Aim: Necrosis in composite grafts used for the repair of tissue defects in the nasal wings, columella, and nasal sidewalls after tumor resection or trauma is an important problem related to the size ...of the graft. Success in the surgical or medical interventions on the recipient field or graft in order to enhance composite graft survival is clinically limited. The aim of this study is to research the effect of platelet-rich plasma (PRP) on composite graft viability during graft operation. Materials and Methods: One of the eight adults New Zealand white rabbits was used isogenically to obtain PRP. Circular full-thickness chondrocutaneous composite grafts in 2 cm diameter were excised from the both ears of each remaining seven rabbits. Right ears were separated as experimental group and left ears were selected as control group. In the experimental group, PRP was applied subcutaneously to the four different points on inner and outer surfaces at the graft donor and topically to the graft sides. The composite graft was turned 180°, and it is sutured back to the donor area. PRP was also applied on suture lines. Composite grafts formed in control group were turned for 180° and sutured without any application. At the end of the 21st day, histological evaluation was performed following measurement and photodocumentation of living and necrosis areas. Results: In the control group, except one total necrosis, partial necrosis and viable areas were identified at the other composite grafts. Mean viable area measurements in the experimental group were 33.62% and 21.15% in the control group (P < 0.05). Histological evaluation was based on the appearance of chondrocyte nuclei in the lacuna in cartilage tissue and the living areas were confirmed histologically. Angiogenesis, fibroblast proliferation, and inflammatory cell proliferation were not significantly different between the groups. Conclusion: Although the viability ratio in the experiment group was found significantly higher than that of the control group, 100% of viability ratio was not identified in any of the composite grafts. However, our findings support that PRP is positively effective on the enhancement of the composite graft viability as well.
Background
In this study, we investigated the effect of matrix metalloproteinase-1 (MMP-1) on wound healing on skin in a model produced in rats.
Methods
Sixteen Sprague–Dawley male rats were included ...in the study. The four full-thickness skin wound was created on the dorsal area of each rat with 4.4 mm punch. The rats were randomly divided into two groups. MMP-1 and saline were administered intraperitoneally once daily for 7 days. The biopsies were taken from the separate wounds on the 4th, 7th, 14th and 21st days of the experiment. The lymphocytic response, vascular proliferation, fibroblast proliferation, epithelial hyperplasia, foreign body reaction, ulcer formation, acute inflammation, keloid scar formation and hypertrophic scar formation were compared in each group in histopathologically.
Results
In our study, epithelial hyperplasia on 14th day was significantly higher in the MMP-1 group compared to the control group (
p
< 0.05). The lymphocytic response on 4th and 21th days, the vascular proliferation on 4th day, the fibroblast proliferation on 4th and 7th days, the acute inflammation on 4th day and the hypertrophic scar formation on 7th, 14th, 21st days were significantly lower in the MMP-1 group compared to the control group (
p
< 0.05). No statistically significant difference was found in comparison with other parameters (
p
> 0.05).
Conclusions
MMP-1 improves the wound-healing process of skin with higher epithelial hyperplasia and reduces scar formation in the animal model. Therefore, MMP-1 can potentially be used as an effective anti-fibrogenic agent for preventing or treating the hypertrophic scar.
No Level Assigned
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors
www.springer.com/00266
.
Background: Among the various procedures that have been used to treat Dupuytren's contracture, percutaneous needle aponeurotomy (PNA) is a popular technique with the disadvantage of a high recurrence ...rate. The purpose of this study is to combine PNA with autologous fat grafting to correct the contracture, return the palmar surface to its normal appearance and feel, and reduce recurrence. Patients and Methods: Thirty-three patients were operated of whom thirty were successfully followed up for 1 year. Forty-two rays were operated on all patients undergoing magnetic resonance (MR) imaging before and after the surgery. All patients had the contracture released by the way of PNA followed by fat grafting. Results: Hand examination revealed a smooth, painless, and soft skin, with an overall improvement rate of 90.1% 1 year postsurgery, presenting a recurrence rate of 18.6% that is significantly lower when compared to other studies performing PNA alone. MR evaluation showed regression in the pathologic cords and stability in the volume of the fat grafts. A minor complication rate of 23.9% and a major complication rate of 6.5% specific for PNA were observed. Conclusion: PNA is a minimally invasive technique that can be used for the treatment of contractures in almost all stages of Dupuytren's disease. Autologous fat grafting can be useful in offering the subcutaneous tissue a soft appearance and feel and preventing recurrence by filling in the potential space by fat instead of fibrosis, preventing expansion of the local mesenchymal progenitor cells responsible for the disease.
