EAR LOBE RECONSTRUCTION WITH A POSTERIOR EAR FLAP: Case reports

We describe a technique for reconstruction of the ear lobe. Although there are many procedures that aim to reconstruct the ear lobe naturally, the aesthetic results of using a posterior ear flap are better because the scar tissue that remains behind the ear is invisible.     

Type A intramural hematoma presenting with acute right heart failure caused by compression of the main pulmonary artery: a case report

Pulmonary artery obstruction is a rare complication of intramural hematoma of the ascending aorta. There were few reported cases presenting with right heart failure due to compression of the pulmonary trunk by intramural hematoma of the aorta.     

Effect of high-energy extracorporeal shock waves on the immature epiphysis in a rabbit model

Introduction We investigated the effect of high-energy extracorporeal shock wave (ESW) on immature tibial epiphysis in a rabbit model. Materials and methods Twenty New Zealand white immature rabbit were used in this study. Animals were divided into two groups and they received 14 kW, 0.6 mJ/mm², 1,500 or 3,000 shots for three times with an interval of 7 days. After 6 weeks all rabbits were killed. The all tibia epiphysis were assessed by histology. The epiphyseal plaque thickness of right tibiae of the 3,000-shot ESW group was significantly higher than those of the 1,500-shot ESW group and the left tibia epiphyses of the 1,500- and 3,000-shot ESW groups as controls (P < 0.05). Results The epiphyseal plaque thickness of right tibiae of the 1,500-shot ESW group was significantly higher than that of the left tibia epiphyses of the 1,500- and 3,000-shot ESW groups as controls (P < 0.05). Discussion We demonstrated that high-energy ESW stimulated the growth of immature rabbit epiphysis. The long-term effect of shock wave on the immature rabbit epiphysis deserves further study.     

Extreme complications of Fixion nail in treatment of long bone fractures

The authors present their experience related to extreme complications in treatment of diaphyseal fractures of the long bones with application of the Fixion expansion intramedullary nail in a total of 48 surgeries. We have encountered six (12.5%) extreme complications in the management of fractures of 3 humeral, 2 tibial, and 1 femoral bones during its application procedure and postoperative follow-up. Of six cases, two with humeral and tibial fractures developed nonunion and rotational instability because of failure of inflation of the Fixion nail. One of the Fixion nail in humerus was broken spontaneously, and one of the Fixion nail deflated at the follow-up and pseudoarthrosis developed in this patient. In a patient with osteogenesis imperfecta, during the inflation of the nail for the treatment of femur fracture, a new longitudinal fracture occurred and conventional non-locking intramedullary nail was inserted. In a patient with a tibia fracture that was treated with the Fixion nail, new fracture occurred due to its bending after weight bearing in the postoperative period. The Fixion nail application is a new technique for the intramedullar fixation of long bones. It is considered as an effective method for the selective fracture types of long bones. Application may need special training. Since the Fixion has not got rotational stability and rigidity as conventional nailing systems, bending and breaking of the nail may occur during postoperative period in patients with over obesity and hyperactivity. In patients with osteogenesis imperfecta, it may not be the first choice as a nailing system.     

Osteomusculocutaneous flap for clavicular reconstruction: a case report

Radiotherapy for tumors can cause soft tissue necrosis, osteonecrosis, and pathologic fractures. A 47-year-old woman presented with a pathologic fracture of the left clavicle 10 years after radiotherapy following radical mastectomy for breast cancer. She was treated with a compound rib-latissimus dorsi osteomusculocutaneous flap with a 4-cm segment of the sixth rib. Fusion of the bones was achieved in three months. Donor site morbidity was cosmetically acceptable and function of the shoulder was improved. The Constant shoulder score which was 36 preoperatively increased to 88 after 38 months of follow-up.     

GGT levels in type II diabetic patients with acute coronary syndrome (does diabetes have any effect on GGT levels in acute coronary syndrome?)

Elevated gamma-glutamyltransferase (GGT) level is independently correlated with conditions associated with increased atherosclerosis, such as obesity, elevated serum cholesterol, high blood pressure and myocardial infarction. It is demonstrated that serum GGT activity is an independent risk factor for myocardial infarction and cardiac death in patients with coronary artery disease. Diabetes is also a well-known cardiovascular risk factor and an equivalent of coronary artery disease. Although the relationship between GGT and coronary artery disease has been reported, there are limited data exploring the changes of GGT in acute coronary syndromes, especially in patients with diabetes. So, this study aimed to determine changes in GGT level in diabetic and non-diabetic acute coronary syndromes. This trial was carried out at Kosuyolu Cardiovascular Training and Research Hospital and Van Yuksek Ihtisas Hospital, Turkey. A total of 219 patients (177 men and 42 women) presenting with acute coronary syndrome) and 51 control subjects between September 2007 and September 2008 were included in the study. Serum γ-glutamyltransferase and serum lipoprotein levels were determined. The resuls indicated that serum GGT levels were higher in acute coronary syndrome patients compared with control. In subgroup analyses, there was no difference between diabetic and non-diabetic subgroups. There was also weak correlation between GGT and blood glucose levels. There was no correlation between GGT and serum lipoprotein levels. In conclusion, serum GGT levels were higher in acute coronary syndrome patients. In subgroup analyses, There was no difference between diabetic and non diabetic subgroup.