Gluteal artery perforator flaps have gained popularity due to reliability, preservation of the muscle, versatility in flap design without restricting other flap options, and low donor-site morbidity in ambulatory patients and possibility of enabling future reconstruction in paraplegic patients. But the inconstant anatomy of the vascular plexus around the gluteal muscle makes it hard to predict how many perforators are present, what their volume of blood flow and size are, where they exit the overlying fascia, and what their course through the muscle will be. Without any prior investigations, the reconstructive surgeon could be surprised intraoperatively by previous surgical damage, scar formation, or anatomic variants.For these reasons, to confirm the presence and the location of gluteal perforators preoperatively we have used color Doppler ultrasonography. With the help of the color Doppler ultrasonography 26 patients, 21 men and 5 women, were operated between the years 2002 and 2007. The mean age of patients was 47.7 (age range: 7-77 years). All perforator vessels were marked preoperatively around the defect locations. The perforator based flap that will allow primary closure of the donor site and the defect without tension was planned choosing the perforator that showed the largest flow in color Doppler ultrasonography proximally. Perforators were found in the sites identified with color Doppler ultrasonography in all other flaps. In our study, 94.4% flap viability was ensured in 36 perforator-based gluteal area flaps. Mean flap elevation time was 31.9 minutes. We found that locating the perforators preoperatively helps to shorten the operation time without compromising a reliable viability of the perforator flaps, thus enabling the surgeon easier treatment of pressure sores.

Surgical treatment is extremely difficult with the combined defects of skin, cartilage, and nasal mucosa. Besides efforts geared toward ascertaining the best aesthetic outcome, an important concern is restoring normal nasal function. This can be achieved only by providing sufficiently and anatomically adapted cartilage and bone support, followed by covering the inner part using tissue closely resembling mucosa and the outer part using skin compatible with the surrounding skin. The surgical technique for three-dimensional nasal reconstruction in the first session of this study involved placing a silicon sheet between the skin and galea, which allowed two separate flaps to be obtained for the next session without vascular damage. For the epithelialization of the defect on the nasal surface, the lower surface of the galea was prefabricated with a thin skin graft obtained from the thigh. In this way, nasal mucosa cover was ensured. The expander placed under all these structures thinned them down to a thickness close to that of nasal skin and mucosa and also enabled primary closure of the donor area. Thus, the defect that emerged during the second session in cartilage framework was repaired by cartilage grafts taken from the nasal septum. The mucosal surface and skin part then could be closed with two separate flaps. The forehead flap used in this technique enabled production of an aesthetically and functionally satisfactory outcome by providing an anatomically sufficient amount of nasal skin and nasal mucosa for whole-layer wide nasal defects in only three sessions without necessitating an additional flap.

There are many ways to provide soft-tissue coverage of silicone breast implants in breast reconstruction. These include acellular dermis slings, polyglycolic mesh, deepithelialized skin, and muscle. The ideal soft-tissue cover would be supple, easily harvested, of minimal morbidity, of minimal cost, and preferably autologous. We feel that the technique described here has these qualities and allows for complete coverage of silicone implants. An additional benefit of this technique is that it helps to increase the definition of the inframammary sulcus. This method is a good alternative in providing implant coverage during breast reconstruction, especially when there is a large implant or small pectoralis major muscle.

The clinical hallmark of asymmetric crying facies (ACF) is a symmetric appearance of the oral aperture and lips at rest, but significant depression of one side of the lower lip with animation (crying or smiling). ACF can resolve spontaneously in the first year of life, but surgical intervention may be required at some point to ensure a good cosmetic outcome. The authors report on the successful use of botulinum toxin type A to achieve temporary facial symmetry in two children with ACF with results lasting up to six months and suggest that such treatments may be helpful in providing more time to consider and/or plan surgical intervention.

As the authors have shown in the present study, ADSCs have favorable effects on the viability of composite grafts. They have increased the survival rate of the grafts to a considerable extent. As a clinical implication of this experimental study, the authors think that in the patient of auricular and nasal defects involving the cartilage and the skin, injection of the ADSC and the adaptation of composite grafts 4 days after the preparation of the receiving bed may increase the composite graft viability rates. Thus, it has been found that if the composite grafts are implanted 4 days after stem cell injection, the injection of adipose tissue-derived mesenchymal stem cells is useful in enhancing the survival of composite grafts.