Plastic, reconstructive, and esthetic surgery (PRS) differs from other surgical disciplines in the diversity of procedures performed and the breadth of its scope of practice, requiring a multidisciplinary approach and close collaboration. Whether there are enough PRS specialists to meet societal needs has long been debated. A descriptive study conducted by the senior author in 2014 reported the number of PRS specialists in Türkiye and their distribution relative to the national population. Using a similar methodology, the present study collected updated demographic data a decade after the initial analysis and compared them with historical findings to identify and discuss changes over time. The ratio of PRS specialists in Türkiye increased from 1.05 per 100,000 to 1.74 per 100,000 over a 10-year period. Province-level analysis showed a marked increase in specialist density in large metropolitan areas, alongside a proportional decline in less populous cities. Compared with the 2014 study, there was a substantial increase in the number of specialists working in the private sector, accompanied by a decline in those employed in the public sector and academic institutions. The impact of increased PRS residency quotas in the Medical Specialization Examination (TUS) has not yet been fully realized, and these findings provide a baseline for evaluating future workforce trends. The findings of this retrospective cross-sectional database analysis may inform workforce planning and health and education policy in Türkiye.
Impalement injuries, defined as the penetration of rigid objects into body tissues, represent uncommon but potentially serious traumatic events. This report presents a pediatric forearm impalement caused by a domestic door handle and its escutcheon, focusing on case-specific anatomical and surgical considerations. A 15-year-old boy arrived at the emergency department after running into a metal door handle, sustaining a penetrating injury to the dorsal left forearm. The penetrating component was the handle, whereas the escutcheon had been detached by the family before admission. Finger motion was intact, but wrist extension was painful. Radiographs showed a single, unfragmented metal piece within the soft tissues without bone involvement. The object was removed under operating room conditions and was found to traverse between the extensor carpi radialis brevis and extensor digitorum communis tendons without neurotendinous injury. Recovery was uneventful. This case underscores the importance of controlled extraction, careful anatomical assessment, and object-specific surgical planning in pediatric impalement injuries.
Background: Short-nose deformity is a complex issue in rhinoplasty, and lengthening is only possible with grafting. Besides, the successes and failures are not apparent over the midterm period and the predictors of dissatisfaction. Objective: This study examines 3-year outcomes of nasal lengthening rhinoplasty, timing of late complications, and the role of preoperative measures in predicting postoperative complaints. Materials and Methods: This retrospective cohort study was conducted at a tertiary care center. The study involved 100 short-nose lengthening rhinoplasty patients undergoing primary rhinoplasty from January 2022 to December 2024 and had a follow-up of up to 36 months. The study sample comprised 68 females and 32 males, and the median follow-up was 22 months. Methods were septal extension grafts, caudal septum pivot, and dorsal augmentation. Demographic characteristics, operative details, clinical measurements, and patient-reported outcome measures, including the Rhinoplasty Outcome Evaluation and the Standardized Cosmesis and Health Nasal Outcomes Survey, were collected. Postoperative complaints were categorized as esthetic or functional, and associations with sex and technique were analyzed. Results: Complaints in the postoperative phase were reported in 46% of patients, with 28% related to cosmetic issues and 18% to functional concerns. Forty-one percent of complaints occurred within the 1st postoperative year, of which 14 of 19 (74%) were esthetic in nature. Fifty-nine percent of complaints occurred between 12 and 36 months, divided evenly between esthetic (14) and functional (13) failures. There was no significant predictor of the type of complaint based on sex (P = 0.29; Cramer’s V = 0.10). A random-forest model with exploratory accuracy (level = chance [0.54]; balanced accuracy = 0.50; k = 0.0031; P = 0.893). Conclusion: Nasal extension rhinoplasty is a challenging surgery, and most patients experience early cosmetic and subsequent functional problems. Consequently, postoperative dissatisfaction could not be reliably predicted using demographic or routine operative variables alone.
Necrotizing Sweet syndrome (nSS) is a rare and aggressive form of acute febrile neutrophilic dermatosis. It can closely resemble necrotizing fasciitis in both clinical presentation and histopathological appearance. We report a 46-year-old woman with acute myeloid leukemia in remission who presented with rapidly progressing necrotic lesions on the abdomen, systemic inflammation, and elevated inflammatory markers. A high laboratory risk indicator for necrotizing fasciitis score led to multiple debridements and broad-spectrum antibiotics. However, the lesions continued to progress, and cultures remained sterile. Serial biopsies demonstrated dense dermal neutrophilic infiltrates without fascial necrosis, resulting in the diagnosis of nSS. Systemic corticosteroids produced rapid clinical improvement, and intravenous immunoglobulin was added due to hematologic concerns. No further debridement was required, and the patient later underwent skin grafting under controlled immunosuppression. After 5 months, complete healing was achieved with low-dose corticosteroids. This case highlights the diagnostic challenge of distinguishing nSS from necrotizing fasciitis and emphasizes the importance of early recognition, multidisciplinary care, and awareness that abdominal involvement may delay diagnosis.
