Prof. Dr. A. Emre Aksu | Hacettepe University (original) (raw)

Papers by Prof. Dr. A. Emre Aksu

Which instrument should we use to assess

British Journal of Radiology, 2006

Chondroid syringoma, also known as mixed tumour of the skin, is a relatively rare, usually benign... more Chondroid syringoma, also known as mixed tumour of the skin, is a relatively rare, usually benign tumour. A few malignant cases, especially in the lower extremities, have been published, but most of them behave in a benign fashion. A case of a middle-aged woman with surgically proved chondroid syringoma in the pretibial region is presented in this report with MRI and histological findings. Despite rapid growth over a short period of time and a location reportedly associated with malignancy, the histological features were benign.

Ulusal Travma Acil Cerrahi Dergisi, 2023

It is clinically vital to determine the best technique to reconstruct thumb defects with satisfac... more It is clinically vital to determine the best technique to reconstruct thumb defects with satisfactory esthetic and functional outcomes. We aimed to quantitatively present the safety, versatility, limitations, advantages, and functional results of the first dorsal metacarpal artery flap (FDMAF) and evaluate its outcomes in thumb defect reconstruction by comparing it with the other current surgical options. METHODS: A total of 21 patients underwent thumb defect reconstruction. They were evaluated with the following parameters: Etiology, age, timing of reconstruction, flap vitality, Semmes-Weinstein monofilament (SWM) test, static two-point discrimination (2PD) test, pain, cortical reorientation, cold intolerance questionnaire, and Michigan hand outcomes questionnaire. Their functional outcomes were evaluated by comparing their scores with the other current surgical options published in the literature. RESULTS: The mean follow-up period was 22.3 months. The mean pain score of the flap was 0.4±0.6 and no patient had pain in the donor area (range, 0-10). The sensory outcome was "good" (8.6 mm) based on the static 2PD test. The mean SWM test score was 4.02 g. Patient satisfaction was 4.6 according to the Michigan hand outcomes questionnaire (range, 0-5). The cold intolerance questionnaire scores showed that the patients had mild cold intolerance (mean, 10.5; range 0-100). Complete cortical reorientation was seen in 81% of the patients. CONCLUSION: Restoration of the innervation of thumb defects is possible with the FDMAF with high satisfaction rates based on our results. The absence of the microsurgical vessel or nerve repair facilitates the surgery, shortens its duration, and reduces morbidity, reserving the microsurgical options for more complicated cases. Therefore, it can be concluded that the FDMAF is an effective flap with great modifications for complicated thumb defects but surgeons should consider their clinical outcomes and prolonged surgery when choosing which technique to be used.

This book and the individual contributions contained in it are protected under copyright by the P... more This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.

Joint Diseases and Related Surgery, 2022

Pacinian disorders are exceedingly rare, and the exact pathogenesis is still unknown. The most co... more Pacinian disorders are exceedingly rare, and the exact
pathogenesis is still unknown. The most common symptoms
are pain, sensory changes, and a visible or palpable mass, and
diagnosis is usually made by pathological examination after the
excision of the painful nodule. In this case report, we present the
case of a 49-year-old male with Pacinian corpuscle hyperplasia
located on the metacarpophalangeal joint, emerging at the same
hand of the patient two years after the treatment due to complex
regional pain syndrome (CRPS). To the best of our knowledge,
this is the first case report revealing the association of CRPS with
hyperplasia of Pacinian corpuscles.

Journal of Hand Surgery (European Volume), 2022

Treatment of flexor tendon injuries in children poses unique challenges for the hand surgeon. Pos... more Treatment of flexor tendon injuries in children poses unique challenges for the hand surgeon. Postoperatively, poor compliance with rehabilitation, such as irregular attendance at therapy sessions.In children, parental understanding and support are important factors determining compliance and one aspect of parental understanding that may have an impact is the level of education. The aim of the study is to investigate the effect of the family education level as an independent variable on the outcome of paediatric tendon repair.

