Süleyman Çeçen

Background: Soft tissue defects around the knee remain a reconstructive challenge because of limited local tissue availability, exposure of vital structures, and the need to preserve joint function. Previous anatomical studies and small clinical reports have described the superior lateral genicular artery perforator (SLGAP) flap, but evidence guiding selection among propeller, bilobed, and keystone configurations remains limited. This report describes clinical outcomes in a retrospective series of predominantly anterior and lateral knee soft tissue defects and explores configuration selection in relation to defect size, geometry, and location. Methods: A retrospective review was performed of consecutive patients who underwent reconstruction using an SLGAP flap between January 2017 and December 2025. Perforators were mapped preoperatively using handheld or color Doppler ultrasonography. According to defect size, geometry, location, and required flap mobility, the flaps were designed in propeller, bilobed, or keystone configurations. Flaps were elevated in the subfascial plane with preservation of the identified perforator, mobilized and transferred without excessive tension or pedicle compression, and inset after clinical confirmation of adequate perfusion. Patient demographics, defect characteristics, flap design, postoperative complications, flap survival, and clinical outcomes were analyzed. Ambulatory status was recorded from routine subjective clinical assessment; no standardized functional outcome instrument was used. Results: Fifteen patients underwent reconstruction with an SLGAP flap. Mean defect dimensions were 6.9 × 5.7 cm (length range, 4–15 cm; width range, 3–10 cm), and defects were located in the anterior patellar ( n = 9), lateral patellar ( n = 5), and medial patellar ( n = 1) regions. Mean flap dimensions were 14.7 × 7.0 cm (length range, 6–25 cm; width range, 5–10 cm); 10 propeller, four bilobed, and one keystone flap were used. Trauma was the most common etiology ( n = 9), followed by electrical burns ( n = 2), tumor resection ( n = 2), radiation necrosis ( n = 1), and prosthesis exposure ( n = 1). Initial defect coverage was achieved in all patients, with no early total flap loss. Marginal necrosis occurred in two patients and transient venous congestion in one; these complications resolved without further reconstruction. One patient developed delayed total flap necrosis approximately 5–6 days after surgery and underwent secondary reconstruction with a lateral gastrocnemius muscle flap. Among the 13 patients with available follow‐up data, mean follow‐up was 17.4 months (range, 2–72 months). Stable wound coverage was maintained in 14 of 15 patients, with no major donor‐site complications. All 15 patients were documented as ambulatory during postoperative care based on routine subjective clinical assessment; however, knee range of motion, gait, and functional status were not assessed using standardized instruments. Conclusions: In this retrospective series, SLGA perforator flaps were used to reconstruct predominantly anterior and lateral knee soft tissue defects in propeller, bilobed, and keystone configurations. Stable wound coverage at the latest available follow‐up was observed in 14 of 15 patients, with no major donor‐site complications. These findings suggest that adapting flap configuration to defect characteristics may be feasible in selected patients; however, the small sample, absence of a comparison group, variable follow‐up, and lack of standardized functional outcomes preclude conclusions regarding superiority, broad reliability, or general applicability.

