Murat Engin - Academia.edu (original) (raw)

Papers by Murat Engin

DergiPark (Istanbul University), Jul 3, 2017

In literature there are reports on alleviation of depressive symptoms and anxiety levels and incr... more In literature there are reports on alleviation of depressive symptoms and anxiety levels and increased quality of life in individuals who underwent breast reduction. However, the relation of this improvement with patient satisfaction is unclear. The purpose of our study is to fulfill the aforementioned objective. In this study, A total of 72 female patients who were operated for only reduction mammoplasty between 2011 and 2015 were included. Technical details regarding the surgery were recorded. Patients were applied Beck Depression Scale (BDS) and Beck Anxiety Scale (BAS) preoperatively. In the 6 th postoperative month, Beck scales were repeated and patient satisfaction was evaluated via "Visual Analogue Scale "(VAS). Also, surgical outcome has been graded by three other plastic surgeons from one to 10. Data were evaluated statistically. Apparent postoperative alleviation BDS and BAS scores was significant at postoperative 6th month. Average VAS scores for the patients' postoperative satisfaction with their surgical outcome was 8.8. These scores by three other plastic surgeons were found to be 7.6. Individual satisfaction scores and professional evaluation scores were found to yield positive correlation. The tissue amount excised was not found to be correlated with patient age or satisfaction, however it was found to be negatively correlated with professional evaluation. Moreover, regression analyses revealed patient satisfaction was not influenced by anything other than the surgery itself. In other words, preoperative BDS and BAS scores were not found to be predictors of postoperative patient satisfaction. To our findings, although depression and anxiety symptoms improve after breast reduction surgery, patients are not influenced by their preoperative psychological condition when assessing their surgical outcomes. This important finding may be a possible preoperative relief for the surgeon who is dealing with an anxious or depressive breast reduction patient.

Plastic and Reconstructive Surgery, 2014

Plastic and Reconstructive Surgery, 2014

393 engineered with a transglutaminase substrate sequence (TGVEGF) to allow covalent cross-linkin... more 393 engineered with a transglutaminase substrate sequence (TGVEGF) to allow covalent cross-linking into fibrin hydrogels. BMSC were seeded on apatite granules in fibrin pellets. Bone formation and vascularization were determined histologically 1, 4 and 8 weeks after ectopic subcutaneous implantation in nude mice. Results: One week after implantation, both the constructs with naive BMSC and fibrin-bound TG-VEGF and those with VEGFexpressing BMSC (VICD8) displayed increased vascularization compared to the controls with naive BMSC only. After 4 weeks fibrin gels were completely degraded in all conditions. After 8 weeks both fibrin-bound TG-VEGF and VEGF-expressing BMSC induced significantly increased vascularization compared to naive BMSC only. However, while bone formation was severely impaired with VEGF-expressing BMSC as expected, fibrin-bound recombinant TG-VEGF allowed the formation of bone tissue as efficiently as by naive BMSC alone. Conclusion: These data suggest that short-term delivery of recombinant VEGF protein, providing an attractive and clinically applicable strategy to ensure both rapid vascularization and efficient bone formation.

Plastic and Reconstructive Surgery, Aug 1, 2015

Plastic and Reconstructive Surgery, Aug 1, 2015

Introduction: Healthcare Resource Group (HRG) codes define the tariff associated with each episod... more Introduction: Healthcare Resource Group (HRG) codes define the tariff associated with each episode of care. They are generated from diagnostic and intervention codes. For the latter, all procedures performed in the National Health Service are coded via the Office of Population Censuses and Surveys (OPCS) classification system. We assess the HRG coding accuracy of trauma care episodes within our department and the consequent financial implications. Material and Methods: Coding of all plastic surgery trauma procedures over a 3-month period was retrospectively analysed. Comparison was made between operation notes and OPCS codes assigned by both theatre staff and hospital coders. Areas of inaccuracy were assessed including procedure code, site of surgery and co-morbidities. New OPCS codes were assigned to each operation by the surgical trainees and the resultant HRG codes were used to determine if financial remuneration changed. Results: A total of 100 cases were reviewed. Of the initial codes generated by theatre staff, 81% were changed by hospital coders. There were 139 OPCS codes generated by the hospital coders of which 21% were incorrect, with only 5% correlating exactly to those assigned by the surgical trainees. Revised coding generated 100% more codes with potential income loss from these inaccuracies equating to £75 000. Conclusion: Accurate coding is crucial for audit, research and fair financial remuneration. However, the current coding system is complex and healthcare professionals often lack training on the subject. There also needs to be more communication between healthcare professionals, clinical coders and the finance department to ensure accuracy.

