Pericranial flap is a composite flap involving the periosteum of the skull with its overlying loose areolar tissue termed subgaleal fascia. The multiple blood supply of the pericranial tissue enables this versatility, with a rich, anastomosing arterial supply from the supraorbital, supratrochlear, superficial temporal, posterior auricular, and occipital vessels. Thus, the shape, size, and location of the pericranial flap could be altered as long as a sufficient pedicle width could be fashioned to maintain a blood supply. In our study, we have performed wide bipedicled pericranial flap in scalp reconstruction in 2 cases. After tumor excision was completed, a pericranial flap was planned on the caudal side of the defect. A bipedicle-based pericranial flap was outlined with the use of a sharp dissection; this flap was elevated in a submusculoaponeurotic plane. The bipedicled pericranial flap, whose arterial supply was from the superficial and posterior auricular arteries, was transposed to the frontal defect.We preferred a bipedicled flap, whose arterial supply is from the superficial temporal and posterior auricular arteries to augment vascular supply. If a large, long pericranial flap is required, making the flap pedicled ensures stable blood supply.

BACKGROUND: Maxillofacial injuries constitute a substantial proportion of cases of trauma. This descriptive analytical study assesses the cause, type, incidence, and demographic and treatment data of maxillofacial fractures. METHODS: A retrospective study on maxillofacial traumas was carried out in the Department of Plastic and Reconstructive Surgery at Sişli Etfal Hospital (Istanbul, Turkey) between January 1, 2000 and December 31, 2005. The study included 216 patients with a mean age of 29.8 years. Sex and age distribution of patients, etiology of trauma, localization of the fractures, treatment modalities, time to treatment after the trauma, and postoperative complications were recorded. RESULTS: The male predilection was 75.5%. Road traffic accident was the most common causative factor (67.1%), followed by interpersonal violence (19.4%), falls (12.5%), and work- and sport-related accidents (0.9%). A total of 50% of the patients suffered isolated mandibular fractures, 23.6% had isolated midface fractures, and 26.3% had combined midface and mandibular fractures. Regarding distribution of mandibular fractures, the majority (26.8%) occurred in the parasymphysis, 14.8% in the angulus, and 11.1% each in the symphysis and corpus. Complications occurred in 6% of patients, and the most common was malocclusion followed by infection and nonunion. CONCLUSION: The causes and pattern of maxillofacial fractures reflect trauma patterns within the community and, as such, can provide a guide for the design of programs geared toward prevention and treatment.

Nasal edema and volume changes are unavoidable processes during the healing period after rhinoplasty. Various applications were reported regarding the prevention of early edema; however, the literature shows no study focused on the course of the nasal edema and volume changes up-to-date. We aimed to study the nasal volume changes during the first year of postoperative healing period and to form a recovery and volume change diagram with the obtained data. We prepared standard frames and nasal molds of 7 rhinoplasty patients at regular time intervals (preoperative period and at the postoperative 1st, 2nd, 4th, 8th, 12th, 24th, and 52nd weeks). Plaster nasal models were created by using these molds. Volumes of models were measured by computed tomographic scanning and three-dimensional image processing programs. According to our results, the nasal edema reaches its maximum level at the postoperative fourth week and then rapidly decreases until its minimum level at the eighth week. In contrast with the general opinion, the nasal volume begins to increase smoothly reaching to a level minimally below the preoperative value by the end of the first year.

BACKGROUND: Nipple reconstruction is the last step in breast reconstruction. An entirely satisfying breast reconstruction can be achieved only with a symmetrically placed and ideally shaped nipple-areola complex. Several techniques and modifications have been described for nipple-areola reconstruction but long-term projection loss is still a problem in nipple reconstruction. METHODS: Between January 2005 and October 2008, 13 female patients underwent 19 nipple reconstructions in our department. Among these patients, seven underwent breast reconstruction with a DIEP flap following unilateral mastectomy, and six were diagnosed with gigantomasty and underwent bilateral breast reduction with a modification of free nipple grafting. Our method for nipple reconstruction relies on a vertically oriented bipedicled flap with horizontally oriented extensions from the mid-portion. RESULTS: Nineteen nipple reconstructions in 13 patients were evaluated and the mean follow-up period was 15 months. We did not see any necrosis or any significant projection loss in our cases. Patients' satisfaction was noted as high and the results were evaluated as pleasing. CONCLUSION: We present a new technique that uses a bipedicled flap, oriented vertically. A rich blood supply to the flap may be the principal cause for long-lasting nipple projection.

Reconstructing auricular defects is a challenging task for facial reconstructive surgeons. Although autologous reconstruction is the first choice for reconstruction, there may be circumstances of inconvenience such as previously attempted surgery, radiotherapy, systemic conditions, or patient's wish. Auricular restorations with facial prosthesis have produced promising results, but there are still problems to be tackled for improved results. Rapid prototyping in the production of an auricular prosthesis uses the mirror image of contralateral ear and produces excellent forms, eliminating the subjective perception of the prosthodontist. Rapid prototyping also lowers the production costs by reducing the need for several sessions in the process of producing the prostheses. Between 2004 and 2007, 10 patients applied to our department with the absence of an ear on a single side. All patients were male, with an average age of 23.1 years. The etiology for the loss of the ear was mostly tumors, followed by congenital deformities and trauma, respectively. In this study, we present our application of rapid prototyping technique and report our case series of 10 patients, two of which are presented in detail.

