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Background Periorbital fractures are a condition encountered after high-energy trauma in the face region. In the follow-ups after surgical repair, some changes may occur in the lower eyelid. Scleral show, ectropion, entropion, and canthal malposition are the most common complications. In this study, the effect of subciliary soft tissue approaches on lower eyelid position in patients with infraorbital rim fracture was investigated. Methods Patients admitted with orbital lower rim fracture between January 2017 and January 2021 were included in the study. A total of 90 patients, 15 patients in each group, were followed up for 6 months. Before the operation, the patients were randomly assigned to the groups by an impartial observer and the surgeons who would perform the operation were informed about the method. The patients were divided into six groups according to the type of soft tissue approach for fracture repair. Results There were 6 groups in total and each group included 15 patients. The mean age was 41.4 in group 1, 50.6 in group 2, 38.2 in group 3, 36.4 in group 4, 38 in group 5, and 39.9 in group 6. There was no statistically significant difference between the groups in terms of age (p = 0.090), gender distribution (p = 0.835), and smoking (p = 0.685). Ectropion was observed in 14 of 73 male patients and 5 of 17 female patients. Ectropion was observed in 9 of 38 smokers and 10 of 52 nonsmokers. When all groups were evaluated together, the scleral show measurement was 0.072 on the operated side and 0.034 on the healthy side. This measurement was statistically significant (p = 0.000). Conclusion Subciliary skin-only or step incision approaches can be used safely in the exposure of infraorbital rim fractures, but both approaches must be supported by canthopexy.

Purpose: The aim of this study is to evaluate the influence of patient demographics, operative techniques and post-operative care on patient satisfaction after breast reduction operations were evaluated in this study. Materials and Methods: Patients who undergo breast reduction surgery were offered to fulfil Breast-Q reduction module survey in pre-operative and post-operative sixth month period. Patient data such as age, height, weight, smoking, marital status and parenting have been recorded. Operative variances such as drain use and cutaneous stitches and complications, post-operative discharge days, staying in a private room were recorded with post-operative survey module. Results: Seventy-six patients were included in this study. The average age was 45.8 and mean body mass index (BMI) was 29.2. Post-operative satisfaction with breasts, psychosocial, sexual and physical wellbeing scores were significantly higher than pre-operative scores. Older women had higher pre-operative scores from satisfaction with breasts and psychosocial wellbeing. Younger patients and normal weight patients had higher scores from post-operative physical wellbeing. Satisfaction with breasts, sexual and physical wellbeing, satisfaction with information, surgeon and medical stuff scores were significantly lower in patients who had a post-operative complication.Conclusion: Surgery without complications is the most powerful factor that increases patient satisfaction. Patient demographics such as age and BMI can be used for patient selection for higher patient satisfaction., Amaç: Bu çalışmada meme küçültme amelyiatı sonrası, hasta demografik özellikleri, ameliyat teknikleri ve ameliyat sonrası bakımın hasta memnuniyetine etkisi değerlendirilmiştir.Gereç ve Yöntem: Meme küçültme ameliyatı geçiren hastalar arasından, ameliyat öncesi ve ameliyat sonrası altıncı aylık dönemde Breast-Q meme redüksiyonu modülü anketi doldurmayı kabul eden hastalar çalışmaya dahil edildi. Hastaların evlilik durumları, çocuk sahibi olup olmadıkları, sigara kullanımı, boy ve kiloları, yaşları ameliyat öncesinde sorularak kaydedildi. Ameliyat sonrası dren kullanılıp kullanılmadığı, cilt dikişleri olup olmadığı, herhangi bir komplikasyon gelişip gelişmediği, postoperatif yatış gün sayısı, hastanede kaldığı odada başka hasta bulunup bulunmadığı sorgulanarak kayıt altına alındı. Bulgular: Çalışmaya 76 hasta dahil edildi. Ortalama yaş 45.8 ve ortalama vücut kitle indeksi (VKİ) 29.2 idi. Ameliyat sonrası memelerden tatmin, psikososyal, cinsel ve fiziksel iyilik hali puanları ameliyat öncesi puanlardan anlamlı derecede yüksekti. Yaşlı kadınlarda memelerden memnuniyet ve psikososyal iyilik hali ameliyat öncesi puanlarda daha yüksekti. Genç hastalar ve normal kilolu hastalar ameliyat sonrası fiziksel iyilikten daha yüksek puan aldı. Ameliyat sonrası komplikasyonu olan hastalarda memelerden memnuniyet, cinsel ve fiziksel iyilik hali, bilgi memnuniyeti, cerrah ve tıbbi malzeme puanları anlamlı olarak düşüktü.Sonuç: Komplikasyon olmayan cerrahinin, hasta memnuniyetini artıran en güçlü faktör olduğu görüldü. Yaş ve VKİ gibi hasta demografisi bilgileri, hasta memnuniyetini arttırmak için hasta seçiminde kullanılabilecek kriterlerdir.

