Background: Staged pedicled skin flaps that require pedicle division are frequently employed in reconstructive surgery, rely on their pedicle for vascular supply following transfer until neovascularisation occurs at the recipient site, a phenomenon referred to as autonomisation (pedicle-independent flap viability following neovascularisation). This study sought to investigate the application of topical pentoxifylline to expedite the autonomisation process. Methods: Caudal-based skin flaps were surgically created in the dorsal region of 60 Wistar rats. On the fifth day, the bases of the flaps were surgically cut, and the flaps were subsequently monitored for an additional 7 days. The rats were divided into three groups: (1) Control group (Vaseline for 5 + 7 = 12 days), (2) Experimental-1 group (topical pentoxifylline for 5 days + vaseline for 7 days), and (3) Experimental-2 group (topical pentoxifylline for 5 + 7 = 12 days). Flap viability was assessed both macroscopically and microangiographically, and histopathological examinations were conducted. Results: On day 12, the viable flap areas were 40.7% in the control group, 95.5% in experimental-1 group, and 100.0% in experimental-2 group (p < 0.05). Microangiography was conducted on day 5 and 12, and both experimental groups exhibited markedly greater vascularisation compared to the control group. Histopathological and immunohistochemical analyses revealed that pentoxifylline significantly enhanced angiogenesis, new vessel formation, and epithelisation, while mitigating early-stage inflammation, edema, and late-stage fibrosis (p < 0.05). Conclusion: The application of topical pentoxifylline significantly promoted angiogenesis, thereby expediting the autonomisation of rat dorsal randomised skin flaps. Consequently, its use in reconstructive surgery may be considered, as it has the potential to reduce reliance on the pedicle, minimise complications, and enhance patient outcomes.

Interpolated flaps are frequently used in reconstructive surgery when free tissue transfer is not feasible, but they require staged procedures due to pedicle dependence. Flap autonomization, the process by which transferred tissue develops new vascular connections and survives independently of its pedicle, is essential before division. Although methods such as delay techniques, hyperbaric oxygen (HBO), vascular endothelial growth factor (VEGF), and stem cell therapies have been tested to enhance angiogenesis, the effect of topical nitroglycerin (NTG), a nitric oxide (NO) donor with vasodilatory, anti-inflammatory, and angiogenic properties, has not been investigated. This study aimed to evaluate the effect of topical NTG on neoangiogenesis and flap autonomization in a rat dorsal skin flap model. Sixty Wistar-Albino rats were divided into five groups (n = 12). A 3×3 cm dorsal flap with a caudal pedicle was elevated in all animals. In Groups 1-3, pedicles were transected on day 5: Group 1 received vaseline, Group 2 received NTG for 5 days then vaseline, and Group 3 received NTG continuously. Groups 4 and 5 were sacrificed on day 5 to assess early angiogenesis after vaseline or NTG. Flap survival was analyzed with ImageJ, angiogenesis with VEGF, CD34, and CD105 staining, and histology with Hematoxylin and Eosin (H&E) and Masson's Trichrome. Flap survival was significantly greater in Groups 2 (485.5 mm²) and 3 (757.3 mm²) than in Group 1 (273.5 mm²), with Group 3 highest (p < 0.01). NTG-treated groups showed increased VEGF, CD34, and CD105 expression, with the strongest angiogenesis in Group 3. Group 5 also had higher vascular proliferation than Group 4 (p < 0.001). Histology showed that NTG reduced epithelial disruption, hemorrhage, collagen degradation, and leukocytic infiltration while enhancing vascular proliferation. In conclusion, continuous topical NTG enhanced angiogenesis and accelerated flap autonomization, leading to greater viability after pedicle division. NTG may help shorten pedicle division intervals and improve outcomes in reconstructive surgery, but further molecular and clinical studies are needed.