Introduction
Soft-tissue mallet finger occurs due to loss of terminal extensor tendon secondary to rupture of distal phalanx. Although using noninvasive splints for 6–8 weeks is the gold standard for ...conservative treatment of closed soft-tissue mallet injuries, patient compliance is an important factor impacting on patient outcomes. In this study, we used a single Kirschner Wire (K-W) to fix the distal interphalangeal (DIP) joint in extension in those patients failed to comply with routine splinting.
Materials and methods
In this prospective study, 190 patients with Doyle type 1 closed soft-tissue mallet finger deformity were included in four groups between 2011 and 2015. These groups were determined according to treatment modalities. Patients in the first group were treated with a finger splint (
n
= 109). Patients in the second group first received a finger splint and then K-W was applied due to lack of adequate compliance (
n
= 23). Patients in the third group were treated with K-W only (
n
= 47), and the fourth group did not accept surgical treatment nor conservative treatment (
n
= 11). After 20 weeks of follow up, we evaluated the results with functional measurements according to Crawford criteria and patient satisfaction. Additionally, the mid-term outcome was assessed with a follow-up at 2 years.
Results
At 20th week postoperatively, average DIP extension lag was 6 degrees (0–30) for the first group, 6.1 degrees (0–30) for the second group, 3.8 degrees (0–25) for the third group, and 17.3 degrees (7–30) for the fourth group. Total patient satisfaction was 85%, which was considered excellent or good. Swan neck deformity was observed in 11% of patients. Osteomyelitis and KW related complications were not observed. There were no statistically significant differences between short-term and mid-term results.
Conclusion
Internal fixation via K-W may be a suitable treatment option compared to splint therapy for management of closed soft-tissue mallet finger in noncompliant patients. Using this treatment approach, the success rate for patients could satisfactorily be improved.
Amaç: Diz ve çevresi yumuşak doku rekonstrüksiyonunda ekspoze yapıların yeterli yumuşak dokuyla örtülmesi gerekliliği yanında diz
fonksiyonunun korunması da önemlidir. Diz çevresi cilt defektleri ...için çok çeşitli flepler tarif edilmiştir. İleri yaşlı, eşlik eden komorbiditeleri
olan ve lokal flep seçenekleri kısıtlı olan olgularda ise çapraz bacak flebi dışında iyi bir alternatif bulak zordur. Distal anteromedial uyluk
flebi klasik tanımlanmış fleplerin dışında diz ve çevresi cilt defektlerinin rekonstrüksiyonu için iyi bir lokal alternatif flep seçeneği
sunmaktadır. Bu çalışmada komplike hastalarda diz bölgesi yumuşak doku defektlerinin distal anteromedial uyluk flebi ile
rekonstrüksiyon sonuçları sunulmuştur.
Materyal ve Metot: 2014-2019 yılları arasında diz ve diz çevresi cilt defektleri için opere ettiğimiz üç kadın üç erkek toplam altı hasta bu
çalışmaya dahil edildi. Bu hastaların dördü yaşlı ve eşlik eden çoklu ek hastalıkları mevcut iken iki hastada geçirilmiş kompartman
sendromu ve nekrotizan fasiite bağlı lokal flep seçenekleri kısıtlıydı.
Bulgular: Bir hasta hariç tüm hastalarımızda defektler başarılı bir şekilde kapatıldı. Yüzeysel marjinal nekroz gelişen hastamızda kalan
defekt sorunsuz şekilde greftlendi. Parsiyel %40 nekroz gelişen hastamızda patella üzeri defekt kapatılabilirken pretibial bölge üzeri
kapatılamadı ve çapraz bacak flebi planlandı.
