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The purpose of this study was to investigate the effects of combined application of human amniotic membrane wrapping and hyaluronic acid injection on peripheral nerve scarring in an adult rat model. After circumferential epineurectomies of right sciatic nerves were performed in each of 72 rats, nerves were randomly divided into three groups: (1) nothing was done additional to epineurectomy; (2) the epineurectomized segment was wrapped with human amniotic membrane; and (3) the epineurectomized segment was wrapped with human amniotic membrane and hyaluronic acid was injected inside. The extent of adhesions and perineurial scar thickness was macroscopically and histologically evaluated at 4 and 12 weeks. The least adhesion and perineurial scar tissue were observed in nerves treated with human amniotic membrane wrapping and hyaluronic acid injection. This combination appears to be safe and effective in preventing perineurial scar formation after peripheral nerve surgery in rats.

Object. Peripheral nerve repair surgery is still replete with challenges. Despite technical improvements in microsurgery, classic methods of nerve repair have failed to provide satisfactory results. The purpose of this study was to investigate the effects of amniotic fluid from humans on peripheral nerve scarring and regeneration in rats. Methods. Forty adult Sprague—Dawley rats were used in this study. After the right sciatic nerve in each rat was transected and repaired using an epineural suture procedure, the nerves were divided into two groups according to the solution applied around the repair site: experimental group, 0.3 ml human amniotic fluid (HAF); and control group, 0.3 ml saline. Macroscopic and histological evaluations of peripheral nerve scarring were performed 4 weeks postsurgery. Nerves treated with HAF demonstrated a significant reduction in the amount of scar tissue surrounding the repair site (p < 0.05). No evidence of a reaction against HAF was noted. Functional nerve regeneration was measured once every 2 weeks by using a sciatic function index until 12 weeks postsurgery. Functional recovery in nerves treated with amniotic fluid occurred significantly faster than that in nerves treated with saline (p < 0.05). Peripheral nerve regeneration was evaluated histomorphologically at 12 weeks postsurgery. Nerves treated with amniotic fluid showed significant improvement with respect to the indices of fiber maturation (p < 0.05). Conclusions. Preliminary data show that HAF enhances peripheral nerve regeneration. The preventive effect of HAF on epineural scarring and the rich content of neurotrophic and neurite-promoting factors possibly contribute to this result.

The purpose of this experimental study was to investigate the effects of topical applications of hyaluronic acid on peripheral nerve scarring and regeneration in an adult rat model. After the right sciatic nerves of 48 rats were transected and immediately repaired, nerves were randomly divided into two groups. Nerves to which were applied hyaluronic acid comprised the experimental group, and nerves to which were applied saline comprised the control group. Perineural scarring was evaluated at 4 and 12 weeks macroscopically and histologically. Nerves treated with hyaluronic acid demonstrated significant reduction in perineural scar thickness (P < 0.05, Student's t-test). Histomorphologic nerve analysis, electrophysiologic studies, muscle mass evaluation, and serial functional walking-track analysis were performed for evaluation of peripheral nerve regeneration at 12 weeks. The results showed better conduction velocities, increased axon-fiber diameter, and faster functional recovery in hyaluronic acid-treated nerves (P < 0.05, Student's t-test). In conclusion, hyaluronic acid appears to be effective in preventing perineural scar formation, resulting in enhancement of peripheral nerve regeneration.

Development of severe scar contractures following burns of the anterior wall of the female chest can lead to various breast deformities. This paper presents a report of 14 female patients operated on for postburn breast deformities over the past 5 years. Our aim in reviewing these patients is to establish the epidemiology and etiology of the breast burns and to present the techniques used for breast reconstruction. Most of these burns were domestic, 70% resulting from scalds. The majority were children, the mean age at the time of the burn being 4 years, and mean age at the time of admission to the hospital for postburn breast reconstruction was 16.5 years. In these cases, split-thickness skin graft, Z-plasty, local skin flap, and areola transposition were the most frequently used reconstruction techniques. In all cases, acceptable aesthetic results were obtained.

Background The aim of this study was to demonstrate a new, easy and safe technique, which has not been defined in the literature previously, that enables the gradual primary closure of fasciotomy wounds using barbed sutures. Methods The technique was performed on five patients who presented with fasciotomy wounds on both upper and lower extremities, varying in size, observed after compartment syndrome due to different causes. The average width of the defects for which primary closure was planned was 8.8 cm. Following the fasciotomy incision, absorbable barbed sutures were inserted through the dermal tissue around the wound similar to that of a subcuticular closure, but left loose, after which closed dressing was applied. During the clinical follow-up, with the decrease in tissue edema and tightness around the wound, the barbed suture was tightened at bedside every 48-72 hours. Results At the end of this gradual closure, all the fasciotomy defects were primarily closed within an average of 8.6 days. All the patients had complete and uncomplicated primary closure with the exception of one with high-voltage electrical burn injury, who developed necrosis in the distal part of the defect, and was treated by secondary healing. Conclusion The gradual fasciotomy closure technique with barbed suture seems to be an easy, rapid and effective method.