OBJECTIVES:The epidemiology of acute hand injuries that require surgery in children is poorly defined. The purpose of this study was to outline the epidemiological and injury characteristics of surgically treated acute traumatic hand injuries in children and offer preventive recommendations. METHODS:We performed a retrospective descriptive epidemiological study of surgically treated acute traumatic hand injuries observed between 2004 and 2024 in a tertiary university hospital. The analysis included patients under 18 years of age, and examined demographics, injury mechanisms, causes, injury characteristics, and severity using the Modified Hand Injury Severity Scale (MHISS). RESULTS:Two hundred ninety-five patients were enrolled in the study. Injuries were most common among males and adolescents. The most frequent mechanism of acute hand injury was laceration (78.6%). Accidental falls with glass cups in toddlers and preschool children, street glass shards in schoolchildren, and punching glass and chainsaw injuries in adolescents were the most common causes of lacerations. The Modified Hand Injury Severity Score (MHISS) indicated that most hand injuries were moderate (35.9%). Complex injuries accounted for 39.7% of all cases, and 10.8% of patients required additional surgeries. CONCLUSIONS:The main cause of acute traumatic hand injuries requiring surgery in children is laceration due to glass, motorized and non-motorized farming equipment, cutting machines, knives, and various sharp objects. Raising parental awareness and educating the community can help to reduce the incidence of these injuries.

OBJECTIVE:This study aimed to introduce a reliable and useful model of selective sensorial or motor denervations of the sciatic nerve in rats with clinical and laboratory outcomes.METHODS:The surgical technique was determined via detailed cadaveric dissections of rat sciatic nerve roots and cross-sectional histoanatomy. Forty animals were divided into the sham, sensorial denervation (SD), motor denervation (MD), and combined denervation (CD) groups and evaluated clinically via the pinch test and observation. Electrophysiological tests, retrograde neuronal labeling, and histologic and radiographic studies were performed. The weights of the muscles innervated by the sciatic nerve were measured.RESULTS:The nerve root topography at the L4 level was consistent. Hemilaminectomy satisfactorily exposed all the roots contributing to the sciatic nerve and selectively denervated its sensorial and motor zones. Sensorial denervation caused foot deformities and wound problems, which were more severe in SD than in MD and CD. Nerve histomorphometry, electrophysiological tests, retrograde neuronal labeling studies, and measurements of the muscle weights also verified the denervations.CONCLUSION:This study has shown the feasibility of selective (sensory or motor) sciatic nerve denervation through a single-level hemilaminectomy. The surgical technique is reliable and has a confounding effect on gait. Sensorial denervation had more severe foot problems than motor and combined denervation in rats.

Amaç: Pediküllü kasık flebi, eldeki geniş defektlerin çoğu için standart bir flep olarak önerilmiştir. Kasık flebini serbest flep olarak kaldırmak da mümkündür. Geniş el defektleri olan hastalarda pediküllü ve serbest kasık flebi rekonstrüksiyonlarını hasta bildirim sonuçlarına göre retrospektif olarak karşılaştırmayı amaçladık. Hastalar ve Yöntem: 2013-2020 yılları arasında ellerindeki geniş defektler nedeniyle pediküllü veya serbest kasık flebi yapılan 16 hasta bu çalışmaya dahil edildi. Çalışma retrospektif klinik anket çalışması olarak gerçekleştirildi. Hastalar pediküllü kasık flebi grubu (n=8) ve serbest kasık flebi grubu (n=8) olmak üzere iki gruba ayrıldı. Hastalar 2 yıl takip edildi. Hastalara postoperatif dönemde DASH ve SF-36 testleri uygulandı. Bulgular: Pediküllü flep uygulanan hastaların yarısında ciddi dirsek ve omuz ağrısı vardı ve fizik tedavi gerektirdi. Yara iyileşmesi serbest kasık flebi grubunda anlamlı olarak daha erken tamamlandı (p<0,05). Pediküllü grupta ortalama hastanede kalış süresi serbest flep grubundan (sırasıyla 21 gün ve 13 gün) daha uzundu ve bu istatistiksel olarak anlamlı değildi. DASH skorları pediküllü flep grubunda subakut ve kronik evrede 92 ve 72 iken, serbest flep grubunda sırasıyla 52 ve 24 bulundu (p=0,012 ve 0,002). SF-36 skorlarına göre pediküllü flep grubunda fiziksel fonksiyonlar anlamlı olarak bozulmuştu (p < 0.001). Sonuç: Kasık flebinin serbest flep olarak transfer edilmesi ile omuz ve dirsek eklemi ile ilgili problemler ortadan kalktı, el rehabilitasyonuna daha erken başlanabildi ve günlük işlere dönüş süresi kısaldı. Eğer kasık flebi tercih edilecekse, serbest stil ilk olarak gözönüne alınmalıdır.