Turkish Journal of Plastic Surgery, 2021

IntroductIon The hand, described as "window to the brain" by Immanuel Kant, [1] is a highly funct... more IntroductIon The hand, described as "window to the brain" by Immanuel Kant, [1] is a highly functional unit of the human body. Upper extremity tumors (UETs) may worsen hand functions. Treatment of hand tumors may be complicated, as the hand contains bones, muscles, nerves, and vessels in close proximity. UETs show a large degree of benign behavior. The most common benign tumors encountered during practice are warts, pigmented lesions, ganglion cysts, giant cell tumors of the tendon sheath, and vascular tumors. [2-5] Warts can be treated using cryotherapy, electrocoagulation, laser therapy, and topical drug applications, so they are rarely encountered by the hand surgeon. [6] With other benign tumors, treatment is excision with clear surgical margins. Yet, 1%-2% of primary hand tumors are malignant and these tumors require broader margins and further work-up. [7] There is a relative consensus on the most common malignant skin tumor of the upper extremity as squamous cell carcinoma (SCC). [8,9] Frequencies of the sarcomas differ from each other in different case series, as these tumors are extremely rare. Undifferentiated pleomorphic sarcoma (formerly known as malignan fibrous histiocytoma), liposarcoma, and fibrosarcoma are the most common soft-tissue sarcomas diagnosed in the upper extremity. [10,11] Although malignant tumors are rarely seen in the upper extremity, the rate of malignancy is higher if the patient has certain conditions. Having inherited diseases such Background: Upper extremity tumors (UETs) and their treatment may impair hand functions. Successful prediction of the histopathological examination before surgery will speed up the treatment process. The aim of this study is to determine the frequency and prediction accuracy of tumors encountered in the upper extremity. Patients and Methods: Records of patients operated for UETs between January 2010 and December 2019 were reviewed. Patient gender, initial complaint, the anatomic region of the tumor, comorbidities predisposing to malignancy, method of biopsy, preliminary diagnosis and predicted malignancy status after initial examination, definitive histopathological diagnosis, and malignancy status were extracted retrospectively. Prediction accuracy rates were calculated for each tumor group. Chi-square analysis was used for comparative analysis of prediction accuracy rates between cutaneous pigmented versus soft-tissue lesions and patients with/without a predisposition to malignancy. Results: The study included 416 pathological specimens from 290 patients. The most common tumors of the upper extremity were lipoma (20%), ganglion cyst (10.1%), and epidermoid cyst (5.8%). After pathological evaluation, 23 specimens were diagnosed as malignant (5.5%) and 32 specimens as premalignant (7.7%). The prediction of malignancy status was accurate in 390 specimens (93.7%). Soft-tissue sarcomas (67.7%) and vascular lesions (58.1%) have the lowest accuracy rates among all tumors. Conclusion: Definitive diagnosis and malignity status can be predicted after the initial examination in the majority of the cases. However, imaging studies or incisional biopsies are needed for soft-tissue sarcomas, vascular tumors, or tumors of patients with a predisposing condition to malignancy.

Journal of Plastic Reconstructive and Aesthetic Surgery, 2021

The posterior auricular nerve (PAN) is an inspiring candidate for the additional axonal source in... more The posterior auricular nerve (PAN) is an inspiring candidate for the additional axonal source in long-term facial paralysis to improve the functional results of the cross-facial nerve (FN) graft technique. However, no studies have analyzed the PAN's axonal load and its microscopic anatomy to assess its utilization in facial reanimation. The present study aims to examine the anatomical and microscopic features of the PAN to analyze its feasibility as a donor nerve. Methods: The bilateral facial side of 14 fresh frozen adult human cadavers was examined for the study. The PAN's anatomical course was recorded, and nerve specimens from the PAN and zygomatic nerve (ZN) were obtained to compare their microscopic anatomy and axon counts using a light microscope and transmission electron microscope. Results: The PAN's average branching distance and its course length were 5.8 ± 2.69 mm and 59.2 ± 5.85, respectively. The mean number of myelinated axons was 600.28 ± 69.97 in the PAN and 728.85 ± 166.31 in the ZN. This difference between the two nerves was statistically significant (p = 0.002). However, considering the gender variable, the mean axon counts of PAN and

Hand Surg Rehabil, 2021

The superficial location of critical structures, including tendons, nerves and vessels, in the vo... more The superficial location of critical structures, including tendons, nerves and vessels, in the volar surface of the wrist makes them vulnerable to penetrating trauma. Extensive injuries to these structures are described as "spaghetti wrist". The main objective of this study was to report functional outcome in spaghetti-wrist injuries. The records of patients presenting to our clinic with extensive volar wrist injuries between January 2016 and January 2019 were reviewed retrospectively. Age, gender, comorbidities, date of injury, injury mechanism, affected hand and transected structures were noted. Tendon function, opposition, intrinsic hand function, deformity and sensitivity were evaluated following the Noaman report. The Michigan Hand Outcomes Questionnaire (MHOQ) was used to evaluate hand-specific outcomes. Twenty patients were included. Mean age was 32.7 years (range, 18-47 years). Mean follow-up was 21.9 months (range, 12-50 months). Mean number of injured structures was 11.9 (range, 10-16 structures) per patient. Physiotherapy duration had an effect on postoperative outcome in all six MHOQ domains (r = 0.821, p = 0.00001). However, no significant difference in overall hand function was found according to the number of injured structures (r = -0.105, p = 0.661). Precise initial evaluation, meticulous surgical treatment within 24 h and early physical therapy are essential after spaghetti-wrist injury. Good functional results are associated with prolonged physical therapy, but not with the number of structures injured.

