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Background: The purpose of this study was to determine whether use of a video camera surveillance system for hand hygiene (HH) monitoring, video-based education, and feedback could improve the HH compliance in a neonatal intensive care unit (NICU)., Methods and Materials: This was an interventional before-after trial conducted in a level-III NICU between July 2019 and June 2020. HH compliance was measured using randomly selected video-camera footage in the baseline, intervention, and maintenance periods. After the baseline, an intervention consisting of feedback and education with video scenarios was implemented. The primary outcome was change in HH compliance. The compliance rates were analyzed as an interrupted time series (ITS) with a segmented regression model adjusted for autocorrelation for each study period., Results: We identified a total of 8335 HH indications. There were non significant increases in the total compliance rate (9.0%, 95% CI -2% to 20%) at the time of intervention and in the compliance rate after intervention (0.26%, 95% CI -0.31% to 0.84%) per day. The hand hygiene compliance before patient contact significantly increased (19.8%, 95% CI, 4.8%-34.8%). Incorrect glove use improved non-significantly with the intervention (-3.4%, 95% CI -13.4% to 6.7%)., Conclusion: In this study of HH monitoring using video-camera footage combined with an intervention including feedback and education, there were inconsistent improvements in HH compliance. However, these improvements were not sustained in the long term. Frequent feedback and education may be required to sustain high compliance., (Copyright © 2023 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Nasal tip support is critical to achieve a lasting result in rhinoplasty. In this article, the authors compared the effects of strut grafts (SG) and caudal septum-based nasal tip supporting techniques (CSB-T) in terms of reaching the desired tip projection.Included in this study were 40 patients (24 women and 16 men) who underwent primary open rhinoplasty via transcolumellar incision between January and June 2012. To achieve a good nasal projection, SG and CSB-T were used for 15 and 25 of these patients, respectively.Certain anatomic landmarks were identified on preoperative, simulative, and 1-year follow-up photos. With these landmarks, certain angular and proportional values were calculated.In the SG, the authors found no statistically significant difference in between simulative goals and postoperative results regarding bending angle. Postoperative nasolabial angle (NLA), tip angle, subnasal-tip/subnasal-radix (SnT/SnR) ratios were significantly lower than the simulation values; radix angle and supratip index values were significantly higher.In the CSB-T group, the authors found no statistically significant difference in between preoperative values and postoperative results regarding NLA, tip angle, bending angle, (SnT/SnR) ratio values. Postoperative supratip index and radix angle measurements were found to be significantly higher than the simulation values.With these findings, the authors concluded that CSB-T support is superior than the SG for supporting the nasal tip in noses that also need shortening in caudal length. In noses that do not need caudal shortening, nasal tip projection can again be supported by the caudal septum by just forming a bridge between lower lateral cartilage and quadrangular septum using a wider SG that mimics septal extension grafts.

Objective: In breast reduction surgery, while the primary objective may appear to be decreasing the breast volume, the ultimate goal is to achieve symmetrical, appealing, and sustainable breast cosmesis. To circumvent late-term ptosis following inferior pedicle mammoplasty, methods such as pedicle suspension to the ribs, support with dermal flaps and grafts, and the use of some alloplastic materials have been proposed. This paper presents a method of folding and fixing the inferocentral pedicle on itself and the underlying pectoral fascia., Methods: Inferocentral pedicled, inverted T-scar reduction mammoplasties were performed on 50 patients from June 2009 to June 2014. The inferocentral pedicle, which was kept narrow and long, instead of the conventional inferior-based pyramidal design, was folded over its de-epithelialised surfaces in an accordion fashion and sutured. The confection was then sutured to the pectoral fascia by its lateral and superior borders for long-term preservation of breast moulding., Results: In inferocentral breast reduction, the quest for a method that achieves appealing and lasting pyramidal breast shape continues., Conclusions: This technique is regarded as a simple and effective method for achieving good short- and long-term results for patients being considered for moderate and advanced breast reduction.

Maxillofacial traumas with long-barreled guns may sometimes cause catastrophic results by means of smashing in facial structures. In these patients, reconstruction strategies of both fragmented/lost soft and hard tissues still remain controversial. In their clinic, the authors treated 5 patients with severely injured face after failed suicide attempt between 2008 and 2013. In this study, the authors aimed to present their clinical experiences on these severely injured maxillofacial gunshot traumas and offer a treatment algorithm to gain a result as possible as satisfactory in terms of functionality and appearance.

The free microvascular transfer of toes for reconstruction of the thumb remains to be an area of interest in microsurgery. The goal of reconstruction is to restore the prehensile abilities of the thumb, while achieving acceptable appearance and minimizing morbidity at the donor site. We report the case of a 21-year-old man who had second toe-to-thumb reconstruction after post-traumatic amputation of his left thumb at the metacarpophalangeal level. Before the accident, he played a musical string instrument, the "Saz", regularly. The traditional method of playing the Saz is to pluck the strings with the fingers of the right hand and pick the strings with the thumb and fingers of the left hand. Three months after the operation, he was playing the saz again, proving that he had sufficient strength in opposition, adduction, and flexion force in the transferred toe.

