Double-Layer Reconstruction of the Achilles’ Tendon Using a Modified Lindholm’s Technique and Vascularized Fascia Lata
Loss of the Achilles’ tendon with overlying soft tissue and skin defects remains a
complex reconstructive challenge. Herein we present our experience using a free
composite anterolateral thigh (ALT) flap with vascularized fascia lata and a modified
Lindholm’s technique to repair the Achilles’ tendon. A 37-year-old man suffered from
tertiary Achilles’ tendon rupture. For reconstruction, the free composite ALT flap with
vascularized fascia lata was used to wrap Achilles’ tendon. A modified Lindholm’s
technique was used to cover overlying soft tissue defects. The patient was followed up
for 12 months. No wound healing problems were reported, and the patient was able to
walk and return to his daily ambulating activities without any support after 5 months
postoperatively. This technique may be useful to achieve satisfactory outcomes in
patients with ruptured Achilles’ tendons following tertiary repair.
Using Human Hair as Suture Material in Microsurgical Practice
For practice in microsurgery, animal models and microsurgical instruments are
required. The use of some synthetic and non-animal materials such as human placenta
and other tissues have also been suggested for practicing. The other material that is
needed is microsuture. These materials are expensive and often not easily obtained. To
meet this requirement, the authors present human hair as a microsuture material for microsurgical practice.
A Comparison of the Effects of Veau-Wardill-Kilner Palatoplasty and Furlow Double-Opposing Z-Plasty Operations on Eustachian Tube Function
Objective: The purpose of this study was to compare the effects of VeauWardill-Kilner (VWK) two-flap palatoplasty and Furlow double-opposing Z-plasty operations on eustachian tube (ET) opening in patients with cleft palate (CP).
Design: Twenty-six patients underwent CP repair between 1993 and 1997.
VWK and Furlow operations were used in 13 patients each. All patients were
examined by the otorhinolaryngologist before and after the operations; mean
follow-up time was 27.3 months. Secretory otitis media (SOM), as identified by
tympanograms, was the comparison criterion used.
Results: The prevalence of SOM was 69% (n 5 18) in all CP patients preoperatively. Among those with preoperative SOM, we did not find any statistically significant difference in the frequency of postoperative SOM between
the two techniques.
Conclusion: This study suggests that there is no difference in postoperative
ET function between patients undergoing either VWK or Furlow operations, in
spite of the differences in muscle positioning in these operations. We discuss
the implications of this finding in relation to surgical anatomy and histology
of the soft palate muscles
Rekonstrüktif Mikrocerrahide Algoritma
Plastik cerrahide onarım (rekonstrüksiyon) algoritması sorunun küçük yada büyük ve basit yada karmaşık ve eşlik eden başka patolojinin var olup olmamasına bağlı olarak geniş tabanında primer onarım, basamaklarında sekonder iyileşme, greftle veya lokal fleplerle onarım ve tepesinde uzak (serbest) doku aktarımları (free flap) olan bir piramid ile temsil edilir. Aşağıdan yukarıya doğru ilerledikçe zorluk derecesi artar, daha fazla skar ve donör alan morbiditesi oluşur. Alt basamağında yara taze iken basit dikişlerle kapatmanın yer aldığı bu rekonstrüksiyon piramidinin en üst basamağında yer alan serbest damarlı (vaskülarize) doku nakilleri mikrocerrahi tekniği gerektirir. Mikrocerrahinin öğrenme eğrisi uzun süreçli ve zahmetlidir. Damar ve sinirlerin uç-uca veya uç-yan ağızlaştırılmaları (anastomoz) ve perforatör flep ve pedikül disseksiyonları için büyütmeli cerrahi gözlük (loupe) veya ameliyat mikroskopları kullanılır.