Two cases of congenital midline upper lip sinuses associated with miscellaneous deformities.
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Alveolar Process↗
Biomedical subjects
Dogan Tuncali
Publications and source records attributed to Dogan Tuncali.
Reconstruction of small to medium defects in the soft tissues of the nose with nasalis musculocutaneous V-Y advancement flaps.
Defects in the soft tissues of the nose are usually reconstructed with skin grafts or frontal flaps. However, skin grafts may cause scar tissue and changes in colour. Frontal flaps, however, may be thicker than normal skin and may give unsatisfactory results. Nasalis musculocutaneous V-Y advancement flaps avoid these disadvantages. We suggest an algorithmic approach for the use of these flaps in the reconstruction of small to medium defects in the soft tissues of various regions of the nose. The pedicles of these flaps are the dorsal and lateral nasal arteries. This approach provides a simple, safe, and reliable reconstruction for small and medium defects in the soft tissues of the nose.
Adult↗
The hatchet flap for reconstruction of fingertip amputations.
BACKGROUND: Emmett has described a single triangular flap that contains a partial skin bridge on one of its sides and called it the hatchet flap. It was successfully used for defects located on various body parts. The aim of this study was to present the authors' experience and results obtained with this flap in fingertip amputations. METHODS: Nine patients who have completed their 1-year follow-up period were included in the study. Two-point discrimination and stiffness were tested, and the patients were queried about the existence of cold intolerance, hypersensitivity, numbness, and pain in the early (3 months) and late (1 year) postoperative periods. RESULTS: The amputations were located on the thumb in three patients, index finger in one patient, middle finger in three patients, and ring finger in two patients. The average defect size was 2.1 x 1.5 cm. Partial wound dehiscence was observed in one patient. The flap has provided good protective padding and aesthetic contour for the fingers. All incisions healed with inconspicuous scars. Average two-point discrimination was 6.3 mm (range, 4 to 8 mm). Cold intolerance was observed in two (22.2 percent) and paresthesia in one patient (11.1 percent). Joint stiffness was not noted. Most patients could return to their normal routine in approximately 4 to 5 weeks. CONCLUSIONS: The hatchet flap is a good alternative for transverse and lateral oblique fingertip amputations and valuable for volar oblique amputations (defects <2 cm) with more extensive flap designs. The technique is simple and safe and provides good protective padding and acceptable tactile gnosis.
Adult↗
The thenar index: an objective assessment and classification of thenar atrophy based on static hand imprints and clinical implications.
BACKGROUND: The aims of this study were to test the effectiveness of the subjective clinical evaluation and to search for any possibility of constituting an objective assessment system for the diagnosis of thenar atrophy based on static hand imprints. METHODS: Static hand imprints were obtained from normal subjects (group A, n = 116) and carpal tunnel syndrome patients with thenar atrophy (group B, n = 26). Thenar index and the bilateral thenar index ratio were defined. Cutoff values were considered by analyses with receiver operating characteristic curves. RESULTS: No statistically significant difference could be demonstrated in thenar index values of dominant and nondominant hands between genders and age groups (p > 0.05). A statistically significant difference was observed between severity groups in group B (p < 0.05). There was a statistically significant difference between thenar index and bilateral thenar index ratio values of groups A and B (p < 0.05). Cutoff values were considered a thenar index of 31 and a bilateral thenar index ratio of 0.8, which revealed acceptable specificity (95.3 percent) and sensitivity (77.4 percent). A new quantitative classification for thenar atrophy severity is proposed. CONCLUSIONS: Understanding the true onset and natural progression of thenar atrophy can only be anticipated with the aid of an objective assessment system. Currently, this method should be regarded as a system for patient records and comparison for presurgical and postsurgical data. The authors believe that the thenar index classification has some merit for future use. It seems that additional objective and scientific evaluation systems and novel approaches are still needed to demystify the true nature of carpal tunnel syndrome.
Adult↗
The propeller flap for postburn elbow contractures.
Flexion contracture of the elbow is a common sequela of burn injury. Numerous methods have been suggested for release, including grafting, Z-plasty, Y-V flaps, local or distant fasciocutaneous flaps, muscle or myocutaneous flaps, free flaps, tissue expanders and non-surgical orthotics. In this article the authors present their experience with the propeller flap method in seven cases of elbow flexion contracture. Sufficient extension and an acceptable aesthetic outcome were obtained. Other benefits include easy design and rapid flap elevation that permits a single stage correction of the deformity without further sacrificing an artery or muscle. We think that the main disadvantage of the propeller flap is using the same skin that has suffered from the burn insult which has a poorer cosmetic result. Other than this and excluding deep burn injuries, we believe that the propeller flap is a useful alternative for elbow contracture release.
Adolescent↗
Transverse carpal muscle in association with carpal tunnel syndrome: report of three cases.
Anomalous muscles of the upper extremity are common, however, symptomatic anomalies causing CTS are rare. Three cases of CTS that are believed to be caused by an anomalous muscle located palmar to the transverse carpal ligament with transversely oriented muscle bundles is presented. Despite the arguments in literature, this is certainly an anomalous muscle that can be encountered during carpal tunnel release and be problematic to manipulate when minimally invasive approaches are chosen.
