Fatih Parmaksizoglu - Academia.edu (original) (raw)
Papers by Fatih Parmaksizoglu
Acta Orthopaedica et Traumatologica Turcica, Oct 1, 2016
The aim of this study was to determine long term follow up of the patients who had femoral head o... more The aim of this study was to determine long term follow up of the patients who had femoral head osteonecrosis and had been treated with free vascularized fibular grafting. Patients and methods: We retrospectively reviewed 28 hips of 21 patients who had undergone free vascularized fibular grafting for the treatment of osteonecrosis of femoral head. There were 16 male and 5 female patients. The mean age of the patients at the time of surgery was 30.7 years (between 15 and 53 years). The mean follow-up time was 7.6 years (between 5 years and 9.2 years). Results: During follow-up, one patient died because of leukemia, and one patient was lost. The remaining 26 hips of 19 patients were evaluated. According to the Ficat classification, at the time of surgery, 17 hips were in grade 2 and 9 hips were in grade 3. The post-operative Harris hip scores in grade II disease were excellent in 12 patients, good in 3 patients, and fair in 1 patient. In grade III disease, 1 patient was excellent, 5 patients were good, and 1 patient was fair. There was a significant increase in HHS scores (61 ± 9.7 vs 84 ± 17.8, p < 0.001). Conclusion: Free vascularized fibular grafting yields extremely good results, particularly in pre-collapse stages of disease in young patients. The operation time does not mark increased if the surgical team is "familiar" with the procedure, and the residual fibular defect of the donor site does not impair the functions of daily living.
PubMed, 2004
Objectives: We evaluated the results of lengthening of the phalanges by callus distraction in tra... more Objectives: We evaluated the results of lengthening of the phalanges by callus distraction in traumatic amputations of the fingers. Methods: We treated traumatic amputations of 16 fingers of 13 male patients (mean age 27.7 years; range 12 to 43 years) by callotasis of the phalanges. Callus distraction was performed with a rate of 1 mm/day using a unilateral dynamic external fixation device. The mean follow-up period was 42 months (range 12 to 80 months). Results: The mean lengthening was 24 mm (range 18 to 26 mm) and 21 mm (range 18 to 26 mm) for the thumbs and the other fingers, respectively. The achieved thumb length provided adequate depth and width of the first web space and enabled functional improvement in the ability of gripping, and pulp-to-pulp and pulp-to-side pinching. In the absence of flexor pollicis longus, the mean strength of the thumbs was 7 kg (range 5 to 9 kg), amounting to 65% of the normal side. Lengthening of the other fingers resulted in improved functioning of the hand. The mean healing index (number of months per centimetre of lengthening) was 1.7 months/cm (range 1.6 to 2.1 months/cm) and 1.6 months/cm (range 1.4 to 1.9 months/cm) in the thumbs and the other fingers, respectively. Pin tract infections were observed in four phalanges. Conclusion: Callotasis of the proximal phalanx of the thumb is an effective reconstruction method to compensate for the loss of distal phalanx and to alleviate functional problems due to shortness. It may also be applied to the phalanges of the other fingers in patients who do not accept ray resection with or without transposition.
The journal of hand surgery, Oct 1, 2003
Handchirurgie Mikrochirurgie Plastische Chirurgie, 2003
Two total and one subtotal above-elbow amputations had replantation or revascularization for thei... more Two total and one subtotal above-elbow amputations had replantation or revascularization for their severely damaged upper extremities followed by functional latissimus dorsi island pedicle musculocutaneous flap to restore elbow flexion. The mean follow-up was 68 months (range: 14 to 121 months). At final follow-up examinations, the patients had sufficient range-of-motion of their elbows with good strength. Restoring elbow function eliminates one of the most important limiting factors for above-elbow replantations. Functional latissimus dorsi island pedicle musculocutaneous flap is very reliable, has minimal donor-site morbidity and offers a wider choice when deciding about arm replantation in the upper arm region by providing a chance of restoring functions.
Journal of Reconstructive Microsurgery, 2003
The role of side branches, when the parent arterial trunk is stretched, with emphasis on preventi... more The role of side branches, when the parent arterial trunk is stretched, with emphasis on preventing the effects of avulsion injury, was investigated in an experimental model. In ten New Zealand rabbits, the femoral arteries were isolated with and without side branches in the left and right legs, respectively, and controlled longitudinal traction was applied. The elongation of the arteries just before avulsion rupture at each side, with and without side branches, was compared, by measuring the initial and final length from the inguinal ligament to the mid-point of the distance between the inguinal ligament and the saphenous bifurcation. Side branches were observed to be tethered in a way that resisted elongation of the trunk artery. Arteries without side branches in the right legs elongated more, as they lacked the fixating and protective support provided by the side branches. Comparison of the two legs, with and without side branches, showed an average of 50 percent more arterial elongation, resulting in severe injury to the arteries without side branches. In the light of these results, the authors suggest performing microsurgical arterial anastomosis after resection past a minimum of two unruptured branch points of the avulsed part, in order to obtain a safer arterial segment for a better patency rate.
