A newborn infant with pulmonary atresia, intact ventricular septum, and moderately hypoplastic right ventricle underwent radiofrequency perforation and balloon dilation of the pulmonary valve immediately after birth, followed by one-and-one-half ventricle (1.5 V) repair at 5 months of age. At 7 years of age, the patient developed worsening cyanosis and exercise intolerance with increasing right-to-left shunting through the atrial septal defect (ASD). Due to the combination of tricuspid regurgitation and such ASD shunting, the pulmonary regurgitation fraction reached 110%. Consequently, the advantages of utilizing the right ventricle as an additional antegrade source of pulmonary blood flow in the 1.5 V circuit were not achieved. This case report highlights the importance of phase-by-phase assessment of blood flows using phase-contrast magnetic resonance imaging for understanding the complex hemodynamics.

The optimal timing for intranasal splint removal following septoplasty remains controversial. This systematic review and meta-analysis assessed how splint removal timing affects postoperative pain, nasal function, olfactory performance, and complications. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically searched PubMed, Google Scholar, and Web of Science (PROSPERO: CRD420251129055). Six studies from Turkey (2011-2024) involving 516 patients were included. Participants were stratified into early (days 1-3), intermediate (days 4-7), and late (>7 days) removal groups. Data were pooled using random-effects models. Results indicated that pain outcomes did not differ between early and intermediate removal, evidenced by a standardized mean difference (SMD) of 0.04 (p=0.80), but pain was significantly lower with late removal compared to intermediate timing (SMD 1.24, p<0.001). Nasal Obstruction Symptom Evaluation (NOSE) scores favored early (SMD -0.57, p=0.037) and intermediate (SMD -0.73, p=0.008) removal over late removal. Olfactory function, assessed using the Connecticut Chemosensory Clinical Research Center (CCCRC) odor test, was impaired with early removal compared to intermediate (SMD -0.56, p=0.039) and late removal (SMD -0.55, p=0.045). While complications showed no significant differences among groups, septal perforation risk was higher with early removal (OR 5.69, 95% CI 0.94-34.44, p=0.059), but this difference did not reach statistical significance.Notably, all included studies were conducted in Turkey, which may limit the generalizability of these findings to other populations and clinical settings. Ultimately, intermediate splint removal (days 4-7) may offer a favorable balance between pain control, functional recovery, and complication prevention following septoplasty.

An axial pattern flap incorporates an anatomically named vascular pedicle.[1] Due to the direct cutaneous blood supply, a large skin area can be transferred acutely rather than in a delayed fashion that has previously been the gold standard. Historically, random pattern flaps were harvested in a delayed manner to foster better circulation to the flap. There are several advantages when using an axial pattern flap, which includes no need for delay procedures, full-thickness, durable skin, and excellent cosmetic results.[2] Furthermore, it has been shown that the area of survival in axial pattern flaps is significantly better versus flaps which do not incorporate a direct cutaneous blood supply. Studies have shown the difference in 95% survival for axial pattern flaps versus 53% survival in flaps without a direct cutaneous supply.[3] Some examples of axial pattern flaps include:  Nasolabial flap off of the angular vessels  Paramedian forehead flap off of the supratrochlear vessels  Facial artery musculomucosal flap  Melolabial flap.