Adult↗
Hemangioma of the lower lip associated with schistosomiasis: a case report.
Hemangiomas may occur in any region of the body, and is the most common tumour of the childhood age. The first case report of multiple Schistosoma mansoni larvae associated with hemangioma of the lower lip is presented. A 7-year-old boy presented with hemangioma of the lower lip. The tumour was subtotally excised under general anaesthesia for aesthetic reasons. The histopathologic diagnosis was multiple Schistosoma mansoni larvae associated with the hemangioma. Patient was treated with an antischistosomal drug.
Child↗
Multiple occurrences of different histologic types of the glomus tumor.
A patient with 3 glomus tumors that occurred at different locations and times is presented. Two of the 3 tumors were of the same histologic type. The third tumor was a different type. Although it is rare, a solitary type of glomus tumor on initial presentation may exhibit multiple occurrences in the same patient.
Adult↗
Is surgical hemostasis really necessary in open carpal tunnel release?
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Bandages↗
Good old Z-plasty for correction of finger angulations.
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Accidents, Occupational↗
Histologic characteristics of the human prepuce pertaining to its clinical behavior as a dual graft.
The aim of this study was to investigate the unique histologic structure of the normal human prepuce, paying particular attention to the resemblance and dissimilarities between the inner (ie, mucosa) and outer (ie, skin) layers. Histologic sections were stained using hematoxylin-eosin and Van Gieson stains. Transmission electron microscopy was used to evaluate the ultrastructure. Dense capillary networks can be observed in both the upper and lower dermal zones. The dermis lacks a dense collagenous zone. Melanocytes could not be observed in the mucosa. Elastin fibers and bundles were very abundant and dense. Early edema formation can be explained by the loose character of the dermal structure. Better graft "take" in mucosal grafts may be the result of the dense vascular dermal network. Mild hyperpigmentation can be explained by the limited number of melanocytes. However, this can also be observed in mucosal grafts, despite the absence of melanocytes. This may be solely the result of inflammatory hyperpigmentation, which can be seen in skin grafts. The abundance of elastin fibers in the prepuce may be the reason behind the superior wound contraction inhibition.
Humans↗
Periareolar-transareolar-perithelial incision for the surgical treatment of gynecomastia.
Gynecomastia is an abnormal enlargement of the breast tissue in men. It is the most common disorder of the male breast. Surgical sharp resection of the excess breast tissue is still the mainstay of treatment when medical treatment modalities are proved to be ineffective. The authors believe that areolar incisions give the best results, especially for grades I and IIA gynecomastia. The authors review the ever-increasing areolar incision techniques that have been previously recommended, propose a classification for these techniques, and introduce an alternative technique for areolar resection of the enlarged gland in gynecomastia. An inferior pole, periareolar-transareolar-perithelial (PTP) incision was designed and 15 patients were operated successfully using this technique. Twelve cases were bilateral and 3 were unilateral (27 breasts). A 65-mm access port can be obtained from a 30-mm-diameter areola. No color changes or slough was observed in any of the patients. Areolar access incisions can be classified into 4 main groups: circumareolar, periareolar, transareolar, and circumthelial, and their subgroups. Like every incision proposed, the PTP incision cannot be recommended for every grade of gynecomastia. It is best suited for grades I, IIA, and IIB gynecomastia. Its wide exposure and potential advantage for areolar reduction makes this incision a good alternative to other areolar approaches.
Gynecomastia↗
The "duck" modification of the tensor fascia lata flap.
Various common locations of pressure sores require specific considerations. The most commonly used flap for the treatment of trochanteric ulcers is the tensor fascia lata (TFL) flap. According to our experience with the original flap, excessive tension and eventual suture separation at the confluence of the donor site flaps and the TFL flap is the most common problem. The purpose of this article is to present a new design for the TFL flap for the coverage of trochanteric pressure sores. An anterior triangular extension is designed exactly at a point where the flaps that will cover the donor site unite after transposition. The desepithelialized proximal part of the flap is folded into the pouch and sutured. The duck flap was applied to 31 trochanteric pressure sores in 27 patients with no major complications. This modification has many advantages: (1) the flap is reliable and easily designed, (2) formation of dead space and cone-shaped dog-ear deformity due to rotation is prevented, (3) better esthetic results are achieved, (4) suture separation is prevented via a tension-free closure, (5) the desepithelialized part produces tight attachment of the flap to the recipient bed, (6) as no muscle tissue is included, the flap is more resistant to pressure.
Adult↗
The rate of upper-extremity deep-structure injuries through small penetrating lacerations.
Despite the abundance of epidemiologic studies concerning hand injuries, there is no study that emphasizes the significance of the initial laceration size. The aim of this study is to investigate the incidence of tendon, nerve, and artery injuries that may result from small, penetrating lacerations of the hand and forearm. A total of 226 patients with small lacerations were included in the study. Glass (68.7%) and knife (31.3%) lacerations were the only etiological factors. One hundred thirty-four patients (59.3%) had at least 1 deep-structure injury. One hundred twenty-four patients (92.5%) had at least 1 tendon, 25 patients (18.7%) had at least 1 nerve, and 20 patients (14.9%) had at least 1 artery injury. Extensor tendons were more commonly injured (61.3%). Combination injuries were found in 20 (14.9%) patients. The most-encountered combination was the injury of all 3 structures. Small laceration injuries of the upper extremity have the potential to conceal an underlying deep injury.
