Introduction: In fingertip injuries where replantation is not possible, options for reconstructing the fingertip with similar type of tissue are limited. Palmar and plantar regions are the donor sites that offer similar characteristics. In this study, we aim to evaluate the clinical outcomes of the hypothenar perforator free flap from the palmar region, compare this flap with the reports available in the literature, and share our experience regarding the practicality of the flap. Patients and Methods: The two-center retrospective clinical study included 15 patients who were operated on between 1 June 2015 and 31 December 2017. All patients were analyzed according to their demographic characteristics, mode and level of injury. Perforator flaps used in fingertip reconstruction were analyzed for skin island size, number of anastomosed arteries and veins, and number of reconstructed nerves. Static and dynamic two-point discrimination tests were applied, and grip strength and pulp-to-pulp pinch measurements were performed in the 13^th-month visit of each patient. Surgical results were assessed with the Michigan Hand Outcomes Questionnaire (MHQ). Results: Mean age of the 15 patients was 39.1 years (range: 27-61). While majority of the injuries were of crush type, 8 cases were classified as Ishikawa subzone 2 and 3 cases as Ishikawa subzone 1. One perforator artery and 2 veins were anastomosed in 13 cases. Neural reconstruction was performed in all of the cases. Mean dynamic two-point discrimination value was 3.0 mm (range: 2.8-3.2). Mean grip strength was 42.5 kg (range: 17.7-74.8) and mean pulp-to-pulp pinch strength was 10.7 kg (range: 5-19). MHQ results were 90% in subgroup 1, 95.3% in subgroup 2, 79.5% in subgroup 3, 92.9% in subgroup 5, and 93% in subgroup 6. Conclusion: In cases of fingertip injuries where replantation is not possible, hypothenar free perforator flaps come forth as a sophisticated reconstruction option with favorable outcomes suitable to the similar tissue principle.

Introduction: Penis replantation cases may serve as a model for identifying important elements in developing clinical penile allotransplantation. Material and Methods: We reviewed 82 published cases of penis replantation. Results: Besides the basic repair of urethra and corpora, we found that dorsal artery and dorsal nerve repair was associated with significantly better sensory return. Deep dorsal vein repair was associated with decreased sensation and increased complication rates. Conclusion: Penile allotransplantation may need to incorporate these findings.

Background: Tumors of the hand are usually benign in nature, and therefore, treatment is usually nonessential. Indications for the surgical treatment are cosmetic concern and potential for malignancy. Since malignant hand tumors are seen very rarely, suspicious findings should be assessed thoroughly, and the diagnosis should be established as well. The purpose of this article is to evaluate those lesions that commonly arise in the hand region including lipomas, ganglion cysts, and glomus tumors as well as malignant tumors such as soft-tissue sarcomas and squamous cell carcinomas. Material and Methods: A retrospective review of all 528 surgically removed primary skin and soft-tissue tumors of the hand at our department between 1996 and 2016 was performed. Results: A total of 528 patients were evaluated in this study. The most common benign tumor of the hand was pyogenic granuloma (24%), and the most common malign tumor of the hand was squamous cell carcinoma (65.2%). Malignant tumors incidence was higher in males, whereas benign tumors incidence was higher in females. Conclusions: A careful history and physical examination performed by a specialist can narrow down the possibilities regarding the type of tumor. The vast majority of hand tumors tend to be benign. In contrast to skin cancers in general, those occurring on the hand frequently have a worse prognosis, with a greater propensity for recurrence, metastatic spread, and functional deficit.

Background : The objective of this study was to determine the applicability and reliability of the medial sural artery perforator (MSAP) flap in patients with diabetes with peripheral arterial disease (PAD) for lower extremity defects and to assess the effects of sacrificing the MSA on distal circulation. Patients and Methods: A radiologic and clinical study has been utilized to assess safety and applicability of MSA perforator flap in diabetics. Five diabetic patients operated for complex lower extremity defects were analyzed and radiological findings from 43 lower limbs of patients with diabetes previously subjected to angiography for PAD were analyzed. Age, duration of diabetes, concomitant complications and occluded vessel type, the diameter of MSA at the popliteal junction, the branching pattern, and the number of sizeable perforators were documented. Results: One total flap loss occurred, one donor side dehiscence occurred. All other flaps survived, and defects were successfully closed. Radiologically MSA was present in unoccluded form in all 43 diabetic patients. At least one sizeable perforator was observed in all patients. There was a statistically significant, but negative, correlation between the size of MSA and the occlusion of the popliteal artery. Conclusions: Diabetes solely is not a contraindication of MSAP flap usage, as MSA is not affected by PAD. However, perigenicular collateral hypertrophy through arteriogenesis can be an issue in patients with severe occlusion at the level of the popliteal artery, since MSA enlarges. Cases of MSA hypertrophy in the presence of PAD constitute a high risk; therefore, selection of another flap is recommended.