Background: Radial polydactyly is a common congenital anomaly of the thumb, often managed surgically to achieve both functional and cosmetic restoration. While various scoring systems have been used to evaluate surgical outcomes, the relationship between objective radiological correction and clinical function remains underexplored. Materials and Methods: In this retrospective study, we evaluated 32 thumbs in 27 patients who underwent surgical correction for radial polydactyly between 2013 and 2022. Wassel classification was used to categorize the duplication level. Postoperative angular correction was measured on anteroposterior radiographs by assessing the axis between the metacarpal and distal phalanx. Functional and esthetic outcomes were assessed using the modified Tada score, incorporating Horii and Tien modifications. Interobserver reliability was analyzed using the intraclass correlation coefficient (ICC).Results: The mean preoperative thumb axis was 158 degrees, improving to 169 degrees postoperatively, with an average correction of 11 degrees. ICC for angular measurements was 0.91, indicating excellent reliability. Modified Tada scores were "good" in 71.8% and "fair" in 28.2% of cases, with no poor outcomes. A significant correlation was found between higher Wassel types and improved Tada scores, although angular correction did not significantly differ across types. No major postoperative complications occurred. Conclusions: Postoperative radiological correction correlates strongly with functional outcomes as assessed by the modified Tada score. Higher Wassel types may predict better functional results, suggesting that the classification system could have prognostic utility beyond morphology. This combined radiologic-functional analysis provides an objective framework for predicting outcomes in radial polydactyly.
Perineal groove (PG) is a rare congenital anomaly of the perineum, often asymptomatic and expected to undergo spontaneous epithelialization. Due to its rarity, PG is frequently misdiagnosed, leading to inappropriate counseling, unnecessary treatment, and overlooked complications. The infant, delivered through cesarean section at 38-39 weeks due to maternal preeclampsia, presented with a red, moist mucosal tract extending from the posterior fourchette to the anterior anal verge, with no associated anogenital anomalies. Congenital hydrocephalus was confirmed by antenatal imaging and postnatal computed tomography scan, with no familial history of malformations. While PG and hydrocephalus are embryologically unrelated, shared potential risk factors in this case include maternal hypertension, possible folic acid deficiency, secondhand smoke exposure during pregnancy, and maternal betel nut chewing. The PG was managed conservatively and showed spontaneous epithelialization over 2 years. This case highlights the importance of recognizing PG to avoid mismanagement and suggests that maternal health and environmental exposures may contribute to its development. Surgical intervention should be reserved for associated anomalies or complications.
Context:The clinical benefits of hydrosurgical debridement over conventional debridement in burn patients are not well established. Aim:We aimed to compare healing time and postoperative infection rates between the two methods in acute burn injuries. Methods and Statistical Analysis Used:This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four databases were searched for studies involving burn patients of any age and burn depth undergoing surgical debridement. The included studies directly compared hydrosurgical and conventional debridement techniques using scalpel-based methods. The primary outcome was healing time following burn injury or skin grafting. Secondary outcomes included operative time, scar quality, dermal preservation, and infection rates. Pooled estimates were calculated using a random-effects model, and heterogeneity was assessed using the I-2 statistic. Results:Six studies were included, including 445 participants with partial- to full-thickness burns. Four studies were included in the meta-analysis of healing time. The pooled analysis demonstrated a mean difference of -10.12 days (95% confidence interval [CI]: -16.72 to -3.52; P = 0.003; I-2 = 97%), in favor of hydrosurgical debridement. Infection rates from three studies showed no significant difference (relative risk: 1.06; 95% CI: 0.66-1.69; P = 0.82). Two randomized controlled trials demonstrated significantly greater dermal preservation with hydrosurgery. Findings regarding scar quality were mixed. Conclusion:Hydrosurgery may better preserve viable dermis and reduce healing time; however, these findings are based on a limited number of studies with substantial heterogeneity. Therefore, its use may not be generalizable to all patients and should be considered on a case-by-case basis.