Jt Dis Relat Surg, 2021

Surgical site gout is an extremely rare complication that is difficultto diagnose, particularly i... more Surgical site gout is an extremely rare complication that is difficultto diagnose, particularly in patients without a history of gout. A57-year-old male patient was admitted with no previous historyof gout, complaining of surgical site gout located at the junctionwhere flexor carpi ulnaris tendon was transferred to extensordigitorum communis tendon after 33 years of the initial surgery.The patient was presented with a progressive swelling over thelast three months which was located on the dorsoulnar side ofthe right wrist joint. Magnetic resonance imaging revealed aniso/hypointense mass. During the excisional biopsy, retainednon-absorbable suture materials were observed within the mass.Histopathological examination result was reported as a typical gouttophus. No recurrence was observed after 18 months of follow-up.In conclusion, surgical site gout may be observed at transferredtendons years after the initial surgery

The Journal of Hand Surgery (Asian-Pacific Volume), 2021

Aneurysmal bone cyst (ABC) is a benign expansile bone tumor without metastasis capability. Only 3... more Aneurysmal bone cyst (ABC) is a benign expansile bone tumor without metastasis capability. Only 3-4% of ABCs occur in the hand and they mainly take place in metaphysis' of long bones like metacarpals or phalanges. Carpal ABCs has been reported as individual case reports in the literature due to rarity. A patient presented with pain in her right wrist. Magnetic resonance imaging revealed a well circumscribed one cm sized mass in the pisiform bone that resembled an aneurysmal bone cyst. Total pisiformectomy was performed. Treatment options are total excision or curettaging in ABCs. But rarity of these lesions may delay the diagnosis process for the inexperienced surgeon.

Turkish Journal of Plastic Surgery, 2021

Congenital unilateral upper limb muscular hypertrophy is a rather new entity. Patients have unbal... more Congenital unilateral upper limb muscular hypertrophy is a rather new entity. Patients have unbalanced muscular forces on their upper extremities
due to muscular hypertrophy. These unbalanced forces preclude physiological movements, and in the late course, cause joint deformities.
Once joint deformities occur, benefit from surgery diminishes; botulinum toxin can be used for the prediction of a possible benefit from
surgery. A 14‑year‑old girl presented with flexion and ulnar deviation contracture of the left wrist, narrowing of the first web space, flexion
contracture of all fingers, and more evident on the first, third, and fourth fingers. After botulinum toxin injection, the most notable benefit was
seen on the wrist contracture. In surgery, adductor myotomy, flexor carpi ulnaris transfer to palmar aponeurosis, and tendon transfers of flexor
digitorum superficialis to flexor digitorum profundus in the third, fourth, and fifth fingers were made. The postoperative gain was similar to
the outcome after botulinum toxin injection. Botulinum toxin may help the surgeon to understand if chronic joint deformities have occurred
and predict possible benefit from surgery.

Annals of Plastic Surgery, 2020

Purpose: Although the Oberg-Manske-Tonkin (OMT) classification has been recommended by the Intern... more Purpose: Although the Oberg-Manske-Tonkin (OMT) classification has been
recommended by the International Federation of Societies for Surgery of the Hand
owing to some insufficiencies of the Swanson classification system, it has not
achieved a universal adoption by hand surgeons. In this study, we hypothesize that
the OMT classification can be used easily to classify congenital upper extremity
anomalies. We also aim to make epidemiological analysis of congenital upper extremity
anomalies with the OMT classification and to compare the applicability
of the OMTand the Swanson classifications.
Methods:We retrospectively analyzed 711 patients and 833 extremities operated
on between 2012 and 2017. Photographs, plain x-rays, and brief medical histories
of the patients were evaluated by 4 plastic surgeons. Two independent evaluations
were made by each surgeon in 1-month interval using these classification systems.
Results: Total number of upper extremity anomalies recorded was 1050. Of the
711 patients operated on, 122 had bilateral anomalies. The anomalies were identified
in 833 extremities because many extremities had more than a single diagnosis.
We were able to classify all of the anomalies within the OMT classification. The
OMT classification gives better reliability results compared with the Swanson classification
according to intrarater and interrater reliabilities.
Conclusions: Compared with the Swanson classification system based on phenotypic
evaluation of the extremity, theOMT classification systemis easier to apply
and the association of the anomaly with the embryologic origin during
evaluation is possible.We believe that multiple studies from different centers will
boost the international acceptance of the OMT classification.
Key Words: congenital hand anomalies, OMT classification,
Swanson classification, classification of congenital differences
(Ann Plast Surg 2020;85: 245–250)