Temporomandibular joint dislocation is defined as the movement of condyle out of the fossa and the advancement of the posterior surface of the condyle in front of the articular eminence. If this condition becomes chronic, surgical treatment is the only option. The goal of surgical treatment is to reposition the condyle and prevent further recurrences. In this study, a retrospective analysis is presented examining 73 patients and 83 joints that were treated with hook-shaped miniplates and miniscrews fixed to otolog bone grafts. Records were obtained from archives of the Uludag University Medical Faculty, Plastic, Reconstructive and Aesthetic Surgery Department. The duration of postoperative follow-up was 3–30 months. In one case, the miniplate was fractured, and in two cases, abscesses existed. This study aims to emphasize that using miniplates and otolog bone grafts is more cost effective.

Gangrene presenting at birth is a rare clinical problem; it results from diminished perfusion of a part of the body, usually the extremities. A variety of aetiological factors may account for this situation. Arterial thrombosis, emboli, trauma, congenital heart disease, sepsis, coagulopathy, polycythaemia, congenital bands, and birth trauma are some of the causes which should be considered. In the majority of cases, an aetiological factor is not identified. The management of neonatal gangrene is usually conservative, preventing infection of the affected part and allowing the gangrenous portion to declare itself in order to optimise future reconstruction and rehabilitation. In this paper, two cases of newborn with gangrene of an upper extremity are reported.

After the chondrogenic potential of free grafts of perichondrium was shown in several experimental studies, perichondrium has been used to reconstruct cartilage tissue in various clinical situations. This study investigates the effects of human amniotic fluid on neochondrogenesis from free perichondrial grafts in a rabbit model. Since this fluid contains high concentrations of hyaluronic acid, hyaluronic acid-stimulating activator, growth factors, and extracellular matrix precursors during the second trimester, it may have a stimutating effect on neochondrogenesis. Perichondrial grafts, measuring 20 x 20 mm(2) were obtained from the ears of 144 New Zealand young rabbits and were sutured over the paravertebral muscles. The rabbits were randomly divided into three groups with 48 rabbits per group. In group 1, 0.3 ml human amniotic fluid, and in group 2, 0.3 ml saline were injected underneath the perichondrial grafts. Group 3 formed the control group in which no treatment was given. Histologically, neochondrogenesis was evaluated in terms of cellular form and graft thickness at 2, 4, 6, and 8 weeks after surgery. In group 1, the mature cartilage was generated quickly and the cartilage plate in this group was significantly thick and extensive when compared with groups 2 and 3 at 8 weeks (p < 0.05, ANOVA). In conclusion, our study shows that human amniotic fluid enhances neochondrogenesis from free perichondrial grafts. The rich content of hyaluronic acid and growth factors possibly participate in this result. Bursa Plastik Cerrahi-Yanık ve El Cerrahisi Derneği

Many surgical procedures have been described for the correction of the depressed, fixed post-tracheostomy scar, which produces a “tracheal tug” during swallowing. The purpose of this article is to review the common techniques and to present a new and simple surgical procedure for the correction of this deformity. During this procedure, the retracted scar is released from the trachea, left superior and right inferior based platysma muscle flaps are sutured in an overlapping fashion to provide thick and adequate soft tissue coverage over the tracheostomy site. This paper includes the presentation of two patients with a follow up of 6 and 12 months respectively, in which the tracheal tug and depressed scar were eliminated in a satisfactory manner.

Bu çalışma, 16-20 Eylül 2001 tarihlerinde İtalya Roma'da gerçekleşen 9. Avrupa Plastik Rekonstrüktif ve Estetik Cerrahi Cemiyetleri Kongresi'nde sunulmuştur. Several Surgical techniques have been designed to construct a neovagina that will be satisfying in appearance, function, and feeling when the vagina is congenitally absent. However, no method has yet been approved as a perfect solution. With the aim of solving the problems with conventional methods, the authors describe a new surgical technique that is simple and safe for treating vaginal agenesis. This technique consists of creating a mucosal lining of the neovaginal cavity using multiple full-thickness buccal mucosal patch grafts. Four patients with congenital absence of the vagina treated with this technique are presented. This Surgical procedure created a mucus-providing lining inside the neovagina. Selecting the donor site in the oral region resulted in all inconspicuous donor-site scar. Histologically, the neovaginal lining was confirmed as mucosal, and the ceream-colored viscous fluid found in the neovaginal cavity was confirmed as mucus. At a mean follow-up period of 15 months, the neovagina remained adequate in depth and width. All of the patients were interviewed to evaluate the function of the neovagina. Each patient reported having regular sexual intercourse and that the neovagina had felt. normal to their partners. The encouraging results obtained in four cases Suggest that this new technique deserves further application. European Soc Plast Reconstruct & Aesthet Surg

