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   2021| June  | Volume 29 | Issue 5  
    Online since March 17, 2021

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A review of current developments in three-dimensional scaffolds for medical applications
Ufkay Karabay, Resit Bugra Husemoglu, Mehtap Yuksel Egrilmez, Hasan Havitcioglu
June 2021, 29(5):38-43
Humans require treatment due to the loss of tissues after trauma and diseases. Tissue engineering is a growing field of engineering and medical science to restore, maintain, or improve function of damaged or diseased tissues. The use of three-dimension (3D) scaffolds in particular offers a potential option for patients with tissue deficiency. Polylactic acid (PLA), poly-caprolactone (PCL), polyether-ether-ketone (PEEK), and thermoplastic polyurethane (TPU) are biomaterials that are commonly used in tissue engineering. Their applications of pure material or composite and supportive materials are of great importance for clinical practices. This review provides information on biomaterials and major areas of application and discusses their advantages and disadvantages against each other. The literature search from the database PubMed was done for the key words 3D PLA, PCL, PEEK, and TPU separately and 2029 articles were identified. These articles were limited according to clinical, in vivo and observational studies published in English and 140 articles were evaluated for this review. We selected the main articles according to the current data of 3D scaffolds and identical articles were removed. Fifty articles were included in the review. Many studies have reported the advantages of 3D scaffolds with composite or supplement materials over pure materials in the medical treatment. The advances in the development of new 3D scaffolds hold great promise for the prospective applications in the medical treatment.
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Surgical options in chronic extensor tendon subluxation: A case report and a literature review
Gokce Yildiran, Cemil Isik, Osman Akdag, Zekeriya Tosun
June 2021, 29(5):61-63
Ulnar subluxation of the extensor tendons at the metacarpophalangeal joint level after damage to the sagittal bands is a rare problem in nonrheumatoid patients. It is aimed to discuss the treatment options for the extensor tendon subluxation and present a rare chronic case. A 25-year-old male patient presented with the complaint of stucking and snapping feeling in the middle finger when moving it after falling as a child. Type 2 sagittal band injury was detected in which the extensor tendon was subluxated to the ulnar side, and the sagittal band was strengthened with a junctura tendinum flap harvested from the adjacent finger. The patient returned to his daily life, and no recurrence was detected. Extensor tendon subluxation is the instability that occurs in the tendon as a result of damage to the sagittal bands. Many techniques have been described since the ideal technique is not available yet. Techniques that provide realignment by centralizing the extensor tendon are successful ones that can be preferred in chronic sagittal band ruptures and in professional athletes in whom primary repair is not possible.
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Complicated patients with cleft lip and palate: Our experience with multidisciplinary approach
Anil Demiroz, Ugur Celik, Can Ege Yalcin, Yagmur Aydin
June 2021, 29(5):14-16
Background: Cleft lip and palate is one of the most commonly seen congenital deformities. The aim of treatment should be providing normal speech, normal nutrition, normal appearance, and adaptation of the child in society. Thus, the importance of multidisciplinary approach in this patient group is high. In this study, we aim to present the patient results obtained from cleft lip and palate meeting records, with the attendance of plastic surgeon, ear, nose, throat surgeon, orthodontist, speech therapist, pedodontist, nutrition nurse and pediatrician, and genetics specialist when needed. Materials and Methods: Patient records of cleft lip and palate meeting held between September 1998 and September 2018 were evaluated retrospectively. The patients regarded as complex cases were examined in these meetings. Results: Seven hundred and five patients were regarded as complex cases to be examined at the cleft lip and palate meetings in this 20-year period. One hundred and five of these patients (15%) had the history of being inbred. Ninety-eight patients (14%) had additional anomaly of other systems. Thirty-six patients (5%) suffered from the cleft of lip and primary palate only. Cleft palate patient numbers for Veau Class 1, 2, 3, and 4 was 12 (2%), 99 (14%), 297 (42%), and 246 (35%), respectively. Conclusions: Creating multidisciplinary teams consisted of specialists from various fields is an accepted method for handling of this patient group. These multidisciplinary teams not only provide the patients to have care by professionals from different specialties at once but also have the benefits of data unification.
