Adrenal incidentaloma as a cause of postoperative exaggerated ecchymosis.
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Biomedical subjects
Publications and source records attributed to R Yavuzer.
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Uniform patient photographs that create permanent records are essential for any visually oriented medical specialty. These images are valuable for any plastic surgeon's practice for various reasons; thus, standards and recommendations for clinical photography should be well-known. There are several articles published on this issue, but it is still not uncommon to be exposed to medical publications and presentations that fail to satisfy clinical photography standards. This stimulated an interest in reviewing the important factors that are essential to achieve consistent, comparable clinical photographs with 35-mm single-lens reflex photography.
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Congenital granular cell tumor, also known as congenital epulis, is a very rare lesion seen in newborns. The typical presentation is a solitary nodule occurring on the gingiva of the anterior alveolar ridge of either jaw. Multiple-site involvement is seen very seldom but has been noted on the same or different alveolar ridges. However, tongue involvement is exceptional, and there have been only three cases reported involving both the alveolus and the tongue. A female newborn with multiple congenital epulis on the mandibular alveolar ridge and tongue is presented, and her preferred treatment and histopathological diagnosis are discussed.
After nasal surgery, thinning of the nasal skin, bony irregularities, or adhesions of dorsal skin to underlying bone can all occur. These problems can be solved by using either alloplastic materials or various autogenous tissues. In this study, AlloDerm, a dermal replacement derived from cadaveric skin, has been used to cover the osseocartilaginous framework of the nose in an attempt to achieve a smooth contour and a natural feel in secondary rhinoplasties. Fifteen patients were treated and observed for a minimum of 24 months. Clinically palpable or visible bony irregularities were successfully covered, and adhesions of dorsal skin to nasal bones were diminished. Prolonged but not socially unacceptable dorsal nasal swelling, which resolved during the first 4 months, seemed to be the only problem related to its use. With this limited experience, AlloDerm was found to be useful in secondary nasal surgery to cover osseocartilaginous irregularities, to eliminate the adhesions between nasal bones and overlying skin, and to create a smooth nasal dorsum.
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Hydroxyapatite cement is a calcium phosphate preparation composed of tetracalcium phosphate and dicalcium phosphate anhydrous powders. When mixed with water it isothermically forms a paste which can easily be shaped intraoperatively. This mixture sets in approximately 15-20 min and converts into water insoluble, nonceramic, microporous hydroxyapatite in 4 h. This biomaterial was used to correct either congenital or traumatic craniofacial contour irregularities or deficiencies in 20 patients. On follow-up there was only one patient who required repeat surgery for further correction, there were no other complications. The good cosmetic results, the ease of operation, the pliability of the cement paste allowing precise moulding during application, the short operation time and the avoidance of a donor site makes hydroxyapatite cement an attractive material for treating craniofacial contour defects. Careful long term follow-up is necessary to establish its safety and reliability.
Autologous nerve grafting is the conventional technique for bridging nerve gaps, despite its various disadvantages. In this study, the authors investigated the effects of the turnover epineurial sheath tube (TEST) as an alternative to nerve grafting for the repair of nerve gaps, using a rat sciatic nerve model in four groups: Group 1 (n = 5): sham control; Group 2 (n = 10): segmental nerve resection + no repair; Group 3 (n = 10): segmental nerve resection + nerve grafting; Group 4 (n = 15): segmental nerve resection + TEST. Functional recovery was evaluated by walking-track analysis. The sciatic nerves and gastrocnemius muscles were harvested for histologic and quantitative histomorphometric evaluation at 12 weeks. Sciatic functional indices and histomorphometric analyses revealed statistically significant differences between the sham control and the three experimental groups (p < 0.001). The difference between the TEST group and the nerve graft group was not significant; however functional recovery was significantly improved in these two groups, compared to the non-repaired group (p < 0.05). The authors suggest that the TEST provides a suitable conduit between two stumps, eliminates donor-site morbidity, reduces the number of suture sites, fibrosis, and operating time, and might be an alternative to nerve grafting for nerve gap repair.
Development of urethral fistulas is one of the most common late complications of hypospadias surgery. A total of 161 male patients who had 186 urethrocutaneous fistulas were first classified according to the fistula classification of Horton and colleagues and then treated with three types of procedures: simple closure, local rotation flaps, or tube graft reconstruction. With initial surgical intervention, 156 of 186 fistulas were treated successfully. The remaining 30 fistulas (16.1%) recurred during the follow-up period. In the recurrent cases, immediate closure was not preferred, and an average of 6 months was waited before considering any additional surgical attempt. Distal cases had a higher failure rate, and the simple closure technique failed to show a success rate as high as local flap or tube graft repair. The high recurrence of distal cases was attributed mainly to the lack of adequate soft tissue adjacent to the fistula, which is vital for safe closure. In addition, the traction effect of erection on the skin and urethra, which is more prominent distally than proximally, is also believed to play an additive role. To increase success, the selection of appropriate treatment modality and customization of techniques for each patient cannot be overemphasized. However, the authors conclude that careful presurgical assessment of the patient, a 6-month delay before any secondary surgical attempt, inversion of the urethral mucosa, avoidance of any overlapping suture lines, urinary diversion proximal to the repair site for 5 to 11 days, and usage of thin, absorbable suture materials are the main criteria that should be met for a satisfactory hypospadias fistula repair.
Meatal stenosis is a complication that can occur after hypospadias surgery. Although there are many different surgical techniques that can solve this problem, once it has occurred, meatal stenosis can be difficult to treat. To decrease meatal stenosis risk and to achieve an anatomically placed, aesthetically pleasing meatal opening, a new W flap was designed for glanuloplasty. The authors describe the technique in detail along with long-term results. A total of 356 hypospadias cases were operated using various urethroplasty methods. Independent from the preferred urethroplasty method, the W-flap was used for glanuloplasty in all patients. Patients were followed for 1 to 10 years. Meatal stenosis incidence was 0.8%, and good cosmetic results with a natural-looking, anatomically placed meatus and a well-directed urinary stream during urination were achieved. W-flap glanuloplasty, an addition to reconstructive surgeons' armamentarium, is applicable to most patients. It places the meatus in its appropriate anatomic location, increases the meatal diameter by insetting two flaps, avoids a circular anastomosis, reduces the risk of late contraction, helps to achieve good aesthetic results with good urinary stream, eliminates the need for stents, and reduces meatal stenosis risk overall. It is a good glanuloplasty alternative that can be applied with most hypospadias repair techniques.
Cranioplasty is the most common method for correcting cranial defects. A number of innovations have been made to optimize bone repair. Before their use in humans, extensive animal trials must be performed to establish efficacy. However, the literature provides only scant and inconsistent data regarding animal controls. The purpose of this study, therefore, was to determine the critical size cranial defect in the rabbit model. Cranial defects ranging from 0.5 to 1.5 cm were created in 18 New Zealand White rabbits. The rabbits were then killed at 9 and 18 weeks and the defects examined using CT imaging and histologic analysis to determine bone healing. It was determined that cranial defects greater than 1.5 cm failed to heal spontaneously. Thus, the critical size cranial defect in the rabbit model is 1.5 cm.
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Reconstruction of oroantral defects, which are usually caused by tumor resection, is challenging. These defects become an even more difficult problem when they comprise multiple layers including oral mucosa, subcutaneous tissue, muscle and skin. This paper describes such a case in which a three-layer closure using a palatal flap, a buccal fat pad flap and a local skin flap was successfully performed.
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