Large language models (LLMs) are increasingly being integrated into medical education, research, and clinical decision‐support applications; however, their ability to apply anatomical knowledge in clinically relevant surgical scenarios remains insufficiently studied. This study evaluated and compared the performance of six contemporary LLMs (ChatGPT, Gemini, Claude, DeepSeek, Copilot, and Manus) using 25 expert‐derived applied surgical anatomy scenarios relevant to plastic surgery. Scenarios were developed by an expert panel consisting of one associate professor of anatomy and two plastic surgeons. Responses were generated using a standardized prompt and assessed with a structured scoring rubric evaluating anatomical accuracy, clinical reasoning, completeness, and safety, with a maximum score of 10 points per question. Critical errors were additionally assessed. Significant differences in overall performance were observed among models (Friedman χ ² = 43.51, p < 0.001). ChatGPT achieved the maximum aggregate score (250/250), followed by Gemini (248/250), DeepSeek (241/250), Copilot (240/250), Claude (235/250), and Manus (219/250). Critical errors were infrequent and were confined to a reconstructive vascular physiology scenario: DeepSeek, Claude, and Manus each demonstrated one observed critical error, whereas ChatGPT, Gemini, and Copilot demonstrated none. Although all evaluated models demonstrated excellent performance, clinically significant anatomical misconceptions persisted despite high aggregate scores. These findings demonstrate strong performance by the tested LLMs on this specific scenario‐based benchmark, while also identifying clinically meaningful anatomical errors in a subset of responses. Future evaluations should focus not only on overall accuracy but also on clinically meaningful error patterns that may influence surgical decision‐making. Importantly, substantial ceiling effects limited discrimination among high‐performing models, and the findings should therefore be interpreted as performance on this specific benchmark rather than as evidence of a general hierarchy of anatomical reasoning capability.

Background/Objectives: Non-melanoma skin cancer (NMSC), particularly basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), may adversely affect quality of life (QoL), especially in cosmetically sensitive areas. This study aimed to identify factors associated with QoL in patients with NMSC and to evaluate changes in dermatology- and skin cancer-specific QoL following treatment. Methods: This prospective study included 169 patients with NMSC evaluated at baseline and 3 months after treatment using the Dermatology Life Quality Index (DLQI) and Skin Cancer Quality of Life Impact Tool (SCQOLIT). Factors associated with baseline QoL and changes according to treatment modality and histological subtype were analysed. Results: The mean age was 69.2 ± 11.85 years; 82.8% had BCC and 17.2% had SCC. Mean DLQI scores decreased from 2.29 ± 2.81 to 0.34 ± 0.75 and SCQOLIT scores from 4.78 ± 5.53 to 1.20 ± 1.76 at 3 months (both p < 0.001). Lower educational level was associated with higher baseline DLQI scores, whereas younger age and higher socioeconomic status were associated with higher and lower baseline SCQOLIT scores, respectively; these associations persisted in sensitivity analyses. The associations of younger age, female sex, and SCC histology with higher DLQI scores were less robust. SCC patients had higher baseline DLQI scores than BCC patients (3.66 ± 4.82 vs. 2.01 ± 2.10, p = 0.040), but this difference was no longer statistically significant at 3 months. QoL improved following both surgical and medical treatment, with no significant differences in the magnitude of improvement among surgical or medical treatment types. Conclusions: QoL improved significantly within 3 months after NMSC treatment. Different factors were associated with baseline DLQI and SCQOLIT scores, suggesting that these instruments may capture complementary aspects of QoL. Their combined use may provide a more comprehensive assessment of patients with NMSC.