Adult↗
Upper eyelid full-thickness skin graft in facial reconstruction.
BACKGROUND: The potentially available upper eyelid skin, as an alternative donor site, deserves more attention in clinical use. OBJECTIVE: The objective of this study was to prospectively evaluate the clinical behavioral characteristics of upper eyelid full-thickness skin grafts in facial reconstruction. METHODS: Sixteen patients who concluded the 12-month follow-up period were included in the study. Graft dimensions were measured in place before the graft harvest. Defect sizes were measured following lesion excision and postgrafting. Graft sizes were measured postoperatively at 1, 3, 6, and 12 months. RESULTS: The largest and smallest grafts were 46 x 22 mm and 40 x 15 mm (average 43.1 x 19.3 mm) in size, respectively. The largest and smallest defect dimensions were 33 x 23 mm and 17 x 9 mm (average 22.6 x 15.6 mm), respectively. The average postgrafting size was 21.1 x 14.6 mm. Grafts and donor sites healed very well. Generally, an acceptable to good texture and color match was observed beyond 6 months. Wound bed contraction was not observed beyond the first month (p<.05). CONCLUSION: Special characteristics of hairless skin, good color and texture matching, and inconspicuous and hidden donor scar make the upper eyelid a good alternative donor site for small- to medium-sized facial skin defects. The main disadvantages that limit its clinical use are the age of the patient, a lack of adnexal structures, comparatively limited sun exposure, and possible insufficient thickness, especially when deep defects are of concern.
Aged↗
Effect of full-thickness skin graft initial dimension on secondary wound contraction: experimental study in rats.
BACKGROUND: The size of a full-thickness skin graft (FTSG) is typically determined using a pattern of the defect usually obtained following excision of a skin lesion. OBJECTIVE: The aim of this experimental study is to investigate the effects of various graft sizes on secondary wound contraction. METHODS: Four 2.5 x 2.5 cm defects were created on the backs of 20 rats. Defect A was left to heal by secondary intention. The graft obtained from defect B (exact size graft) was sutured to its original bed. The wound of defect C (large graft) was patterned, and this was used to obtain a generous graft from the abdomen. A presized 1.5 x 1.5 graft obtained from defect D (small graft) was sutured to its original wound. Graft areas on days 0, 3, 7, 10, 14, 18, and 21 were calculated and converted into a percentage of the original wound size. Analysis of variance was used for statistical comparison. Open wounds reached a final wound size of 5% at day 21. Exact-size grafts showed the least secondary contraction rate (74.19 +/- 4.30 %) (p < .05). CONCLUSION: A graft in the size of a planned excision preserves its original area better than grafts larger or smaller in size in the rodent model. The size of a FTSG is an important factor in preventing secondary wound contraction. However, it should be stressed that the results of this study cannot necessarily be extrapolated to real clinical scenarios without further detailed studies.
Animals↗
Squamous cell carcinoma of the lower lip: exact location match in siblings.
BACKGROUND: In recent years, genetic contribution to the development of skin cancers is under the magnifying glass of several authors and is now regarded as the main initial etiology in carcinogenesis. OBJECTIVE: Two siblings who had squamous cell carcinoma of the lower lip showing an exact location match are presented. PATIENTS: They did not share common environmental factors, and there was no history of tobacco and/or alcohol abuse. CONCLUSIONS: It would be scientifically deceptive to draw generous conclusions for the cases here, other than being a very interesting and unusual coincidence, because further evaluation could not be done to scientifically prove a possible genetic contribution.
Carcinoma, Squamous Cell↗
Animal bites.
OBJECTIVE: The aim of this study was to put forward a retrospective analysis of animal bites treated in our department. METHODS: A total of 1315 patients treated in the Department of Plastic Reconstructive and Aesthetic Surgery of Ankara Education and Research Hospital, Ankara, Turkey between January 2002 and March 2004 are included in the study. The fundamental treatment approaches were; copious saline irrigation, attentive debridement, appropriate antibiotic protocol, elevation and immobilization. RESULTS: Bites were produced by tamed (23.4%) and untamed animals (76.6%). The mostly encountered bites were from dogs (76.2%) followed by cats (21.7%). The injury sites were mostly in the lower (35.0%) and upper (33.0%) extremities. Overall infection rate was found to be 4% which were mainly due to cat bites. A very low infection rate (0.03%) was found in the group of patients who did not receive prophylaxis. CONCLUSION: Prophylactic antibiotics are recommended for severe injuries. Deep, dirty and defective injuries should be treated with delayed reconstruction. The majority of animal bite injuries in our country are consequence of untamed dogs and cats. The excessive lower extremity injuries can be attributed to this fact.
Adolescent↗