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Augmentation of the calf region with autologous fat and platelet-rich plasma-enhanced fat transplants: A comparative study
Ufuk Bilkay, Ahmet Bicer, Zeyyat Cuneyt Ozek, Tahir Gurler
June 2021, 29(5):21-27
Background: Contour and volume deficiencies in the calf region, either unilateral or bilateral, may raise an esthetic concern in affected individuals. There are numerous methods described for volume augmentation or contour reshaping in this region including implant placement, autogenous tissue transfer, liposuction, and/or fat injections. The authors present their series of patients to whom they performed fat injections with or without platelet-rich plasma (PRP) enrichment for addressing this problem. Methods: Fifty-two patients who had undergone calf lipostructuring procedure(s) in our clinic were included in this retrospective study. The procedure was repeated with a fixed value of fat volume per leg until a satisfactory limit for both the patient and the senior author could be achieved. Regarding the analysis of outcome, the number of sessions needed to be repeated was recorded for each patient. Results: 125 cc of fat was injected per session per leg. Ten patients were treated with PRP enriched fat transplants while 42 were treated with fat only. The mean number of sessions was 2.76 (min. 2, max. 6). For the group treated with PRP-enriched fat grafts a mean 2.00 number of sessions had to be carried out while the mean was 2.95 for the patients in the fat-only group. The mean number of sessions to achieve our goal was significantly lower in the PRP-enriched fat injected group (P < 0.001). Conclusion: Addition of PRP significantly reduces the need of repeated operations to achieve the best possible outcome in lipostructuring around the calf region. Level of Evidence: Retrospective comparative study, level III.
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To study the effect of activated platelet-rich plasma in cases of androgenetic alopecia
Vijay Kumar, Navneet Sharma, Brijesh Mishra, Divya Upadhyaya, Arun Kumar Singh
June 2021, 29(5):28-32
Context: Growth factors released from platelets act on stem cells in the bulge region of follicles and thus stimulate the development of new hair follicles. Aims: Primary aim of the study was to assess the efficacy and safety of activated platelet rich plasma in AGA. Settings and Design: Prospective double arm non-randomized pre-post study. Material and Methods: Activated Platelet-rich plasma was injected in either anterior half of alopecia scalp in first 20 patients and posterior half in next 20 patients (Group I) and the other half was injected with placebo (Group II). Each patient received a total of 5 session of aPRP, 15 days apart. Statistical analysis used: Quantitative variables were compared using student T test and Mann-Whitney Test between two groups. A p value of < 0.05 was considered statistically significant. Results: 40 male patients with a clinical diagnosis of AGA (stage II to VI) were recruited but only 35 patients completed the whole study. At 1 month and 3 months follow-up, Group I showed statistically significant increase in hair count, hair density and anagen/telogen ratio as compared to Group II. Conclusion: aPRP is a safe and good alternative to medical treatment. It seems to have a stabilizing effect on hair fall and may be considered as a measure to prevent progression of alopecia in early stages.
  2,029 218 -
Predicting mastectomy skin flap necrosis in immediate breast reconstruction
Zeynep Akdeniz Dogan, Mustafa Onal, Melek Cavus Ozkan, Umit Ugurlu, Bulent Sacak
June 2021, 29(5):9-13
Background: As evidence emerged supporting the oncological safety of nipple-sparing mastectomy (NSM), immediate reconstruction following these procedures has also gained popularity. The aim of this study was to identify surgical and patient characteristics that may be associated with skin and/or NAC necrosis following NSM and immediate reconstruction. Patients and Methods: Medical records of patients who underwent NSM with immediate breast reconstruction from January 2013 to September 2020 were retrospectively reviewed. Patient and surgical characteristics were collected. The primary outcome measure was mastectomy skin flap necrosis (MSFN). Results: MSFN was observed in 68 out of 243 (28%) breasts. On univariate analysis, reconstruction method and body mass index (BMI) (odds ratio: 1.09, 95% confidence interval: 1.00–1.18, P = 0.04) were found to be significant risk factors. On multivariate analysis, neither BMI (P = 0.30) nor reconstruction methods (implants (P = 0.16) or tissue expander (P = 0.06) showed significant association with skin flap necrosis. However, BMI was found to be significantly higher in the autologous group (P < 0.0001). The best subset selection method also confirmed the reconstruction method as the single variable related to outcome. Conclusion: Even though our results showed autologous reconstruction to have a higher risk for necrotic complications, it should be kept in mind that this group of patients can be managed in the outpatient clinic with debridement, wound care, and – if necessary – skin grafting. However, full-thickness necrosis in an implant patient will require an implant exchange and possibly a local skin/muscle flap for coverage.