Prominent ear deformity is an autosomal dominant inherited deformity. Surgery is the most effective treatment method for prominent ear patients. Different prominent ear operations have been described in the literature. In this study, it is aimed to compare the transcutaneous fixation-assisted method that we described in prominent ear repair with the classical needle-assisted method.Patients who were operated for bilateral prominent ear deformity between January 2017 and January 2020 were included in the study. Two different approaches were used in the operations. In the first group, conventional needles were used to adjust the position of the concha-scaphal sutures. In the second group, transcutaneous suturing was used to adjust the position of the concha-scaphal sutures. The duration of the operation was recorded. Patients were called for controls in 1-3-6 and 12th months; photographs were taken. Measurements were made in the preoperative period, in the intraoperative and at the postoperative 12th month. SPSS program was used for statistical analysis.A total of 52 patients were included in the study. There were 27 patients in Group 1and 25 patients in Group 2. There was no significant difference between the groups in terms of demographic characteristics (p0.05). While the average operation time was 80.37 minutes in Group 1, the average operation time was 60.40 minutes in Group 2. The operative times between the groups were statistically significant (p0.05). There was no statistically significant difference between the groups in preoperative, intraoperative and postoperative measurements (p0.05).As a result, transcutaneous fixation-assisted method is performed faster than the classical needle-assisted method and the results are understood right at the beginning of the operation.This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Plastic and reconstructive surgeons perform operations under local anaesthesia very frequently. However, there is no consensus regarding a protocol for preoperative control of serologic markers. The aim of this study is to clarify the importance of preoperative control of serologic markers for operations done under local anaesthesia by evaluating the incidents that have occurred during these operations. All operations done under local anaesthesia in a plastic surgery clinic in 2018 were evaluated. The study looked at the patients’ ages, sexes, the operations they had, the times of the operations, the preoperative control of serologic markers, any incidents that occurred during the operations and the operating surgeons and nurses. The study evaluated 873 consecutive operations done under local anaesthesia. Only 43.6% of the patients had given blood samples before their operations for control of serologic markers. The operation that was performed most frequently was excision of a skin lesion and direct closure (41%). The mean operation time was 29.5 min, and 13 incidents occurred during these operations (1.5%). The risk of having an incident increases with the length of time of the operation (p

Objective: Tissue expanders are widely used in the reconstruction of tissue wounds. This study aims to demonstrate how to choose the correct size of rectangular expander in relation to wound size and the maximum advancement technique for wound coverage in order to achieve a successful outcome. Methods: The present study included patients who were operated on between January 2013 and January 2017. The expander height chosen was more than half the length of the wound and the expander width was chosen to be as wide as possible, based on the width of the wound. The expander was placed in a site adjacent to the wound. Maximum advancement method was used to achieve coverage of the wound. Results: A total of 19 patients were included in the study, mean age 17.5 (range: 11–25) years. Indication included burn scar (n=14) and congenital nevus (n=5). The tissue expander was inserted into the scalp in 17 patients and supraclavicular area in two patients. A successful wound repair was achieved with the planned flaps in all patients. Conclusion: In expansion using rectangular expanders, the required expanded skin is gained through the height of the expanded tissue. Thus, expander size should be preoperatively planned to ensure the height of expanded tissue would be, at least, half of the wound length. Maximum benefit will be achieved from the expanded tissue through the correct placement of expanded tissue lateral flaps.

