As in many other countries, burn injuries are a challenging healthcare problem in Turkey. Initial management of burn patients is very important for future morbidity and mortality. Therefore, the Turkish Ministry of Health prepared "National Burns Treatment Algorithm" aided by the Scientific Burns Council. The basic aim of this algorithm is to guide physicians in the treatment of burn victims until they reach an experienced burns center. The content of this algorithm is first aid, initial management, resuscitation, and transfer policy. The Council started to work on this algorithm in 2011. Various consultants, including general surgeons, pediatric surgeons, aesthetic, plastic and reconstructive surgeons, anesthesiologists, and intensive care physicians, revised the first draft and it was sent to eight education and research hospitals of the Ministry of Health, four universities, and seven non-governmental organizations. In the last quarter of 2012, the algorithm was finalized and approved by the Scientific Council, after which, it was approved by the Ministry of Health and published.

A new paraumbilical-based pedicled abdominal flap was used in 11 patients with extensive soft-tissue defects of the forearm and hand. With a relatively narrow pedicle, large flaps up to 5- x 14-cm can be raised. Another advantage of this flap is the comfortable position of the hand and forearm for the patient. The main disadvantage is the conspicuous abdominal scars like the other pedicled abdominal flaps.

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Objective Unoperated bilateral complete cleft lip and palate in an adult or elderly patient is seen rarely, and the existence of unoperated clefts is a result of unfavorable economic and social circumstances. We report an unoperated 65-year-old patient with bilateral complete cleft lip and palate and present our preference for the surgical management. Interventions Repair of the bilateral complete cleft lip and palate was successfully carried out using straight-line closure for the bilateral cleft lip and two-flap pushback palatoplasty with superiorly based lateral port control pharyngeal flap for the wide cleft palate at the first stage, and large residual anterior palatal fistulas were closed using bilateral superiorly based (retrograde flow) full-thickness nasolabial island flaps at the second stage. Conclusions To our knowledge based on a review of the literature, this is the first report of an elderly patient with bilateral complete cleft lip and palate and the first application of bilateral superiorly based (retrograde flow) full-thickness nasolabial island flaps for closure of large residual anterior palatal fistulas or alveolar clefts. The bilateral superiorly based (retrograde flow) full-thickness nasolabial island flap may be a good solution in large anterior palatal defects using unilaterally or bilaterally in a single stage with minimal donor site morbidity, in which there is not enough tissue for local repair or if previous attempts are unsuccessful.

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