  2,021 205 -
A novel technique for trochanteric region soft-tissue reconstruction: coxal region perforator flaps
Soysal Bas, Mustafa Durgun
June 2021, 29(5):33-37
Aims: Due to the complex anatomical structure of the trochanteric region, the options for reconstruction are relatively limited. This study aims to present a unique reconstruction of trochanter defects using a coxal region perforator flap and geometric planning to standardize the flaps. Subjects and Methods: Twelve patients with trochanteric defects that had been repaired with coxal region perforator flap following tumor excision between June 2016 and January 2019 were included in this study. The patients were aged between 20 and 68 years. Patients were evaluated with regard to age, gender, etiology, defect side and size, flap size, number of perforators, and complications. Results: Two patients were operated on for squamous cell carcinoma, one for Marjolin's ulcer, two for malignant melanoma, two for malignant fibrous histiocytoma, and five for dermatofibrosarcoma. Defect sizes ranged between 8 cm × 7 cm and 12 × 10 cm. The smallest flap size was 13 cm × 7 cm and the largest flap size was 21 cm × 10 cm. Nine flaps were raised from the single perforator, and three flaps were raised from two perforators. Venous congestion was seen in one patient postoperatively. There was no flap loss, infection, hematoma, suture detachment, and limitation of hip and knee movements in the patients. Conclusions: The pedicled perforator flaps are elevated over the major perforators located close to the defect in many parts of the body. Thus, low surgical morbidity is achieved, and surgery time is decreased. Furthermore, as in this study, preserving the muscles and preventing the functional deficits in the movement hip joint the body's major joint of the body, reveal the importance of using coxal region perforator flaps for reconstruction in ambulatory patients.
  1,941 204 -
The effect of adipose stromal vascular fraction on the viability of transverse rectus abdominis myocutaneous flap after abdominoplasty: An experimental study
Erhan Coskun, Burak Ozkan, Aysen Terzi, Eda Ozturan ozer, Cagri Ahmet Uysal, Huseyin Borman, Nilgun Markal Ertas
June 2021, 29(5):1-8
Introduction: A prior abdominoplasty is considered as an absolute contraindication to transverse rectus abdominis musculocutaneous (TRAM) flap surgery. The aim of this study is to investigate the effect of nonexpanded adipose stromal vascular fraction (ASVF) on the viability of TRAM flap after abdominoplasty. Materials and Methods: Thirty-five male Sprague Dawley rats were divided into five groups. Reverse abdominoplasty model was used in all groups except Group 1. TRAM flap was performed 2 weeks after abdominoplasty in Groups 2 and 4 and 4 weeks after in Groups 3 and 5. ASVF cells were injected during abdominoplasty in Groups 4 and 5. The viable flap area (VFA) percentage and newly formed perforators were assessed. Capillary density and fibrosis gradient and plasma vascular endothelial growth factor (VEGF) levels were measured. Results: The mean VFA to total flap area was measured as 82.90% ± 7.59%, 3.31% ± 3.29%, 9.40% ± 6.18%, 31.92% ± 9.29%, and 64.98% ± 10.95% in Group 1, Group 2, Group 3, Group 4, and Group 5, respectively (P < 0.05). The number of newly formed musculocutaneous perforating arteries was 0.29 ± 0.49, 1.14 ± 0.69, and 2 ± 0.82 for Groups 3, 4, and 5, respectively (P < 0.05). The mean capillary density was 6.86 ± 0.50, 0.67 ± 0.13, 2.79 ± 0.53, 3.71 ± 0.47, and 7.01 ± 0.70 in Groups 1, 2, 3, 4, and 5, respectively (P < 0.05). There was a statistically significant increase between the baseline VEGF values and the second VEGF values in Groups 4 and 5. Conclusions: The study showed that local injection of ASVF increases the viability of TRAM flap after abdominoplasty.