Objective: To describe a single suture technique for the simultaneous repair of cutaneous and subcutaneous wounds. Method: Skin and subcutaneous wounds of >3cm in size were repaired using a single suture technique. Different suture sizes were chosen for different wounds. Timing of suture removal was decided according to body area and wound healing status. Results: A total of 78 patients were treated (41 women and 37 men). Mean age was 31.7 years (range: 14–72 years). At one month postoperatively, 56 patients attended a follow-up visit and 27 patients attended at six months postoperatively. Local infection was observed in one patient and wound dehiscence observed in two patients after suture removal. Resulting scars were similar to those of other types of suture techniques. Conclusion: This study describes a single suture technique for the simultaneous repair of cutaneous and subcutaneous wounds. It is easy to learn and perform. This technique reduces the risk of infection, cost and procedure time.

Background Posterior interosseous artery flap PIAF is one of the most preferred reconstructive options for upper extremity defects. As a reverse flap, venous congestion is always a threatening factor. In this report authors aimed to present their experience with venous super-drained posterior interosseous artery flap VS-PIAF. Methods Between January 2013 to September 17, 2017 patients were treated with VS-PIAF. Tumor excision, trauma, traffic accident, burn contracture release, and industrial injuries were the causes of defects. Defects were located on the dorsum of the hand, first web space, ulnar and radial side of the hand, and the palm. All the defects were reconstructed with a VS-PIAF, which a distal superficial end-to-end venous anastomosis was added to overcome venous congestion problems. Results The flap sizes were between 5 × 7 cm and 8 × 12 cm. All the flaps have survived completely without any early or late complications. No venous problems were seen. The donor areas were healed uneventfully. The mean follow-up time was 15.3 months. The results of reconstructions were satisfactory, no functional restrictions was seen. Conclusion The major drawback of PIAF is venous congestion problems that can be manageable with adding a distal superficial end-to-end venous anastomose. VS-PIAF is a robust, much safer and easy-to-learn reconstructive method for upper extremity defects.

BACKGROUND Breast ptosis is an inevitable consequence of gravity and time. Every breast tends to become ptotic in different shapes and degrees. Many surgical techniques were described to solve this problematic issue. The aim of this article is to describe a mastopexy technique used for grades 1 to 2 ptosis, "tuck-in" mastopexy technique. METHODS Keyhole pattern was used for skin markings. All the planned skin excision areas were de-epithelialized. Breast mound was elevated as a 1-piece flap with extensive subglandular dissection. Elevated breast flap was reshaped and repositioned. Skin incisions were sutured in 2 layers. RESULTS Seventeen patients were operated on with this technique; average follow-up time was 10.1 months. No major complications were seen. The results were pleasing for both the patients and the surgeon. CONCLUSIONS The "tuck-in" mastopexy technique uses breast mound as 1-piece flap, which has great vascularity from medial, superior, and lateral pedicles. Large areas of de-epithelialization facilitate reshaping and repositioning. It permits simultaneous or secondary breast augmentation with silicone gel implants. This easy-to-do technique has low complication rates and a short learning period.

Ulnar hemimelia is a rare congenital deformity. The severity of the deformity increases with the number of fingers that are absent. Clearly, grip function is impossible with a mono-finger hand. Here, we present a case report of a patient with bilateral ulnar hemimelia that included the absence of radial fingers and also deformity in the toes of his left foot. A toe-to-hand transfer was performed successfully to help the patient gain grip function. Both the patient and the parents were very pleased with the result. To our knowledge, this is the first case report of a patient with ulnar hemimelia and absent radial fingers who was treated with a toe-to-hand transfer.The most important factors in a successful surgery are careful preoperative planning and microsurgical expertise. Angiography is the key to careful planning, and physiotherapy should also be done to increase the patient's functions. The psychological well-being of patients and parents will be positively affected after a successful surgery.