BACKGROUND: This study investigated the differences from the literature in terms of preoperative and postoperative features, complications, and aesthetic and functional results of patients who underwent a DCIA-based free iliac flap for large maxillomandibular bone defects in our clinic. METHODS: A total of 25 patients who underwent maxillomandibular reconstruction with a free iliac flap were included in the study. The patient files were retrospectively analyzed in terms of perioperative features. Complications and management strategies were reviewed. The functional and aesthetic results of the patients were evaluated with functional and facial appearance evaluation questionnaires. RESULTS: The average age was 42, and the male-to-female ratio was 19:6. The most common indication (11 patients) was gunshot wounds. Mandibular body (B) defects, neck skin (CN), inferior alveolar nerve (NİA), and buccal (B) mucosal defects were the most common defects. Fourteen osteotomies were applied to 11 flaps. Blood transfusion was 1.28 units, operation time 305 minutes, intensive care follow-up time 0.68 days, and hospitalization time was determined as an average of 13.3 days. Twenty-four recipient site and 8 donor site complications were observed. During the functional evaluation of 25 patients, it was observed that 19 patients could be fed a normal diet, 22 had speeches that were easily understood, and the social activity of 4 patients was found to diminish. In the aesthetic evaluation survey of 21 patients, 42.51% of the patients evaluated themselves as excellent/good, 33.3% as acceptable, and 23.8% as bad. When the evaluations were made by plastic surgeons, the patients were evaluated as excellent (19.04%), good (42.85%), acceptable (23.83%), bad (9.52%), and, very bad (4.76%). CONCLUSION: Free iliac flap can be preferred as the first choice for the reconstruction of the orofacial region, especially in trauma patients when its applicability to varied defects in terms of shape, size, content, flap viability, suitability of donor and recipient sites for aesthetic evaluations, and complication rates are considered.

BACKGROUND:Mole guns are handmade destructive tools used in the fight against harmful rodents in agricultural areas. Acciden-tal triggering of these tools at the wrong time can result in major hand injuries that impair hand functionality and cause permanent hand disability. This study aims to draw attention to the fact that mole gun injuries cause severe loss of hand functionality and that these tools should be considered within the scope of firearms.METHODS:Our study is a retrospective, observational cohort study. The demographic characteristics of the patients, the clinical features of the injury, and the surgical methods applied were recorded. The severity of the hand injury was assessed by the Modified Hand Injury Severity Score. The Disabilities of Arm, Shoulder, and Hand Questionnaire was used to evaluate the upper extremity-re-lated disability of the patient. The patients' hand grip strength and palmar and lateral pinch strengths, and functional disability scores were compared with healthy controls.RESULTS:Twenty-two patients with mole gun hand injuries were included in the study. The mean age of the patients was 63.0±16.9 (22-86), and all but one were male. Dominant hand injury was found in more than half of the patients (63.6%). More than half of the patients had major hand injuries (59.1%). The functional disability scores of the patients were significantly higher than the controls, and the grip strengths and palmar pinch strengths were significantly lower.CONCLUSION:Even after years from the injury, our patients had hand disabilities, and their hand strengths were lower than that of the controls. Public awareness should be raised on this issue, and mole guns should be prohibited and considered in the scope of firearms.

Aim: In this study, we have investigated the oxidative effects of long-term electric field (EF) exposure on the skin and sciatic nerve tissue. It is seen that astaxanthin (AST) can have protective effects on the skin and sciatic nerve tissue with its powerful antioxidant effect. Materials and Methods: Rats are divided into 3 groups as control, EF, and EF + AST, with 10 animals in each group. 0.1 ml 0.9% sodium chloride for 30 days in the control group, 10 kV/m (50 Hz) EF 23 hours a day for 30 days in the EF group, 10 kV/m (50 Hz) EF 23 hours a day for 30 days and 100 mg/kg/day AST in 0.1 ml solution for 30 days in EF + AST group is given by gavage. Skin and sciatic nerve tissue are removed bilaterally and homogenized for biochemical analysis. Malondialdehyde (MDA), superoxide dismutase (SOD), and catalase (CAT) enzyme activities are studied in the skin and sciatic nerve. Results: The applied EF increases the MDA levels in the skin and sciatic nerve compared to the control group (p = 0.013, p = 0.011, respectively). While AST treatment decreased MDA levels in the skin and sciatic nerve compared to the EF group (respectively; p = 0.046, p = 0.039), SOD (respectively; p = 0.001, p = 0.009) and CAT (respectively; p = 0.004, p = 0.008) enzyme activities were increased.Conclusion: The results show that AST can be used to treat oxidative stress caused by the electric field due to its antioxidant properties.

