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Escharotomy is the relaxation of an eschar through longitudinal or horizontal incisions in order to protect regional perfusion. In peripheral areas, such as limbs, trunk, and neck, eschar pressure poses significant issues; it causes circulatory disorder in limbs and potential limb loss, inadequate thoracic expansion in the thorax, and perfusion and oxygenation problems in the neck. To prevent complications, a basic rule of burn surgery is to perform escharotomy incisions quickly and without hesitation. However, the face is not an area in which eschar formation is commonly seen due to its robust vascular supply and patients' protection reflex. Although descriptive drawings and guides for facial escharotomy have yet to be published, relaxation of axial arteries in terms of compression from eschar formation may be needed. Here, we present a case of escharotomy based on facial subunit principles. [ABSTRACT FROM AUTHOR]

Recently, most of the immediate breast reconstructions following mastectomy are being carried out with the use of silicone implants. In these patients, methylene blue is being used for the detection of sentinel lymph nodes. This experimental study was performed to determine the effect of methylene blue on capsular contracture around breast implants. Thirty-two Sprague Dawley rats were divided into 4 groups. Custom made silicone blocks were placed on the back of animals. In group 1, the incision was closed without performing any additional procedure. In group 2 (control), 0.1 mL of 0.9% normal saline was instilled into the pocket. Group 3 and 4 (study groups) received 0.1 and 0.2 mL of 1% methylene blue, respectively. On postoperative day 60, implants and capsular tissue were extracted. Capsule formation was evaluated both macroscopically and microscopically. The histological evaluation included capsule thickness, inflammation, neovascularization, and fibrosis gradients. Regarding capsule thickness, there were statistically significant differences between groups 1–3, 1–4, 2–3, and 2–4. Although there were more moderate and severe inflammation gradients in groups III and IV, there was no significant difference regarding inflammation severity between control and study groups. In respect of vascular proliferation, there was a statistically significant difference between control and study groups. Similarly, fibrosis gradients were higher in both groups 3 and 4. The study showed that the injection of methylene blue around silicone implants enhanced the formation of capsular contracture. In this case, the degree of contracture was independent of the dose given. Abbreviations: CC: capsular contracture; MM: methylene blue; SLNB: sentinel lymph node biopsy; NS: normal saline; H&E: hematoxylin and eosin; D: dorsal; V: ventral; L: lateral; n: frequency. [ABSTRACT FROM AUTHOR]

Background: Preconditioning is the improving the overall viability of the flaps before surgery. Hypothermia is one of preconditioning methods. In literature, the effect of short time hypothermia in skin flap viability has been studied. However, there is no information about the effects of long-term application of hypothermia on skin flap viability. In this study, we investigated the effect of long-term local hypothermia on flap viability and new vessel formation on random pattern skin flaps. Materials and Methods: Thirty-six adult male Sprague-Dawley rats were used. The flap model was, 3 cm x 9 cm sized random pattern skin flap. Three groups were composed as control group, continuous hypothermia induction group with ice bags, and intermittent hypothermia induction with chloroethyl spray. Flaps were raised on the 15th day of hypothermia sessions. Flap viability was measured in the software program. Microangiography and blood vascular endothelial growth factor (VEGF) levels were assessed for the detection of new vessel formation. Results: Average flap viabilities were found to be 64.87% in Group I, 57.69% in Group II, and 62.22% in Group III. The difference between Group II and other groups were statistically significant. When microangiographies were examined macroscopically, diameters, and amount of vascular branches of vessels in Group II were found to be higher than other groups. The difference between blood VEGF levels day 1 values among groups was not statistically significant. When day 4 values were compared to baseline values difference in Group III was statistically significant. At days 7 and 15, differences between groups and corresponding baseline values were not statistically significant. Conclusion: Continuous long-term application of hypothermia with ice-water bags causes a significant increase in neovascularization in random pattern skin flaps without an increase in skin flap viability. Hence, we can say that 2 weeks of hypothermia on random pattern skin flaps is not an efficient preconditioning method in clinical use. [ABSTRACT FROM AUTHOR]