Teratomas, the most common extragonadal germ cell tumor of childhood, involve at least two of the ectodermal, mesodermal, and endodermal layers. Of the teratomas seen in the first 2 months of life, 82% are sacrococcygeal. The head and neck region is the second most common location for teratomas in early infancy, accounting for five (14%) of those cases. We describe a female neonate with a teratoma of the nasopharyngeal area, bilateral cleft palate/lip, and columellar sinus pathologies. The mass, which was 8 x 5 x 7 cm and soft in consistency, blocked the airway and prevented oral feeding. On macroscopic examination of the excised mass, there was a notable typical cilia arrangement and lower eyelid appearance. The patient, who was diagnosed with a well-differentiated teratoma after the pathologic examination, did not have any complications in the postoperative period.

Background/aim: The purpose of this study was to investigate the use of tissues with multiple traumas, scarred pedicles, and medial scarring as a flap. Materials and methods: Forty-eight rats were randomly divided into four equal groups. The modified McFarlane flap was chosen as the flap model. In Group 1 (control), a dorsal skin flap was elevated and then sutured back into original position. In the other groups, a two-phase procedure was used. In Group 2 (pedicle incision), scar tissue was created with a skin incision at the prospective pedicle site of the flap and then sutured to its original site. In Group 3 (preconditioning), multiple full-thickness traumas were performed along the entire flap body, and in Group 4 (middle incision) scar tissue was created with a skin incision at the prospective middle region of the flap. Then, after 45 days, dorsal flaps were raised in all rats and then sutured back into position. Seven days later, flap survival was evaluated through microangiography and histological evaluation of flap segments. Histopathological examination included assessment of the number of vessels, necrosis, infiltration with polymorphonuclear leukocytes, edema, fibrosis, inflammation, increase in fibroblast activity, and neovascularization. Results: The flap survival rates were 66.78% in Group 1, 68.05% in Group 2, 68.5% in Group 3, and 60.01% in Group 4. The flap survival rate was significantly lower in Group 4 (p < 0.05). There was no significant difference in flap survival between Groups 1, 2, and 3. On microangiographic examination, the vascular network extended more distally and was densest around the scar line in Group 2. Vascularization was poorest in Group 4. On histological examination, the number of vessels tended to be greatest in Groups 3 and 4 but this was not significantly different between groups (p < 0.05). Conclusion: The study findings showed that it may be possible to raise a flap from a previously mutilated site secondary to scar formation and multiple full-thickness traumas along the flap body. However, distal necrosis may occur in situations when the scar is positioned in the middle region of the prospective flap.

Background/Objectives: Gender-affirming care is a complex, multidisciplinary process that has gained increasing recognition worldwide. This practice report presents the unique clinical model developed at the Kocaeli University Hospital Gender Dysphoria Clinic, one of the pioneering centers in Türkiye. Methods: An experience-based descriptive approach was adopted to capture two decades of clinical experience, institutional processes, and socio-political challenges not fully reflected in systematic reviews. The article reflects on the authors’ direct practice in a university-based transgender health clinic in Türkiye, structured around the multidisciplinary team model, patient pathways, institutional processes, and the sociopolitical context of care. Results: The Kocaeli University model integrates psychiatry, endocrinology, surgery, nursing, social work, and legal consultation. Since 2004, the clinic has evaluated and treated hundreds of transgender individuals and produced numerous theses and peer-reviewed publications. Key strengths include a structured board system, the training of psychiatry residents, and close interdepartmental collaboration. Conclusions: This model illustrates how gender-affirming care can be effectively implemented in a challenging sociopolitical context. Sharing this experience may inform global practices and support the dissemination of multidisciplinary approaches to transgender health.

Background Keloid is a dermal fibroproliferative disease unique to humans. Due to the ambiguity in its pathophysiology and the frequent recurrence of keloid, there is no clear consensus on the treatment of keloid and there are many treatment methods defined. In order to benefit from the positive effects of fat grafting on pathological scars, we applied fat grafting to patients who underwent keloid enucleation. Methods Fifteen ear keloid patients included in the study. All patients underwent the same surgical procedure by the same surgeon. Routine follow-ups and examinations were performed to evaluate the results and in addition, the Patient and Observer Scar Assessment Scale (POSAS) survey was used. Results In the study, 15 patients were followed for a median (IQR) period of 21 (13–28) months. No recurrence was observed in any patient during follow-up, which occurred for a median of 21 (13–28) months. In the questionnaire filled out by the patients, the preoperative median value was found to be 48 (IQR: 12), whereas the postoperative median value was found to be 14 (IQR: 8). According to the patients, there was a statistically significant (P < 0.05) positive improvement after surgery. Conclusions Historically, surgical procedures were avoided because the surgical recurrence rate was very high, but today, recurrence rates are decreasing with combined treatments. These treatment combinations may require more than one intervention and require frequent clinical follow-ups. With our technique of fat grafting after enucleation, the treatment was completed with a single operation and no additional intervention was required.

Objective: Cephalic malposition and weakness of the lateral crus may result in a long alar line, boxy nasal tip, parenthesis-deformity of the alar rim and external nasal valve insufficiency in deep inspiration, in addition to alar retraction. There is no gold standard method for correcting alar retraction and lateral crus deformities in rhinoplasty operations. Caudal extended lateral crural strut (CELCS) graft is a technique used to correct malposition of the lateral crus, to strengthen a weak lateral crus and to correct the alar rim retraction. An autologous septal cartilage graft may be used during CELCS. Methods: CELCS graft was placed in 46 primary, open rhinoplasty procedures between 2014 and 2019. The graft was harvested from septal cartilage and placed on the lateral crus so that the cephalic areas overlapped while the caudal portion would extend into the pocket created in the caudal rim. Results: Of the 46 patients, 30 (65.2%) were female and 16 (34.8%) were male. Median (range) age was 32 (23 to 41) years. All patients underwent CELCS graft, placed to correction cephalic malposition and alar rim retraction simultaneously. The average follow-up period was 12 months (9-15 months). Satisfactory results were achieved in all patients. Conclusion: CELCS graft was a successful method to correct both lateral crus malposition and alar rim retraction simultaneously.

Perineal reconstruction in males can be challenging due to the complex anatomy and the potential for complications such as infection, hematoma, and wound dehiscence. In this retrospective case series, we present seven patients who underwent perineal reconstruction between 2020 and 2023 using bilateral scrotal flaps. All defects were secondary to debridement for Fournier's gangrene. In patients with defects involving up to 70% of the total scrotal surface and with sufficient intact scrotal tissue preserved superiorly and inferiorly, reconstruction was performed using bilateral trapezoid-like scrotal flaps based on perforators of the anterior and posterior scrotal arteries. The mean follow-up period was 6 months. Longer-term follow-up was not consistently available for all patients due to loss to follow-up. Nevertheless, selected cases were followed up for 1 year, as demonstrated in the clinical figures. Clinical outcomes were evaluated in seven patients enrolled in the study. The median operative time was 48 (43.5–53.5) minutes. The median length of hospital stay was 3 (2.5–4.0) days. Complete healing time was recorded as 19 (16.5–21.0) days. All flaps used for tissue coverage were successful. Among the observed complications, wound dehiscence was identified as the most prevalent, which occurred in three of seven patients (42.9%) and was managed successfully with local wound care and minor debridement. No partial or total flap loss was observed. Due to its short operating time, low donor site complication rate, and favorable tissue match, the trapezoid-like flap may represent a practical and reliable option in selected patients.