Objective: Microangiopathies expose diabetic patients to lower extremity wounds at certain stages of their lives. Split-thickness skin grafting (STSG) has an important place in the surgical treatment of such wounds. The aim of the present study is to evaluate the effects of negative pressure wound therapy (NPWT) on STSG survival. Methods: A total of 25 diabetic patients (M = 20, F = 5) with acute or chronic lower extremity open wounds were included in the study. All patients underwent wound debridement under regional anesthesia. STSG was applied after wound debridement. NPWT was applied to STSG to increase graft survival. Results: The hospitalization times of the patients ranged from 1 to 2 weeks. The mean follow-up period of the patients was 6 months. All wounds healed on the 14th postoperative day. There was no recurrence in the 6-month follow-up period. Conclusion: We objectively demonstrated the positive effects of NPWT application on STSG and graft survival.

BACKGROUND:Various reconstructive options exist for distal finger and pulp defects, including grafting and local or distant flaps. In addition to reconstructing the normal anatomical structure, preserving the sensory function of the finger is crucial. This study presents the results of using bone grafting combined with a spiral flap (BGcSF) technique for reconstructing pulp defects accompanied by bone loss.METHODS:Twenty-three patients with fingertip defects were treated using the BGcSF technique. Flap sensitivity was assessed us-ing the Semmes-Weinstein monofilament (SWM) and static two-point discrimination (2PD) tests at six months postoperatively. Cold intolerance of the affected fingers was evaluated using the Cold Intolerance Severity Score (CISS) questionnaire at one year postop-eratively. Patient satisfaction was assessed using the Michigan Hand Outcomes Questionnaire (MHQ). Range of motion (ROM) for the proximal and distal interphalangeal joints was measured with a goniometer at one year postoperatively.RESULTS:Distal flap necrosis, affecting 10-15% of the flap area, was observed in one patient. No other complications were noted. The mean static two-point discrimination value at six months postoperatively was 5.6 mm, and the mean SWM score was 3.56. The mean CISS score at one year postoperatively was 18.8. The mean active ROM angle for the proximal interphalangeal joint was 106.7 degrees, and for the distal interphalangeal joint, it was 65.4 degrees. The mean MHQ score at one year postoperatively was 18.5.CONCLUSION:The BGcSF technique provides soft tissue with a texture similar to that of the fingertips and supports effective sensory repair. It can be considered a viable option for fingertip reconstruction in cases where replantation is not feasible.

Flexor tendon injuries cause serious work and health losses. Studies on flexor tendon injuries have generally focused on treatment modalities. The study's goal is to retrospectively screen the cases admitted to a single center and reveal in detail the causes of injury and the patients' sociodemographic characteristics. The study included 120 patients who applied to our center between January 2015 and December 2017 with a flexor tendon injury and underwent surgery on the same day. We investigated the patients' age, gender, and hand dominance as demographic characteristics. We classified the injury characteristics as the mechanism of the injury, the nature of the injury, the identity and number of affected fingers, the injured area and side, the number of involved tendons, the accompanying fractures, the nerve injury, and the vascular injury. As surgical details, we evaluated the type of anesthesia and the duration of the surgery. We identified 171 flexor tendons and 120 patients, of which 85% (n=102) were male and 15% (n=18) were female. Home accidents caused 26.6% of the injuries (32/120). Most patients had a single finger injury (88/120, 73.3%). Injuries were most common in Zone 2 (61/171, 35.6%). Patients with vascular and nerve injuries, along with flexor tendon injuries, were in the majority (48%). Our study provides detailed sociodemographic information about flexor tendon injuries. Because this study sheds light on injury mechanisms, it will serve as a guide for preventing such injuries. [Med-Science 2024; 13(3.000): 644-8]

In this study, it was aimed to investigate the monocyte/high-density lipoprotein ratio as a prognostic criterion in adult burn patients. A descriptive and cross-sectional method was adopted in this study. The sample included 177 patients with burn injuries. This study was conducted in a research and training hospital in Turkey. Data were collected by the researchers in the burn unit. Descriptive methods, Kruskal-Wallis, Mann-Whitney U, ROC curve, and correlation analyses were used for the statistical analyses of the data. While 66.1% of the patients were second-degree burn patients, 96.6% of all patients recovered and were discharged from the hospital, and the rest died. In this study, the monocyte/high-density lipoprotein ratios of the patients decreased as their clinical condition worsened. The mean C-reactive protein value of the patients was 8.52 ± 5.02 on the 7th day. A statistically significant correlation was found between an increase in monocyte counts and a decrease in high-density lipoprotein concentrations at the 24th hour, 3rd day and 7th day after the burn (p < 0.01). The monocyte/high-density lipoprotein ratio can be considered a biomarker in the identification and follow-up of sepsis and morbidity durations in burn patients. A low monocyte/high-density lipoprotein ratio in burn patients can provide an insight into the severity of sepsis.