Intraosseous epidermoid cyst is an uncommon bone tumor. The differential diagnosis of expansile, lytic lesions of the phalanges remains broad, and definitive diagnosis requires histopathological tissue analysis. Differentiation of intraosseous epidermoid cysts of the phalanx from other radiolucent lesions of the digits remains challenging, especially when classical radiographic findings are not seen. Here, we present a case of an intraosseous epidermoid cyst with atypical findings at the base of the distal phalanx of the thumb without a history of trauma. It was treated successfully without any complications. [Hand Microsurg 2017; 6(1.000): 43-46]

The stromal vascular fraction (SVF) obtained from inguinal adipose tissue was injected into the sciatic nerve region in diabetic rats. The effects of the SVF on the sciatic nerve and functional, electrophysiological and histopathological changes were examined in this study. Rats were divided into five groups; a non-diabetic control group, and four diabetic groups. In the first diabetic rat group, the SVF was obtained from inguinal adipose tissue. The remaining diabetic groups included a sham control group, a phosphate-buffered saline (PBS) injection group and an SVF injection group. Injections were made into the sciatic nerve region. Electromyography and walking track analyses were conducted on all groups at the beginning of the experiment. Diabetes was induced via a single dose of streptozotocin. Walking track analysis and electromyography measurements were repeated in week 8. SVF or PBS was injected into the right sciatic nerve region on week 8 of experiment group rats. Walking track analysis and electromyography were repeated in week 12 and all sciatic nerves were examined histopathologically. In the diabetic SVF group, the sciatic functional index calculated from walking track analysis in week 12 was better than week 8. Additionally, the myelin sheaths of the right sciatic nerve were thicker and more uniform and the nerve fibers were thicker than those of the left, untreated sciatic nerve. No statistical differences were detected in electromyographic measurements. The adipose-derived SVF may be beneficial for nerve regeneration in diabetic neuropathy.

Background:. Blepharoplasty is one of the most common procedures performed. To achieve optimal results in periorbital rejuvenation, a systematic approach to patients that addresses all the problems in the periorbital region is important. The aim of this study is to analyze blepharoplasty patients according to preoperative deformities and postoperative results and to create a basic algorithm for periorbital aesthetic surgery. Methods:. Patients who underwent periorbital aesthetic surgery were examined retrospectively. Patients’ medical records and preoperative and postoperative photographs were analyzed. Preoperative and postoperative photographs were analyzed for 6 main criteria: brow position, blepharoptosis, canthal tilt, excess skin or deficiencies, excess subcutaneous tissue or deficiencies, and periorbital skin rhytides. After the anatomical analyses, researchers rated the results as optimal or suboptimal. Results:. In total, 176 patients’ medical records were analyzed. Among them, 154 were women and 22 were men. The mean age was 43.8 years. No comorbid situation was detected in 133 of these patients. The postoperative result was evaluated as suboptimal in 151 patients (86%) and optimal in 25 patients (14%). An algorithm was proposed for the systematic evaluation of periorbital surgery patients to achieve satisfactory results. Conclusions:. A simple 6-step checklist is designed to define periorbital deformities and to achieve the optimal youthful appearance.

