Background The skin-soft tissue envelope (STE) is a critical component of rhinoplasty and can have a significant impact on the final result. To prevent potential complications related to the skin detachment and to improve rhinoplasty results, we applied the concept of skin contour sutures (SCS). The aim of this study is to assess the efficiency of SCS for nasal skin approximation. Objectives We describe a technique using a SCS which implies the use of external sutures to stabilize the STE flap and is based on the principle that the pressure of the sutures helps to approximate the STE to the underlying nasal skeleton. The clinical use of SCS for nasal skin approximation has minimized nasal edema, shortened the healing period, and improved aesthetic results. Methods The first study group demonstrates the utilization of SCS in 459 consecutive rhinoplasty cases between December 2016 and April 2022 which were retrospectively reviewed. The second study group consists of 30 patients with thick skin who had insertion of SCS with ultrasonic evaluation both preoperatively and postoperatively. Results The average postoperative follow-up period in the first study group was 41 months (range, 12-64 months). Any suture site that was visible after removal of the suture disappeared completely after 6 weeks in most patients. No complications were reported. In the second group our ultrasound data indicated that STE healing was faster as its thickness returns to its preoperative state earlier in the healing process when SCS were used. Conclusions It is our impression that SCS helps to decrease severe nasal edema, hematomas, loss of tip definition, fibrosis, and pollybeak deformity, which improves the results and predictability of rhinoplasty surgery.

Background Camouflage of nasal dorsum, aesthetic augmentation and highlighting the dorsal aesthetic lines are essential elements in modern rhinoplasty. Numerous techniques have been utilized including deep temporal fascia, rectus abdominis fascia, and diced cartilage in fascia (DC-F). Despite their wide spread adoption, technical challenges remained, especially when utilized for aesthetic purposes. Objectives The paper details the use of fascia (F) and diced cartilage in fascia grafts (DC-F) for aesthetic dorsal refinement in primary and secondary cases. One of the main goals was to achieve ideal dorsal aesthetic dorsal lines rather than just volume augmentation. Methods We used grafts from the deep temporalis fascia (F) and rectus abdominis fascia (RF) in 4 configurations: 1) single layer, 2) double layer, 3) full length diced cartilage in fascia grafts (DC-F), and 4) partially filled – segmental DC-F grafts. Technical refinements included careful determination of dimensions and meticulously suturing to the dorsum at appropriately 10 points to prevent graft displacement. Results We report our experience: 146 clinical cases over 35 months from January 2017 to December 2019. The patients were divided for 4 groups depending on which type of graft was used. Conclusions Use of autogenous deep temporal fascia, rectus abdominis fascia, and diced cartilage in fascia (DC-F) to camouflage dorsal irregularities, to highlight dorsal aesthetic lines, and to aesthetically augment either the entire nasal dorsum or its individual parts. Optimization of cutting, stitching, filling the graft, careful fixation of these grafts on the nasal dorsum, significantly increases the predictability of these techniques and minimizes problems.

Background Dorsal augmentation is one of the most challenging procedures in rhinoplasty. Solid grafts and DC-F have been often used for this purpose with varying success. Warping, irregularities, and variability of final height are some of the potential pitfalls. The aim of this study is to assess the efficiency of our approach combining multiple grafts for nasal dorsal augmentation. Objectives We describe a technique using a composite dorsal augmentation that is a combination of a foundation layer using high spreader grafts plus a dorsal gap graft combined with a contour layer of three possible types of fascia or DC-F grafts. Combination of the two layers for the nasal dorsum can be varied to achieve the required height that corrects the patient’s deformity and achieves the desired aesthetic goals. Methods Fifty-one patients underwent dorsal augmentation with composite technique between 2017 and 2020 were retrospectively reviewed. A step-by-step algorithm is applied to achieve the required dorsal height. Results The patients are divided into 3 groups, according to the type of contour graft used to increase the nasal dorsal height: double-layer fascia graft, Segmental DC-F or narrow thin Full-Length DC-F. Smooth continuity and increased projection of the nasal dorsum were achieved in all patients. Conclusions Composite dorsal augmentation is an effective technique for dorsal augmentations requiring 4mm or more of height increase. This technique allows to achieve dorsal augmentation using a combination of grafts from a single donor site together with camouflaging dorsal irregularities and highlighting dorsal aesthetic lines. This algorithm allows optimize greatly the aesthetic profile of our patients.

The patients received radiation therapy 30-36 Gy by standard indications and some CNS prophylaxis by investigator choice. Primary end-point was 2-year event-free survival (EFS). Secondary end-points were overall response (OR) rate, 2-year overall survival (OS), toxicity rates, quality of life (QOL), index of cost-effectiveness (ICE) for each couple of regimens (for the pharmaco-economy analysis). The analysis of direct costs of treatment and Quality-adjusted life years (QALY) was used for calculation of ICE. As an acceptable level of ICE was chosen amount of 20000 US dollars. Results: Four Ukrainian centers recruited 140 patients during the period since January 2014 till Decmber 2016. Final analysis was performed in July 2016. Median age was 53 years. CHOP-like regimens received 53 patients (I group), R-CHOP -60 patients (II group), R-DA-EPOCH -27 patients (III group). Average number of treatment cycles was (5.8 ± 1.7). Radiation therapy received 20 patients (27.0 %), CNS prophylaxis -15 patients (20.3 %). Median FU period was 24.7 months. Groups were comparable by demographic and clinical data, except level of CNS prophylaxis, that was higher in the III group (P = 0,04). 2-year EFS was higher in the III group 86,3 ± 7,5 % vs 64,3 ± 10,4 % in the II group and 42,7 ± 11,4 in the I group (P = 0,045). OR rate didn't differ statistically in three groups, but was higher in the III group. 2-year OS was higher in the III group as well, but not statistically significant. Number of patients, who needed further treatment was 7.4% in the III group, 35.0% -in the II group, 49.1% in the I group (p = 0.001). Anemia was less frequent in the group II (P = 0.04) as well as neutropenia (P = 0.04). Among non-hematological complication significant difference was revealed in the rate of neurotoxicity that was higher in the group III (P = 0,023) and hyperglycemia, that was higher in the group I (P = 0,05).

Background: Multiple myeloma (MM) patients compose approximately 10% of patients with hematological malignancies. Polyneuropathy (PN) is one of the most important complications related to the disease and treatment. Aims: Multiple myeloma (MM) patients compose approximately 10% of patients with hematological malignancies. Polyneuropathy (PN) is one of the most important complications related to the disease and treatment. Methods: A total of 121 MM cases followed in the Hematology Clinic of Atatürk Training and Research Hospital between 2010-2018 were included in the study. Electromyography results were evaluated retrospectively and clinical and laboratory findings were compared. Five cases with diabetes mellitus were excluded from the study. Chi-square method was accepted as statistically significant p < 0.05. Results:The median age of the patients was 64.5 (min 39 max: 88), and Female / Male ratio was 51/65 (44% / 65%). Demographic data of 28 (24.3%) patients with PN and 87 (75.7%) patients without PN were presented in Table 1. Renal function tests were normal in 64 (55.7%) of 87 patients without polyneuropathy (p = 0.005). There were 28 (23%) cases with extramedullary plasmacytoma larger than 1.5 cm which were detected by MR imaging at the time of diagnosis. In cases with extramedullary plasmacytoma, the prevalence of polyneuropathy was higher at the initial diagnosis (p = 0.012).