Soft tissue injuries from animal bites are encountered occasionally in rural areas, resulting from attacks by, for example, dogs, wolves, horses, donkeys, and cats. The commonly affected body parts include the face, head and neck, nose, ears, hands, arms, and legs. The traumatic exposure of the external genital organs following an animal bite is a highly rare condition. Dog bite injuries in this area are a clinical condition that requires careful management due to the bacterial density of the oral flora of dogs, and also the potential bacterial flora in the genital area, resulting in a high risk of infection.Tissue defects following dog bites to the genital area are at high risk of morbidity, and may even result in life-threatening conditions in the event of a major infection.The classical treatment approaches to soft tissue defects resulting from animal bites include wound irrigation, debridement, rabies and tetanus immunoprophylaxis, antibiotic therapy, and reconstruction after the elimination of the infection. Recently, however, the early acute approach seems to have replaced the conventional late period treatment, with studies recommending surgical repair in the early stage where possible. In this article, an unusual etiology of scrotal defect was determined under the light of detailed literature data. The present study reports on a case in which an early repair was made after wound cleaning and care, debridement, and then prophylactic antibiotic therapy, soon after the referring of the case to the hospital. No signs of local or systemic infection were noticed at the wound site during follow-up. Post-operative recovery was uneventful and the repair performed on the case had a satisfactory outcome. Based on our clinical experience, we believe that reconstruction accompanied by an early prophylactic antibiotherapy can produce satisfactory outcomes in genital defects caused by animal bites.

Foreign bodies observed in the parotid gland generally origins from trauma. These foreign bodies are commonly solid structures such as metal, stone, and glass, but foreign body compatible with plant histomorphology is a rare condition. In this study, we present the diagnosis and treatment methods that we applied to this clinical entity, which is very rare in the literature. A 44-year-old female patient who applied to our clinic with a mass on her left cheek that developed in the past 3 months was evaluated. The patient underwent foreign body excision from the parotid gland. On the patient who had a stricture in the Stensen duct during intraoperative exploration, the duct was dilated, and the patient was followed up. Foreign body with vegetative morphology, which settles into the parotid gland by retrograde migration, is a very rare condition. The importance of being aware of possible complications, and a meticulous surgical approach should also be taken into consideration.

Abstract This study was designed to evaluate the efficacy of epineural tubulization (ENT) with or without intratubal application of adipose-derived mesenchymal stem cells (ASCs) in the rat model of sciatic nerve transection. After formation of 1-cm defect in the left sciatic nerve and ENT, 32 adults female Wistar albino rats were separated into 4 groups (n = 8 for each) including ENT per se (group 1; ENT group) and ENT plus intratubal ASC injection groups killed on day 21 (group 2; ENT-ASC-21-day group), 60 days (group 3; ENT-ASC-60-day group), and 120 days (group 4; ENT-ASC-120-day group). Functional (sciatic function index, hip circumference, withdrawal reflex latency, muscle weight ratio), electrophysiological, histomorphometric, and immunohistochemical analyses were performed in each group. Sciatic function index was significantly higher (−51.98 ± 5.94, P < 0.01) and withdrawal reflex latency was shorter (−6.21 ± 2.14, P < 0.01), in the group 4 as compared with all other groups on day 21. Amplitude of contraction was significantly lower in the group 4 as compared with all other groups (0.22 ± 0.05 vs 0.34 ± 0.07, 0.50 ± 0.11, and 0.61 ± 0.16, P < 0.01 for each). Immunohistochemical analysis revealed presence of green fluorescent protein, vimentin-stained cells, and single neural progenitor cells indicating that induction of neuronal differentiation by ASCs and direct involvement of ASCs within the axonal structure alongside extension of ASCs to the muscular layer of the group 4. In conclusion, our findings revealed that use of ENT plus intratubal ASC injection in a rat sciatic nerve transection model was associated with satisfactory functional outcome and improved peripheral axonal regeneration along with stem cell neural differentiation.