DergiPark (Istanbul University), Jul 3, 2017

In this study we report our experience with a gravely neglected case of rhinophyma. Rhinophyma is... more In this study we report our experience with a gravely neglected case of rhinophyma. Rhinophyma is a disorder characterized by hypertrophy of the sebaceous glands, mononuclear infiltration and fibrous tissue deposition in the nasal skin. Clinically, the disorder manifests itself as disproportionate enlargement and severe disfigurement of the nose. As for the treatment, excision with cold knife, dermatome, dermabrasion, cauter knife and ultrasound blade, and reconstruction with skin graft, flap or secondary intention has been described in the literature. Presented in this study is a neglected and oversized case of rhinophyma. The hypertrophic mass sizing 7x6x3 cm has been excised from the supraperichondral plane. A similiar lesion with the size of 8x6x2 cm was attached to the main mass via a cutaneous pedicle on the left alar region. Resultant defect was reconstructed via a full thickness cutaneous graft harvested from the inguinal region and healed uneventfully. Along with this case report, available treatment alternatives were reviewed and their indications interpereted.

Turkish Journal of Plastic Surgery, 2017

Profil gorunumunden memnun olmayan hastalar siklikla rinoplasti istemiyle basvurmaktalardir. Buru... more Profil gorunumunden memnun olmayan hastalar siklikla rinoplasti istemiyle basvurmaktalardir. Burun yan profilden en belirgin alan olmakla beraber ideal bir profil icin alin, dudaklar, cene ve cene alti dokular birlikte degerlendirilmelidir. Bu calismanin amaci rinoplasti icin basvuran hastalarda ideal yan profil olcumlerinin olusturulmasi ve bu olcumler kullanilarak hastalarin hangi oranda ek cerrahi girisimlerden fayda goreceklerinin belirlenmesidir. Calisma Ocak-Ekim 2013 tarihleri arasinda basvuran 100 hastanin (60 bayan-40 Erkek) yan profil fotograflari cekilmistir. Bu fotograflarda hekim ve hasta birlikte karar vererek rinoplasti ve gerekli ek cerrahi girisim sonuclari simule edilmistir ve bunlar ideal profil kabul edilmistir. Bu preop ve simule fotograflarda alin, burun, alt ve ust cene ile cene alti yag dokusuna yonelik cesitli aci, oran ve endeks hesaplamalari yapilmistir. Daha sonra preoperatif antropometrik olcumler ideal degerlerle kiyaslanarak hastalarin hangi oranda han...

Plastic and Reconstructive Surgery, 2015

Plastic and Reconstructive Surgery, 2015

Journal of Experimental and Clinical Medicine, 2011

The hand holding devices are generally used during the course of micro-surgical operations in neu... more The hand holding devices are generally used during the course of micro-surgical operations in neurosurgery to prevent hand tremor. Recently we designed a new instrument for holding two arms. This instrument used for stabilization of two arms especially during microsurgical operations. We used this instrument in different type of operations such as aneurysm surgery, brain tumor surgery, hypophysis surgery, pontocerebellar tumor surgery and posterior fossa surgery. The ability of the instrument in the preventing of arm tremor, and comfort of the arm during surgery was graded as bad, good and excellent in terms of the description of surgeon during microsurgical operations. This instrument was used during 20 neurosurgical operations. The capability of the instrument during microsurgical operation was found as excellent in 65% of the operations. The capability was found as good in 35% of the operation. In conclusion; this instrument holds two arms in the same time and provide unrelated moving from each others. The capability of this instrument is high in the preventing of hand tremor. This instrument may be used during microsurgical operations in neurosurgery.

