Background: Anastomotic coupling device (ACD) has reached wide popularity, especially in venous anastomosis of free-tissue transfers. There are scant reviews in the literature about the reliability of these devices in venous anastomosis. We retrospectively analyzed our free flap cases to compare the thrombosis rates between ACDs and handsewn anastomosis and other possible risk factors that may contribute to venous thrombosis. Materials and Methods: Data of all microvascular free-tissue transfers performed between January 2015 and August 2019 were retrospectively reviewed. Patient characteristics were recorded. Reconstruction characteristics such as venous anastomosis type (hand-sewn vs. anastomotic coupler device), reconstruction site, and number of surgical interventions were also recorded. Results: A total of 385 consecutive-free microvascular reconstructions were identified. Total venous thrombosis rate was 4.7%. There was no statistically significant difference between hand-sewn anastomosis and anastomosis with coupler device (5.2% vs. 3.2%, P = 0.58). Only reconstruction site was found to be significantly associated with higher venous thrombosis (P = 0.03). Discussion: Our results involving different reconstruction sites and including multiple flap types demonstrated comparable revision rates between ACDs and hand-sewn anastomosis. This finding is consistent with the current literature.

Background: Palatal defects are still challenging for the reconstructive surgeon since the palate carries important functional roles in swallowing and articulating while providing an adequate airway. The aim of this article is to discuss the preferred free flap types for palatal reconstruction and present the functional outcome. Material and Methods: Records of patients who underwent microsurgical palatal reconstruction between 2012 and 2017 were reviewed for demographic properties, defect properties, flap of choice, and complication rates. A questionnaire was applied to the patients for assessment of speech, swallowing, regurgitation, snoring, and overall satisfaction. Results: Four patients were operated for palatal defects with a mean size of 23.25 cm². The most commonly used free flap was the radial forearm flap in our four patient series. All patients reported improvement for every functional criterion in the questionnaire. Conclusion: Free flaps are an acceptable method for restoring palatal function. Radial forearm free flap was the flap of choice for reconstruction of large palatal defects in this retrospective review.

Introduction: Nose is the most noticeable feature in the facial profile. Any deformity of nose causes social embarrassment and ridicule. Isolated nasal alar hypoplasia/cleft or traumatic loss is a rare anomaly which requires reconstruction. Congenital deficiency of soft triangle of nose and part of ala is not paid attention to in early childhood. Hence, most of these individuals present in late childhood, adolescence or adulthood. We report ten such cases and their reconstruction using two stage ipsilateral interpolated nasolabial flap. Material and Methods: Demographic data including age, sex, associated co-morbidities, previous surgeries or history of trauma were documented. Patients were in age group of 10-25 years. The mean size of defect was 1.5 X 1.6 cm. Inferiorly based skin flap raised from ala was turned down and used as inner lining. Conchal cartilage graft was placed for support in the first stage itself. Nasolabial flap was raised by subcutaneous dissection and insetting done to create outer cover. Second stage for pedicle detachement was done after 3 weeks. Results: Post operative period was uneventful in all cases. Minimal cosmetic morbidity was noted. Scar was well concealed in the nasolabial crease and colour match was also acceptable with good patient satisfaction at 6-12 months. Conclusion: Nasal alar hypoplasia/cleft, congenital or traumatic, is a rare entity which needs to be recognised and reconstructed. According to the size of the defect, it can be reconstructed with composite cartilage graft or local flaps. Interpolated nasolabial flap with cartilage graft is a good option with minimal scar and excellent patient satisfaction.

