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   2022| October-December  | Volume 30 | Issue 4  
    Online since September 9, 2022

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Comorbidity analysis of turkish patients operated for dupuytren's contracture in a university hospital
Aydan Ayse Kose, Bahadir Demirkan, Adnan Sevencan, Büsra Tokmak, Can Ekinci
October-December 2022, 30(4):102-107
Background: Dupuytren's contracture (DC) is characterized by progressive fibroplasia of the palmar fascia resulting in significant impairment of hand function. Genetic factors and environmental factors are suspected in the etiology. Although the disease has a benign character, its formation and course follow a tumoral pattern. Several studies show that cancer-related mortality is higher in people with DC. Besides, various risk factors such as diabetes, smoking, and heavy handwork as triggers for DC led us to analyze the epidemiologic characteristics of our patients and search for the concomitance of chronic diseases and cancer. Methods: Seventy patients were operated for DC between 2009 and 2019. Information on occupation, dominant hand, diseased hand, family history, additional comorbidities, cancer, smoking, and drinking habits was sought. Results: A significant number of the patients were manual laborers. Most of the patients were active smokers at the time of the surgery. Dominant hand was predominantly right hand and the disease was mostly observed in the right hand but it was not significant (P > 0.05). Diabetes and cardiovascular disease (CVD) were the most common accompanying diseases. After surgery for DC, seven patients were diagnosed with cancer. Conclusions: This is the first Turkish study to show the relationship between DC and several comorbidities. Male gender and medium-heavy handwork were associated with DC. Although it was not statistically significant, the dominant hand was more affected by DC. Diabetes, CVD, smoking, and alcohol were significant comorbidities in our patients. The association between DC and cancer was remarkable.
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Freestyle anterolateral thigh flap and perforator variations
Ersin Gur
October-December 2022, 30(4):91-95
Introduction: Anterolateral thigh (ALT) flap has become an increasingly popular reconstructive option, especially for head-and-neck and extremity defects. In addition to the many advantages of the ALT flap, there are also some disadvantages such as individual variations in the number and location of cutaneous perforators. Doppler ultrasonography (USG) is one of the most frequently used methods to overcome variations in perforator anatomy. However, the Doppler device may obtain false results so some clinics use the “freestyle” harvesting technique for ALT flap. The aim of the study is to examine experience with freestyle ALT flap harvesting and to evaluate the perforator variations. Materials and Methods: Between 2018 and 2021, 59 ALT flaps were harvested by the same microsurgical team for head-and-neck reconstructions. Of 59 patients, 23 were female and 36 were male. Cases were performed without using preoperative or peroperative imaging techniques. Results: In 2 (3%) of 59 patients, different septocutaneous flap options were used because suitable perforators could not be found in both thigh regions. For 57 ALT flaps, the rate of descending branch of lateral circumflex femoral artery (LCFA) perforators was 73%, transverse/ascending branch was 17%, aberrant perforators other than classical branches of LCFA was 7%, and the perforator from medial circumflex femoral artery was 1%. Partial necrosis due to perfusion problem was experienced in one flap and total necrosis was in two flaps. Conclusion: The advantages of the freestyle technique, such as allowing the evaluation of all perforators and designing flaps according to the appropriate perforator, provide great flexibility and convenience to the surgeon. With this, surgical problems caused by inaccurate results obtained by devices such as Doppler USG are excluded.
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The anterolateral thigh perforator flap is a versatile resource for reconstructive surgery
Sergii V Sliesarenko, Pavlo Olexii Badiul, Oleh I Rudenko
October-December 2022, 30(4):96-101
The Aim of Work: The aim of this study was to increase the efficiency of reconstruction of extensive soft-tissue defects of various localizations by differentiated use of the anterolateral thigh (ALT) perforator flap. Methods: We have retrospectively reviewed 39 patients, who had undergone soft-tissue reconstruction using pedicled and free transposition of ALT flaps. Results: In this series, all cases ended with a complete recovery of patients with adequate restoration of integumentary tissues. In the postoperative course, we encountered complications during free flap transplantation in nine cases (23%), two of which were associated with arterial insufficiency (5.1%) and seven – with venous thrombosis (17.9%). Most of these complications were not critical, and the problem was resolved by conservative treatment; in two cases, partial tissue death required a secondary suture. In three cases (7.7%), the complications were critical and led to the loss of the flap. Conclusions: The unprecedented versatility and the minimal trauma of the donor area make the ALT perforator flap one of the most demanded skin flaps. Despite the variable vascular anatomy, the ALT flap is the most adaptable plastic resource for extensive soft-tissue coverage of abdominal, perineal, and hip joints as a transposition flap on the vascular leg and for closing distant defects in any area of the body using it as a free microsurgical transplant. Other advantages include its variability in size and the ability to harvest multiple tissue components in different combinations depending on the desired outcome.