Journal of Experimental & Clinical Medicine, 2016

Self mutilation poses a stigmatizing concern for a repentant patient and yield to social eschewin... more Self mutilation poses a stigmatizing concern for a repentant patient and yield to social eschewing. Many of them undergo surgery for treatment of such scars. In this report, we present a case in whom we elected a self mutilation scar bearing dorsal surface of the forearm as a flap donor site for resurfacing a defect on the back of the first web space. Patient had been referred hand injury by shotgun. While that particular flap (posterior interosseous flap) is not our first choice in such cases, in the face of this preexisting condition we stepped out of our comfort zone for the sake of treating both conditions in one sitting. We think that if a patient with stigmatizing scars presents in need of surgical reconstruction, scarred sites should be chosen as donor sites whenever possible. Therefore, when the hand defects reconstructed, simultaneously, an acceptable single longitudinal scar can be leaved on the forearm instead unpleasant transvers scars.

Journal of Reconstructive Microsurgery, 2013

Vessel grafting is commonly used for revascularization or pedicle lengthening. Although veins are... more Vessel grafting is commonly used for revascularization or pedicle lengthening. Although veins are more commonly used, they can form aneurysms when bridging an arterial gap. This can lead to thrombosis, and the risk is increased when there is a size discrepancy. This study reports the long-term results of arterial lengthening via size discrepant carotid artery and femoral vein grafts in a rat femoral artery model (1:1.5 ratio). A total of 28 rats were used in this study, divided into two groups of 14. By the 21st day, one anastomosis in each group has been found to be thrombosed. Long-term patency rates were the same for both groups (93.3%). Radiologic imaging showed that size match in the carotid artery grafts was excellent despite of slightly fusiform dilatation, but in the vein groups, pronounced aneurismal deformation and distortion in the anastomosis was seen. Histologic analysis revealed that in the arterial grafts, endothelial continuity was smooth and mural inflammation was less than that of the vein grafts. Organized or recanalized mural thrombi were seen in 38.5% in the vein grafts, whereas in arterial grafts there were none.

Turkish Journal of Plastic Surgery / Türk Plastik, Rekonstrüktif ve Estetik Cerrahi Dergisi

Objective: Treating severe post-burn deformities of the face and neck region in pediatric populat... more Objective: Treating severe post-burn deformities of the face and neck region in pediatric populations is challenging because of technical difficulties (e.g., limited full thickness skin graft donor site, limited flap options, unavailability for expander placement) and increased donor site morbidity (e.g., related to flap and graft donor sites). In this study, we present the single-stage treatment of severe post-burn skin deformities of the face and neck region in pediatric patients using collagen-elastin matrix (Matriderm®) combined with partial thickness skin grafts. Material and Methods: The total number of cases was eight (four females, four males), and the ages were between two and 11 years. All cases were operated on for only one region. Following the release of contractures and/or excision of wide excessive/unfavorable dermal scars, defects were reconstructed using collagen-elastin matrix (Matriderm®) combined with partial-thickness skin grafts. The final functional and aesthetic results were evaluated using photography and examination. Results: The deformities were in the form of contractures and/or excessive dermal scarring. The involved regions were the face (n=3) and neck (n=5). The grafts yielded favorable plication and texture, and no recurrence of excessive dermal scarring was observed. All contractures healed unproblematically. Two patients were re-operated on for regrafting caused by minor graft loss (5% and 12% of the total area, respectively). Conclusion: In this study, we observed that collagen elastin matrix combined with partial-thickness skin grafts provides a favorable option for the treatment of pediatric late post-burn complications in the face and neck region with limited surgical options.

Facial plastic surgery : FPS, 2017

Among aesthetic surgery procedures, rhinoplasty is one of the most common. Preoperative simulatio... more Among aesthetic surgery procedures, rhinoplasty is one of the most common. Preoperative simulations have become increasingly commonplace through the recent years along with a controversy regarding their use. Although capable of building a solid rapport between the surgeon and the patient by visualizing the end result, it can also prove to be a liability for a surgeon who is not confident about delivering the result which has been put on screen. The objective of this study is to evaluate the outlook of the surgeons and patients on preoperative simulations. Plastic surgeons who perform rhinoplasty and individuals who consider rhinoplasty were surveyed via an online questionnaire system. Their opinions about the practice of simulation were questioned and they were asked to distinguish between simulated and actual postoperative results. Statistical analyses were performed using SPSS software. Major factors influencing the decision-making process of patients were the availability of preo...

