Rectoneovaginal fistula (RnVF) is one of the major complications for the gender reassignment surgery. Closure of the RnVF with interposition of a pedicled tissue flap is a useful surgical approach to reconstruct the perineal space and provide neovascularization. Martius flap, gracilis muscle flap, and Singapore flap are the options of pedicled tissue flap. An HIV-positive 37-year-old male-to-female trans-sexual patient presented with a large RnVF (8–9 cm × 4 cm) after penile inversion vaginoplasty. A modified Singapore flap was performed to repair RnVF and to reconstruct the perineal space. Vaginal reconstruction with a fasciocutaneous Singapore flap can be considered for male-to-female trans-sexual patients with a complex RnVF as it provides excellent neovascularization with a sensate flap and desirable cosmetic outcome.

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Objective: Mandibular condylar fracture has an incidence rate between 14 and 48% of all mandibular fractures. Rigid fixation along with open reduction internal fixation is so far the most successful method to ensure the mandible stays in its natural anatomy. Facial nerve injury is the most feared complication for open reduction methods. We aimed to explain the surgical method using transmasseteric antero-parotid approach in mandibular condylar fractures, through which the buccal branch of the facial nerve is explored and maintained. Material and Methods: Since April 2015 to February 2018, the 12 patients (age range 19-42 years) with 15 fractures were treated with open reduction and internal fixation with transmasseteric antero-parotid approach. There were 9 male and 3 female patients. All patients were reviewed 2 weeks, 4 weeks, 3 months and 6 months after surgery. The clinical follow-up examinations included dental occlusion, maximum mouth opening (interincisal distance), weakness of the facial nerve, postoperatively complications (hematoma, infection,fistula,seroma) and salivary leak. Results: Infection, hematoma, fistula or seroma complications were not observed in any of our cases. The postoperative occlusal relationship was well restored in 11 patients. One patient with bilateral subcondylar fracture had unsatisfactory dental occlusion with anterior open bite. There was no permanent facial nerve palsy. All patients were satisfied with results. Conclusion: In mandibular condylar and subcondylar fractures, the transmasseteric antero-parotid approach is a reliable method that can ensure sufficient exposure and osteosynthesis.

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Cyanoacrylate glue is widely used in daily life. Because of its strong adhesive property, it is widely known as “super glues.” Cyanoacrylate may cause burn injuries on the skin by their interaction with wool and cotton textiles that contact with the skin.

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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 21^st 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.

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Background/Aim: Benign skin tumors are soft-tissue lesions that present with poor cosmesis along with pain, functional limitations, deformity, and hypoesthesia. Rapid progression and giant forms should be evaluated and differentiated from malignant transformation. The aim of this study is to evaluate the patients operated for giant benign skin tumors and to assess clinical experience about indications, size, location, and histopathological results and follow-up period. Materials and Methods: The present study included 16 consecutive patients who underwent surgery for giant benign skin tumors between 2015 and 2018 based on the literature definition of “giant benign skin tumors.” Demographic parameters, indications, symptoms, pathological results, and postoperative complications were evaluated retrospectively. Results: Sixteen patients (11 males and 5 females) were operated for giant benign skin tumors. The mean age of the patients was 53.38 (range: 37–72) years. Tumor locations were on the scalp for four patients, the upper extremity for three patients, lower extremity for three patients, trunk for five patients, and generalized for one patient. Pain was the most common symptom, and hypoesthesia, functional limitations, ulceration, and infection were also observed. Total excision was performed for all patients. No major complications and recurrence were observed. Conclusion: Clinical follow-up is an option for patients presenting to clinic with lesions that are small in size and asymptomatic. However, a detailed history and examination along with total excision and histopathological examination should be planned in patients with rapid progression or with benign skin tumors of giant size.

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Background: This study aimed to evaluate the utility of bilateral axial, lateral nasal flaps sharing a single skin pedicle in the reconstruction of large midline nasal dorsum defects. Materials and Methods: Six patients with large midline nasal dorsum defects due to tumor ablation (four basal cell carcinomas and two squamous cell carcinomas) were included in this study. Nasal defects were reconstructed by bilateral axial, lateral nasal flaps that easily reached nasal dorsal defect bilaterally. After the two parts of the flap were sutured on the dorsum of the nose, the donor area defects on each side of the flap were easily closed by pulling the cheek skin toward the flap sides. Results: After an average of 10 months of follow-up, the color and texture matches were good, and all the scars were at the borders of the esthetic units and symmetrical. Share of single pedicle by the two lateral nasal flaps enabled larger defect closure, and the likelihood of lengthening of the flap through the nasolabial sulcus bilaterally to enable the closure of nasal tip defects. Preparation of relatively smaller size flaps enables the formation of smaller defects in the donor site which could easily and safely be repaired with minimal complication risk. There were no complications related with the flaps or donor sites, except for venous congestion in one patient, and neither a tumor relapse nor a metastasis was detected. Conclusion: In conclusion, our findings revealed feasibility and safety of using bilateral axial, lateral nasal flaps sharing a single skin pedicle in repair of large midline nasal dorsum defects due to tumor ablation, which enables maximal defect closure and minimal donor-site morbidity.