Background: Oral submucous fibrosis (OSMF) is a chronic disease of insidious onset predominant in the Asian subcontinent. It is a progressive condition resulting in forced closure of mouth and inability to take solid oral feeds. Having a multifactorial etiology, it is a well-known premalignant condition. Measures such as forcing the mouth open and releasing the fibrotic bands have resulted in aggravated fibrosis and disability. Aim: The aim was to evaluate the outcomes of bilateral inferiorly based nasolabial flaps in the management of severe trismus in patients with submucous fibrosis. Materials and Methods: The study included patients with progressive trismus presenting to the department of plastic surgery who underwent release and cover with nasolabial flap during the period from August 2014 to July 2018 (4 years). A total of eight patients were studied for their offending agents, the progression of the disease, the preoperative and postflap transfer, and inter-incisal distance, and this was followed up for a period of 1 year. Patients were studied for their improvement in mouth opening, flap status, and donor-site scar acceptability. Results: A total of eight patients of submucous fibrosis with severe trismus were treated with nasolabial flaps and followed for an average of 1 year from 2014 to 2018. The mean preoperative inter-incisal opening of 2 mm was treated by the bilateral release of mucosal fibrous bands and covered with tunneled facial artery-based nasolabial flaps. All patients received postoperative mouth-opening physiotherapy. Their inter-incisal opening improved from a mean of 2 mm to a mean of 30.8 mm. Conclusion: Bilateral pedicled nasolabial flaps can be successfully used for long-term relief of severe trismus in OSMF. Our study showed easy elevation of bilateral flaps, adequate postoperative mouth opening, with no recurrence of disease, and no flap contracture. This small-sized flap gives good coverage of the buccal mucosa without flap redundancy and cosmetically acceptable donor site.

Background: Several decades have witnessed the use of free flaps in clinical science. With the advancement and refinement in operative techniques, survival rates of free flaps have increased. There is a need to compare the efficacy and safety of anterolateral thigh (ALT) flap and radial forearm free flap (RFFF) in head-and-neck reconstruction surgeries. Objective: The objective of this study was to compare the ALT flap and RFFF in head-and-neck reconstruction. Materials and Methods: This prospective study was carried out among 25 patients posted for head-and-neck reconstruction in whom either a RFFF or an ALT free flap (ALTF) was performed. Group A had 16 patients reconstructed using the RFFF. Group B had 9 patients reconstructed using ALTF. Results: Majority of the cases were of buccal mucosa cancer. Majority of the RFFFs were performed in buccal mucosa carcinoma patients (43.75%). Majority of the patients with squamous cell carcinoma of the scalp underwent ALTF. RFFFs were most commonly performed in oral cavity (43.75%). Most of the cases of ALTF were performed in the midface and scalp. Mean values of pedicle length, flap length, flap width, and flap thickness were significantly less in the RFFF group compared to the ALTF group. However, the mean time of harvest (min) was significantly less in the RFFF group allowing quick harvest. The difference in donor-site complications in the two groups was not statistically significant except donor-site social stigma. Patients of the RFFF group complained of donor-site social stigma due to ugly looking Split thickness skin graft (STSG) patch at the donor site. The average stay in the hospital after surgery was not found to be statistically significant. Conclusion: ALTF allows a harvest of large tissue for reconstruction as compared to RFFF. Donor-site morbidity is comparable in both the groups except donor-site appearance. RFFFs are harvested easily in less time as compared to Anterolateral thigh free flap (ALTF) due to the complex anatomy of ALTF.

Purpose: The purpose is to propose a modification of Wassel/Flatt classification system for radial polydactyly based on radiological findings and previously described classification systems. Materials and Methods: Thirty-five patients with radial polydactyly were included in the study. There were 47 supernumerary fingers. Patients' clinical and radiological data were evaluated retrospectively. Family history, sex, age, unilateral or bilateral placement, the origin of radial polydactyly, coexisting anomalies, and syndromes of each patient were documented. We classified cases into 13 different subgroups, according to X-rays and clinical findings. Results: One supernumerary digit was rudimentary Type, 2 were hypoplastic type, one was Wassel Type I, 3 were Wassel Type II, and 5 were Wassel Type III, 12 were Wassel Type IV, 5 were Wassel Type V, 7 were Wassel Type VI, 9 were Wassel Type VII, one was symphalangism, one was complicated type. Conclusion: We think it is beneficial to add complicated type (tetraplication, triplication) symphalangism, rudimentary and hypoplastic malformations together as a single comprehensive classification system to better define diagnosis and treatment plans.