Journal of Craniofacial Surgery, 2017

Neglected malignant tumors within the orbital region can invade the eyeball, extraocular muscles,... more Neglected malignant tumors within the orbital region can invade the eyeball, extraocular muscles, and bone substance surrounding the eye. Such patients require orbital exenteration, which may involve extraocular skeletal structures (even exposing paranasal sinuses), resulting in 3-dimensional defects requiring reconstruction. This study presents our experience with anterolateral thigh vastus lateralis (ALT/VL) chimeric free flaps for the reconstruction of extensive orbital exenteration defects involving various paranasal sinuses.Between 2012 and 2016, 4 patients with extensive 3-dimensional orbital defects with sinus involvement were treated using the ALT/VL chimeric flap. The ALT component (117-170 cm) was used to resurface the cutaneous defect while the VL component (105-243 cm) was used to obliterate the cavitary defect. The flaps were all based on the common descending pedicle, and branches to separate components were individually dissected. Recipient vessels were in the neck region, to which the donor pedicles were passed through a tunnel for anastomosis.All cavitary and surface defects were simultaneously reconstructed via the ALT/VL chimeric flap. Within an average of 17 months, no complications associated with flap surgery were observed. One patient received postoperative adjuvant radiotherapy with no complications. With its separate components supplied by a common vascular pedicle, the ALT/VL chimeric free flap allows the surgeon to conveniently reconstruct separate spatial and volumetric defects resulting from extensive orbital exenteration.

Aesthetic Plastic Surgery, 2016

Open and closed approaches for rhinoplasty have individual advantages and disadvantages; however,... more Open and closed approaches for rhinoplasty have individual advantages and disadvantages; however, the resultant columellar scar of the open approach is directly considered as a disadvantage. This study focuses on the columellar scar awareness and its implications on overall satisfaction of the patients after open rhinoplasty. A total of 91 patients who have undergone open rhinoplasty were included in this study. A written questionnaire algorithm consisting of 4 sequential questions was applied. Except for the first question [Do you have any scar(s) caused by any trauma, operation or any other reason on your face?], every question was answered on a scale from 1 to 5. The respondents were given the 25-question "Modified Body Cathexis Scale (MBCS)"and their scars graded using the "Columellar Scar Assessment Scale" (CSAS). The data were statistically interpreted. Of the 91 open rhinoplasty patients, 12 of them responded with a "yes" to the first question reporting their columellar scars. There was no significant difference with regards to patient satisfaction regarding these patients (p > 0.05). However, those who reported the scar yielded a significantly lower MBCS scores. 9 patients declared that they exerted effort to conceal their scars. Those who concealed their scars and those who did not yielded a significant difference in patient satisfaction. The CSAS scores of those who reported the columellar scar were significantly higher than those who did not. Our study suggests that MBSC can be a valuable tool for determining the impact of outcomes from the patient's standpoint, and awareness of the columellar scar is not related to patient satisfaction but with bodily perception. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Medical Hypotheses, 2016

Excessive dermal scarring (EDS) is a wound healing complication, characterized by protruded eryth... more Excessive dermal scarring (EDS) is a wound healing complication, characterized by protruded erythematous and inelastic 'proliferative scar tissue' which is associated with increased and prolonged inflammation process within the wound microenvironment. As inflammation plays a key role in this process, methods to contain or attenuate excessive inflammation hold promise in treatment and prophylaxis of EDS conditions. While cold exposure is notorious as the causative agent a wide array of morbidities and fatalities, its tempered use is exploited in medicine for ablative and therapeutic applications. "Subphysiological cold" has been administered for its antiinflammatory effects which act via decreasing vascular permeability and downregulating proliferation of cells in the wound environment; this knowledge supports our hypothesis that "subphysiological cold application" can also be utilized in human EDS prophylaxis and treatment. In this study, we are reviewing the mechanisms of its both deleterious and therapeutic actions and suggesting another possible application for prevention and/or treatment of human EDS conditions.