Introduction: Postoperative pseudoptosis ("bottoming-out") and upward nipple-areola complex rotation remain important late esthetic problems after reduction mammaplasty. Dermal flap suspension to the pectoralis major fascia provides internal support, but maintaining a stable breast cone requires parenchymal reshaping. This study compared dermal flap suspension with a novel anatomic resuturing technique designed to reconstruct internal breast architecture without external fixation. Materials and Methods: A retrospective comparative analysis included 39 women undergoing Wise-pattern reduction mammaplasty with a superomedial pedicle. Group 1 underwent dermal flap suspension to the pectoralis major fascia (n = 21); Group 2 underwent anatomic resuturing with pedicle rotation and pillar-based parenchymal reapproximation (n = 18). Outcomes included body mass index, resection weight, pre-and postoperative nipple-jugulum distances, and 12-month BREAST-Q Reduction/Mastopexy scores. Independent-samples t-tests were performed, and analysis of covariance (ANCOVA) adjusted for baseline nipple-jugulum distance. Results: Baseline body mass index, preoperative nipple-jugulum distance, and resection weight were comparable. Postoperative nipple-jugulum distance differed between techniques (21.16 +/- 0.39 cm vs. 22.26 +/- 1.49 cm; P = 0.007), and technique remained an independent predictor after adjustment (ANCOVA P = 0.003). Despite this difference, the anatomic resuturing group reported higher BREAST-Q scores across domains, particularly satisfaction with outcome (81.3 +/- 14.5 vs. 68.5 +/- 12.0; P = 0.002) and sexual well-being (72.9 +/- 10.1 vs. 64.4 +/- 7.9; P < 0.001). Conclusions: In Wise-pattern, superomedial-pedicle reduction mammaplasty, anatomic resuturing with pedicle rotation and pillar-based parenchymal reapproximation produced better 12-month patient-reported outcomes than dermal flap suspension to the pectoralis major fascia.
Ankle equinus deformity secondary to intramuscular hemangioma (IMH) of the gastrocnemius is an exceptionally rare and often misdiagnosed condition due to its deep anatomical location and nonspecific symptoms. Delayed diagnosis can lead to chronic pain, progressive muscle atrophy, and fixed contracture, resulting in severe gait impairment. We report the case of a 26-year-old woman with a 10-year history of persistent right calf pain, progressive atrophy, and gait dysfunction, culminating in a rigid 35 degrees ankle equinus deformity. Magnetic resonance imaging (MRI) revealed an 8 cm & times; 3 cm intramuscular mass within the medial head of the gastrocnemius, consistent with cavernous hemangioma. The patient underwent wide excision of the tumor via a posterior S-shaped approach, combined with percutaneous Achilles tendon lengthening performed through three small stab incisions to address the mechanical contracture. Histopathological analysis confirmed a cavernous hemangioma. Postoperative rehabilitation was structured over 12 months, leading to full, pain-free ankle dorsiflexion, a normal heel-to-toe gait, and no recurrence on follow-up ultrasound or MRI. This case emphasizes the importance of early imaging, particularly MRI, in identifying deep soft-tissue lesions in patients with unexplained calf pain and contracture. It also highlights the effectiveness of a combined surgical approach - addressing both the lesion and the secondary deformity - in achieving durable pain relief and functional recovery. Further studies with larger patient cohorts and longer follow-up are necessary to validate this treatment strategy.
Chronic wounds are characterized by prolonged inflammation and impaired healing, often attributed to infection, vascular insufficiency, metabolic disease or mechanical trauma. When lesions remain refractory to treatment, malignancy must be included in the differential diagnosis. However, such wounds may also represent the first clinical manifestation of an underlying malignancy. We report two male patients (ages 51, 62) with chronic, treatment-resistant wounds persisting for months to years eventually diagnosed as malignancies: High-grade diffuse large B-cell lymphoma in a persistent axillary ulcer, and extranodal lymphoma in a lower-leg ulcer. Delayed diagnosis resulted from prolonged conservative care and nonspecific initial samples, and led to systemic symptoms. Early tissue biopsy, imaging, and multidisciplinary evaluation are critical to prevent diagnostic delays and improve prognosis. This case series aims to emphasize the clinical importance of malignancies that may initially present as chronic, nonhealing wounds.
