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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.