Objective: There is new information increasingly added about wound healing, which is one of the most complex physiological processes. In this study, it is aimed to evaluate the effect of plateletrich plasma on the wound healing process in pursuit of creation of skin defect on the back skin of the rat and application of graft to it. Material and Methods: The study was planned on 30 randomly selected inbred Sprague-Dawley rats. In the rats in the experimental group, 3x2 cm full-thickness skin defect was created after the back area was shaved. The skin taken from the defected area was thinned and turned into a full-thickness skin graft and sutured again to the area where it was taken. Platelet-rich plasma was applied under the graft to the rats in the 1st group, and physiological saline was applied to the 2nd group. The 3rd group did not undergo any surgical procedure, and it was created as the control group. Results: Significant differences were observed in glucose, lactate, glycerol, and pyruvate values in the tissue in Group 1, compared to other groups. In the histopathological evaluation, a significant decrease was detected in the rate of inflammation and edema in the Group 1, in comparison with the other groups. Conclusion: Based on the data obtained from this study, it was taken into consideration by us that platelet-rich plasma application is a method that can be applied in addition to the classical wound care, especially in the cases with wound healing problems.

The aim of this study was to present and discuss our clinical experience of patients presenting with a mass in the upper extremity, in respect of demographic characteristics, localisation of the mass, clinical and pathological characteristics. A retrospective evaluation was made of 114 cases (60 females, 54 males) who presented at our clinic with complaints of localised pain and swelling in the upper extremity between 1 June 2016 and 31 December 2018. The cases were separated into 3 groups; Group 1 with a mass determined in the carpal region, Group 2 with localisation between the wrist and the metacarpophalangeal joint, and Group 3, in the distal of the metacarpophalangeal joint. The mass was of soft tissue origin in 90 cases, and of bone origin in 24 cases. The distribution of cases was 6 in Group 1, 20 cases in Group 2, and 88 in Group 3. The tumour was benign in 105 (92%) cases and a primary malignancy in 9 (7.8%) cases. Recurrence occurred in 4 cases, of which 2 were enchondroma, 1 was a giant cell tendon sheath tumour, and 1 was hemangioma The majority of painful masses seen in the hand are benign and very few are malignant. In the approach to hand tumours, clinical evaluation guided by demo- graphic data, and the evaluation of diagnostic and treatment options according to the radiological ap- pearance and anatomic localisation will determine the ideal approach providing a full cure.

Prominent ear deformity is an autosomal dominant inherited deformity. Surgery is the most effective treatment method for prominent ear patients. Different prominent ear operations have been described in the literature. In this study, it is aimed to compare the transcutaneous fixation-assisted method that we described in prominent ear repair with the classical needle-assisted method. Patients who were operated for bilateral prominent ear deformity between January 2017 and January 2020 were included in the study. Two different approaches were used in the operations. In the first group, conventional needles were used to adjust the position of the concha-scaphal sutures. In the second group, transcutaneous suturing was used to adjust the position of the concha-scaphal sutures. The duration of the operation was recorded. Patients were called for controls in 1–3–6 and 12th months; photographs were taken. Measurements were made in the preoperative period, in the intraoperative and at the postoperative 12th month. SPSS program was used for statistical analysis. A total of 52 patients were included in the study. There were 27 patients in Group 1and 25 patients in Group 2. There was no significant difference between the groups in terms of demographic characteristics (p>0.05). While the average operation time was 80.37 minutes in Group 1, the average operation time was 60.40 minutes in Group 2. The operative times between the groups were statistically significant (p<0.05). There was no statistically significant difference between the groups in preoperative, intraoperative and postoperative measurements (p>0.05). As a result, transcutaneous fixation-assisted method is performed faster than the classical needle-assisted method and the results are understood right at the beginning of the operation. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The etiology of maxillofacial fractures is closely related to society and lifestyles, cultural structure, and social values. Various methods are used in maxillofacial fracture surgery, and these methods are determined aesthetically and functionally. In our study, it was aimed to examine in detail the prevalence, patient characteristics, and treatment approach of patients with maxillofacial fractures. This study was carried out retrospectively, based on the records of patients with maxillofacial fractures treated in the last 10 years in our clinic. Descriptive statistics, t-test, and Kolmogorov-Smirnov test were used in data evaluation. The results were evaluated at a 95% confidence interval with a significance level of p<0.05. The total of 700 patients were examined. Most of the patients were between 0 and 30 years old, and their distribution is as follows; 21.9% of them were 0-10 years old, 24.7% of them were 11-20 years old and 24.4% of the patients were 21-30 years old. A total of 700 patients were included in the sample group. It was found that 29.1% of the patients developed maxillofacial fractures due to traffic accidents and 41.7% due to falling from a height. Intermaxillary fixation was applied to 32.1% of the patients, and open reduction internal fixation was applied to 60.7% (n=424) of the patients as a treatment method. Maxillofacial fractures are an important public health problem. Education and preventive practices should be planned at the community level. High-speed causing traffic accidents and not using seat belts should be avoided. Breaking the culture of sleeping on the terrace, specifically to the region where the study was conducted, may be effective in preventing traumas caused by falling from a height. The selection of appropriate treatment methods based on age and psychosocial parameters is very important in determining treatment options.