Bu çalışma, 2000 yılında İzmir'de düzenlenen 22. Ulusal Türk Plastik Rekonstrüktif ve Estetik Cerrahi Derneği Kongresi'nde bildiri olarak sunulmuştur. Since several experimental and clinical studies demonstrated the chondrogenic potential of perichondrium there has been great interest in examining factors that might promote neochondrogenesis from perichondrium. Human amniotic fluid contains hyaluronic acid. growth factors and extracellular macromolecules, and may. therefore, have a stimulating effect on cartilage regeneration. This experimental Study investigated the effect of human amniotic fluid on cartilage regeneration from rabbit ear perichondrial flaps, using 96 ears of 48 New Zealand young rabbits. A perichondrial flap was elevated and a cartilage defect measuring 20 min x 15 nim was created on the dorsum of each ear, then the perichondrial flap was Sutured in place. The ears were divided into two groups according to the solution injected underneath the perichondrial flap. The right ears, which were injected with 0.2 ml human amniotic fluid, formed the experimental group, and the left ears, which were injected with 0.2 ml saline, formed the control group. Macroscopic and histological progression of neochondrogenesis were evaluated at 2, 4 6 and 8 weeks after surgery. Macroscopically, the cartilage in the experimental group was generated quickly and had a similar appearance to the surrounding cartilage tissue, whereas in the control group minimal cartilage formation was observed at 4 weeks. Histologically, the neocartilage was significantly thicker in the experimental group than in the control group at 8 weeks (P < 0.05, Student's t-test). It can be concluded that human amniotic fluid enhances new cartilage formation from rabbit car perichondrial flaps. The preventive effect of human amniotic fluid on scar formation and the rich content of growth factors and extracellular matrix precursors may play a role in this result. (C) 2002 The British Association of Plastic Surgeons.

The effect of the topical application of human amniotic fluid (HAF) on peritendinous adhesion formation and tendon healing was investigated in 32 New Zealand adult rabbits. The long flexor tendons of the digits of each hind paw were completely divided and repaired with a modified Kessler technique. The rabbits were randomly divided into 4 experimental groups according to the type of repair used: sheath excision, sheath excision and local HAF application, sheath repair, and sheath repair and local HAF application. The extent of adhesions and the healing status of the tendons were macroscopically and histologically evaluated at 12 weeks. Tensile strength of the repaired tendons was measured biomechanically at 20 weeks. The least adhesion and the best healing were observed in tendons treated with sheath repair and HAF application. Tendons treated with HAF had significantly higher tensile load values. Topical application of HAF immediately after tenorrhaphy is significantly effective in preventing peritendinous adhesion formation without impairment of tendon healing in this rabbit model.

Sialorrhoea is an indication of dysfunction in the coordination of the swallowing mechanism. Disturbance in this coordination results in excess pooling of saliva in the anterior mouth and resultant drooling. Several surgical techniques have been described for the management of sialorrhoea. In this experimental study, we planned to try a more safe and physiologic technique by repositioning of the parotid duct orifices into the glossopalatal arch, using autologous free grafts of vein and artery in dogs. Ten adult dogs were used. In each dog, both of the parotid duct orifices were included in the study. The surgical procedure involved the dissection of both parotid duct orifices and their relocation via a submucosal tunnel into the glossopalatal arch, using a vein graft for the right side and an artery graft for the left side. Functional assessment was based on the clinical observations and retrograde sialography done on the 60th day. Results were excellent. No stricture or obstruction was noted. Histological examinations done on the 90th day showed the replacement of endothelium by multilayered cubic Stensen's duct epithelium in both artery and vein grafts. There was no difference between the results of artery and vein grafts. Surgical transposition of Stensen`s duct into the glossopalatal arch with autologous vein or artery graft is a safe technique which may be used in clinical cases of drooling us an alternative to the other techniques described.

This study was designed to evaluate the epidemiology and outcome of burn injuries due to paint thinner in a local burn center. During a 10-year period, 32 patients were admitted to our Burn Unit for paint thinner thermal burn. Patients were reviewed regarding the age, sex, etiologic factors, extent and localization of burn, treatment methods, length of hospitalization, and results. There were 30 males and 2 females. The mean age of patients was 25.9 +/- 11 years. The most common etiologic factor was kindling a fire with paint thinner. The mean extent of burn was 33.6 +/- 24% of the total body surface area. All patients sustained burn injury on the face, arms, and hands and five patients among them had extended burn areas on the trunk and/or lower extremity. The mean length of hospitalization for the survivors was 34.5 +/- 21.6 days. Twenty-eight patients were treated by early excision and split-thickness skin grafting. In four patients, burn wounds were healed by conservative management. Five patients with burn size of over 75% of the total body surface area died. In conclusion, paint thinner may be the cause of a catastrophic thermal injury and should not be used for the purpose of kindling fire.

As the sensory nerves supplying the abdominal wall are divided during abdominoplasty, sensory changes occur in the abdominal skin after surgery, which are troublesome for some patients. These sensory changes can lead to burn injury in uninformed patients. We report the case of a patient who sustained a second-degree burn to the anterior abdominal skin following the application of a heating pad after an abdominoplasty. This burn healed with conservative treatment. Burn injuries due to sensory loss in the abdominal skin following abdominoplasty must be kept in mind, and patients must be informed about this complication.