The most common anatomic variant seen in donor kidneys for renal transplantation is the presence of multiple renal arteries, which can cause an increased risk of complications. Accessory renal arteries should be anastomosed to the proper source arteries to improve renal perfusion via the appropriate vascular reconstruction techniques. In microsurgery, 2 kinds of vascular augmentation methods, known as ‘supercharging’ and ‘turbocharging,’ have been introduced to ensure vascular perfusion in the transferred flap. Supercharging uses a distant source of the vessels, while turbocharging uses vascular sources within the same flap territory. These technical concepts can also be applied in renal transplantation, and in this report, we describe 2 patients who underwent procedures using supercharging and turbocharging. In one case, the ipsilateral deep inferior epigastric artery was transposed to the accessory renal artery (supercharging), and in the other case, the accessory renal artery was anastomosed to the corresponding main renal artery with a vascular graft (turbocharging). The transplanted kidneys showed good perfusion and proper function. No cases of renal failure, hypertension, rejection, or urologic complications were observed. These microsurgical techniques can be safely utilized for renal transplantation with donor kidneys that have multiple arteries with a lower complication rate and better outcome.
Arteries ; Epigastric Arteries ; Humans ; Hypertension ; Kidney ; Kidney Transplantation* ; Microsurgery ; Perfusion ; Reconstructive Surgical Procedures ; Regional Blood Flow ; Renal Artery ; Renal Insufficiency ; Tissue and Organ Harvesting ; Tissue Donors ; Transplants

PURPOSE: Soft tissue coverage of the distal leg and ankle region represents a surgical challenge. Beside various local and free flaps, the perforator flap has recently been replaced as a reconstructive choice because of its functional and aesthetic superiority. Although posterior tibial artery perforator flap (PTAPF) has been reported less often than peroneal artery perforator flap, it also provides a reliable surgical option in small to moderate sized defects especially around the medial malleolar region. MATERIALS AND METHODS: Seven consecutive patients with soft tissue defect in the ankle and foot region were enrolled. After Doppler tracing along the posterior tibial artery, the PTAPF was elevated from the adjacent tissue. The average size of the flap was 28.08±9.31 cm² (range, 14.25 to 37.84 cm²). The elevated flap was acutely rotated or advanced. RESULTS: Six flaps survived completely but one flap showed partial necrosis because of overprediction of the perforasome. No donor site complications were observed during the follow-up period and all seven patients were satisfied with the final results. CONCLUSION: For a small to medium-sized defect in the lower leg, we conducted the close-by islanded PTAPF using a single proper adjacent perforator. Considering the weak point of the conventional propeller flap, this technique yields much better aesthetic results as a simple and reliable technique especially for defects of the medial malleolar region.
Ankle* ; Arteries ; Follow-Up Studies ; Foot ; Free Tissue Flaps ; Humans ; Leg ; Necrosis ; Perforator Flap* ; Surgical Flaps ; Tibial Arteries* ; Tissue Donors

PURPOSE: Pollicization typically involves surgical migration of the index finger to the position of the thumb. This procedure facilitates the conversion of a useless hand into a well-functioning one in patients who are not amenable to the toe-to-hand transfer. However, middle finger pollicization has been rarely reported. MATERIALS AND METHODS: We reconstructed a thumb by immediate pollicization of the remnants of the middle finger in two patients who sustained a tumor and a trauma, respectively. The former, after cancer ablation was performed, has not been reported literally, and the latter involved free devitalized pollicization of the middle finger using a microsurgical anastomosis. The distal third extensor communis tendon was sutured to the proximal extensor pollicis longus tendon and the distal flexor digitorum superficialis and profundus were sutured to the proximal flexor pollicis longus. The abductor pollicis brevis tendon was sutured to the distal end of the first palmar interosseous muscle. Coaptation of the third digital nerve and the superficial radial nerve branch was performed. RESULTS: Patients showed uneventful postoperative courses without complication such as infection or finger necrosis. Based on the principles of pollicization, a wide range of pinch and grasp movements was successfully restored. They were pleased with the functional and cosmetic results. CONCLUSIONS: Although the index finger has been the digit of choice for pollicization, we could also use the middle finger on specific occasions. This procedure provides an excellent option for the reconstruction of a mutilated thumb and could be performed advantageously in a single step.
Fingers* ; Hand ; Hand Strength ; Humans ; Necrosis ; Radial Nerve ; Tendons ; Thumb

The absence or disfigurement of the umbilicus is both cosmetically and psychologically distressing to patients. The goal of aesthetically pleasing umbilical reconstruction is to create a neoumbilicus with sufficient depth and good morphology, with natural-looking superior hooding and minimal scarring. Although many reports have presented techniques for creating new and attractive umbilici, we developed a technique that we term the "four flaps technique" for creating a neoumbilicus in circumstances such as the congenital absence of the umbilicus or the lack of remaining umbilical tissue following the excision of a hypertrophic or scarred umbilicus. This method uses the neighboring tissue by simply elevating four flaps and can yield sufficient depth and an aesthetically pleasing shape with appropriate superior hooding.
Abdominal Wall ; Abdominoplasty ; Cicatrix ; Humans ; Umbilicus