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Sphenoidal process of septal cartilage: Useful autologous graft option in revision rhinoplasty
Oguzhan Demirel, Mustafa Serdar Atesci
June 2021, 29(5):17-20
Background: One of the main difficulties of revision rhinoplasty is the lack of sufficient septal cartilage. To overcome this problem, additional cartilage sources such as costal or conchal cartilages are widely used among surgeons. However, these methods can cause some complications. The sphenoidal process of septal cartilage (SPSC) is a unique part of septal cartilage located between the vomer bone and the perpendicular plate of the ethmoid bone and generally untouched during the surgery. As an autologous graft option, the SPSC may be an important cartilage source for revision rhinoplasty cases, especially in patients requiring minor surgical intervention. Methods: Between February 2019 and February 2020, a total of 50 patients who underwent paranasal computed tomography were enrolled in this retrospective study. The length, height, and surface area of the SPSC and surface area of total septal cartilage were calculated. Results: The mean total septal area was 886.2 mm2, ranging from 554.7 mm2 to 1277.5 mm2. The mean total SPSC area was 67.39 mm2. The mean length of SPSC was 12.8 mm in all populations. The highest sphenoidal process length measurement was 27.32 mm, and the lowest was 4.82. Mean sphenoidal process height values were similar in female and male groups (4.99 mm and 5.2 mm, respectively). Conclusion: The sphenoid process of septal cartilage may be an important autologous cartilage option for revision surgeries in terms of sufficient length and height dimensions.
  1,902 199 -
Double keystone flap for large lower thigh defect
Amrita More, Dharini Dharini, Anoop Sivakumar
June 2021, 29(5):67-71
Large lower thigh defects are a reconstructive challenge. Keystone design perforator island flap in the lower thigh is not routinely performed as the skin here is less extensible. We present a case of a large anterolateral lower thigh defect wherein we used double keystone flaps from the remaining circumference of the thigh and grafted the donor site in the posterior thigh. Circumferential incision/scarring in the limbs risk damage of superficial lymphatico-venous circulation and distal edema. However, our case demonstrates an uneventful recovery and excellent aesthetic and functional outcome.
  1,892 181 -
Problematic patient
Ismet Kirpinar, M Suhan Ayhan, Ethem Guneren
June 2021, 29(5):44-52
The group of patients defined as “problematic patient” in aesthetic plastic surgical practice has distinctive features. The “problematic patient” is the patient who blocks the establishment of a therapeutic relationship with him/her. In other words, the patient who does not adapt to the patient role that the health-care professional expects, has different values, beliefs, or personal characteristics than he/she expects to see, and sometimes causes the professional to even suspect himself/herself. They are not good candidates for esthetic surgery, and they should definitely not be operated, so to speak, these patients should be removed from the game by removing a red card, and somehow be disqualified from the process.
  1,770 184 -
Arthroscopic removal of synovial chondromatosis of the first carpometacarpal joint
Gokce Yildiran, Zekeriya Tosun
June 2021, 29(5):53-55
Synovial chondromatosis or loose body is frequently encountered in the knee, elbow, and shoulder joints. However, hand is a rare localization. It is aimed to present the arthroscopic excision of the loose body inside the first carpometacarpal (CMC) joint. A 47-year-old female patient presented with pain in the left thumb root. The grind test was positive in the patient; however, there were no signs of arthritis in the first CMC joint. Tomography revealed the loose bodies inside the joint. Under traction, CMC joint was palpated, two portals were opened, dry and wet arthroscopy was performed, and loose bodies were extracted. Synovial chondromatosis is a disorder that can be solved arthroscopically and should be kept in mind in hand and wrist pain, which reminds osteoarthritis of the hand and wrist where there are no signs of osteoarthritis in the physical examination and direct radiographs.