Background:In daily practice, plastic surgeons frequently distinguish between benign and malignant skin lesions to plan appropriate excisions. Artificial intelligence (AI) algorithms offer potential decision support in this domain. This study evaluated the diagnostic accuracy of model dermatology (ModelDerm), a deep-learning algorithm, using real-world clinical data from a tertiary plastic surgery center.Materials and Methods:This retrospective study included 354 patients (total 378 images) presenting with cutaneous lesions. Clinical photographs were analyzed by ModelDerm, which provides five ranked diagnoses and a malignancy risk score. The AI outputs were compared with the gold-standard histopathological diagnoses. Performance was assessed using match rates, sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC).Results:Of the 104 malignant and 250 benign lesions analyzed, the correct diagnosis appeared within the AI's top-5 candidates in 55.4% of cases. The correct diagnosis was ranked first in 29.7% of cases. For differentiating benign from malignant lesions, the algorithm achieved an AUC of 0.89 (95% confidence interval: 0.85-0.93). The sensitivity for malignancy detection (rank-one output "skin cancer") was 82.7% (86/104 cases), and specificity was 93.6% (234/250 cases). Performance was particularly robust in Fitzpatrick skin types III and IV (AUC 0.92 and 0.98, respectively).Conclusions:ModelDerm demonstrated strong discriminative ability between benign and malignant lesions. While the system shows promise as a clinical decision-support tool to reduce diagnostic uncertainty, particularly for triaging suspicious lesions, human oversight remains essential due to limitations in specific subtype diagnosis.
Background: In this study, we take a closer look at the management strategies involved in hypospadias repair, exploring the various techniques and the potential complications that may arise afterward. We also explore the various factors that lead to these complications, the importance of expertise, and share some insights into the demographics related to hypospadias. Materials and Methods: This study took place at our center from January 2019 to December 2024, including all male patients of any age who presented with hypospadias. We gathered data from the hospital's database and analyzed it using SPSS (Statistical Package for Social Sciences). Results: We examined 214 patients, with an average age of 8. 13 years (+/- 5. 03 standard deviation), who underwent hypospadias repair. The most frequently observed type of hypospadias was mid-penile. We noted chordee, meatal abnormalities, cryptorchidism, and inguinal hernias in 73. 5%, 10. 2%, 2. 7%, and 2. 2% of cases, respectively. Repairs were performed using the TIP (tubularized incised urethral plate) method in 20. 9% of cases, whereas 75. 5% underwent two-stage (Bracka) repairs and other methods. We noticed that the most common complications were edema and urethrocutaneous fistula. Interestingly, surgeries carried out by specialists had fewer complications compared to those done by residents, and this difference was quite significant (P = 0. 0087). In addition, single-stage repairs resulted in fewer complications compared to two-stage repairs (P < 0. 001). Conclusions: hypospadias repair is a procedure that comes with a steep learning curve, requiring patience, surgical skill, and familiarity with magnification techniques. Whenever possible, we should promote single-stage repairs due to their lower rates of postoperative complications.
Artificial Intelligence is transforming medicine and may also change the field of hand surgery is different aspects such as artificial intelligence-assisted diagnosis, surgical planning and decision making, robotic surgery, rehabilitation, bionic hand development and medical documentation. The aim of this manuscript as a retrospective literature review is to summarize current applications relevant to the clinical field of hand surgery. A comprehensive literature review of publications on PubMed including keywords like artificial intelligence, hand surgery and reconstructive surgery was conducted. Especially artificial intelligence -driven imaging analysis may allow rapid detection of complex fracture-dislocation facilitating early and accurate diagnosis and currently represents the most advanced aspect of hand surgery with artificial intelligence integration. Large language models have also been successfully used to create postoperative rehabilitation protocols providing improved access to hand rehabilitation. The body of literature concerning surgical planning and decision making, robotic and bionic applications specific to hand surgery is less extensive. Machine learning algorithms assisting in medical documentation are currently more advanced in its clinical implementation. The integration of artificial intelligence into hand surgery promises improved patient care in the future. While currently artificial intelligence assisted diagnostic tools and medical documentation are at the forefront of clinical use, fields considered still in an experimental phase such as robotic and bionic applications may transform the field of surgery in the future. However, many challenges inherent to artificial intelligence exist in regards to ethics, data security and reliability.
