No abstract

Epidermolysis bullosa (EB) is a progressive familial disorder composed of dermal mucosal blisters, flexion contractures and pseudosyndactylies. Flexion contractures and pseudosyndactyly can be treated with surgery but usually require skin grafting. Because of poor wound healing, skin graft harvesting is a challenge in these patients. In order to prevent donor-site morbidities due to skin graft harvesting some alloplastic materials were introduced. In this study, we focused on Suprathel(®) as a new allograft material for covering the skin defects of a patient with dystrophic EB.

A cadaver model was used for microvascular training as nonviable biologic model. Twenty-four fixed and 2 fresh adult cadavers were used for microvascular training. The radial artery, ulnar artery, and cephalic vein of the forearm were preferred. Respectively, end-to-end, end-to-side, and end-on-side microanastomosis techniques were performed.A cadaver model has several advantages over other training models. There are numberless vessels to perform different techniques for microvascular anastomoses. Several students can simultaneously work on the same cadaver at the same time. In addition, there is the opportunity of working on vessels of different sizes and diameters.The same conditions on the cadaver can be created before operation, and effective presurgical microvascular practice can be performed. A free-flap dissection can be easily performed to get experience before clinical operations. Furthermore, it may be combined with live animal models.

There are few local nasal flap options for repair of proximal nasal defects. Absence of suitable donor sites and the large dimensions of the defects limit the use of local nasal flaps in this region. Regional paranasal flaps may not be suitable in these cases because of color, texture, and donor-site scars. The composite procerus muscle and nasal skin flap, which is vascularized by the dorsal nasal branch of the angular artery, can be a useful treatment modality for proximal nasal reconstruction. Seven patients were successfully treated using the composite nasal flaps. The maximal size of the defects was 2.4 cm. In one case, the composite nasal flap was readvanced to close a new defect resulting from reexcision. The composite nasal flap has several advantages in reconstruction of proximal nasal defects. Reconstruction is performed with the same tissue and the donor defect is closed primarily. The composite nasal flap can be moved in multiple directions and has great mobility to reach every point of the proximal part of the nose with axial blood supply. Furthermore, it can be easily readvanced without additional morbidity in case of reexcision.