Background: Middle crura support deficiency and shortmiddle crura can usually cause insufficient definition and projection of the tip and can sometimes result in a flat tip. The aim of this study was to investigate the effectiveness of a new technique involving a tip reinforcement flap to strengthen the middle crura and to achieve a well-projected and defined tip.

Methods : Twenty-nine patients who underwent primary open-approach rhinoplasty that included the use of tip reinforcement flaps were included in the study. Cartilage flaps that had been created fromthe excess cephalic portion of the lateral crura were prepared as medial crura-based cartilaginous flaps.

Results: There were 29 patients (17 women, 12 men) aged 18 to 44 years (mean age, 31 years). Follow-up time ranged between 3 and 25 months (mean, 21months). Preoperative and postoperative average of nasal tip length was 10.84 (±1.07) mm and 14.32 (±2.34)mm, respectively (P = 0.0214). Preoperative and postoperative average of nasolabial angle was 97.42° (±9.84°) and 107.99° (±12.16°), respectively (P = 0.0344). Preoperative and postoperative average of nasal projection ratio was 0.53 (±0.04) and 0.57 (±0.03), respectively (P = 0.4347). The tip reinforcement flap technique provided strengthening and extra support for themiddle crura and increased definition, projection, and stability to the domal area.

Conclusion: The tip reinforcement flap technique offers advantages for tip plasty in those caseswithmiddle crural deficiency, shortmiddle crura, andmiddle crural weakness. The technique also provides an additional projection, stabilization, and definition to the nasal tip while reducing lateral crural cephalic excess. This technique improves nostril-lobular disproportion and has the advantage of hiding extra support grafted into the folded flap. Complications such as graft visibility, malposition, and asymmetry, which may occur with the use of classic tip grafts, can be eliminated with the tip reinforcement flap technique.

Methods: A retrospective review of reconstructive rhinoplasties performed for saddle nose deformities was conducted. A part of the costochondral graft was carved and thinned (roof graft) for reconstruction of the keystone area and upper lateral cartilages, and another portion was used for making a neoseptal (reconstructed septum) graft and strut graft. The roof graft was capped onto the neoseptal graft with sutures, and this cartilage framework was adapted with fitting the cranial edge of the neoseptal cartilage between the nasal bones. Finally, the strut graft was fixed to the cartilage framework.

Conclusion: A significant improvement in nasal shape and overall appearance was achieved in all cases, and 71.42 percent of patients recovered from nasal obstruction. No gross absorption, graft exposure, or recurrence of deformities was observed.

Surgical correction of a saddle-shaped nose should be an acceptable and uncomplicated technique, and the cosmetic result should be totally acceptable. There are many management options for a saddle-shaped nose. Use of roof grafts (shrunk gull-wing grafts) with neoseptal and strut grafts enables simulation of the internal nasal valve and results in a natural nasal position.

A surgical case, in which inferior dermal flap was used to cover a tissue expander for breast reconstruction, is reported. In spite of the skin necrosis on the seventh postoperative day, flap coverage successfully protected the tissue expander from exposition.

Methods: The malignant melanoma patients treated at the inpatient services of our clinic in the period between January 1991 and April 2017 were screened in the records retrospectively. These patients were evaluated for age, sex, tumor type, Breslow, metastasis, and treatment. Among these patients, 4 cases of unknown primary origin were examined in detail.

Results: During the period between January 1991 and April 2017, 173 patients received inpatient care at our clinic due to malignant melanoma. As regards to the melanoma subtypes, nodular type in 45 patients, acral lentiginous type in 43 patients, superficial spreading type in 63 patients, lentigo maligna melanoma in 15 patients, subungual type in 7 patients, and either unidentified melanoma or other subtypes in 10 patients were identified.

Conclusion: The ideal treatment of a melanoma patient is multidisciplinary, with plastic surgery having a central role.

Methods A retrospective cohort analysis of 87 patients with lower extremity NF was performed to evaluate the management techniques and the amputation and survival rates according to serum lactate and creatinine levels as well as the time between the onset of symptoms and surgery.

Results: The mean time between the onset of symptoms and surgery was 3.7 days. As the time between the onset of symptoms and surgery increased, the rate of amputation and mortality significantly increased (p<0.001). In all, 66% of the mortality in the group was seen among the 12 patients who had a serum creatinine level greater than 2 mg/dL at the time of presentation. In 12 of 14 patients (85.7%) who underwent mputation/disarticulation, the mean serum lactate level was 5.7 mmol/L (range: 5.1-8.7 mmol/L), and the mean serum creatinine level was 1.92 mg/dL (range: 1.4 to.3.3 mg/dL). The high levels of serum creatinine and lactate were found to be statistically significant in terms of predicting mortality and amputation (p<0.001).