Background: Pediatric mallet finger is characterized by the disruption of the terminal extensor mechanism at the distal interphalangeal (DIP) joint and differs fundamentally from adult injuries because of the biomechanical and biological implications of an open physis. Despite these distinctions, the relationship between postoperative radiographic alignment and clinical extensor function in skeletally immature patients remains insufficiently defined. Objective: This study aimed to evaluate the clinical and radiological outcomes of pediatric patients who underwent surgical treatment for mallet finger; to determine the effectiveness of commonly used surgical techniques, extension-block pinning and retrograde Kirschner-wire (K-wire) fixation; and to investigate the association between radiographic angular correction and postoperative extensor function in skeletally immature patients. Materials and Methods: Twenty pediatric patients treated surgically between 2010 and 2024 were retrospectively reviewed. Patients were assessed for the duration of K-wire retention, postoperative follow-up period, DIP joint function according to the Crawford criteria, and radiographic angular measurements. Results: Twelve patients had Doyle type 4a fractures. The mean duration of K-wire retention was 39.85 days, and the mean postoperative follow-up was 42.1 +/- 36.7 months. The mean preoperative distal phalanx-middle phalanx long-axis angle was 21.4 degrees +/- 10.6 degrees, which improved significantly to 10.4 degrees +/- 7.9 degrees postoperatively (P < 0.05). No residual extension lag was observed in any patient, and all outcomes were classified as "excellent" according to the Crawford criteria, within the scope of this categorical assessment. Conclusion: Surgical management of pediatric mallet finger using extension-block pinning combined with retrograde K-wire fixation yields favorable clinical and radiological outcomes. In selected pediatric patients who underwent surgical treatment, extension-block pinning combined with retrograde K-wire fixation was associated with favorable clinical and radiological outcomes. These results reflect the performance of this technique within defined surgical indications and should not be interpreted as superiority over conservative management.
Background:Fingertip contributes to the pincer function as well as the esthetic appearance of the hand. Fingertip amputations are commonly encountered in the emergency department. Their management options range from conservative methods to replantation.Materials and Methods:This prospective study included a total of 30 patients presenting with fingertip amputations. Surgical procedures involved microsurgical and nonmicrosurgical reconstruction of the amputated stump. Postoperative assessments, clinical photography, and patient questionnaires in the follow-up period were done.Results:In microsurgical series, fingertip replantation was done in 15 patients. Replantation was successful in 13 patients and 2 patients needed revision surgery. Fifteen patients underwent nonmicrosurgical reconstruction for fingertip amputation. Functional outcomes were similar in both groups, but esthetic outcomes were superior in the replantation group. Patient satisfaction was higher in the microsurgical group.Conclusion:Fingertip replantation should be done whenever possible for better esthetic results. It requires expertise as well as availability of resources, whereas nonmicrosurgical procedures can be done when the amputated part is not brought by the patients or resources are not available for replantation procedures.
Cement burns are extremely rare and most commonly seen in extremities. A literature review revealed only a few articles related to patients with cement burns, and, in those cases, the burns had resulted from the contact of cement with skin. In this case report, the formation of a cement burn in a 32-year-old male patient's open scalp wound is presented. After powder cement was poured onto an open wound on the scalp, the first intervention was to clean the area with serum physiologic. Exothermic reactions and a high alkali compound resulting from contact with liquid and powder cement had caused the scalp to burn. The patient underwent surgery 45 min after contact with the cement, during which flaps covered with cement were cleaned, and a rotation flap was used to reconstruct the tissue defects. A second surgery was performed 1 week later to cover the necrotic area at the distal margin of the traumatic skin flap, and tissue defects were repaired with a second rotational flap. Neither wound-healing problems nor infection occurred in the postoperative period. At a 6-month follow-up, permanent alopecia was observed on the scalp surrounding the wound margins.
Background: Soft-tissue defects involving the distal third of the leg, ankle, and foot pose a significant challenge for reconstruction due to poor circulation and paucity of available local tissue. The extended Reverse Sural Artery Flap (eRSAF) offers a reliable and local reconstructive option in such cases. This study evaluates the clinical use and outcomes of eRSAF in various lower limb defects. Materials and Methods: A retrospective study was conducted including 25 patients who underwent eRSAF reconstruction over 5 years. Data concerning patient demographics, comorbidities, defect characteristics, associated fractures, complications, and clinical outcomes were extracted from the medical records and analyzed. Results: The cohort had a male predominance (88%), with majority of patients in the age group of 15-30 years. Road traffic accidents were the leading cause of defects (56%). The heel pad was the most affected site (36%) followed by the tendoachilles region (28%). Defect sizes ranged from 9 cm(2 )to 120 cm(2) (mean: 24.88 +/- 11.68). Complications occurred in four patients, of which two cases developed partial flap necrosis (both smokers) which was managed by flap advancement in one and split-thickness skin grafting in the other case. In the third case, complete flap loss was documented which required a secondary procedure of dorsalis pedis artery flap. Fourth one developed postoperative infection which was managed with wound bed debridement, antibiotics, and dressings. Conclusion: The extended RSAF with primary delay is a safe and effective alternative to free tissue transfer for distal leg and foot reconstruction, especially in the resource-limited settings providing an extended reach with reasonably satisfactory coverage with manageable complication rates.