DergiPark (Istanbul University), Jul 3, 2017

In literature there are reports on alleviation of depressive symptoms and anxiety levels and incr... more In literature there are reports on alleviation of depressive symptoms and anxiety levels and increased quality of life in individuals who underwent breast reduction. However, the relation of this improvement with patient satisfaction is unclear. The purpose of our study is to fulfill the aforementioned objective. In this study, A total of 72 female patients who were operated for only reduction mammoplasty between 2011 and 2015 were included. Technical details regarding the surgery were recorded. Patients were applied Beck Depression Scale (BDS) and Beck Anxiety Scale (BAS) preoperatively. In the 6 th postoperative month, Beck scales were repeated and patient satisfaction was evaluated via "Visual Analogue Scale "(VAS). Also, surgical outcome has been graded by three other plastic surgeons from one to 10. Data were evaluated statistically. Apparent postoperative alleviation BDS and BAS scores was significant at postoperative 6th month. Average VAS scores for the patients' postoperative satisfaction with their surgical outcome was 8.8. These scores by three other plastic surgeons were found to be 7.6. Individual satisfaction scores and professional evaluation scores were found to yield positive correlation. The tissue amount excised was not found to be correlated with patient age or satisfaction, however it was found to be negatively correlated with professional evaluation. Moreover, regression analyses revealed patient satisfaction was not influenced by anything other than the surgery itself. In other words, preoperative BDS and BAS scores were not found to be predictors of postoperative patient satisfaction. To our findings, although depression and anxiety symptoms improve after breast reduction surgery, patients are not influenced by their preoperative psychological condition when assessing their surgical outcomes. This important finding may be a possible preoperative relief for the surgeon who is dealing with an anxious or depressive breast reduction patient.

Plastic and Reconstructive Surgery, 2014

Plastic and Reconstructive Surgery, 2014

393 engineered with a transglutaminase substrate sequence (TGVEGF) to allow covalent cross-linkin... more 393 engineered with a transglutaminase substrate sequence (TGVEGF) to allow covalent cross-linking into fibrin hydrogels. BMSC were seeded on apatite granules in fibrin pellets. Bone formation and vascularization were determined histologically 1, 4 and 8 weeks after ectopic subcutaneous implantation in nude mice. Results: One week after implantation, both the constructs with naive BMSC and fibrin-bound TG-VEGF and those with VEGFexpressing BMSC (VICD8) displayed increased vascularization compared to the controls with naive BMSC only. After 4 weeks fibrin gels were completely degraded in all conditions. After 8 weeks both fibrin-bound TG-VEGF and VEGF-expressing BMSC induced significantly increased vascularization compared to naive BMSC only. However, while bone formation was severely impaired with VEGF-expressing BMSC as expected, fibrin-bound recombinant TG-VEGF allowed the formation of bone tissue as efficiently as by naive BMSC alone. Conclusion: These data suggest that short-term delivery of recombinant VEGF protein, providing an attractive and clinically applicable strategy to ensure both rapid vascularization and efficient bone formation.

Plastic and Reconstructive Surgery, Aug 1, 2015

Plastic and Reconstructive Surgery, Aug 1, 2015

Introduction: Healthcare Resource Group (HRG) codes define the tariff associated with each episod... more Introduction: Healthcare Resource Group (HRG) codes define the tariff associated with each episode of care. They are generated from diagnostic and intervention codes. For the latter, all procedures performed in the National Health Service are coded via the Office of Population Censuses and Surveys (OPCS) classification system. We assess the HRG coding accuracy of trauma care episodes within our department and the consequent financial implications. Material and Methods: Coding of all plastic surgery trauma procedures over a 3-month period was retrospectively analysed. Comparison was made between operation notes and OPCS codes assigned by both theatre staff and hospital coders. Areas of inaccuracy were assessed including procedure code, site of surgery and co-morbidities. New OPCS codes were assigned to each operation by the surgical trainees and the resultant HRG codes were used to determine if financial remuneration changed. Results: A total of 100 cases were reviewed. Of the initial codes generated by theatre staff, 81% were changed by hospital coders. There were 139 OPCS codes generated by the hospital coders of which 21% were incorrect, with only 5% correlating exactly to those assigned by the surgical trainees. Revised coding generated 100% more codes with potential income loss from these inaccuracies equating to £75 000. Conclusion: Accurate coding is crucial for audit, research and fair financial remuneration. However, the current coding system is complex and healthcare professionals often lack training on the subject. There also needs to be more communication between healthcare professionals, clinical coders and the finance department to ensure accuracy.