Conclusion: Based on the results of this study, it was determined that risk factors for mortality include age, late presentation, increased serum creatinine and lactate levels, and that these factors can predict the rate of death from NF at the time of presentation.

Method: Fifty-two patients hospitalized with pressure ulcer indication were retrospectively analyzed. Age, gender, decubitus ulcer localization, treatment modality, comorbid diseases and postoperative complications were analyzed.

Results: Thirty-five patients were male and 17 were female. The mean age was 50.3 years. The most common accompanying disease was diabetes mellitus and the most common etiology was paraplegia. Pressure ulcers were localized on the sacral area in 45 patients, the ischial area in 23, the trochanteric area in 11 patients, and other parts of the body (scapular, lumbar) in 3 patients. Fasciocutaneous rotation flaps, myocutaneous flaps, and perforator flaps were the most used reconstruction techniques. No major complication was observed.

Conclusion: The most important aspect of pressure ulcers is prevention. Health system costs can be significantly reduced by preventing the development of decubitus ulcers. The progression of pressure ulcers can be easily controlled if the necessary care and treatment is provided early on. The role of the plastic surgeon in the later stages is to perform reconstruction when appropriate and to educate patients and their caregivers to prevent recurrence.

Materials and Methods: A retrospective review of all 528 surgically removed primary skin and soft‑tissue tumors of the hand at our department between 1996 and 2016 was performed.

Results: A total of 528 patients were evaluated in this study. The most common benign tumor of the hand was pyogenic granuloma (24%), and the most common malign tumor of the hand was squamous cell carcinoma (65.2%). Malignant tumors incidence was higher in males, whereas benign tumors incidence was higher in females.

Conclusions: A careful history and physical examination performed by a specialist can narrow down the possibilities regarding the type of tumor. The vast majority of hand tumors tend to be benign. In contrast to skin cancers in general, those occurring on the hand frequently have a worse prognosis, with a greater propensity for recurrence, metastatic spread, and functional deficit.

Methods : Thirteen patients who had depressed scars after tracheostomy are included in this study. The mean patient age was 44 years (range, 27–56 years). All patients who suffered from tracheal tug, dysphagia, and bad appearance are included in the study. The area with the depressed scar is de-epithelialized after incising around the depression. Bilateral SCM muscles are split in the coronal plane toward superior half of the muscle while leaving the posterior part of the muscle attached to the bone. After elevation, both SCMmuscle flaps are overlapped in the midline.

Results: The mean follow-up period of the patients was 11 months (range, 5–20 months). Tracheal tug and dysphagia complaints were resolved in all patients. The depressed area due to the scar was either reduced or completely recovered in all the patients. Apart from 1 hematoma case, none of the early or late complications such as infection, wound dehiscence, skin necrosis, seroma, recurrence, or neck contracture was seen.

Conclusions: We think that this technique, which gives functionally and aesthetically satisfying results, can be used safely in depressed scars formed after tracheostomy and treatment of functional impairment due to this procedure.

Methods: A retrospective review of all surgically excised primary squamous cell carcinoma of the hand operated in our clinic between 2006 and 2011 was included in the study. Patients were evaluated regarding age, anatomic location of the tumor, gender, treatment modality, survival, and recurrence rate. In addition, recurrence and survival rates were also categorized according to the tumor size.

Results: A total of 129 patients were evaluated. Tumors smaller than 2 cm had a recurrence rate of 9.7 % and a metastatic rate of 6.5 %; tumors larger than 2 cm had a recurrence rate of 16.7 % and a metastatic rate of 33 % during 5-year follow-ups.

Conclusion: In contrast to squamous cell carcinoma of the face, those occurring on the hand are malignancies with a worse clinical course, greater tendency for recurrence, metastatic spread, and functional deficiency which might require amputation and complex soft tissue reconstruction.

Introduction: Burn healing is a complicated process and very few treatments can positively alter its effects. The aim of this study was to investigate the effects Salvia miltiorrhiza (SM -Danshen), a traditional Chinese medicine, on burn wound healing.