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Aims: There is no current study presenting a descriptive cost-based analysis of operative maxillofacial fracture managements in Turkey. Therefore, this study attempted to investigate the overall treatment costs of maxillofacial traumas. Materials and Methods: Maxillofacial trauma patients treated between January 2012 and December 2016 with at least 12 months of follow-up were included in this study. Parameters including age, gender, etiology of injury, site of trauma, additional traumas, comorbidities, length of hospitalization, treatment technique and material used in surgery, duration of surgery, complication rates, and hospital costs for treatments were analyzed retrospectively. The costs were converted into USD ($) according to the currency exchange rate. Results: The most cost-effective (351$) was the teenage group (10–17 years) and the most expensive (793$) was the group over 61 years of age with significant differences. Etiologically, assaults were statistically significantly (P = 0.047) cheaper than motorbike accidents. The most expensive treatments were tetrad site fractures, and the most cost-effective treatments were maxillary fractures. The total costs of tetrad site fractures (1088$) was statistically significantly expensive than that of maxillary fractures (245$) (P = 0.006). Additional injuries caused statistically significantly higher costs to maxillofacial trauma treatments (P = 0.002). Closed techniques or plate fixations with six holes or less were statistically significantly cheaper than plate fixations with more than six holes (P < 0.001). Maxillofacial treatments had a complication rate of 8.6%. Complications caused statistically significantly higher treatment costs (P = 0.038). Conclusions: The results of this study suggest that maxillofacial surgeons should use the resources in the most effective way to maintain low complication rates and treatment costs in managing maxillofacial traumas.

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A new modification by hyoid suspension improves swallowing function and risk of aspiration in postglossectomy tongue reconstruction patients.

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Introduction: One question has led us to conduct this study: “Can we increase skin flap viability?” We found many published articles on flap viability in every journal about reconstructive surgery. However, we did not encounter any study on human subjects. The aim of this study is to evaluate the articles that have been published on flap viability in the last 10 years, to find potential agents or methods that can be used for flaps performed on humans. Materials and Methods: English articles published between 2008 and 2017 in the PubMed database were evaluated. The search terms used for this review included “flap viability” and “flap survival.” Details about the test subjects, sample sizes, and interventions and the effects on flap viability were recorded for each study. Results: A total of 995 articles were evaluated according to the inclusion and exclusion criteria; 231 studies were then included in the study and 764 were excluded from the study. No previous study on human subjects was encountered. An increase of flap viability was detected in 209 studies (90.5%), and a decrease was detected in 16 studies (6.9%). Six studies reported no effect on flap viability (2.6%). Conclusion: Although it is inevitable that animal experiments will be undertaken before human experiments, when researchers are planning animal experiments, they should consider how well the methods used can be adapted for human beings. We recommend planning human clinical trials with physical methods such as extracorporeal shockwave therapy, laser therapies, and the chemical agent botulinum toxin A. Physical methods are locally effective methods, and their side effects are well known.

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Background: The TRAM flap has proven to be the autogenous tissue of choice for breast reconstruction. The progressive improvement of the aesthetic results in long-term follow-up of patients with well-executed TRAM flap breast reconstructions is observed to be highly satisfactory for both patients and the surgeon. Aims and Objectives: In this article, I aimed to present long term results of cases with pedicles TRAM flap reconstruction. Material and Methods: Between January 1999 and July 2001 period, 22 pedicled TRAM flap breast reconstructions were performed to 21 patients with breast carcinoma. The mean age of the patients was 42 (28-53) years. In this study, the contralateral rectus abdominis muscle was preferred as a pedicle in patients who had received adjuvant radiotherapy- (10 patients) and vertical or oblique flap inset was applied in most of them- (9 patients). In patients without adjuvant radiotherapy but with infraclavicular tissue losses, or with small opposite breast, again vertical or oblique flap inset was preferred- (4 patients). In all patients with vertical or oblique flap inset, the contralateral rectus abdominis muscle was used as a pedicle- (13 patients). In patients with full and attractive opposite breast, horizontal flap inset was preferred- (7 patients). In patients with horizontal flap inset, ipsilateral rectus abdominis muscle was used as a pedicle unless the patient had received adjuvant radiotherapy- (6 patients); contralateral rectus abdominis muscle was used as a pedicle if the patient had received adjuvant radiotherapy- (1 patient). Results: The follow-up period is 18-20 years for this series. During the early postoperative days, highly satisfactory results have been obtained. Eighteen of the cases were totally satisfied. Three of the cases had dissatisfactions mostly related to complications. During 18 to 20 years period follow-up of 12 patients has been performed regularly. Oncologic tracing, the degree of maintenance of the breast shape of the flap and symmetry, softness, and naturality of the reconstructed breast, maturational changes in surgical scars, abdominal strength, sensational changes over the flap skin, color and shape changes over nipple areola complex have all been periodically observed. Conclusion: TRAM flap is still the gold standard among all breast reconstruction modalities. Progressive improvement in all measures such as breast, symmetry, softness, and naturality of the reconstructed breast, maturational changes in surgical scars, abdominal strength, sensational changes over the flap skin are very satisfactory for patients and the surgeon.

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