Background and Aim: The injuries due to gunshot can form extensive defects. The management of these defects is required in multistage procedures, and the treatment achievement should be evaluated in many aspects. In this study, a methodology was tried to be developed to reveal the path to be followed in the management of maxillofacial defects caused by high-energy close-range gunshot injury. In addition, similar cases were analyzed retrospectively, and the functional and social successes of the treatment were evaluated. Subjects and Methods: Five patients with high-energy gunshot injuries were retrospectively analyzed. The tissue requirements of the patients were identified. The technical and quantitative details of the treatment were recorded. The facial disability index was used to evaluate the patient's social and motor functions in the 1^st year after the operations were completed. Results: The patients' mean age was 31 (17–45), and all of them were male. The mean follow-up time was 25 months (14–26), and the mean operation amount was 7.6 (3–11). Four mandibular, one maxillary, and five soft-tissue defects were detected. It was detected that these defects were managed in basic four steps. Satisfactory, functional, and social results were obtained in four patients in the postoperative 1 year. Conclusions: The management of this group of patients comprises complicated procedures. First, the patient should be stabilized vitally. Definitive reconstruction should be carried out after the wound is stabilized. To increase treatment success, the patient's mental status should be stabilized during the treatment period. Providing social function is important along with physical function.

Introduction and Purpose: The aim of this study is to investigate the factors affecting University students' attitudes toward aesthetic surgery. Materials and Methods: This descriptive study was carried out in the spring semester of the 2018-2019 academic year with the students of the nursing Karabuk University. A form determining the sociodemographic characteristics of the students, the Cosmetic Surgery Acceptance Scale, and the Social Appearance Anxiety Scale were used to collect the study data. Results: The mean age of the students participating in the study was 21 ± 1.9 years, the mean body mass index was 22.54 ± 3.8, 72.5% were female, and 97.2% were single. The mean scores of the students obtained from the Cosmetic Surgery Acceptance Scale and Social Appearance Anxiety Scale were 45.73 ± 17.68, 34.85 ± 10.05, respectively. A significant relationship was determined between the mean of the Cosmetic Surgery Acceptance Scale and the ages of the students (P < 0.0001). In addition, there was a positive and strong relationship between the mean scores of the sub-dimensions of the Cosmetic Surgery Acceptance Scale (personal, social, and intellectual levels) and the mean score of the Social Appearance Anxiety Scale (P < 0.0001). Conclusion: In this study, it was determined that age and social appearance anxiety among university students are the factors that increase the possibility of opting for aesthetic surgery. Before aesthetic surgery interventions, determining psychological factors such as aging anxiety and social appearance anxiety that affect attitude toward aesthetic surgery in psychosocial evaluations and integrating the necessary interventions into nursing care will be beneficial in evaluating the suitability of patients for surgical intervention more accurately, applying more qualified nursing care, and increasing patient satisfaction.

The rapid developments in aesthetic medicine and the exaggerated results promised on the social media platform drive people to spend considerable budgets on such procedures to look more beautiful. Individuals often work extra jobs, take out bank loans, or borrow from friends to be able to pay for the prices that exceed what they can afford. This study is a survey designed to feel the pulse of the community on the economic aspect of aesthetic procedures. The study was carried out during March 30 to April 30, 2019, in the province of Bursa. Face-to-face interviews were conducted with participants selected based on the socioeconomic status and age according to the data of the Turkish Researchers' Association and the Turkish Statistical Institute. The distribution by age statistical data provided by the Turkish Statistical Institute for the province of Bursa was taken as the base in the selection of the participants. The survey was conducted with women as they undergo more aesthetic procedures and drive the cosmetic industry. Five hundred women, half of whom had undergone aesthetic intervention, were asked 15 questions to understand their viewpoint on the economic aspect of aesthetic procedures. The questions asked to all participants, i.e., those who had and had not undergone aesthetic intervention, were structured as easy-to-understand phrases without specifically guiding the participants and with clear response options such as “yes,” “no,” and “I have no idea.” The participants could also elaborate on their response using free text. The results were shown in percentile. Intra-analysis and cross-analysis were performed to interpret the results. The results of our study suggest that people tend to push the limits of their budget for aesthetic procedures. More importantly, however, the study showed that aesthetic procedures are often performed at incompetent centers. Most of those who have undergone a procedure in such places are of high education and economic levels, i.e., of high socioeconomic status (A and B) with undergraduate or postgraduate degree, which depicts a hard-to-understand and a troubling picture.