Materials and methods: Twenty rats were included in this study and divided into two groups. 3 × 2 cm wide burn areas were created in the dorsal skin of all the animals with thermal contact. Intraoral 1 ml/day saline and 1 g/kg/day SM were given in control and experiment groups, respectively. Fourteen days following the burn injury burn zones were evaluated with indocyanine green-SPY imaging device, and multiple samples were collected for histopathological evaluation. Standard photographs were taken for the evaluation of necrotic skin areas.

Results: Neovascularization was increased in the SM group when compared with the control group (p = 0.0406). SPY studies revealed a meaningful increase in the tissue perfusion in the SM group (p = 0.0286). The average amount of necrotic area in the control and experiment group on the postoperative 14th day was 71.6% (±16.51) and 42.5% (±10.64) respectively (p = 0.0002).

Conclusion: Our study shows that SM can decrease the amount of necrosis in burn wounds by increasing tissue perfusion and neovascularization.

Materials and Methods: This retrospective study was conducted the University of Health Sciences; Şişli Hamidiye Etfal Application and Research Center, Departmant of Plastic, Reconstructive and Aesthetic Surgery and the Intensive Burn Care Unit between April 2009 and April 2014. Burns were assessed based on etiology, anatomical location, percentage of total body surface area affected, and depth of injury. Treatment was categorized as conservative, elective operative, or urgent operative.

Results: In the study period, 788 patients were admitted to our Burn Unit. Of these, 240 were females (30.5%) and 548 were males (69.5%). The most common type of burn injury in this study was thermal injury (695 cases; 88.2%), followed by electrical injury (67 cases; 8.5%), and chemical, frictional or unknown injuries (26 cases; 3.3%). Majority (more than 85%) of the patients had second-degree burns, and some had third-degree burns.

Results: Burns commonly affect the hands, and many functional problems may develop if appropriate basic treatments are neglected. The best treatment for burns is prevention. Appropriate indoor arrangement and simple but effective measures that can be taken at home can significantly reduce burn trauma exposure.

Objectives: Composite chondrocutaneous grafts have been used widely for patients with cleft lip nasaldeformity, alar defects, and septal perforations; however, the graft viability can be easily compromised. The aim of the present study was to extend the safe length of the composite chondrocutaneous grafts by enhancement of angiogenesis and re-epithelialization through platelet-rich plasma (PRP) and to investigate the changes that occur when PRP is administered to the graft and the recipient site.

Materials and Methods: Composite grafts of critical sizes (1.5, 2.0, and 2.5 cm) were planned on the rabbit ears on 1 side. Group A consisted of grafts pretreated with PRP, group B consisted of recipient beds pretreated with PRP, and group C was the control group in which defects 1.5, 2.0, and 2.5 cm in size were formed on the right ears of the rabbits. On postoperative day 7, matching size chondrocutaneous grafts were adapted to the defect areas without PRP. In all groups, graft viability was evaluated 7 days after graft adaptation in group C and 14 days after PRP administration in groups A and B. Wound healing was scored histopathologically and immunohistologically using hematoxylin and eosin, CD34, and smooth muscle actin staining. The terminal transferase fluorescein-dUTP nick end labeling assay was performed to quantitatively demonstrate the apoptosis ratio among the groups.

Results: In groups A, B, and C, the mean graft survival of the 2.0-cm equilateral triangle-shaped composite grafts was 65.43% _ 15.7%, 78.12% _ 12.8%, and 41.31% _ 37.4%, respectively (P = .0364).

Conclusions: PRP pretreatment accelerated composite graft survival in the 2.0-cm equilateral triangle grafts by increasing epithelial regeneration and fibrosis, inducing neovascularization, and ameliorating apoptosis rates.

Acquired partial lipodystrophy is a rare disorder, and it is characterized by the absence of subcutaneous fat from the face, the neck, the trunk, and the upper extremities. The etiology of acquired partial lipodystrophy includes scleroderma and discoid lupus erythematosus. Literature review reveals studies involving 10 patients until today with lipoatrophy due to or after the onset of discoid lupus erythematosus; all are female patients. We want to report a young male patient with progressive symmetrical facial lipoatrophy. In addition, he has discoid lupus erythematosus and celiac disease. Fat grafting and adjuvant oral coenzyme Q10 tablets (Deka-none; Deka Pharmaceuticals, Istanbul, Turkey) were administered for treatment. To our knowledge, this case involves the first male patient in the literature presenting with symmetrical facial lipoatrophy with very prominent periorbital lipoatrophy and bitemporal hollowing symptoms.