The DAP flap is a reliable, free-style perforator flap that can be used for all types of fingertip injuries.

Microsurgery is a valuable discipline performed in many surgical practices. In literature, hundreds of studies dealing with different aspects of microsurgical practice including studies about new agents for anastomosis, different suturing materials and methods plus new models for surgical training, etc., 1-3 have been published. However, not much attention has been given to the newly developed microsurgical equipments. For decades, traditional clamps, microporteques, forceps, dilatators, and approximators have been slightly modified. [4][5][6][7][8] To bring a new dimension to this field, an interesting and a useful microvascular approximator which will be hopefully attractive for the microsurgeons, particularly for the beginners has been designed.The device is a simple, regular 1.8 cm double-microclamp based on a rectangular light green plate, which provides a complementary underground. There are three L-shaped flexible rods hinged on the base at 08, 908, and 1808. These rod ends have curved ends which help to hold sutures inside (Fig. 1). In addition, the main trunk of the double clamp is fixed to the base with two independent joints which enables the vessel in the clamps to move back and forth, up and down without distortion. This two way action of the approximator maintained by the simple double-joint system also prevents the vessel from getting out of the operative field when the vessel is rotated around itself (Fig. 2).Initially, distal and proximal ends of the vessel are identified. Routine steps like irrigation, dilatation, and adventitia removal are done as usual. After that, to place the vessel ends on the plate, third mobile rod, which is on the top is deplaced from its original position (Fig. 2a). First suture is placed at 08 and the suture is left long to be attached to the rod 1. Next suture is placed 1808 away from the first, and is attached to rod 2 in the same manner. Third suture is placed in the middle of previous sutures (908). After this step, the mobile rod (rod 3) is approximated to the top of the field and is connected to the 908 suture. This gives the vessel a tent-like shape where the back wall can be easily seen (Fig. 2b). Successive sutures are placed in between these stay sutures according to the vessel size and thus the front wall suturing is over now.Afterwards, first and second sutures which were attached to rods 1 and 2, respectively, are de-attached without cutting. However, the third suture connected to rod 3 is cut short and removed from the operative field (Fig. 3). Later, the double microclamp system is turned upside down with the help of the two-joint mobile system which prevents vessel distortion. Hence, the back wall can be clearly visualized (Fig. 2c). Zero and 1808 long suture ends are again attached to rods 1 and 2, respectively. Two hundred seventy degree suture is placed and as before, the third mobile rod is brought to the field for attachment. Other sutures are placed as described above. After carrying out these steps successfully, all the sutures are cut short, rod...

Conchal cartilage and temporal fascia grafts are useful materials for secondary rhinoplasty cases. Generally, surgeons require to access autologous grafts fast and effortlessly. Harvesting 2 different types of graft, such as cartilage and fascia, however, are associated with limitations, such as additional surgery time, extra incisions, and postoperative additional distortions at the graft-host interface. The authors evolved a modified single incision that would harvest conchal cartilage and temporal fascia simultaneously by using 4 mm endoscope and 3 mm angled phaco slit knife.

Obstructive sleep apnea is a difficult problem to deal with. Many studies on the pathogenesis of obstructive sleep apnea were performed in the past, and we present cervical lipohypertrophy causing severe obstructive sleep apnea in this article.

The preoperative performed limited adventitiectomy is a useful preparation for super microsurgery. Especially in clinical practice before the free flap surgery, limited adventitiectomy can be applied if the recipient site is expected to have vascular problems.