Turkiye Klinikleri J Plast Surg-Special Topics 2015;4(3):19-26, 2015

Recently, following the discovery of the adipose tissue as a novel source of mesenchymal stem ce... more Recently, following the discovery of the adipose tissue as a novel source of mesenchymal stem cells, the stem cell research is a growing field of plastic surgery. Mesenchymal stem cells
having trophic effect, immunomodulation, homing to injured tissue and ability to differentiate to
other cell lineages appears to be promising in application for regenerative purposes. Stromal vascular
fraction known to possess high quantity of stem cells obtained by the enzymatic degredation of the
adipose tissue is hoped to be promising as well. Besides having a potential benefit in combined application with fat grafting procedures to increase the viability of adipocytes and postmastectomy
breast reconstruction, stromal vascular fraction has a potential application field of chronic wound
treatment, autoimmune diseases, tissue engineering research and many indications of regenerative
medicine. Most striking restriction in their application in the long term period is the oncologic concerns and there is no doubt that it will be an emerging field of research in the upcoming decades

Turk J Plast Surg 2012;20(2), 2012

A thirty year old male patient presented to our hand surgery team 2 hours after a motor vehicle ... more A thirty year old male patient presented to our hand surgery team 2 hours after a motor vehicle accident. His physical
examination revealed lack of circulation in his right forearm
with totally severed median and ulnar nerves and loss of forearm flexion. Additionally, a 14 x 7 cm skin area was lost. After
brachial artery anastomosis with vein graft and median and
ulnar nerve coaptation, a functional latissimus dorsi musculocutaneous flap was transferred to maintain elbow flexion and
defect coverage. However, an excursion problem occurred in
the post operative third month. In order to fix this, insertio of
the muscle was transferred to a more proximal position. Post
operative one year result was satisfactory with the complete
flexion of the elbow. This problem appears to occur due to insufficient muscle relaxation during first surgery. In this report
the importance of the monitoring anaesthesia and muscle
relaxation during this type of functional muscle transfer was
stressed to ensure optimum results.

Clinical Immunology, 2008

We investigated the effect of autologous mesenchymal stem cells (MSC) on multipleunmodified donor... more We investigated the effect of autologous mesenchymal stem cells (MSC) on multipleunmodified donor bone marrow (BM) infusions and vascularized skin graft outcome. BM-derived ratMSC were examined for phenotype and function. MSC/MSC-conditioned-medium suppressed IFN-γ production by T cells and modified DC function. Infusions of MSC with one-time BM improvedvascularized skin graft survival, while with one–two-times BM reversed graft versus host disease(GVHD). Mixed chimerism was enhanced in recipients given two–four-times BM with MSC infusions.Interestingly, four-times BM infusions with MSC delayed GVHD onset, reduced host tissue damageand enhanced vascularized skin allograft survival compared to four-times BM alone. These datademonstrate that, the co-infusion of MSC with unmodified BM limit the toxicity of allogeneic BMtransplantation, enhance mixed chimerism and improve vascularized skin graft survival. Thesefindings provide insights for the development of autologous MSC-based BM transplantation andprevention of graft rejection or treatment of autoimmunity.

Journal of Plastic Reconstructive and Aesthetic Surgery, 2013

Amniotic band syndrome (ABS) is characterized by the attachment of amniotic and placental remnant... more Amniotic band syndrome (ABS) is characterized by the attachment of amniotic and placental remnants and encircling the fetus leading to malformations and even amputations. Its incidence is estimated at 1/1200 to 1/15,000 live births. ABS is a heterogenous condition with broad spectrum of anomalies ranging from simple ring constrictions to major craniofacial and visceral anomalies. We would like to share
a rare presentation of ABS as circumferential abdominal constriction band with fenestrated syndactyly.