DergiPark (Istanbul University), Jul 3, 2017

In this study we report our experience with a gravely neglected case of rhinophyma. Rhinophyma is... more In this study we report our experience with a gravely neglected case of rhinophyma. Rhinophyma is a disorder characterized by hypertrophy of the sebaceous glands, mononuclear infiltration and fibrous tissue deposition in the nasal skin. Clinically, the disorder manifests itself as disproportionate enlargement and severe disfigurement of the nose. As for the treatment, excision with cold knife, dermatome, dermabrasion, cauter knife and ultrasound blade, and reconstruction with skin graft, flap or secondary intention has been described in the literature. Presented in this study is a neglected and oversized case of rhinophyma. The hypertrophic mass sizing 7x6x3 cm has been excised from the supraperichondral plane. A similiar lesion with the size of 8x6x2 cm was attached to the main mass via a cutaneous pedicle on the left alar region. Resultant defect was reconstructed via a full thickness cutaneous graft harvested from the inguinal region and healed uneventfully. Along with this case report, available treatment alternatives were reviewed and their indications interpereted.

Turkish Journal of Plastic Surgery, 2017

Profil gorunumunden memnun olmayan hastalar siklikla rinoplasti istemiyle basvurmaktalardir. Buru... more Profil gorunumunden memnun olmayan hastalar siklikla rinoplasti istemiyle basvurmaktalardir. Burun yan profilden en belirgin alan olmakla beraber ideal bir profil icin alin, dudaklar, cene ve cene alti dokular birlikte degerlendirilmelidir. Bu calismanin amaci rinoplasti icin basvuran hastalarda ideal yan profil olcumlerinin olusturulmasi ve bu olcumler kullanilarak hastalarin hangi oranda ek cerrahi girisimlerden fayda goreceklerinin belirlenmesidir. Calisma Ocak-Ekim 2013 tarihleri arasinda basvuran 100 hastanin (60 bayan-40 Erkek) yan profil fotograflari cekilmistir. Bu fotograflarda hekim ve hasta birlikte karar vererek rinoplasti ve gerekli ek cerrahi girisim sonuclari simule edilmistir ve bunlar ideal profil kabul edilmistir. Bu preop ve simule fotograflarda alin, burun, alt ve ust cene ile cene alti yag dokusuna yonelik cesitli aci, oran ve endeks hesaplamalari yapilmistir. Daha sonra preoperatif antropometrik olcumler ideal degerlerle kiyaslanarak hastalarin hangi oranda han...

Plastic and Reconstructive Surgery, 2015

Plastic and Reconstructive Surgery, 2015

Journal of Experimental and Clinical Medicine, 2011

The hand holding devices are generally used during the course of micro-surgical operations in neu... more The hand holding devices are generally used during the course of micro-surgical operations in neurosurgery to prevent hand tremor. Recently we designed a new instrument for holding two arms. This instrument used for stabilization of two arms especially during microsurgical operations. We used this instrument in different type of operations such as aneurysm surgery, brain tumor surgery, hypophysis surgery, pontocerebellar tumor surgery and posterior fossa surgery. The ability of the instrument in the preventing of arm tremor, and comfort of the arm during surgery was graded as bad, good and excellent in terms of the description of surgeon during microsurgical operations. This instrument was used during 20 neurosurgical operations. The capability of the instrument during microsurgical operation was found as excellent in 65% of the operations. The capability was found as good in 35% of the operation. In conclusion; this instrument holds two arms in the same time and provide unrelated moving from each others. The capability of this instrument is high in the preventing of hand tremor. This instrument may be used during microsurgical operations in neurosurgery.