BACKGROUND: Glomus tumors were first described by Wood in 1812 as painful subcutaneous tubercles. It is an uncommon benign neoplasm involving the glomus body, an apparatus that involves in thermoregulation of cutaneous microvasculature. Glomus tumor constitutes 1%-5% of all hand tumors. It usually occurs at the subungual region and more commonly in aged women. Its classical clinical triad consists of pain, tenderness and temperature intolerance, especially cold sensitivity. This study reviews 15 cases of glomus tumor which were analyzed according to its anatomic location, surgical approach and histologic findings. METHODS: Fifteen patients with subungual glomus tumors of the hand operated on between January 2006 and March 2013, were retrospectively reviewed. Patients were evaluated preoperatively with standard physical examination including ice cube test and Love's test. Diagnostic imaging consisted of ultrasonography, computed tomography, and magnetic resonance imaging. All procedures were performed with tourniquet control under local anesthesia. Eleven patients underwent excision using the transungual approach, 3 patients using the volar approach and 1 patient using the lateral subperiosteal approach. RESULTS: Total of 15 cases were reviewed. 11 tumors were located in the nail bed, 3 in the volar pulp and 1 in the radial aspect of the finger tip. After complete excision, patients remained asymptomatic in the immediate postoperative period. In the long term follow up, patients exhibited excellent cosmetic results with no recurrence. CONCLUSIONS: Accurate diagnosis should be made by physical, radiologic and pathologic examinations. Preoperative localization and complete extirpation is essential in preventing recurrence and subsequent nail deformity.
Anesthesia, Local ; Body Temperature Regulation ; Congenital Abnormalities ; Diagnosis ; Diagnostic Imaging ; Female ; Fingers ; Follow-Up Studies ; Glomus Tumor* ; Hand* ; Humans ; Ice ; Magnetic Resonance Imaging ; Microvessels ; Physical Examination ; Postoperative Period ; Recurrence ; Retrospective Studies ; Tourniquets ; Ultrasonography ; Wood

The reconstruction of recurrent pressure sores is challenging due to a limited set of treatment options and a high risk of flap loss. Successful treatment requires scrupulous surgical planning and a multidisciplinary approach. Although the tensor fascia lata flap is regarded as the standard treatment of choice-it provides sufficient tissue bulk for a deep trochanteric sore defect-plastic surgeons must always consider the potential of recurrence and accordingly save the second-best tissues. With the various applications of anterolateral thigh (ALT) flaps in the reconstructive field, we report two cases wherein an alternative technique was applied, whereby pedicled ALT fasciocutaneous island flaps were used to cover recurrent trochanteric pressure sores. The postoperative course was uneventful without any complications. The flap provided a sound aesthetic result without causing a dog-ear formation or damaging the lower-leg contour. This flap was used as an alternative to myocutaneous flaps, as it can cover a large trochanteric defect, recurrence is minimized, and the local musculature and lower-leg contour are preserved.
Fascia Lata ; Femur* ; Myocutaneous Flap ; Perforator Flap ; Pressure Ulcer* ; Recurrence ; Surgical Flaps ; Thigh*

The microscope is a surgical instrument with wide use in plastic surgeries more often than other departments due to the high rate of microscopic surgeries. Unfortunately, because the microscope is used mainly for digital replantations and free flaps, the utilization rate is low compared to the price and usability of the microscope itself. From September 2013 to March 2014, a foreign body which was untraceable with radiology in a patient who desired surgical exploration (one case), and a foreign body which was detected but was smaller than 3 mm (two cases) were removed using the microscope. All foreign bodies, which were fish bone, thin metals, or wooden objects, matching the history of the patients, were completely removed without damage. There were no complications and patient satisfaction was high through follow-up. We have described the microscope as the last and optimal examination tool in removal of micro foreign bodies. A simple change of thought, so that the microscope can be used as a second diagnostic tool will decrease complications by foreign bodies.
Follow-Up Studies ; Foreign Bodies* ; Free Tissue Flaps ; Humans ; Metals ; Microscopy ; Patient Satisfaction ; Replantation ; Surgical Instruments

No abstract available.
Lymphangioma*

Ganglion cyst is the most common benign tumor arising from the hand and wrist. Rarely, they are found within the tendon. To date, only 10 cases in English papers and 7 cases in domestic papers on ganglion cysts in extensor digitorum tendons have been reported. Due to the rarity of this entity, it is difficult to suspect intratendinous ganglion fully based on the physical examination. Accordingly, preoperative studies such as ultrasonography, magnetic resonance imaging are recommended when suspicious result is revealed on the physical examination. Treatment should include en bloc resection of the affected tendon to reduce recurrence. But functional loss always has to be considered. This study reports two cases of intratendinous ganglion cysts that arised from the second and fourth extensor digitorum tendon.
Ganglion Cysts* ; Hand ; Magnetic Resonance Imaging ; Physical Examination ; Recurrence ; Tendons* ; Ultrasonography ; Wrist

No abstract available.
Foot* ; Hand* ; Tendons*