Tamoxifen is an estrogen receptor modulator and has been shown to increase risk for microvascular flap complications. This study aimed to investigate the clinical and histopathological effects of tamoxifen use in venous microvascular anastomosis model in rats. The role of vitamin E combination therapy and discontinuing tamoxifen therapy preoperatively were also evaluated.Forty rats were equally divided into 4 groups as follows: group 1 was given saline by oral gavage, group 2 was given tamoxifen citrate, group 3 was given tamoxifen citrate and vitamin E, and in group 4, tamoxifen citrate was given everyday except between days 12 and 16. In each group, femoral veins were dissected in each side and end-to-end anastomosis was performed in one side. Clinical and histopathological evaluations were performed. The ratio of total endothelial area to total vein area in a cross-sectional view of the vein was evaluated and compared.All veins with anastomosis in postoperative 15 minutes were found to be patent. In postoperative 1 week in groups 1 to 4, visible thrombus were present in 1, 3, 2, and 3 samples, respectively. Vitamin E group showed similar histopathological findings with control group. The ratio of endothelial layer to total vein cross-sectional area was increased in groups 2 and 4 in all samples. The increase was statistically significant between groups 2NA and 3NA (P = 0.023) and 2A and 1A (P = 0.006).Chronic tamoxifen consumption in the presence of anastomosis have led to prominent endothelial proliferation in rat femoral veins. Vitamin E combination therapy reversed this endothelial proliferation and should be focused in future studies.

Background Experimental research using laboratory animals provides substantial data about reconstructive surgery. However, the literature does not include any experimental studies that have used flap models on the hind limbs of rats. To gain an understanding of the physiology of lower-extremity flaps and of flap failures, this study assessed the cutaneous perforators of the saphenous artery, and new flap models were designed for the hind limbs of rats. Materials and methods The experiment was designed to include three stages and used 35 rats. The first stage involved mapping the perforators of the saphenous artery. In the second stage, the contents and structures of McFarlane, epigastric, and anterior hind limb flap tissues were compared histologically. The third stage of the study involved designing and comparing different flaps for the hind limbs of the rats and included random flaps, perforator-based peninsular flaps, perforator-based island flaps, and perforator-based flaps with rotated pedicles. Postoperative necrosis ratios were evaluated using computer-based software. Results Mapping of the saphenous artery perforators revealed an average of 2.2 septocutaneous arteries in each hind limb. Histologic studies showed thick dermis and panniculus carnosus in the McFarlane flaps, thick dermis, and thin panniculus carnosus layers in the epigastric flaps, and thin subcutaneous tissue with no panniculus carnosus tissue in the skin of the hind limbs. The results of the flap studies that used random flaps showed a 52.4% necrosis, while there was no necrosis when perforator-based peninsular flaps, island flaps, and flaps with rotated pedicles were used. Conclusions New flap models used on the saphenous artery perforators of the hind limbs of rats can provide valuable information about the physiology of lower-extremity flaps. New studies can also be designed based on these flap models to acquire more knowledge about pathologic conditions such as ischemia and venous insufficiency.

Objective: Most of the malignant cutaneous carcinomas are seen in the nasal region. Reconstruction of nasal defects is challenging because of the unique anatomic properties and complex structure of this region. In this study, we present our algorithm for the nasal skin defects that occurred after malignant skin tumor excisions. Material and Methods: Patients whose nasal skin was reconstructed after malignant skin tumor excision were included in the study. These patients were evaluated by their age, gender, comorbities, tumor location, tumor size, reconstruction type, histopathological diagnosis, and tumor recurrence. Results: A total of 130 patients (70 female, 60 male) were evaluated. The average age of the patients was 67.8 years. Tumors were located mostly at the dorsum, alar region, and tip of the nose. When reconstruction methods were evaluated, primary closure was preferred in 14.6% patients, full thickness skin grafts were used in 25.3% patients, and reconstruction with flaps were the choice in 60% patients. Different flaps were used according to the subunits. Mostly, dorsal nasal flaps, bilobed flaps, nasolabial flaps, and forehead flaps were used. Conclusion: The defect-only reconstruction principle was accepted in this study. Previously described subunits, such as the dorsum, tip, alar region, lateral wall, columella, and soft triangles, of the nose were further divided into subregions by their anatomical relations. An algorithm was planned with these sub regions. In nasal skin reconstruction, this algorithm helps in selection the methods for the best results and minimize the complications.