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Forehead reduction and hairline lowering surgery: Aesthetic implications
Ali Riza Oreroglu
October-December 2022, 30(4):108-114
Background: Forehead reduction and hairline lowering is an underestimated yet important procedure in facial beautification. Proportions of the forehead to the midface and lower face can be corrected with this surgery as well as addressing changes in hairline positioning. Objectives: The aim of this paper was to describe in detail the author's approach to hairline lowering and forehead reduction procedures with emphasis on implications to increase the aesthetic outcome. Methods: The procedure was performed under general anesthesia in a single-stage approach with the following algorithm: pretrichial incision, subgaleal dissection and preparation of a parieto-occipital scalp flap, multiple horizontal galeotomies, scalp advancement and fixation, and finally forehead skin excision and closure. Results: Forehead reduction and hairline lowering surgery was performed on 17 female patients aged between 19 and 42. Forehead length reduction was measured between 1.7 and 4.2 cm. The patients were followed up for 6 months to 3 years. Conclusions: Forehead reduction hairline lowering is an underestimated yet aesthetically important procedure for correcting facial harmony, beautification, and rejuvenative purposes. Following certain planning and technical details can help the surgeon apply the procedure properly, minimizing the risks for major and minor complication and achieving aesthetically successful results.
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Soft-Tissue sarcomas: Diagnosis and treatment from the plastic reconstructive surgeon perspective
Rana Kapukaya
October-December 2022, 30(4):115-120
Advances in multimodal therapy and limb-salvage surgery (LSS) have led to improvements in the quality of life of sarcoma patients. Despite all the advances, controversy continues in the diagnosis and treatment of soft-tissue sarcomas (STSs). Significant structural and functional losses occur in the extremity due to both wide resections and radiotherapy combined with surgery. This situation necessitates the restructuring of extremity functions. The opinion of plastic surgery must be obtained, when planning LSS, before excision of high-volume tumors, to decide postresectional reconstruction and to manage the postsurgical complications. The need for plastic surgery in the multidisciplinary approach to STSs is increasing. The information presented in this article has been compiled from the articles obtained by searching the titles of “soft tissue sarcomas, reconstruction, diagnosis, current treatment” in Google Scholar and PubMed databases, international books written in the field, and the experiences of the authors.
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Polymethylmethacrylate bone cement utilization for hemostasis in an intraosseous arteriovenous malformation
Mehmet Dadaci, Munur Selcuk Kendir, Zikrullah Baycar, Bilsev Ince
October-December 2022, 30(4):121-124
A 15-year-old girl applied to the outpatient clinic with an arteriovenous malformation, measuring approximately 20 cm × 10 cm, on the anterior aspect of the right knee. She was admitted to operation because of the failure of the previous embolization attempts. Intraoperatively, there was uncontrolled bleeding from the nidus which is located at the medulla of the tibia. After the failure of initial efforts, hemostasis could be achieved using polymethylmethacrylate cement. Arteriovenous malformations (AVMs) may cause life-threatening bleeding. In uncontrolled intraosseous bleeding, bone cement could be used for hemostasis. In this study, we present an AVM case and our experience about its management.
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Is iatrogenic sciatic nerve neuropathy following thigh lift surgery uncommon and preventable?
Cagla Cicek
October-December 2022, 30(4):125-127
Obesity is a serious public health problem, and bariatric surgery that is applied for obesity-related morbidities has led to a decrease in obesity-related morbidities and can also improve the quality of life of patients. Plastic, reconstructive, and esthetic surgery plays a major role in the management of skin laxity after bariatric surgery and is therefore generally considered a necessity. However, body contouring surgery can also be associated with some devastating complications. We present a case who developed sciatic nerve neuropathy after medial thigh lift surgery. Complete functional loss of the sciatic nerve was found by clinical and electroneurographic examination on the right side, and full nerve conductance recovery was obtained after 7 months in the patient. It is important to raise awareness about the fact that this significant complication, although rare, can occur even with such a benign and easy procedure and that it is readily reversible with prompt diagnosis and early treatment.
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Tongue schwannoma, an uncommon oral cavity mass: Experience from a case
Einstein Alfredo Viana-Tapia, Juan Felipe Coronado-Sarmiento, Osvaldo Camilo Barraza-Leones
October-December 2022, 30(4):128-130
Schwannomas are benign tumors arising from the Schwann cells, located in the peripheral nerve sheath. The incidence of tumor in the oral cavity is <1%, and the tongue is the most prevalent place in that area. A 32-year-old Hispanic female was sent from the otolaryngology department with a diagnosis of an oral mucocele in the oral cavity floor, after 8 months complaining of dysphonia and dysphagia. Physical examination reveals a submucosal mass in the anterior and ventral portion of the tongue. After characterization with magnetic resonance and biopsy guided by tomography, she underwent surgical management, with no complications. Tongue schwannomas are often misdiagnosed based on their very low incidence. A proper approach including a good physical examination, imaging and histological characterization of the lesion, and proper surgical management of this entity, will lead to cure this condition, with a low relapse rate.
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The first dorsal metatarsal artery adipofascial perforator flap: A useful salvage method for dorsal defects of distal foot
Oguz Eker, Ahmet Dogramaci, Mustafa Sutcu, Zekeriya Tosun
October-December 2022, 30(4):131-132
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High bifurcation of superficial brachial artery
Sudeshna Acharya, Sourabh Shankar Chakraborty, Ranjit Kumar Sahu, Suresh Kotu
October-December 2022, 30(4):133-134
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