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Cross leg free flaps are one of the salvage methods used for free tissue transfer in large tissue defects in the absence of recipient vessels. The fasciocutaneous flap above the posterior tibial artery can be harvested to protect the pedicle and to advance a distance to wound, which is equal to the length of fasciocutaneous flap.Patients who were operated with cross leg free flap with the supporting fasciocutaneous flap on unwounded side were included in the study between years 2010 and 2020. Age, sex, location and size of the defects, arterial patencies, flap choices, fascio-cutaneous flap size, duration of operation, cross flap separation timing, complications, and time to return to work were evaluated.There were six patients with the etiology of high-energy electrical burns and trauma. There was only one arterial refilling for three patients and no refilling for others. Latissimus dorsi skin muscle flap was used in all but one patient. The mean defect size was 6.6×14.8 cm. The mean size of fasciocutaneous flaps was 4.08×5 cm. The mean operation time was 360 min. There was no complication except one dehiscence and one marginal necrosis and infection which were healed with wound care. Average time to return to work was 9 months.In similar cases, as wounded lower extremities with one or no artery refill, harvesting a fasciocutaneous flap with recipient vessels will be useful before considering the option of using a bridge free flap in medium to moderate sized defects.

Objective: The epigastric artery perforator flap is commonly used in the breast reconstruction. Ischemia during surgery results in the necrosis of the flap. We aimed to study the effect of fondaparinux in reperfusion injury in perforator flap model and determined its effects on the flap viability. Materials and Methods: Twenty-eight female Wistar Albino rats were included in this study. Rats were separated into three groups: A control (n = 9), B ischemia (n = 9), and C ischemia + drug (n = 10). Superior epigastric artery perforator flap on the single perforator was elevated in all groups. In Group A, flap was sutured back. In Group B, ischemia was applied for 4 h to the pedicle. In Group C, fondaparinux was administered 30 min before the reperfusion of the flap. Serum malondialdehyde (MDA), myeloperoxidase (MPO) levels, and histopathological examination of the flaps were studied. Results: The mean survival areas of flaps were 92.5%, 50.1%, and 91.1% in Group A, Group B, and Group C, respectively. Statistical differences were observed between these values (P < 0.05). The means of MPO and MDA were 22.3 ng/ml and 4.5 nmol/ml; 31.1 ng/ml and 4.7 nmol/ml; 27.1 ng/ml and 4.5 nmol/ml, respectively, for Group A, Group B, and Group C, and no statistically significant difference was found between groups (P > 0.05). Histopathologically, statistically significant difference was found between Group A, Group B, and Group C in terms of the infiltration of the leukocytes with polymorph nuclei (PMNL) for 24 h (P < 0.05). In the histopathological examinations done at the 7th day, statistically significant difference was found between groups in terms of edema, necrosis, increase in connective tissue, and leukocytes with polymorph nuclei (PMNL) (P < 0.05). Conclusion: Administration of fondaparinux after ischemia increased the flap viability in the epigastric artery perforator flap model.

Objective: Mandibular condylar fracture has an incidence rate between 14 and 48% of all mandibular fractures. Rigid fixation along with open reduction internal fixation is so far the most successful method to ensure the mandible stays in its natural anatomy. Facial nerve injury is the most feared complication for open reduction methods. We aimed to explain the surgical method using transmasseteric antero-parotid approach in mandibular condylar fractures, through which the buccal branch of the facial nerve is explored and maintained. Material and Methods: Since April 2015 to February 2018, the 12 patients (age range 19-42 years) with 15 fractures were treated with open reduction and internal fixation with transmasseteric antero-parotid approach. There were 9 male and 3 female patients. All patients were reviewed 2 weeks, 4 weeks, 3 months and 6 months after surgery. The clinical follow-up examinations included dental occlusion, maximum mouth opening (interincisal distance), weakness of the facial nerve, postoperatively complications (hematoma, infection,fistula,seroma) and salivary leak. Results: Infection, hematoma, fistula or seroma complications were not observed in any of our cases. The postoperative occlusal relationship was well restored in 11 patients. One patient with bilateral subcondylar fracture had unsatisfactory dental occlusion with anterior open bite. There was no permanent facial nerve palsy. All patients were satisfied with results. Conclusion: In mandibular condylar and subcondylar fractures, the transmasseteric antero-parotid approach is a reliable method that can ensure sufficient exposure and osteosynthesis.

Replantation is the first treatment in scalp amputations. Venous insufficiency is the most common cause of failure. There may be difficulties caused by venous anastomosis, especially in cases with cranial bone fractures. There is no agreement about the number of vessels that should be used for replantation. Depending on the severity of the injury, there may be concurrent injuries such as spinal fractures and other system pathologies, such as cranial bone fractures. In this article, we describe and discuss the surgical treatment of a patient with a temporal bone fracture concurrent with a total hairy skin amputation, which extended from both eyebrows anteriorly, in front of the ear laterally, to the hairline posteriorly. Single-artery and single-vein anastomoses were performed. The retromandibular vein was used as the recipient vein because an alternative appropriate vein was not available. Complete improvement was achieved in our patient, both aesthetically and functionally.

The aim of this study was to evaluate the bilateral vertical bipedicled procedure for the closure of large meningomyelocele defects and to emphasise some technical and clinical considerations.This procedure was used to close large meningomyelocele defects in ten patients (six males and four females) between January 2016 and August 2020. Eight of the patients were operated on within the first 24 hours of birth, and the remaining two were operated on between 1-7 days from birth. The average defect size was 6 x 9 cm (5 x 7 and 8 x 13 cm). The location of the lesions was thoracolumbar in two patients and lumbosacral in eight patients. Patient demographics, including sex, gestational age, birth weight, age at operation, defect size, duration of the operation, intraoperative-postoperative blood transfusion, length of hospital stay and complications, were evaluated.In all patients, closure was successful. Two patients required reoperation because of wound dehis-cence, and healing was uneventful, without any complications. No patient experienced late breakdown of the wound during a mean follow-up period of 14.9 months (12-18 months).Bipedicled fasciocutaneous flaps can be used as an alternative method to repair large meningomyelo-cele defects due to their simple and reliable nature, which also causes less haemorrhage, and can be used in selected patients.

BACKGROUND Epidermodysplasia verruciformis (EV) is a rare autosomal recessive genetic disorder of the immune system manifested by increased susceptibility to cutaneous human papillomavirus (HPV) infection beginning from the early years of life, and compromising lesions resembling flat warts, especially on the distal extremities and the face; but malignant transformation occurs in sun-exposed areas within the third or fourth decade of life. OBJECTIVE We describe two case reports of epidermodysplasia verruciformis, one of which was onset and had more aggressive features than the usual presentation. METHODS Intermittent surgical excision of the tumoral lesions were performed in the first case, whereas only one surgical intervestion was sufficient in the second case. RESULTS The early onset case was more aggressive, and new tumoral lesions were seen, whereas the other patients was free of the disease for 2 years.CONCLUSION Epidermodysplasia verruciformis possess multi factorial etiologies, and the main prognostic factor of the behavior of the disease may be the family history and genetic susceptibility.