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Introduction: The algorithm for reconstruction options for lower extremity soft-tissue defects depends on the location, size, and depth of the wound. Regional options include muscle, fasciocutaneous, perforator, supramalleolar, and sural flap. In this study, we aimed to evaluate the return time of postoperative sensory innervations in patients whose reconstruction was performed with a reverse flow sural flap in distal third lower extremity injuries. Materials and Methods: Patients with lower extremity injuries, treated between September 2018 and December 2021, were retrospectively evaluated in terms of sensory innervation of the sural flap at 1, 6, 12, and 18 months postoperatively. Heat, cold, pain, stereognosis, two-point discrimination, and superficial and deep sensory examinations were examined in stages. Results: A total of 12 patients were evaluated, 7 (58.3%) of whom were male and 5 (41.6%) were female. The mean age of the patients was 42.08 years. The mean follow-up period of the patients was 20 months. In the acute postoperative follow-up of the operated patients, infection was observed in three patients and venous congestion in one patient. Total flap loss was not observed in any patient. The superficial sensory test and the deep sensory test did not return until a mean of 6 months, and the stereognosis test did not return until 1 year, while the sensation of pain returned at an average of 18 months, and the heat, cold, and two-point discrimination tests did not return during follow-up in most patients. Conclusion: The reverse flow sural flap is a reconstruction option known to have rapid neurosensory recovery. The exact timing to minimize the risk of trauma that may occur in the flap area is an average of 18th month. Although larger studies are needed to support these results, studies to accelerate the sensory innervation of this flap are needed.

Background: The authors present their experience about the soft-tissue reconstruction of hands and fingers with dorsal metacarpal artery (DMA) perforator flap. Materials and Methods: Patients who were treated by DMA perforator flaps from 2017 to 2019 were evaluated. Results: There were 17 patients with average age of 36 years. DMA flaps were harvested in a fasciocutaneus fashion in all patients except one. The mean flap size was 3.3 cm × 1.8 cm, and the largest flap was 5 cm × 2 cm. The donor area was repaired primarily except for one patient. The bridge skin incision was used to prevent complications caused by compression or edema. The average time for returning to work was 48 days. Conclusion: The DMA perforator flap allows repair of soft-tissue defects of the distal hand and finger neither with sacrificing any major artery nor a major donor site morbidity. Rapid learning curve and relatively stable anatomical structure are the other important entities that make the DMA perforator flap convenient.

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.

Aims: The aim of this study was to evaluate the reliability of the upper breast border (UBB) in determining the new location of the nipple and to objectively analyze long-term nipple position compared to pre-operative markings. Patients and Methods: Thirty-eight patients (76 breasts) patients who underwent superomedial pedicle, reverse-T scar breast reductions and who had long-term (>12 months) follow-up data were included. The sternal notch to the nipple, nipple to inframammarian fold (N-IMF), nipple to chest midline, and areola diameter were measured and recorded at the time of preoperative, markings, and long-term follow-up visit. Statistical Analysis Used: The differences in measurements were compared using a paired, two-tailed T-test, and a P < 0.05 was considered statistically significant. Results: The average follow-up time was 17.9 months (range 12–41 months). The nipple was located, on average, 0.95 cm lower on postoperative assessment compared to preoperative marking (P = 0.060). The nipple was located, on average, 0.75 cm lateral on postoperative assessment compared to preoperative marking (P < 0.001). The average postoperative increase in the N-IMF distance between marking and the long-term follow-up visit was 1.75 cm (P < 0.001). The areola diameter was increased 0.21 cm on postoperative assessment compared to preoperative marking (P < 0.001). Conclusions: The nipple position moved down and the N-IMF distance was greater than planned. However, the nipple was usually located at the area of the greatest projection of the breast due to almost equal elongation of the superior and inferior poles. The outcome of breast reduction procedures in which the postoperative nipple position is planned using the UBB was good.