Journal of Experimental & Clinical Medicine, 2016

Self mutilation poses a stigmatizing concern for a repentant patient and yield to social eschewin... more Self mutilation poses a stigmatizing concern for a repentant patient and yield to social eschewing. Many of them undergo surgery for treatment of such scars. In this report, we present a case in whom we elected a self mutilation scar bearing dorsal surface of the forearm as a flap donor site for resurfacing a defect on the back of the first web space. Patient had been referred hand injury by shotgun. While that particular flap (posterior interosseous flap) is not our first choice in such cases, in the face of this preexisting condition we stepped out of our comfort zone for the sake of treating both conditions in one sitting. We think that if a patient with stigmatizing scars presents in need of surgical reconstruction, scarred sites should be chosen as donor sites whenever possible. Therefore, when the hand defects reconstructed, simultaneously, an acceptable single longitudinal scar can be leaved on the forearm instead unpleasant transvers scars.

Journal of Reconstructive Microsurgery, 2013

Vessel grafting is commonly used for revascularization or pedicle lengthening. Although veins are... more Vessel grafting is commonly used for revascularization or pedicle lengthening. Although veins are more commonly used, they can form aneurysms when bridging an arterial gap. This can lead to thrombosis, and the risk is increased when there is a size discrepancy. This study reports the long-term results of arterial lengthening via size discrepant carotid artery and femoral vein grafts in a rat femoral artery model (1:1.5 ratio). A total of 28 rats were used in this study, divided into two groups of 14. By the 21st day, one anastomosis in each group has been found to be thrombosed. Long-term patency rates were the same for both groups (93.3%). Radiologic imaging showed that size match in the carotid artery grafts was excellent despite of slightly fusiform dilatation, but in the vein groups, pronounced aneurismal deformation and distortion in the anastomosis was seen. Histologic analysis revealed that in the arterial grafts, endothelial continuity was smooth and mural inflammation was less than that of the vein grafts. Organized or recanalized mural thrombi were seen in 38.5% in the vein grafts, whereas in arterial grafts there were none.

Turkish Journal of Plastic Surgery / Türk Plastik, Rekonstrüktif ve Estetik Cerrahi Dergisi

Objective: Treating severe post-burn deformities of the face and neck region in pediatric populat... more Objective: Treating severe post-burn deformities of the face and neck region in pediatric populations is challenging because of technical difficulties (e.g., limited full thickness skin graft donor site, limited flap options, unavailability for expander placement) and increased donor site morbidity (e.g., related to flap and graft donor sites). In this study, we present the single-stage treatment of severe post-burn skin deformities of the face and neck region in pediatric patients using collagen-elastin matrix (Matriderm®) combined with partial thickness skin grafts. Material and Methods: The total number of cases was eight (four females, four males), and the ages were between two and 11 years. All cases were operated on for only one region. Following the release of contractures and/or excision of wide excessive/unfavorable dermal scars, defects were reconstructed using collagen-elastin matrix (Matriderm®) combined with partial-thickness skin grafts. The final functional and aesthetic results were evaluated using photography and examination. Results: The deformities were in the form of contractures and/or excessive dermal scarring. The involved regions were the face (n=3) and neck (n=5). The grafts yielded favorable plication and texture, and no recurrence of excessive dermal scarring was observed. All contractures healed unproblematically. Two patients were re-operated on for regrafting caused by minor graft loss (5% and 12% of the total area, respectively). Conclusion: In this study, we observed that collagen elastin matrix combined with partial-thickness skin grafts provides a favorable option for the treatment of pediatric late post-burn complications in the face and neck region with limited surgical options.

Facial plastic surgery : FPS, 2017

Among aesthetic surgery procedures, rhinoplasty is one of the most common. Preoperative simulatio... more Among aesthetic surgery procedures, rhinoplasty is one of the most common. Preoperative simulations have become increasingly commonplace through the recent years along with a controversy regarding their use. Although capable of building a solid rapport between the surgeon and the patient by visualizing the end result, it can also prove to be a liability for a surgeon who is not confident about delivering the result which has been put on screen. The objective of this study is to evaluate the outlook of the surgeons and patients on preoperative simulations. Plastic surgeons who perform rhinoplasty and individuals who consider rhinoplasty were surveyed via an online questionnaire system. Their opinions about the practice of simulation were questioned and they were asked to distinguish between simulated and actual postoperative results. Statistical analyses were performed using SPSS software. Major factors influencing the decision-making process of patients were the availability of preo...

