and double-pedicled perforator flaps.
Proliferating trichilemmal tumors (PTTs) are neoplasms derived from the outer root sheath of the hair follicle. These tumors, which commonly affect the scalp of elderly women, rarely demonstrate malignant transformation. Although invasion of the tumors into neighboring tissues and being accompanied with anaplasia and necrosis are accepted as findings of malignancy, histological features may not always be sufficient to identify these tumors. The clinical behavior of the tumor may be incompatible with its histological characteristics. Squamous-cell carcinoma should certainly be considered in differential diagnosis because of its similarity in morphological appearance with PTT. Immunostaining for CD34, P53, and Ki-67 is a useful adjuvant diagnostic method that can be used in differential diagnosis aside from morphological findings. In this study, we aimed to present the case of a 52-year-old female patient with clinicopathological features. We reported a low-grade malignant proliferating trichilemmal tumor in this patient and detected no relapse or metastasis in a 24-month period of follow-up.
Our study provides some indication that patients with lymphatic micrometastasis have a reduced DFS. Before creating a new TNM staging system, more information is needed to understand the prognostic impact of micrometastatic dissemination.
BACKGROUND:There are few studies of single forearm arterial injury repair that compare long-term results of intact and obliterated forearm arterial repair. Aim of the present study was to compare long-term results of forearm arterial repair using Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score and color Doppler ultrasound (CDUS).
The purpose of this study is to report our experience and learning curve in avoiding complications at both the recipient and donor sites as well in choosing the best flap for different anatomic locations. For this purpose 155 free flaps done between October 2005 and August 2012 were retrospectively examined. Patient demographics, flap types, etiology, re-exploration indications, timing of the re-explorations, and salvage rates were documented. In the first 60 cases, our re-exploration rate was 26.7% (16 flaps), and the rate decreased to 15.0% for the second 60 flaps (9 flaps). In correlation with this decrease, in the last 35 cases, only three flaps were re-explored (8.6%). This decrease in re-exploration rates over time was statistically significant (P = 0.021). Re-exploration rates for axial and perforator flaps were 14.6% and 22.7%, respectively. Salvage rates were 76.9% in axial flaps and 53.3% in perforator flaps. The total success rate for axial flaps was 95.5% and for perforator flaps was 89.4%. Besides, re-exploration rates were higher with lower salvage rates in perforator flaps compared to axial flaps causing lower overall success rates in the former group. The mean time of re-explorations was 21.4 hours. Salvage rates were significantly higher in re-explorations done within the first 12 hours after the initial surgery than in re-explorations done after 12 hours (83.3% vs. 47.3%) (P = 0.040). We can conclude that axial flaps have a steeper learning curve and are safer options for the inexperienced reconstructive micro-surgeons until they have adequate experience with the perforator dissection.
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