European Journal of Plastic Surgery, 2002

. A 44-year-old woman undergoing abdominoplasty, laparoscopic cholecystectomy, and incisional her... more . A 44-year-old woman undergoing abdominoplasty, laparoscopic cholecystectomy, and incisional hernia repair is presented. Abdominal wall lipodystrophy and incisional hernia, both pathologies leading to esthetic deformity, and cholelithiasis causing biliary symptoms were treated at the same operation without any complications. Combining two or multiple abdominal procedures may reduce the potential risks of multiple anesthesia for each procedure, shorten total hospital

Which instrument should we use to assess

British Journal of Radiology, 2006

Ulusal Travma Acil Cerrahi Dergisi, 2023

Joint Diseases and Related Surgery, 2022

Journal of Hand Surgery (European Volume), 2022

Turkish Journal of Plastic Surgery, 2021

Journal of Plastic Reconstructive and Aesthetic Surgery, 2021

Hand Surg Rehabil, 2021

Jt Dis Relat Surg, 2021

The Journal of Hand Surgery (Asian-Pacific Volume), 2021

Turkish Journal of Plastic Surgery, 2021

Annals of Plastic Surgery, 2020

Turkiye Klinikleri J Plast Surg-Special Topics 2015;4(3):19-26, 2015

Turk J Plast Surg 2012;20(2), 2012

Clinical Immunology, 2008

Journal of Plastic Reconstructive and Aesthetic Surgery, 2013

European Journal of Plastic Surgery, 2002

Journal of the American College of Surgeons, 2006

Purity and phenotype of SSC were assessed by flow cytometry. Immunosuppressive capacity of SSC wa... more Purity and phenotype of SSC were assessed by flow cytometry. Immunosuppressive capacity of SSC was assessed in MLR and in dendritic cell/T cell co-cultures. Irradiated Lewis rats underwent Wistar Furth epigastric skin flap allotransplantation. Cyclosporine-A (day 0 to 20) and donor BM cells (with or without host SSC, at different time points) were administered.

World Transplant Congress, 2006

Risks of chronic immunosuppression hinder composite tissue allograft (CTA) transplantation. A nov... more Risks of chronic immunosuppression hinder composite tissue allograft (CTA) transplantation. A novel modality was investigated using transient immunosuppression and immature host dendritic cells (DC) pulsed with donor antigens following CTA transplantation across full MHC barrier

Lower extremity nerve pathologies may occur due to traumatic causes, systemic diseases and compre... more Lower extremity nerve pathologies may occur due to traumatic causes, systemic diseases and compression neuropathies. While the treatment of traumatic injuries is surgical, conservative treatments are at the forefront in systemic diseases and compression neuropathies. In lower extremity nerve injuries, a treatment modality should be determined according to the type and severity of the injury and the length of time between injury and repair. Treatment options include direct repair, repair using conduits and nerve grafts, nerve and tendon transfers, and arthrodesis. Although the injuries are usually high-energy injuries and the distance for the nerves to regenerate makes treatment difficult, it is possible to prevent or at least keep the loss of function of the patients to a minimum with appropriate treatment selection and surgical technique.

Beauty, Aging, and Antiaging , 2022

Plastik Cerrahinin Temelleri (Essentials of Plastic Surgery - Turkish Edition), 2016

Plastik Cerrahinin Temelleri - Essentials of Plastic Surgery, 2016

Grabb & Smith's Plastic Surgery, 2016

Fiziksel Tıp ve Rehabilitasyon, 2016

FANCONI ANEMIA AND OTHER INHERITED BONE MARROW FAILURE SYNDROMES, 2021

Fanconi anemia is a heterogenous clinical condition requiring a multidisciplinary approach wherea... more Fanconi anemia is a heterogenous clinical condition requiring a multidisciplinary approach whereas these patients are frequently born with upper limb anomalies and are often referred to a hand surgeon long before the diagnosis of the underlying disease. Hand specialists have the responsibility to refer these patients with high risk to pediatrics/hematology specialists for Fanconi testing. Treatment of congenital diff erences of the upper extremity is a signifi cant challenge. From the perspective of hand surgery, the goal is to achieve a functioning limb that should be satisfactorily treated for the child’s physical, social and emotional development. In means of postoperative results, specialized therapy and rehabilitation is as important as proper evaluation and skillful surgical approach.

Çalış M, Öz Z, Uzun H, Özgen B, Çetin A, Aksu AE. Alternative approach to traumatic Stenon duct i... more Çalış M, Öz Z, Uzun H, Özgen B, Çetin A, Aksu AE. Alternative approach to traumatic Stenon duct injuries accompanied by glandular involvement: Botulinum toxin injection to the gland in conjunction with microsurgical repair of the duct at the acute setting. Turk J