Background: Alongside developments in the surgical approaches to flap dissections, significant advances have been seen also in anesthetic techniques, as one of the main factors in the performance of such interventions. Literature contains several clinical studies aiming to determine the optimum anesthetic technique for use in flap and microsurgical procedures, however there is still a lack of consensus on the ideal anesthetic technique. The present study compares experimentally the effects of inhalation and spinal anesthesia on different muscle-skin flaps during flap surgery. Methods: The study assigned 35 rats to five groups: Group 1) a control group with no ischemia induced; Group 2) undergoing an elevated transverse rectus abdominis muscle-skin flap under inhalation anesthesia; Group 3) undergoing an elevated transvers rectus abdominis muscle-skin flap under spinal anesthesia; Group 4) undergoing an elevated gluteus maximus muscle-skin flap under inhalation anesthesia; and Group 5) undergoing an elevated gluteus maximus muscle-skin flap under spinal anesthesia. After the experiment, the malondialdehyde, total antioxidant capacity and total oxidative stress values were measured. Specimens were taken for histopathological examination to assess hyalinization, inflammation, congestion, edema, hemorrhage, nuclear centralization, and fibrotic areas. Results: Inflammation, congestion and edema were significantly higher in Groups 2 and 4 than in the other groups. Conclusion: In the light of the study findings, it can be concluded that regional anesthesia is the preferable anesthetic method in flap procedures, since inhalation anesthesia has an oxidative effect on both transvers rectus abdominis and gluteus maximus muscle-flap models, while such effects are lower with spinal anesthesia.

The most common local and regional metastases of melanoma are skin, soft tissue, and lymph nodes. These metastases spread between the primary tumor and the regional lymph node line. The entity referred to in-transit metastasis is used to describe the lesions occurring in the superficial lymphatics at a distance of at least 2 cm from the primary tumor and in the locoregional lymph node line. In-transit metastases constitute 3.4–6.2% of malignant melanomas. This entity differs histopathologically from distant skin metastases spreading hematogenously. This feature leads to differences in the clinical course. According to the American Joint Committee on Cancer criteria, in-transit metastases are classified as stage 3b (no metastatic node involvement) and stage 3c (metastatic node involvement) disease. In this entity, 5-year survival rates have been reported as 54% in stage 3b and 24% in stage 3c. In-transit metastasis is a heterogeneous disease, and this feature leads to some differences in treatment. In order to increase the success rates in the management of this disease, a multidisciplinary approach should be applied and treatment options should be used effectively. In the treatment of in-transit metastases, a single treatment option cannot provide a complete cure and combined therapies should be applied simultaneously. Treatment options include surgical resection, radiotherapy, intralesional treatments, isolated limb perfusion and infusion, electrochemotherapy, targeted therapies, and immunotherapy. Detailed studies on combinations of these treatment options are ongoing. In this article, current approaches in the management of in-transit metastases have been evaluated. Level of evidence: Not gradable

Free radicals are chemicals that play a role in the etiopathogenesis of ischemia–reperfusion injury. To prevent or reduce this damage, many protective or therapeutic antioxidants are used effectively in alternative medicine. These antioxidants include immunological or pharmacological agents, vitamins, food and herbal products, and spices. Herbs and spices have been used for a long time as coloring or preservative agents by adding to the content of foods, and at the same time to increase the nutritional value of foods. More recently, the nutritional effects of herbs and spices have become more perceived and the area of ​​interest for these products has increased. Concordantly, the biological contents of herbs and spices have begun to be studied in more detailed way at the cellular and molecular level. Sample plants are classified according to different chemical families, with the diet. Therefore, they have different levels of antioxidant capacity. These products also have potent anti-inflammatory, antihypertensive, glucoregulatory, antithrombotic, anticarcinogenic and so forth effects. These properties are used in the treatment of some chronic diseases. In this review, the antioxidant properties of various herbs and spices used to add flavor to foods or to extend their shelf life have been examined in the light of large-scale nutritional epidemiological studies, in vitro cellular/animal studies and clinical trials.