Background and Objectives: Fournier's gangrene is a rare, rapidly progressive, fulminant form of necrotizing fasciitis of the genital, perianal, and perineal regions. It is characterized by progressive spread of necrosis in the skin and subcutaneous tissue which results in defects of various sizes in perineal region. Various techniques have been described for the reconstruction of these defects such as split thickness skin grafts, muscle flaps (e.g., Gracilis flap), and fasciocutaneous flaps (e.g., pudendal flap), perineal flap, anterolateral thigh flap, deep inferior epigastric perforator flap, and anteromedial thigh flap. We intend to study the results of medial thigh flap procedure in patients with scrotal defect following Fournier's gangrene. Materials and Methods: Medial thigh flap was performed in eight patients with Fournier's gangrene. The patients were selected consecutively from December 2016 to December 2017. All patients were followed for 3-6 months postoperatively. Results: All flaps survived well. However, in two cases, there was partial distal necrosis. Both cases were managed conservatively. In all cases, donor site healed well except for one case in which infection of the donor site suture line occurred. It was managed by frequent dressing. Interpretation and Conclusions: The medial thigh flap is a reliable fasciocutaneous flap which can be done in reasonably short operative time to cover difficult defects with excellent results.

Isolated injury to sciatic nerve is not a common entity because of its deeper location and is often associated with musculoskeletal injuries. Though injuries caused by penetratingtrauma,injections and hip surgery are well reported,a self- inflicted complete avulsion of this thickest nerve of the body is unreported. We report a peculiar case of avulsion injury of the sciatic nerve both in terms of its mechanism and the extent of injury. The sciatic nerve along with its branches (tibial and common peroneal nerve) was completely avulsed off its entire anatomical course by a penetrating injury at the buttock. The resulting nerve gaps were reconstructed with sural and superficial peroneal nerve grafts harvested from both lower limbs. Prognostically, proximal nerve injuries in lower extremity fare worse than the upper extremity in terms of recovery after peripheral nerve repair or reconstruction.

Pilomatrixomas are benign subcutaneous masses that originate from the hair follicle. Dimensions do not exceed three cm. When the dimensions exceed five cm, it is called giant pilomatrixoma and is very rare. Giant PMs (pilomatrixomas) can be confused with malignancy due to their locally aggressive features and nonspecific citopathologic and radiologic findings. By presenting a 62 years old men who has a giant PM phenomenon settled in the upper extremity, we wanted to observe the difficulties encountered in the diagnosis in the light of the literature.

Pedicled groin flap is a treatment option in use for hand defects caused by trauma or other etiologic factors. It gains particular significance in multiple finger defects, especially in those with one intact digital artery or in hand defects that cannot be reconstructed with regional flaps. Although several studies have reported the use of split groin flap in the reconstruction of such defects, no previous study has reported cases where specifically complex volar defects of two adjacent fingers. We present the reconstruction of two adjacent fingers with a split groin flap. A 22-year-old male patient, active smoker, admitted to our clinic for second and third finger volar complex defects in his right hand due to traffic accident. It was contaminated with asphalt tar, and bone and flexor tendons were exposed. After initial debridement, the patient was followed up by outpatient treatment until an appropriate wound surface was obtained. Then, split groin flap was planned. The flap was divided in the 3^rd postoperative week and adapted to the wounds. In the follow-up period, no flap loss occurred, and the patient did not require any flap revision or additional surgery. Split groin flap is a reliable flap option for complex volar finger defects.

Merkel cell carcinoma (MCC) is a rare and aggressive cutaneous malignancy with uncertain histogenesis. Here, we present an unusual presentation of giant MCC of the skin with concomitant intra-abdominal metastasis to pancreas. A 53-year-old man was admitted to our clinic with a giant ulcerated mass in the gluteal region. Incisional biopsy of the mass revealed primary poorly differentiated neuroendocrine tumor of the cutaneous origin and confirmed the diagnosis of MCC. Clinically, the patient complained of abdominal discomfort and weight loss of 15 kg over the past 4 months. Intra-abdominal computerized tomographic examination demonstrated a heterogenous-appearing giant mass of the right upper quadrant invading the superior mesenteric artery and leading to obstruction of common biliary duct and a second mass (6 cm Χ 6 cm) located at the inferior pole of pancreas extending toward the duodenum. As the gluteal mass was prone to trauma and leading to massive hemorrhage, excision of the gluteal mass with 2 cm of tumor-free margin was performed. V-Y advancement flap based on the perforators of the inferior gluteal and profunda femoris artery was elevated to cover the resulting defect (22 cm Χ 17 cm). Although the patient was referred to medical oncology for further therapeutic management, he could only survive for 11 months from his initial diagnosis. We would like to emphasize that MCC has the potential to spread to unusual organs in short intervals and prompt evaluation and proper management is essential for optimal survival of these patients.

Barber's syndrome is a plenoidal sinus that occurs in the interdigital space resulting in penetration from the epidermis by exogenous hairs. As an occupational disease, it is named so because of its prevalence in barbers. The penetration of short and hard hairs into the epidermis and the subsequent accumulation in the interdigital space triggers infection and leads to the classic plenoidal sinus pattern. However, unlike the classical plenoidal sinus, this pattern is formed in the interdigital space free of hair follicles and with exogenous, nonpatient hairs. Here, we present the case of a 31-year-old male patient who had plenoidal sinus in the second interdigital space for 1½ years. We would like to emphasize that it is a rare occupational disease which occurs in barbers with exogenous hairs and wanted to show the diagnostic and treatment modalities of this rare syndrome.