Objective: Cutaneous cysts of the head and neck regions have been an important problem because of both aesthetic concerns and their predisposition to infection. Material and Methods: Patients operated for cutaneous cysts of the head and neck regions between January 2008 and December 2013 were analyzed retrospectively for patient age and sex, localization and dimensions of the cysts, type of anesthesia used for excision, excision method, and histopathological diagnosis of cysts. The obtained data was compared with that reported in the literature. Results: A total of 164 patients who underwent operations for head and neck cutaneous cysts were included in the study. Epidermoid cysts were the most common type in the head and neck regions. When the localization of the cysts was analyzed, the scalp (26.3%), cheek (21.3%), and periorbital regions (15.2%) were found to be the most common locations. Conclusion: Cutaneous cysts are easy to diagnose; however, as in every tumor, histopathological examination is mandatory after excision. It should not be forgotten that malign lesions may have similar findings with benign ones.

Purpose To evaluate the effect of selective nerve blocks before tumescent anesthesia on the pain and anxiety levels of patients. Methods A prospective study was performed with 80 patients. Forty consecutive patients received tumescent anesthesia, and 40 consecutive patients received selective nerve blocks followed by tumescent anesthesia. Patients filled out a questionnaire regarding their preoperative, intraoperative, and postoperative pain and anxiety levels. The results of the questionnaire were evaluated with an independent samples t test. Results The 2 study groups showed similar distribution in age, sex, and diagnosis. No complications related to tumescent anesthesia or nerve blocks were observed. The group that received tumescent anesthesia with selective nerve blocks reported lower pain scores in anesthesia injections than the group that received tumescent anesthesia alone. The intraoperative and postoperative pain and anxiety levels between the groups were not different. Conclusion Tumescent anesthesia combined with selective nerve blocks in hand surgery decreased the pain associated with injections and increased patient satisfaction. Type of study/level of evidence Therapeutic I.

Objective: Reconstruction of lateral malleolar region defects with exposed implants is a problematic situation for the reconstructive surgeon because there are limited options. The objective of our study was to revise the management of these defects and point out the role of proximally based peroneus brevis muscle flap. Method: Patients with an implant exposed tissue defects of the lateral malleolar region were evaluated retrospectively. All defects reconstructed with proximally based peroneus brevis muscle flap were included in this study. Results: Of the 17 patients identified the mean age was 37.1 years (range 16–58 years). The size of the defects were 2–9cm in length (mean: 4.9cm) and 2–4cm in width (mean: 2.6cm). All defects were successfully covered with proximally based peroneus brevis muscle flaps combined with split-thickness skin grafts. All flaps healed with no complication or need for secondary surgery. The mean follow-up was18.8 months (range 12–32 months). Conclusion: Proximally based peroneus brevis muscle flap is a good alternative for reconstruction of lateral malleolar region defects with reliable blood supply, short surgical time, and minimal donor site morbidity.

Airbags and seatbelts are among the primary means of preventing severe injuries after motor vehicle accidents. Nonetheless, many studies have examined injuries that were related to airbag deployment. To our knowledge, this is the first case report of multiple mandible fractures caused by impact with the airbag cover. Removal of non-viable bone fragments was performed and the resulting hemi-mandible defect was reconstructed with a free iliac crest flap. A radial forearm free flap was used to reconstruct the mucosal defect. Airbags can prevent deadly injuries; however, they can also cause serious harm to the maxillofacial bones at the time of deployment.

Hand infections are particularly important in diabetic patients, because of the rapid progression and high risk of morbidity. Infections should be treated emergently with sufficient debridement and appropriate antibiotics. Comorbid situations, type of infection and late intervention are important predisposing factors to complications such as tissue necrosis. Tissue defects should be reconstructed with a similar tissue that does not cause movement restrictions or contractures that have adequate thickness. In this study, heterodigital island flap in reconstruction of a palmar defect caused by infection in a diabetic patient is presented. [Hand Microsurg 2014; 3(2.000): 62-65]

Malignant tumors in fingertips have similar findings with fingertip infections. Malignancies should be considered in patients with consistent swelling and erythema of the fingertip, and who exhibit resistance to infection treatments. In this study, two patients with malign fingertip tumors, who were treated under the misdiagnosis of fingertip infections, are presented. [Hand Microsurg 2014; 3(3.000): 80-82]

Maxillomandibular fixation with Erich arch bars is an economic method for handling mandibular fractures. Unfortunately, this method has some disadvantages, such as long operating time, periodontal trauma, and risk of puncture injury to the operator. To overcome these disadvantages, we propose teaching the pits and pearls of maxillomandibular fixation with Erich arch bars to trainees using dentures of a patient. Experiencing the method on dentures will shorten the learning curve.