Journal of Craniofacial Surgery, 2017

Neglected malignant tumors within the orbital region can invade the eyeball, extraocular muscles,... more Neglected malignant tumors within the orbital region can invade the eyeball, extraocular muscles, and bone substance surrounding the eye. Such patients require orbital exenteration, which may involve extraocular skeletal structures (even exposing paranasal sinuses), resulting in 3-dimensional defects requiring reconstruction. This study presents our experience with anterolateral thigh vastus lateralis (ALT/VL) chimeric free flaps for the reconstruction of extensive orbital exenteration defects involving various paranasal sinuses.Between 2012 and 2016, 4 patients with extensive 3-dimensional orbital defects with sinus involvement were treated using the ALT/VL chimeric flap. The ALT component (117-170 cm) was used to resurface the cutaneous defect while the VL component (105-243 cm) was used to obliterate the cavitary defect. The flaps were all based on the common descending pedicle, and branches to separate components were individually dissected. Recipient vessels were in the neck region, to which the donor pedicles were passed through a tunnel for anastomosis.All cavitary and surface defects were simultaneously reconstructed via the ALT/VL chimeric flap. Within an average of 17 months, no complications associated with flap surgery were observed. One patient received postoperative adjuvant radiotherapy with no complications. With its separate components supplied by a common vascular pedicle, the ALT/VL chimeric free flap allows the surgeon to conveniently reconstruct separate spatial and volumetric defects resulting from extensive orbital exenteration.

Aesthetic Plastic Surgery, 2016

Open and closed approaches for rhinoplasty have individual advantages and disadvantages; however,... more Open and closed approaches for rhinoplasty have individual advantages and disadvantages; however, the resultant columellar scar of the open approach is directly considered as a disadvantage. This study focuses on the columellar scar awareness and its implications on overall satisfaction of the patients after open rhinoplasty. A total of 91 patients who have undergone open rhinoplasty were included in this study. A written questionnaire algorithm consisting of 4 sequential questions was applied. Except for the first question [Do you have any scar(s) caused by any trauma, operation or any other reason on your face?], every question was answered on a scale from 1 to 5. The respondents were given the 25-question "Modified Body Cathexis Scale (MBCS)"and their scars graded using the "Columellar Scar Assessment Scale" (CSAS). The data were statistically interpreted. Of the 91 open rhinoplasty patients, 12 of them responded with a "yes" to the first question reporting their columellar scars. There was no significant difference with regards to patient satisfaction regarding these patients (p > 0.05). However, those who reported the scar yielded a significantly lower MBCS scores. 9 patients declared that they exerted effort to conceal their scars. Those who concealed their scars and those who did not yielded a significant difference in patient satisfaction. The CSAS scores of those who reported the columellar scar were significantly higher than those who did not. Our study suggests that MBSC can be a valuable tool for determining the impact of outcomes from the patient's standpoint, and awareness of the columellar scar is not related to patient satisfaction but with bodily perception. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Medical Hypotheses, 2016

Excessive dermal scarring (EDS) is a wound healing complication, characterized by protruded eryth... more Excessive dermal scarring (EDS) is a wound healing complication, characterized by protruded erythematous and inelastic 'proliferative scar tissue' which is associated with increased and prolonged inflammation process within the wound microenvironment. As inflammation plays a key role in this process, methods to contain or attenuate excessive inflammation hold promise in treatment and prophylaxis of EDS conditions. While cold exposure is notorious as the causative agent a wide array of morbidities and fatalities, its tempered use is exploited in medicine for ablative and therapeutic applications. "Subphysiological cold" has been administered for its antiinflammatory effects which act via decreasing vascular permeability and downregulating proliferation of cells in the wound environment; this knowledge supports our hypothesis that "subphysiological cold application" can also be utilized in human EDS prophylaxis and treatment. In this study, we are reviewing the mechanisms of its both deleterious and therapeutic actions and suggesting another possible application for prevention and/or treatment of human EDS conditions.