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.

Medical tattooing of the skin to camouflage scars or to mimic hair or nipple/areola regions has gained popularity in Aesthetic Surgery and Dermatology clinics. The SMP procedure was used in 22 patients to correct scalp pigmentary problems between 2017 and 2020. The study included 16 men and 6 women; all female subjects had female pattern hair loss, while one of them also had alopecia areata. There were 10 male patients with male pattern hair loss and 6 of them were corrected using micropigmentation. The rest were subjected to an adjunctive procedure for hair transplantation. There were six male patients that had scalp scars. All patients had three micropigmentation sessions weekly and a fourth touchup procedure that was included one month after the last session. The follow-up period ranged from 7 to 32 months with a mean of 20 months. The amount of fading observed after the follow-up was minimal. There was an allergic reaction in just one patient following the procedure. There were no serious adverse effects or complications due to the procedure. The questionnaire the authors sent the patients at least six months following the procedure showed 80% of the patients (100% of the women) were very satisfied with the result and 100% of the patients would recommend the procedure to others with similar problems. SMP appears to be good solution for patients who don't want the hair transplantation or who underwent previous hair transplantation surgeries with unsatisfactory results. Also, SMP can be used to camouflage any type of scalp scars.

BACKGROUND:The internal nasal valve is one of the highly important anatomical points in rhinoplasty procedures. As a key anatomical area, the anatomical and functional integrity of this region must be preserved or reconstructed during rhinoplasty procedures. Several techniques have been defined in the literature for midvault restoration, among which, the most common are spreader grafts and flaps. Both techniques achieve a natural and harmonic contour but may fail to provide the splay effect to the upper lateral cartilages in some cases. A new technique known as the "T-splay graft", to be used as an alternative approach in cases where there is a risk of midvault collapse, and in which the splay effect in the upper lateral cartilage is preferred to be augmented, is explained in the present study.METHODS:In the present study, a septal tunnel is opened of sufficient size for the cartilage graft planned for placement, at the planned level of the septum, to expand the midvault region and create a splay effect. A bilateral pocket is created in the inferior mucosa of the upper lateral cartilages. The harvested cartilage graft is passed through the septum in the horizontal plane. The cartilage graft is inserted into the bilateral pockets so as way to create convexity to the dorsum.RESULTS:As a result of the applied method, it was established that the internal nasal valve angle could be expanded to the desired extent and the dorsal aesthetic lines could be achieved in a normal anatomical structure.CONCLUSIONS:This technique enables the lateral direction of the tension between the graft and the upper lateral cartilages, and the creation of a splay effect. As such, we believe that this method is a highly effective alternative for use in appropriate cases.LEVEL OF EVIDENCE IV:This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Introduction: Malignant tumors of the skin include basal cell carcinoma, squamous cell carcinoma, malignant melanoma and tumors of the skin appendages.Skin lesions in the head and neck region are frequently encountered in the geriatric population. Although these lesions are generally benign, it is widely known that the prevalence of malignant lesions increases with age.In adults, 80% of the masses in the neck, except benign thyroid diseases, are of neoplastic origin and this rate reaches 90% after the 5th decade. About 70% of these neoplastic masses are malignant, and three-quarters of these are metastatic and one-fourth is primary malignancies. Objectives: Increasing world population, increasing survival time and increasing geriatric patient population create some differences in healthcare. We planned this study for this purpose. Methods: The data of 73 patients aged 65 and over were retrospectively analyzed. Patients were divided into two groups as 65-75 years old (Group 1), > 75 years old (Group 2), by age. Results: Premalignant lesions were found to be statistically significantly higher in Group 1 (p<0.01). It was observed that malignant lesions were statistically significantly more common in the skin compared to the subcutaneous tissue. (p=0.015) Malignant skin lesions were observed statistically significantly more frequently in the neck region compared to other regions (p=0.004). Conclusions: The risk of malignancy in the patient group over 75 years is approximately doubled. It is necessary to approach the neck and subcutaneous masses carefully in terms of malignancy in the geriatric patient group