Extensive lumbosacral defects remain a major reconstructive challenge because of limited regional tissue mobility, contamination risk, proximity to neural structures, and frequent association with prior surgery or spinal instrumentation. Although lumbar artery perforator (LAP) flaps are recognized as muscle‐sparing options for posterior trunk reconstruction, their capacity to safely reconstruct very large midline lumbosacral defects and their applicability in rare adult presentations of lumbosacral myelomeningocele remain insufficiently defined. We report two adult female patients who underwent reconstruction of extensive midline lumbosacral defects using bilateral pedicled LAP flaps to illustrate the applicability of this approach in exceptionally large post‐instrumentation and adult dysraphic defects. The first patient, a 19‐year‐old woman, presented with a 36 × 28 cm post‐instrumentation defect with exposed L4–S1 hardware following multi‐trauma and repeated soft‐tissue necrosis. After serial debridements and prolonged culture‐directed intravenous antibiotic therapy, bilateral LAP flaps measuring 22 × 12 cm were elevated based on bilateral L4 perforators identified by computed tomography angiography and Doppler ultrasonography. The second patient, a 28‐year‐old paraplegic woman with spina bifida, presented with recurrent cerebrospinal fluid leakage associated with a 22 × 16 cm lumbosacral myelomeningocele defect. Following neurosurgical dural repair, bilateral LAP flaps measuring 18 × 10 cm were harvested based on medially displaced L4 perforators. In both cases, the flaps were designed according to defect geometry and perforator location, then rotated approximately 90° medially to achieve tension‐reduced midline closure while facilitating primary donor‐site closure. Complete flap survival was achieved in both patients without venous congestion or total flap loss. In the first case, limited wound dehiscence related to hardware prominence was successfully revised with a local V–Y advancement flap, and a small donor‐site tension area was managed with split‐thickness skin grafting. In the second case, a limited lateral donor defect also required split‐thickness skin graft coverage. At 13 months, spinal instrumentation was electively removed in the first patient after adequate osseous stabilization, while flap stability was preserved. At 15 and 9 months of follow‐up, respectively, both patients demonstrated durable soft‐tissue coverage without recurrent breakdown or cerebrospinal fluid leakage. These cases suggest that bilateral pedicled LAP flaps may facilitate stable, muscle‐sparing reconstruction in selected extensive lumbosacral defects, including exceptionally large post‐instrumentation wounds and rare adult presentations of lumbosacral myelomeningocele.

Background and Objectives: The effects of nicotine on wound healing and flap survival remain controversial. While smoking is associated with increased flap complications, emerging evidence suggests that nicotine may exert dose- and duration-dependent effects. This study aimed to investigate how short-term, low-dose nicotine affects flap survival and to evaluate its potential role in oxidative stress and ferroptosis. Materials and Methods: Twelve adult male BALB/c mice were randomly assigned to either a control group or a nicotine-treated group, with six mice in each group. Nicotine, at a dose of 2 mg/kg, was given subcutaneously for fourteen days before flap surgery. This treatment continued for seven days after the surgery. A dorsal random-pattern skin flap model was established in all animals. The flap necrosis area was assessed on postoperative day 7 using planimetric analysis. Serum and tissue glutathione peroxidase 4 (GPX4) levels and serum malondialdehyde (MDA) levels were measured. Histopathological evaluation included epithelialization, microvascular density, neovascularization, fibroblast density, and inflammatory cell infiltration. Results: Nicotine treatment significantly reduced flap necrosis compared with the control group. Histopathological analysis demonstrated significantly increased epithelialization and microvascular density in the nicotine-treated group, whereas no significant differences were observed in neovascularization, fibroblast density, or inflammatory cell infiltration. Biochemical analyses revealed no significant differences in serum or tissue GPX4 levels or serum MDA levels between the groups. Conclusions: Short-term nicotine administration enhanced flap survival, correlating with increased epithelialization and microvascular density, while not significantly affecting markers of oxidative stress or ferroptosis. These results imply that the positive impact of nicotine on flap viability might be largely attributable to vascular processes rather than pathways involving oxidative stress.

