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    Neurovascular anatomy of pronator quadratus for reanimation of blepharoptosis
    (Springer France, 2022) İğde, Murat; Yilmaz, Mehmet; Güngör, Yiğit; Sağlam, Murat Enes; Salman, Necati; Tapan, Mehmet; Cömert, Ela
    Purpose Pronator quadratus (PQ) is a quadrilateral muscle on a volar distal side of the forearm. The purpose of this study was to establish a novel surgical technique for reanimation of the upper eyelid for severe ptosis using PQ functional free muscle flap. Methods The current study is a cadaveric study, designed to assess a PQ free flap transfer that lies between the frontalis muscle and the upper eyelid. Fourteen PQ from fourteen embalmed cadavers were dissected, and their neurovascular pedicles were isolated. Then they were transferred to the area on the contralateral side between the frontalis muscle and upper eyelid tarsal cartilage. Measurements of the PQ flap, antebrachial region, orbitofrontal region, recipient vessels, and motor nerve were performed using a caliper. The extendibility of neurovascular pedicles was evaluated by measurements of lengths. In addition, the diameter of PQ flap vascular pedicle vessels was compared with recipient vessels. Results The mean width of the proximal border of PQ was 41.92 +/- 2.05 mm and the distal border of the PQ was 42.84 +/- 4.04 mm. The mean PQ artery (type II, Mathes-Nahai flap classification) length was found to be 117.72 +/- 7.77 mm. The mean diameter of the anterior interosseous nerve was 1.89 +/- 0.08 mm. The mean diameter of the uppermost branch of the frontal branch of the facial nerve was 1.18 +/- 0.25 mm. The length and diameter of neurovascular pedicles of muscle flaps were adequate for microvascular anastomoses and neurorrhaphy. Conclusions The results of this anatomical study demonstrate that the PQ free flap transfer has anatomical features that are suitable and compatible with the surgical treatment of blepharoptosis.
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    Repeated tissue expansions on solit-thickness skin graft in a patient with neurocutaneous syndrome
    (Lippincott Williams & Wilkins, 2007) Canter, Halil İbrahim; İğde, Murat; Vargel, İbrahim; Özgür, Figen
    Soft tissue expansion is a mechanical process that increases the surface area of local tissue available for reconstructive procedures. In most cases, adjacent tissue that matches the recipient site in color, texture, and hair-bearing quality is preferred for tissue expansion. In this particular case with neurocutaneous syndrome, the defects that resulted from removal of parts of a giant hairy nevus overlying the latissimus dorsi muscle bilaterally were grafted with a split-thickness skin graft. Two expanders were then placed under the latissimus dorsi muscles. After full expansion of the grafted area, some part of the remaining nevus surrounding the grafted area was removed and the defects were covered with the expanded skin graft obtained after deflation of the expanders. The expanders placed under the latissimus dorsi muscle in the first operation were reused in the second operation to obtain a second expansion of the skin graft. After the second expansion of the skin graft, the expanders were deflated and another portion of the remaining nevus surrounding the grafted area was removed. The resulting defects were again covered with the excess expanded skin graft. Although repeated expansion of the skin graft is a time-consuming and laborious process, it eliminates the need for taking repeated skin grafts; it decreases skin graft donor site morbidity; it decreases possible infectious complications of tissue expansion by decreasing the number of surgical interventions to the expander pocket; and it increases the aesthetic outcome by keeping all the surgical scars around the grafted Area without extending them into healthy surrounding skin.