Objective We aimed to remind surgeons of the presence of the thoracoacromial arterial trunk and cephalic vein (TATCV) for a comfortable and reliable free flap transfer to the head, arm, and trunk, in case the mainstream recipient vessels of these regions pose some inconveniences due to previous surgery, radiotherapy, or trauma. Material and Methods Eight cases of trauma or tumor involving the head and neck or upper extremity, treated with free tissue transfer in which this vascular system was used with different modalities, were reviewed retrospectively. Results This vascular system proved to be reliable in all cases. It enabled chimerization with the pectoral flap. It was used in six patients for head and neck reconstructions and in two upper extremity restrorations. Switching the anastomoses to TAT-CV site and cephalic vein transposition were found to be rapid and reliable methods to rescue a flap with compromised circulation. Discussion Although anatomically well known by many reconstructive surgeons, its ease of dissection, consistency, supply of branches of differing caliber, and strategic location is not adequately appreciated. Moreover, in cases of pectoralis major flap transfer in which additional tissue is required, this vascular system is already there to receive it.

ABSTRACT Secondary alveolar bone grafting may not be feasible in a considerable number of patients who have cleft lip and palate, mainly because of the requirement for sizeable bony restitution and the insufficient amount of soft tissue for reliable coverage. Bone transport distraction and free vascularized bone transfers are the salvage techniques for treating these deformities and accomplishing successful bone grafting. This report presents a case of bilateral cleft lip and palate with a large palatoalveolar fistula and a rudimentary premaxilla after prior failed attempts at bone grafting. The authors used the free vascularized iliac bone flap with the osteotomies like puzzle for definitive restoration of the deformity.

ÖZET Amaç: Başparmak elin fonksiyonel kapasitesinin yaklaşık %50’sini içermesi nedeniyle diğer parmaklara kıyasla başparmağın konjenital veya edinsel yokluğunda elin pinç ve opozisyon gibi önemli fonksiyonları yerine getirilemediği için ciddi bir fonksiyon kaybı yaşanır. Başparmak rekonstrüksiyonunda seviyelerine göre tedavi algoritmaları değişmekte olup, bununla ilgili olarak kliniğimizde uygulanan rekonstrüksiyon seçeneklerinin irdelenmesi amaçlanmıştır. Materyal ve Metod: Kliniğimizde 2010-2019 yılları arasında konjenital veya edinsel başparmak defekti olan 51 hasta retrospektif olarak incelendi. Hastalar demografik özellikleri, yaralanma şekli, yarlanma seviyesi, rekonstrüksiyon şekli ve komorbid hastalıklar yönünden değerlendirildi. Elde edilen bulgular tablo haline getirilerek analiz edildi. Bulgular: Hastaların ortalama yaşı 42,6(82-4) idi. Kadın-erkek oranı 1/3,25(12:39) idi. Vakaların 49 tanesi (%96) edinsel(travmatik), 1 tanesi(%1,96) malignite, 1 tanesi de(%1,96) konjenital defekt olarak görüldü. Hastaların başparmak amputasyonları, 35’inda Zone1(Distal 1/3), 8’inde Zone 2(Orta 1/3),8’inde Zone 3(Proksimal 1/3) seviyesinden idi. Sonuç: Hastanemizin içinde bulunduğu bölgede yoğun tarımsal faaliyet mevcuttur. Tarım aletleri ile yaralanmaların sıklığına bağlı olarak tüm seviyelerde parmak rekonstrüksiyonu tarafımızca yapılmaktadır. Başparmaktaki defektin anatomik ve klinik sınıflaması göz önünde bulundurulduğunda merkezimizde yapılan rekonstrüksiyonlar literatür ile genel olarak paralellik göstermekte olup komplikasyon oranları benzer görülmüştür.

ÖzAmaç: Konvansiyonel cerrahi hemostaz yöntemlerinin kullanılmasına rağmen ameliyat sahasında kanama tam olarak sonlandırılamaz.Bu çalışmada amacımız mevcut hemostaz yöntemlerine rağmen devam eden kanama üzerinde topikal Ankaferd Blood Stopper®'in (ABS) etkilerini araştırmaktır.Hastalar ve Yöntem: 2009-2010 yılları arasında Le Forte I osteotomi ve/veya bilateral sagittal split osteotomi yapılan 19 hastada, kanamalara konvansiyonel müdaheleleri müteakip ameliyat sahalarına ABS veya plasebo sprey uygulandı.Ortognatik cerrahi grubunda, ameliyat öncesi ve sonrası hemoglobin ve hematokrit düşüş oranlarından kan kaybı miktarı hesaplandı ve bunun ABS kullanımı, tek ya da çift çene ameliyatı olması, ameliyat süresi, ameliyatta ortalama kan basıncı, yaş ve cins faktörleri ile ilişkisi araştırıldı