Background/aim: Skin cancer is the most common malignancy worldwide, particularly among elderly individuals. Many lesions are detected at an early stage because of their visibility and can be excised under local anesthesia, thereby avoiding the risks associated with general anesthesia or sedation. This study aimed to evaluate patient- and tumor-related characteristics in skin cancer surgery performed under local anesthesia, with particular emphasis on age-related outcomes. Materials and methods: This retrospective study included 533 patients with 613 histopathologically confirmed skin cancers excised under local anesthesia between 2019 and 2024. Demographic, histopathological, and surgical variables were recorded, including age, sex, tumor location, measured tumor area, histologic subtype, surgical margin status, reconstruction technique, and comorbid conditions. Patients were stratified into three age groups (80 years) for subgroup analyses. Statistical analyses were performed using the Mann–Whitney U test, Kruskal–Wallis test, chi-square test, and Spearman correlation analysis (SPSS version 26.0; IBM Corp., Armonk, NY, USA), with statistical significance set at p < 0.05. Results: The mean patient age was 68.5 years. Most lesions (86.1%) were located in the head and neck region. Basal cell carcinoma (65.4%) and squamous cell carcinoma (21.0%) were the predominant histopathological diagnoses. Primary closure (43.8%) and fullthickness skin grafting (25.0%) were the most frequently performed reconstruction methods. Larger tumor area was significantly associated with positive surgical margins (p < 0.01), and tumor type was significantly associated with both surgical margin status and reconstruction method (p < 0.0001). Age showed a statistically significant positive correlation with tumor area (p = 2.22 × 10-⁷) and with the presence of comorbidities (p < 0.001). Subgroup analysis demonstrated a higher proportion of squamous cell carcinoma and a larger mean tumor area in patients older than 80 years. No local anesthesia-related complications occurred. Conclusion: Skin cancer surgery performed under local anesthesia appears to be safe and effective across age groups, including elderly and comorbid patients. Tumor type and tumor area were significantly associated with surgical margin status and reconstruction method. These findings support age-conscious and anesthesia-sparing approaches in oncologic dermatologic surgery.

Background: Axillary hidradenitis suppurativa (HS) often requires wide surgical excision and reconstruction. Thoracodorsal artery perforator (TDAP) flaps and split-thickness skin grafts (STSGs) are common options, but comparative long-term data are insufficient. Methods: In this single-center retrospective study, patients aged ≥ 17 years with Hurley stage II–III axillary HS underwent wide excision followed by TDAP flap or STSG reconstruction. Demographic variables, surgical characteristics, complications, recurrence, shoulder mobility, and dermatology-specific quality-of-life outcomes assessed using the Dermatology Life Quality Index (DLQI) were analyzed. Results: In total, 35 reconstructions were reviewed: TDAP (n = 15, 42.9%) and STSG (n = 20, 57.1%). Follow-up was longer for TDAP (28.53 ± 16.38 vs. 19.65 ± 28.06 months; p = 0.014). Mean defect size was 105.47 ± 26.29 cm² (TDAP) vs. 164.65 ± 77.99 cm² (STSG; p = 0.116). Both groups showed significant improvement in DLQI from preoperative to postoperative assessments (TDAP: +20.87; Graft: +18.50; both p < 0.0001), with no significant postoperative difference (p = 0.9608). Smokers had higher preoperative DLQI scores than non-smokers (+5.72; p = 0.0051), but postoperative outcomes were similar (p = 0.5908). Conclusions: Both reconstructions after wide axillary excision provided durable coverage, low complication rates, and significant improvement in quality of life. Incorporating patient-reported and functional outcomes into reconstructive planning may optimize surgical decision-making for axillary HS.

Objective: To retrospectively evaluate the use of soft-tissue free-flap reconstruction for midfacial defects, focusing on defect characteristics, flap selection, recipient vessels, postoperative complications, and functional outcomes.Materials and Methods: A retrospective analysis was conducted on patients who received free-flap reconstruction for midfacial defects from 2021 to 2023. Demographic data, defect classifications, flap selections, recipient vessels, complications, and postoperative outcomes were examined.Results: Fasciocutaneous flaps, primarily anterolateral thigh (ALT) and latissimus dorsi (LD) flaps, were used in all cases. The facial artery and internal jugular veins were the most commonly used recipient systems for microsurgical anastomosis. Complications occurred in 36.4% of patients, including one flap loss and manageable postoperative events. Functional restoration included effective dead space obliteration, basal orbital support, oral-nasal separation, swallowing, speech preservation, and oral competence. Patients receiving adjuvant therapy had higher complication rates.Conclusions: Fasciocutaneous free flaps offer a dependable and efficient reconstructive solution for midfacial defects, providing adequate functional and aesthetic outcomes with minimal morbidity. They represent a viable alternative to bone flaps in selected cases, especially where oncologic safety and margin concerns predominate. Large prospective studies are warranted to further define indications and long-term outcomes.