Öz Perçin Karakol1, Mehmet Bozkurt1, Emin Kapı2 1Health Science University Bağcılar Education and Training Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, İstanbul, Turkey 2Adana Education and Training Hospital, Clinic of Plastic, Reconstructive and Aesthetic Surgery, Adana, Turkey LETTER TO THE EDITOR Address for Correspondence: Perçin Karakol, Health Science University Bağcılar Education and Training Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, İstanbul, Turkey E-mail: ppercin@gmail.com ORCID ID: orcid.org/0000-0003-0068-2139 Received: 06.02.2020 Accepted: 21.04.2020 Cite this article as: Karakol P, Bozkurt M, Kapı E. A Practical Method for Purification of Fat Grafts Using Gelatin Sponge. ©Copyright 2020 by the Health Sciences University, Bagcilar Training and Research Hospital Bagcilar Medical Bulletin published by Galenos Publishing House. Dear Editor, Fat grafting has dramatically become popular during recent years; not only in plastic surgery, but also in other medical fields. Processing of fat grafts can be done in different ways, either with filtering, cotton-gauze rolling, or centrifugation methods (1). A major focus was the use of centrifugation or other methods to separate the aqueous and oil components before injection because this stage is the most important part for fat graft survival (2). There is no consensus on the various techniques, neither a gold standard technique for processing stage. In this letter, we aimed to use an alternative method for purification and filtering of fat grafts using gelatin sponge for low quantities of fat grafts. Our standard tumescent solution is injected into the harvest site. Fat is aspirated by hand using 60 mL syringe and harvesting cannula. In this method, fat lobules are removed through fibrous septas by degrading. For this reason, fat grafts obtained are free of fibrous septa and have a homogenic formation. A gelatin sponge with dimensions of 80×50×10 mm is divided transversely into two parts with using no:10 blades for enlarging the surface area used (Figure 1a, b). The rough surface of the gelatin sponge is used as it is more absorbent. The hand-suctioned specimens are divided into lesser parts and poured onto surface of the sponge. The specimens are rolled with forceps for about 3 minutes until all blood, aqueous and oil components are absorpted and separated (Figure 1c, d). The purified fat grafts area filled to 2 mL syringes using Bagcilar Med Bull DO I: 10.4274/BMB.galenos.2020.02.02 Karakol et al. Gelatine Sponge Bagcilar Medical Bulletin, curettes. The purified and unprocessed fat graft is seen in Figure 2. The gelatin sponge for purifying fat grafts is a cheap, quick method and it is quite easy to apply. Gelatin sponge (Spongostan®, Ferrosan A/S, Denmark) is an absorbable hemostatic agent derived from pig skin collagen and is widely used in humans for over 60 years (3). It is a material that can be absorbed between 4-6 weeks, and sponge-like that contains hemostatic gelatin. It has porous formation. It promotes platelet aggregation and increases the matrix formation of fibrin (4). It is cheap (0.30 € per one) and commercially available, can be found easily almost in every hospital. The surgeon himself can easily perform the technique without any help. Although fat grafting which is performed by closed system has been regarded as ideal, there has not been any kind of evidence that indicates infection is increased through desiccation air oxidation or decreases fat graft viability. (1). As far as the study of the Kuran et al. (5), although the application period is 15-20 minutes, there has been available data that shows air exposure does not increase bacterial growth. In our study, as gelatin sponge has a fast absorbent character, execution time is shorter and thus we believe that potential risks are minimized. The common agreed methods for fat processing are the cotton gauze rolling and centrifugation; and also filtration which is less commonly used. According to literature, there are conflict reports that one of them has superiority to another (1,6). The filtration method has an advantage to process large volumes efficiently and quickly same time. It may be safer for infection and increases graft viability but there is not enough evidence for these situations. It is not widely available, not suitable for little volumes; and also expensive (1). Kuran et al. (5) also described a filtration method inspired by yogurt concentration methods in Anatolia; that’s believed to prevent the adverse effects of centrifugation. The centrifugation and cotton gauze rolling methods are useful for little amounts of fat. The cotton gauze derived technique of Telfa (Covidien, Mansfield, Mass.) commercially available in local market. It is disposable. It is proved to be the best option for removing oil fraction (1). The centrifugation method (Coleman’s technique) is as efficient to purify and drained fat by gravity as the cotton gauze method. It can be found easily, but requires a centrifugation machine and cannot be performed by the surgeons self during the operation. In the comparison of filtering, centrifugation, cotton gauze rolling and gelatin sponge methods; the processing time, residual oil ratio contained in the graft after processing, removing of aqueous oil degree, the fat grafts volume retention percentile which was observed 6 weeks after application were compared (Table 1). According to this, in the cotton gauze sponge and gelatin sponge techniques it was seen that both period of time was shortened and the most favorable results were obtained in terms of efficacy. Compared to all groups, in gelatine sponge group adipocytes were evaluated by looking at the presence of needle-shaped fissure formations, which contain nuclei in terms of viability and the radial distribution formed by dissolving the triglyceride crystals. In terms of this parameter, adipocyte viability was found to be high in fat graft samples. It is noteworthy that fibrotic areas are in narrower areas, and capillary blood vessels are much denser among adipocytes. Minimal necrosis was observed when staining with hematoxylin eosin (Figure 3). As the processes of cotton gauze and filtration a drain work is performed by making the fat grafts held or mixed. In spite of a long holding duration for these works, it can be faced by the situations that the liquid side of the fat is Figure 1. a) View of the gelatin sponge b) View of the division of gelatin sponge c) The appearance of the pouring of the fat grafts d) The appearance of the rolling of the fat grafts with forceps Figure 2. The appearance of the purified fat graft Karakol et al. Gelatine Sponge Bagcilar Medical Bulletin, not absorbed efficiently. As the content of gelatin sponge is of the characteristic for rather absorbing and spongeporous, it absorbs the liquid quickly and it makes fat graft concentrated. In addition to this, the possibility that gauze particles may remain between the fat tissues in cotton gauze method, it brings about the foreign-body reaction risk. Since gelatin sponge is of the kind that melts, we are of the opinion that the tendency of forming foreign-body reaction in the long term period is lower. At the same time, besides mechanical effect over the fat graft application; because of the contribution to fibrin formation, we think that fat grafts increases the penetration to tissue and decreases the melting rate (5). The most important limitation of this method is that it allows little amounts of fat purification. A single gelatin sponge can purify about 10 mL of fat and about 3-4 mL purified fat graft is obtained. We use purified fat grafts into facial areas especially nasolabial sulcus and malar area and the obtained amounts are usually sufficient. If greater amounts are required, it may not be favorable, because of timely and personal constraints; other purification techniques like filtration may be used. Further studies must be performed for the effectiveness and showing the advantages and disadvantages; short and long term results may be helpful for comparison. For the parameters which are the matters in question, performing experimental work is more convenient. For this issue, a more detailed study has been planned. Although, the cotton gauze rolling and centrifugation have become established methods for removing unwanted oil and aqueous fluid from the lipo-aspirate to purify the fat before grafting, the presented gelatin sponge method may be kept in mind as an alternative due to its easiness, cheapness especially for small amounts of fat grafts. The manuscript does not contain clinical studies or patient data.