Hatchet rotation-advancement flap is a well-known flap design, which is a worthwhile option in the reconstruction of lateral nasal region skin defects. In this study, the author's experience with 3 different designs of hatchet flaps, for the reconstruction of the defects in 3 different parts of the lateral nasal region, has been presented. All flaps in 31 clinical cases were planned from the cheek and nasolabial region. For the defects in the upper 1/3 part, flaps were planned in advancement type, for the middle 1/3 part, flaps were planned in rotation-advancement type, and for the lower 1/3 part, flaps were planned in rotation type. Satisfactory results were achieved in all patients except in patients having defects in the lower 1/3 part. In reconstruction of lateral nasal region defects, hatchet flap has different advantages such as versatility, better tissue match, and short final scar in the nasolabial fold. When planned in rotation type, for the lower 1/3 part, the ratio of complications increases significantly, which necessitates considering other flap options as the first-line choice of reconstruction for this region.

Objective: The purpose of this study was to describe the role of public exercise equipment in pediatric hand traumas as a preventable etiological factor. Methods: Pediatric patients with hand injuries referred from the emergency department were evaluated retrospectively. Age and gender of the patients, timing, etiology, mechanism of hand trauma, localization of the injury, diagnoses of the patients, and hospitalization rates were reviewed. Results: Amongst the 310 pediatric patients evaluated, 31 patients (10%) experienced injury related to public exercise equipment. Within this group of patients, most were between 5 to 9 years of age, and all injuries were blunt and crush type. Lacerations and fractures were the main diagnoses. Complex injuries that required inpatient care were reported in 19.3% of the patients. Conclusion: Public exercise equipment-related injuries are increasingly prevalent in pediatric hand traumas. Preventive actions such as shielding the moving parts should be taken to reduce these rates.

Purpose This article discusses the results of orbicularis oris muscle–sparing surgery and reconstruction of defects through the use of facial artery perforator flaps and mucosal advancement flaps. Patients and Methods Patients with lower lip carcinoma were evaluated retrospectively. Patients who underwent reconstruction with facial artery perforator flaps and mucosal advancement flaps with clear surgical margins and no muscle invasion were included in this study. Frozen section examinations were performed intraoperatively. Patients with muscle invasion were excluded. Results Between 2005 and 2015, 42 patients were treated by the described method. Supraomohyoid lymph node dissections were performed in patients whose ultrasonography had detected suspicious lymph nodes (n = 4). No metastases were identified on pathologic examination of the lymph nodes, and no local or distant recurrences were seen during a mean follow-up time of 58.4 months (range, 16 to 82 months). Conclusions The value of resecting the orbicularis oris muscle in cases in which there has been no muscle invasion is an ongoing subject of debate among surgeons. Preserving the muscle means preserving the function, and this is the main purpose of reconstruction. Using facial artery perforator flaps for reconstruction ensures good esthetic results while also maintaining the maximum oral opening. Sphincter-sparing excision and reconstruction with facial artery perforator flaps comprise a safe and reliable treatment method for selected cases involving lower lip carcinomas.

Gynecomastia correction is the most common breast surgery in males.1 Surgical reduction is indicated in Grade IIB and Grade III gynecomastia in Simon's classification.2 A circumareolar incision may chosen according to skin and areolar excess. Achieving a symmetrical nipple-areola complex is one of the major goals of the reduction surgery. The average areola diameter of males is measured as 2.67–2.8 cm in anatomical studies.3,4 Using the parts of 50 cc syringes as templates is appropriate for measuring the …