Management of an open wound is a problem frequently faced, with skin defects that cannot be closed primarily. Functional and aesthetic outcome could be improved if primary approximation of skin in these large defects were possible. Primary closure may be assisted using the viscoelastic properties of the skin. The viscoelastic properties of mechanical creep and stress relaxation in the skin were described more than 40 years ago. If skin is stretched with a constant force, it will expand with time as long as it is kept under tension, a phenomenon known as mechanical creep. In contrast, if the skin is stretched to a constant distance, it will expand and lead to a decrease in the force or tension on the skin with time, a phenomenon known as stress relaxation. We have recently applied these stretching properties to close the scalp because of a defect, which previously would have undergone pericranial flap and split-thickness graft. Because of the partial necrosis of the pericranial flap, skin grafting failed. In the second stage, we inserted only the wrist part of elastic latex gloves to the wound edges in full thickness. The skin margins were advanced slowly and gently.

BACKGROUND:: In considering periorbital reconstructive options, the goals of reconstruction are to obtain functional and esthetic results. At the medial canthus, reconstruction should maintain the normal concavity of the canthus without distortion of the surrounding tissues and should maintain normal eyebrow contour and symmetry. The authors represent their flap in flap technique that provides normal concavity of the canthus and does not cause any complex and undesirable scars. METHODS:: A new modification of conventional glabellar flap which was named "flap in flap technique" was raised to cover medial canthal defect. We designed an inverted V-shaped advancement flap (123Delta-A flap) that contains both B (145Delta flap) and C (2345) flaps. The B flap is designed in the glabellar region, which is at medial side of the defect and is transposed to defect, and the C flap is planned in V-Y fashion to release tension over the B flap. RESULTS:: To date, we have used this technique successfully in 5 patients (4 women and 1 man), requiring a glabellar flap to reconstruct the medial canthus and proximal nasal dorsum. All defects were secondary to excision of basal cell carcinoma. All were satisfied with the cosmetic and functional results. CONCLUSIONS:: Our glabellar flap in flap technique for the reconstruction of medial canthal defects has several advantages such as maintaining concavity of the canthus without distortion of the surrounding tissues and providing normal eyebrow contour and symmetry.

Medial canthal and dorsal nasal defects after surgery have been a challenging problem for surgeons and patients. The main purpose in reconstruction is not solely covering the defects with similar skin and soft tissue, but also causing minimal donor-area morbidity. The authors described an elliptical fashioned frontal island flap at the level of the frontal hairline, nourished by the vascular network composed of supraorbital and supratrochlear arteries, then carried subcutaneously to the defect area at medial canthus and upper nose. Any extra incisions above the eyebrow to control the pedicles were not necessary. Donor region was closed primarily; thus, scarring was hidden at the hairline. We present our frontal hairline island flap design and results in our series of 10 patients.In our study, we aimed to reduce scarring at donor area by planning a forehead island flap in an elliptical fashion at the frontal hairline. There are no more incisions than the elliptical incision over the hairline. Primary closure of skin flaps at the donor ensures a final scar that is hidden at the frontal hairline border. Forehead hairline island flap is an important flap for small- and medium-size defects as an alternative to conventional paramedian forehead flap.

OBJECTIVES: We compared the electrophysiologic and histopathologic results of early primary nerve repair and grafting of transections made at different levels. METHODS: Twenty-two male Sprague-Dawley rats were divided into three groups. In one group (distal group, n=8), the right sciatic nerve was transected near the proximal segment of, and in another (proximal group, n=7) at 15 mm proximal to, its branching. In the graft group (n=7), the nerve was resected from 5 mm to 15 mm proximal to its branching and the defect was repaired with the removed segment. All the nerves were repaired using the epiperineural technique. Electrophysiologic studies were performed before and after surgery. In the third month, bilateral biopsies were taken from the L4-5 dorsal root ganglion and from distal nerve segments for histopathologic examination and neuron and axon counts. RESULTS: At two months, the distal group exhibited significantly shorter latency (p=0.001) and higher amplitude (p=0.05) values. However, at three months, all the groups had similar values of latency, amplitude, and conduction velocity. At three months, the number of the dorsal root ganglion neurons was significantly greater in the distal group compared to the graft group (p<0.001), but this did not differ from the proximal group (p>0.05). Axon counts per square millimeter were similar (p>0.05), but axon diameter was greater in the distal group (p<0.05). In correlation analyses, increases in the number of L4-5 dorsal root ganglion neurons were significantly associated with increases in the percent changes in distal latency (p<0.05) and conduction velocity (p=0.018). CONCLUSION: Our findings suggest that distal injuries and primary repair of the sciatic nerve result in a faster and better recovery.

Various reconstruction techniques, using the remaining lip or the adjacent cheek tissue, have been described for the repair of lower lip defects. With these techniques, microstomia, commissural distortion, functional insufficiency, and sensorial loss might be observed. The authors describe a technique of lower lip reconstruction with preservation of neuromuscular tissue as a single-stage procedure. Lip sensation and orbicularis oris muscle function are preserved. Fifteen patients with lower lip defects, after tumour ablation or after traumatic loss, were treated by this technique. The only prerequisite for the application of this technique is the availability of at least 20% of the remaining lip tissue. Satisfactory functional, aesthetical, and sensational results were obtained.