  1,750 165 -
Low-grade intraductal carcinoma of the parotid gland: Is it low-grade or locally aggressive?
Mehmet Gurler, Muhammed Besir Ozturk, Bekir Atik, Elif Seda Keskin
June 2021, 29(5):72-74
Low-grade salivary ductal carcinoma is a salivary gland tumor with clinically indolent behavior, characterized by intraductal growth. From 1996 to 2019, 54 case reports of Low-Grade Intraductal Carcinoma (LGIDC) were published in the literature. In the present article, we introduce a patient in our clinic who underwent surgery due to a diagnosis of LGIDC, about whom we make new clinical comments. A 75-year-old male patient presented to our clinic with a complaint of a mass in the right parotid area. After multiple biopsies, magnetic resonance imaging (MRI), and operations, the patient health is fine and patient's follow-up continues, now in the postoperative 1st year, and there is no relapse sign on physical examination and MRI. After all, according to our clinical findings and observations, we thought that this tumor could possibly be considered a locally aggressive tumor that does not metastasize, similar to a basal cell carcinoma.
  1,696 152 -
Managing one of the rarest: Recurrent parachordoma
Galip Gencay Ustun, Ferhat Kargalioglu, Muzaffer Caydere, Ugur Kocer
June 2021, 29(5):56-60
Parachordoma is one of the rarest tumors identified, with around fifty cases reported to date. It is reported to have a benign behavior, yet metastatic and fatal cases have been reported. A 63-year-old female patient presented with a subcutaneous mass in the right deltoideal region. After two excisional biopsies with tumor-free surgical margins and 33 cycles of radiotherapy, the case presented with a second recurrence. Due to malignant features in the second histopathological examination, she was treated with excision of the deltoid muscle, and the defect was reconstructed with latissimus dorsi myocutaneous flap. There is no standardized treatment protocol for parachordoma. Yet, increased mitotic activity and atypical mitotic figures arise suspicion for recurrent and malignant behavior. In the presence of these features in histopathological examination, tumor should be considered as low-grade sarcoma and be treated accordingly.
  1,678 169 -
An unusual case of breast cholesterol granuloma
Emin Kapi, Nihal Kilinc, Yavuz Yildiz, Feride Fatma Gorgulu
June 2021, 29(5):64-66
Cholesterol granuloma (CG) is a rare and benign inflammatory tissue reaction caused by the accumulation of lipid and cholesterol crystals in the tissue, resulting from such incidents as localized trauma and hemorrhage. It has been suggested that the reaction starts with the lysis of blood cells in the tissue and the cellular components, leading to a foreign body reaction in the tissue. As a result of this process, a nodular mass forms in the tissue, and the pressure of this mass on the surrounding tissues can cause pain and the loss of various functions. CG commonly occurs in such anatomic areas as the mastoid bone, petrous apex, tympanic cavity and sinus maxillaris, and more rarely in the breast. CGs of the breast mimic breast cancer both clinically and radiologically, which makes such masses important. Incisional or excisional biopsy is recommended for radiographically suspected cases. The presence of multinucleated giant cells, cholesterol clefts, foamy macrophages, and hemosiderin in surrounding damaged cells and tissues in the specimen, as histopathological findings, can steer diagnosis. It should be noted that CGs may occur in atypical localizations besides their usual anatomic localizations, and the case in the present study is particularly interesting due to its rare atypical presentation.
  1,644 136 -
Augmented reality-assisted planning of midpalmar space infection of the hand
Burak Ozkan, Kadri Akinci, Suleyman Savran, Ahmet Cagri Uysal, Nilgun Markal Ertas
June 2021, 29(5):75-76
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