STUDY DESIGN:Prospective cohort study. INTRODUCTION:Identification of risk factors for CRPS development in patients with surgically treated traumatic injuries attending hand therapy allows to watch at-risk patients more closely for early diagnosis and to take precautionary measures as required. PURPOSE OF THE STUDY:The aim of this study was to evaluate the risk factors for the development of complex regional pain syndrome (CRPS) after surgical treatment of traumatic hand injuries. METHODS:In this prospective cohort, 291 patients with traumatic hand injuries were evaluated 3 days after surgery and monitored for 3 months for the development of CRPS. The factors assessed for the development of CRPS were age, sex, manual work, postoperative pain within 3 days measured on a Pain Numerical Rating Scale (0-10), and injury type (crush injury, blunt trauma, and cut laceration injury). RESULTS:CRPS was diagnosed in 68 patients (26.2 %) with a duration of 40.10 ± 17.01 days between the surgery and CRPS diagnosis. The mean postoperative pain score was greater in patients with CRPS than in those without CRPS (P < .001). Patients with pain scores ≥ 5 had a high risk of developing CRPS compared with patients with pain scores <5 (odds ratio: 3.61, confidence interval = 1.94-6.70). Patients with crush injuries were more likely to develop CRPS (odds ratio: 4.74, confidence interval = 2.29-9.80). CONCLUSIONS:The patients with a pain score of ≥5 in the first 3 days after surgery and the patients with crush injury were at high risk for CRPS development after surgical treatment of traumatic hand injuries. LEVEL OF EVIDENCE:II b.

Mandibular bone defects due to extensive trauma impair occlusion and affect the aesthetics of facial contouring, making it difficult to obtain a satisfactory outcome. Distraction osteogenesis and free flap is an effective and aesthetic treatment option for rehabilating these defects. In this clinical report, the authors present rehabilitation of a wide mandibular traumatic defect due to a work-related accident with iliac free flap, distraction osteogenesis, and dental implants.

Atmospheric pressure cold plasmas are used in sterilization, cutting and coagulation without damaging living tissues and cells. The preliminary studies on the production of the plasma pen which will allow cutting and coagulation at lower temperature than the conventional electrosurgery methods are presented. Intended power supply, pen design and manufacture are made. The results related to the first in vitro experiments carried out by the pen are given.

IntroductionVascularized composite allotransplantation (VCA), a new reconstructive option for patients suffering from extensive facial defects leads to superior functional and aesthetic outcomes compared to the standard autologous reconstruction. Among VCA recipients, each case involves different facial structures and tissues depending on the patient's injury, thus drawing conclusions on the mechanism of immune interactions between the donor and recipient is challenging. This study introduces a new total hemiface VCA model, including scalp, external ear, mystacial pad, premaxilla, upper/lower lids, nose, and upper/lower lips to evaluate the effect of transplantation of multitissue VCA on the recipient's immune response.Material and MethodsTen hemiface allotransplantations were performed in two groups between Lewis–Lewis (isograft) and LBN‐Lewis (allograft) rats. Cyclosporine A (CsA) monotherapy was applied in the allograft group to prevent rejection.ResultsAll flaps survived up to 100 days post‐transplant. The mean warm ischemia time was 45 minutes. Histological analysis revealed normal bone, cartilage (ear and nose), conjunctiva, palpebra, and eyelashes. Flow cytometry confirmed donor‐specific chimerism for T cells (CD4/RT1n and CD8/RT1n) and B cells (CD45RA/RT1n) in the peripheral blood of all rats in the allotransplantation group. At post‐transplant day 7, chimerism levels were at 1.68% for CD4/RT1n, 0.46% for CD8/RT1n and 0.64% for CD45RA/RT1n. However, chimerism levels for CD4/RT1n, CD8/RT1n, and CD45RA/RT1n populations decreased at long‐term follow‐up (at post‐transplant day 100) to 0.08%, 0.04%, and 0.23%, respectively.ConclusionThe feasibility and long‐term survival of the new hemiface VCA transplantation model was confirmed, donor‐specific chimerism and post‐transplant tissue changes were evaluated. © 2016 Wiley Periodicals, Inc. Microsurgery 36:230–238, 2016.