No abstract

Intraneural Hemangioma of the digital nerve is rare and so far three cases have been reported in the literature. We present a case of 12-year-old boy with painless soft tissue mass in the right hand and numbness on the radial aspect of the index finger. Magnetic Resonance Imaging showed an isointense subcutaneous lesion without discrete borders in the first web space classically of hemangioma with the radial digital nerve extension. On exploration, the intraneural extension of the hemangioma was confirmed and total resection, microsurgical primary digital nerve repair was done. The patient became better and at 6 months follow up the index finger sensation improved. The patient had no reccurence and he is still under follow up.

The nose is the most commonly affected area by basal and squamous skin carcinomas of the head and neck area (D'Arpa et al. J Plast Reconstr Aesthet Surg. 2009, 62:36-42). The nasolabial flap is a very well known local flap that provides excellent color and texture matches. However, its major drawback is that it requires a 2-stage procedure to restore an adequate nasal cheek groove (Karsidag et al. J Craniofac Surg. 2010;21:1887-1889). In the perforator flaps, there are numerous studies that describe flaps whose vascular supply depend on perforators from the fascial artery.We planned to harvest a perforator flap around the medial cheek area, which included one cutaneous perforator from the facial artery. Free-style facial artery perforator flaps and auricular conchal cartilage framework were performed in 9 patients who have alar defect due to malignancies.From September 2010 to December 2011, the free-style facial perforator artery flap was performed in 9 patients at the Plastic and Reconstructive Surgery Department of the Ankara Numune Training and Research Hospital, Turkey. The whole flap was used to reconstruct the whole alar unit, which includes cartilaginous tissues.Our aim is to define a one-stage reconstruction technique with a perforator-based flap. Our flap is supplied by a perforating branch of the facial artery. We develop this method because of its reliable vascularization, that is, the possibility of performing one-stage technique with sensation preservation.In conclusion, we strongly recommend one-stage reconstruction in any kind of alar region defect with this versatile facial perforator flap.

AIm:The scalp and forehead are the anatomical regions where non-melanoma malignant skin tumors are commonly seen due to direct sun exposure. After surgery for non-melanoma malignant skin tumors located in the scalp and forehead, many complex defects can develop, ranging from sole skin defects to deep defects in which bone and dura mater are opened. results: In order to accomplish satisfactory results these patients have to be carefully assessed with specific parameters while performing the reconstruction of the defect and reconstruction should be planned. Patients with local invasion may need adjuvant radiotherapy postoperatively and reconstruction with free flaps is reliable in the prevention of the possible comorbid problems due to radiotherapy.COnClusIOn: Multidisciplinary approach is needed and the treatment should be managed with neurosurgical team, radiation oncologists and medical oncologists.

The effect of recombinant hirudin, which is the most powerful antithrombotic agent, on flaps with venous insufficiency was investigated. Oedema and congestion are frequent on flaps, causing necrosis unpredictably. Venous insufficiency and thrombosis are experimentally and clinically more frequent than arterial occlusion. Twenty-one adult New Zealand rabbits were used in this study. Skin flaps (3 × 6 cm) were elevated on a 1-cm-wide pedicle on rabbit ears. The artery, nerve, and vein were exposed and examined with the aid of a surgical microscope. Venous insufficiency was established by cutting the vein and nerve. In the control group, no additional surgical or medical procedures were performed and the ear flap was inset to its original location. Subcutaneous low molecular weight heparin (LMWH; 320 IU/kg) was administered to a second group of rabbits after the same surgery, and recombinant hirudin (2 μg) was administered via the pedicle artery 5 minutes after the vein and nerve were bound and cut in a third group of rabbits. Compared with control and LMWH groups on day 3 and 7, the hirudin-treated group had less hair loss, lower oedema scores and less haematoma formation. Furthermore, a lower size of necrotic areas and an increase in the circulating area on day 7 was found in the hirudin-treated group. In addition, angiography revealed new vessel development (neovascularisation) only in the hirudin group. On histologic sections, hirudin-treated animals had lower oedema, inflammation and congestion scores than animals in the other two groups. Thus, when administered into the ear flap through the pedicle as a pure recombinant preparation, hirudin increased flap survival by its antithrombotic effects and by accelerating neoangiogenesis. Recombinant hirudin may be used in clinical practice to treat flaps with venous problems and to increase survival rates.