We present a rare case of benign tumor of the hand.

Unlabelled: Subcutaneous emphysema is a clinical entity that may be associated with trauma. Rhinoplasty is not an atraumatic procedure. This report presents a case of acute periorbital emphysema after cosmetic rhinoplasty., Level of Evidence V: 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 .

The purpose of this study is to report our experience and learning curve in avoiding complications at both the recipient and donor sites as well in choosing the best flap for different anatomic locations. For this purpose 155 free flaps done between October 2005 and August 2012 were retrospectively examined. Patient demographics, flap types, etiology, re-exploration indications, timing of the re-explorations, and salvage rates were documented. In the first 60 cases, our re-exploration rate was 26.7% (16 flaps), and the rate decreased to 15.0% for the second 60 flaps (9 flaps). In correlation with this decrease, in the last 35 cases, only three flaps were re-explored (8.6%). This decrease in re-exploration rates over time was statistically significant (P = 0.021). Re-exploration rates for axial and perforator flaps were 14.6% and 22.7%, respectively. Salvage rates were 76.9% in axial flaps and 53.3% in perforator flaps. The total success rate for axial flaps was 95.5% and for perforator flaps was 89.4%. Besides, re-exploration rates were higher with lower salvage rates in perforator flaps compared to axial flaps causing lower overall success rates in the former group. The mean time of re-explorations was 21.4 hours. Salvage rates were significantly higher in re-explorations done within the first 12 hours after the initial surgery than in re-explorations done after 12 hours (83.3% vs. 47.3%) (P = 0.040). We can conclude that axial flaps have a steeper learning curve and are safer options for the inexperienced reconstructive micro-surgeons until they have adequate experience with the perforator dissection., (Copyright © 2013 Wiley Periodicals, Inc.)

Unlabelled: The extended spreader graft technique in septorhinoplasty is presented. The procedure involves applying spreader grafts before lateral osteotomies to support the whole osteocartilaginous vault. This study enrolled 51 patients who had undergone open septorhinoplasty between January 2010 and March 2012. The dorsal width ratio (DWR) was calculated for each patient by dividing the keystone width score by the intercanthal width score. The preoperative DWR scores classified 32 of the 51 noses as normal, six noses as narrow, and 13 noses as wide. All the patients with a nose classified as narrow preoperatively had a nose with a normal width postoperatively. All but one patient who had a normal preoperative DWR score also had a normal DWR score postoperatively. Of the 13 patients who had a wide nose preoperatively, seven were classified in the normal-width group postoperatively. Although the remaining six patients had a positive DWR score change (DWR closer to 0.50), they still were in the wide-nose group postoperatively. All but three patients were satisfied with their cosmetic and aesthetic results. Inverted-V or open-roof deformities were not observed. For all 18 patients in the normal nasal width group preoperatively (18/32), the nasal dorsum seemed wide after lateral osteotomies due to the spacing effect of the graft. As a result of medializing the bones, the caudal end of the graft became palpable. Although the graft position was checked perioperatively, at the postoperative 6-month follow-up assessment, three patients had palpable cartilages in the keystone area, one of which needed a surgical revision. Extended spreader grafts applied before lateral nasal osteotomies can support the entire nasal dorsum, including the bony vault. This spacing effect could be highly advantageous for both narrow and wide noses. In narrow noses, these grafts prevent further narrowing of the osteocartilaginous vault and support the dorsal aesthetic lines. In wide noses, extended spreader grafts fill the bone gap before lateral osteotomy and help to prevent open-roof deformity. In addition, fixing the upper lateral cartilages before lateral osteotomies might further prevent bone collapses, even after premature fractures. In normal-width noses, after completion of the lateral osteotomies, the bone gap usually does not persist, and nasal bones push the cranial end of the spreader graft dorsally. Therefore, in normal-width noses, extending the graft along the bony gap is not necessary, and the use of extended spreader grafts is not preferred., Level of Evidence Iv: 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 .

With the technical advancement in face allotransplantation, we decided to survey the Turkish population to gain perspective into their thoughts and reactions toward face transplantation. A questionnaire was given to 1000 volunteers, regarding data about demographics, educational status, religious, and behavioral preferences. Their attitudes about donating their faces, knowledge about the pros and cons of this procedure, and personal desire for face transplantation if needed were inquired.The results of the survey demonstrated that knowing more about the procedure increases its acceptance but even so, the majority would rather undergo multiple operations with self-tissues before getting a facial transplantation (FT). When the risks of immunosuppression were exposed, less people agreed to FT, thinking it was not worth the risks.The cultural, ethnical, religious, and social background of different societies may influence the way FT is perceived and accepted. As this procedure is thought to challenge many ethical, physiological, and social points of views, we believe that it is important for a surgical team to have insight into their population's perception and general thoughts concerning the issue.