Congenital unilateral upper limb muscular hypertrophy is a rather new entity. Patients have unbalanced muscular forces on their upper extremities due to muscular hypertrophy. These unbalanced forces preclude physiological movements, and in the late course, cause joint deformities. Once joint deformities occur, benefit from surgery diminishes; botulinum toxin can be used for the prediction of a possible benefit from surgery. A 14-year-old girl presented with flexion and ulnar deviation contracture of the left wrist, narrowing of the first web space, flexion contracture of all fingers, and more evident on the first, third, and fourth fingers. After botulinum toxin injection, the most notable benefit was seen on the wrist contracture. In surgery, adductor myotomy, flexor carpi ulnaris transfer to palmar aponeurosis, and tendon transfers of flexor digitorum superficialis to flexor digitorum profundus in the third, fourth, and fifth fingers were made. The postoperative gain was similar to the outcome after botulinum toxin injection. Botulinum toxin may help the surgeon to understand if chronic joint deformities have occurred and predict possible benefit from surgery.

The airbag is a lifesaver innovation in automobile industry, but the impact of airbag deployment may cause maxillofacial fractures. Airbag deployment in traffic accidents is a rare etiology of orbital fractures. Although there are reports about airbag-induced orbital fractures in the literature, isolated bilateral blowout fractures have not been published yet. We present a case of isolated bilateral blowout fracture due to airbag deployment in a traffic accident and its management in this study.

Osteoarthritis of the hand is rare; however, the most retained joint after the distal interphalangeal joint is the first carpometacarpal (1. CMC) joint. Pain in the rest and increased pain with opposition is the most serious symptom, which significantly decreases the quality of life. The aim of these patients is to obtain a painless and stable thumb. Experience of trapeziectomy and ligament reconstruction tendon interposition technique for a Stage III patient was shared and diagnosis and treatment were discussed through the relevant literature. A 53-year-old female patient was admitted with complaints of pain in the right hand thumb root and unable to open the jar lid. In direct radiography, narrowing in the 1. CMC joint space and osteophytes were detected. After the trapeziectomy, 1^st and 2^nd metacarpals were fixed with K wire. Flexor carpi radialis tendon was passed from the first metacarpal base to the second metacarpal base in the form of a distal-based tendon flap to mimic the beak ligament. There was no pain at the postoperative 6^th month, and the Kapandji opposition score was 10. When diagnosing 1. CMC osteoarthritis, pain during opposition and circumduction movements that is not relieved with analgesics and rest is the most important symptom for a clinician to look for. Many treatment principles have been defined according to the staging for the postdiagnosis period, despite the diagnosis is a challenging process.

Negative pressure pulmonary edema (NPPE) develops when a patient makes a forced inspiration against a closed upper airway resulting in transudation of pulmonary capillary fluid into the interstitium. Young, healthy athletic males are more susceptible to this complication, and NPPE is most frequently encountered during oral and maxillofacial surgeries. Patients who have undergone septorhinoplasty surgery have a significant risk for NPPE, unlike other cosmetic surgeries. Herein, we describe two cases of postoperative NPPE following a septorhinoplasty. Early symptoms of NPPE are severe respiratory distress, tachypnea, agitation, and crushed strawberry-colored bloody sputum during the early postextubation period. An early diagnosis of NPPE is very important, and patient recovery is quick when an early diagnosis is made.

In today's era, it is said that an oral and maxillofacial surgeon with knowledge of aesthetic surgery is like two eyes on the face. Smile is recognized as a killer app for young adults, mainly in young females and people with less beautiful smile face embarrassment. Due to less harmonic smile, people suffer from mental trauma and depression. So many treatment options are advocated to overcome this problem, which included several surgical and nonsurgical methods. Here, we present a case report of a 15-year-old young girl who reported to us with a chief complaint of gummy smile. We advocated surgical lip repositioning procedure, and on 6-month follow-up, no relapse was observed.

Bladder exstrophy is a rare lower urinary tract malformation that occurs less frequently in women than in men. A case of 11-year girl, who presented with the residual bladder exstrophy along with lower abdominal defect secondary to previously operated bladder exstrophy. Anterior osteotomy and abdominal rectus muscle and musculocutaneous flaps are commonly used options for closure of the defect. Due to extensive scarring and atrophic abdominal recti and late presentation, local reconstructive options were exhausted. Hence, the tensor fascia lata flap was used for the defect closure. In the following report, we discuss our experience with this procedure.