Objective: Burn injury is a type of injury which is the disruptin of skin and organs by the effects of heat, electrical current, chemical caustic or burning agents. The purposes of daily burn care are removing of necrotic tissue, prevention of bacterial contamination, control of travma, stimulation of epithelization and protection of systemic complications. In this study, the effects of hyperbaric oxygen and ozone therapy were investigated, and used as adjuvant therapy in burn management, on burned areas utilizing experimental burn model. Material and Methods: In this study, 28 Wistar albino rats weighing 200-220 gr were used and divided into four groups. 10% burn defect areas were occured in all experiments. In the first group, rats were treated with hyperbaric oxygen. Medical ozone therapy was applied to the second group. In the third group, only debridement was used as treatment. Any treatment options were not used to rats in the fourth group. Results: The analysis revealed no statistically significant difference of burns surface areas between Groups 1 and 2, while a significant reduction were noted in Groups 1 and 2 when compared to the other groups. On histopathologic examination of the Groups 1 and 2 we observed a significant decrease in the inflammation and fibrosis rates when compared with other groups. Conclusion: As a result, we observed the affirmative effects of hyperbaric oxygen and ozone therapy on burn management. We suggest that these treatment modalities can be added to standart treatment options as adjuvant therapy. We also think that large researches are needed to support this issue.