Sonuç: Distal anteromedial uyluk perforatör flebi komplike hastalarda diz ve çevresi cilt defektlerinde kullanılabilecek güvenli bir
seçenektir. Patella altına ulaşan defektlerde delay yapılarak kullanılması venöz yetmezliği engellemek için uygun olabilir
Isolated paralysis of the marginal mandibular nerve results in an asymmetrical lip appearance with aesthetic and functional losses. Until today treatment options include mainly muscle transfers, and ...botulinium toxin injections for temporary issues. Since it was first reported by Edgerton, the technique of anterior belly of digastric transfer has been one of the most preferred. Alternatives for this technique still remain limited. In this clinical report, a new alternative technique was defined, stylohyoid muscle transfer, for the situations that digastric muscle is absent. The technique was compared with other conventional treatment methods and the outcomes were discussed.
BACKGROUNDFingertip amputations are among the most common injuries seen in the hand. According to the geometry of the amputation, it may be classified as transverse or oblique (dorsal, volar, or ...lateral type). Although numerous repair techniques have been described in the literature, there are few alternatives suitable for lateral oblique type fingertip amputations.
METHODSBetween 2012 and 2016, we operated on 16 patients with simple rotation flap from the remaining part of the pulpa in a rotation and advancement manner for the reconstruction of lateral oblique type fingertip amputations.
RESULTSAll but two of the flaps healed completely with full flap survival. Superficial distal flap necrosis was observed in two patients. They healed by secondary intention. No obvious hooked nail occurred in patients. Cold intolerance was observed in one patient; joint stiffness or hypersensitivity was not observed in any of the patients. Stiffness of the proximal interphalangeal joint did not occur. Two point discrimination test results were found to be normal.
CONCLUSIONThis technique is simple, rapid, and free from relatively major complications. This flap allows for anatomical reconstruction of the fingertip by using a similar tissue in cases of lateral oblique fingertip amputations, where only a few flap options can be successful.
ABSTRACTThe number of venous anastomoses performed during fingertip replantation is one of the most important factors affecting the success of replantation. However, because vessel diameters decrease ...in the zone 1 level, vessel anastomoses, especially vein anastomoses, are technically difficult and, thus, cannot be performed in most cases. Alternative venous drainage methods are crucial when any reliable vein repair is not possible. In the literature, so many artery-only replantation techniques have been defined, such as arteriovenous anastomoses, forming an arteriovenous or venocutaneous fistula, manual milking and massage, puncturing, and external bleeding via a fishmouth incision and using a medical leech. It has been shown that, in distal fingertip replantations, the medullary cavity may also be a good way for venous return. In this study, we introduce an alternative intramedullary venous drainage system we developed to facilitate venous drainage in artery-only fingertip replantations. The results of 24 fingertip replantations distal to the nail fold by using this system are presented with a literature review.
ABSTRACTExtracorporeal perfusion of organs has a wide range of clinical applications like prolonged vital storage of organs, isolated applications of drugs, bridging time to transplant, and free ...composite tissue transfer without anastomosis, but there are a limited number of experimental models on this topic.This study aimed to develop and evaluate a human extracorporeal free flap perfusion model using an extracorporeal membrane oxygenation device. Five patients undergoing esthetic abdominoplasty participated in this study. Deep inferior epigastric artery perforator flaps were obtained abdominoplasty flaps, which are normally medical waste, used in this model. Deep inferior epigastric artery perforator flaps were extracorporeally perfused with a mean of 6 days. The biochemical and pathological evaluations of the perfusions were discussed in the article.
Sarcoidosis is a multisystem inflammatory disease that manifests as noncaseating granulomas, commonly in the lungs and intrathoracic lymph nodes. Subcutaneous manifestations of sarcoidosis that are ...caused by granulomas are referred to as specific for sarcoidosis, whereas other lesions are considered nonspecific. The authors present "sarcoidosis nodule formation on the lateral nasal osteotomy lines" in a sarcoidosis patient undergoing rhinoplasty surgery as a rare patient.
V.
PDF