Journal of Reconstructive Microsurgery, 2002
In our clinic we consider three factors to evaluate the replantation or revascularization chance ... more In our clinic we consider three factors to evaluate the replantation or revascularization chance of below-knee amputations: A stable knee that can control joint motions; Preservation of the sensibility of the sole; Leg-length discrepancy that can be restored in the future. MATERIALS AND METHODS: MATERIALS AND METHODS: Between 1991 and 2000, four patients with four total and two sub-total below-knee amputations had replantation or revascularization for their severely damaged lower extremities. All of them had extensive debridement, vascular repair, bone shortening and nerve repair for sensibility of their soles. One of the replanted extremities was failured and had to be below-knee amputated because of the sepsis. After bony consolidation, four legs were lengthened; for elimination of the length discrepancy in three cases and for obtaining balanced body proportion in one case in which the other leg was also amputated. In all operations unilateral dynamic axial external fixator was used. The lengthenings were performed from the proximal tibial metaphysis with a subperiosteal osteotomy. The mean follow-up period was 56 months (range 21-124 months). CASE REPORTS AND RESULTS: CASE REPORTS AND RESULTS: Case1: Case1: A male aged 20 years had bilateral below knee amputations with a MESS score of 19 in a car accident. He had bilateral replantations of his lower extremities with end-to-end anastomises of tibialis anterior arteries performed by two different surgical teams. He had a 7-cm. of length difference between two extremities and valgus deformity of the ankle of his shortened left leg. 9 months after the replantation, following the bony consolidation, his left leg was lengthened 6 cm. by external fixator in 6 months' time and the valgus deformity was corrected by osteotomy of the distal tibia and fixating with K-wires. He also had arthrodesis of his right ankle. After the treatment the patient can walk with short heel wedge support for his left foot while wearing ordinary shoes. Case 2: Case 2: A male aged 44 years had subtotal amputation of his right distal cruris with a MESS score of 19 after a train accident. He had revascularization with end-to-end anastomises of tibialis anterior artery. He had 5-cm. of length difference. 12 months later, the patient injured from a second car accident resulting the fracture of his tibia at the revascularization site. Both the lengthening from the metaphysis of proximal tibia and also treatment of the fracture of the distal tibia were performed with a dynamic axial fixator in the same period. Lengthening of 5 cm. was performed in 5 months' time. Arthrodesis was performed to stabilize his ankle. The patient could walk with a short heel wedge support while wearing ordinary shoes. Case 3: Case 3: A male aged 21 years had bilateral below-knee total amputations in a car accident with a MESS score of 20 for each side. Bilateral replantation of the amputated parts were performed, but early failure of the right lower extremity was obtained and below knee amputation was performed at the 28th day, because of the sepsis. He had an unbalanced body proportion with below knee amputated right and shortened, replanted left lower extremities. After 8 months his left leg was lengthened for 7 cm. in 6 months' time and a balanced proportional body was obtained. The patient could walk with a right below knee prosthesis. Case 4: Case 4: A male aged 19 had below knee subtotal amputation of his right leg after a car accident and the revascularization of the tibialis anterior artery was performed by grafting the saphene vein. Arthrodesis of the ankle was also performed during revascularization. Bony consolidation was obtained after 5 months. His 5 cm. shortened lower extremity was lengthened 5 cm. in 6 months' time. He had arthrodesis of his MP joints and tenotomies of the flexor tendons as stabilizing procedures. He had a fracture of the tibia from the lengthening site that was treated conservatively. He could walk wearing ordinary shoes. CONCLUSION: CONCLUSION: The Mangled Extremity Severity Score (MESS) is a guide for the salvage decision and bone and soft tissue shortening increases the score, decreasing the possible replantation chance. While a score of less than 7 points suggests that salvage should be attempted, bone loss more than 6 centimeters adds 6 points to the score. Evaluation of the injury according to MESS would cause the surgeon to avoid salvage surgery with a shortened extremity because of the debridement of the soft tissue and bone. But shortness is an avoidable problem and does not form a contraindication for replantation or revascularization as below knee traumatic total or subtotal amputations can be salvaged by replantation or revascularization following extensive debridement with deliberate shortening. The restoration of the leg length discrepancy can be performed after bony consolidation. We think the amount of limb shortening is not a major criterion in evaluating a traumatic total or subtotal below-knee amputation for salvage replantation or revascularization. A knee that has stable joint motions and possibility of preservation of sensibility of the sole broadens the scope of indications for limb salvage even with deliberate shortening that can be restored by lengthening and length discrepancy is not a contraindication for limb salvage.
The Journal of Hand Surgery, 2003
Handchirurgie Mikrochirurgie Plastische Chirurgie, 2003
Haemangioma localised in the wrist originating from the sheath of the fifth deep flexor tendon an... more Haemangioma localised in the wrist originating from the sheath of the fifth deep flexor tendon and obstructing the movement of the tendon through the carpal tunnel as an unusual cause of trigger wrist is presented. Tumoural masses around the wrist can cause triggering by obstructing the movement of tendons through the carpal tunnel and the clinician should consider other causes of triggering for surgical treatment.
Journal of the American Podiatric Medical Association, Sep 2, 2016
Background Lateral malleolar fractures (Weber type B or OTA 44-B) account for 60% of all ankle fr... more Background Lateral malleolar fractures (Weber type B or OTA 44-B) account for 60% of all ankle fractures. To achieve anatomic restoration, surgical stabilization provides better results than conservative treatment. Various fixation methods are available to treat these fractures; however, the best method is still unknown. Our objectives were to present a new, useful, and efficient surgical technique for stabilizing lateral malleolar fractures and to analyze the outcomes of patients treated with the compression cerclage system. Methods The surgical technique consists of a Kirschner wire that is passed percutaneously and perpendicular to the fracture line, and a cerclage wire that is passed in a semi-circular fashion over the ends of the Kirschner wire on the lateral side of the bone, leaving loops on each side to allow bilateral compression while twisting both wires. We retrospectively evaluated patients treated with this technique, with or without additional fractures. Follow-up of &lt;24 months and bilateral ankle fractures were the exclusion criteria. Fractures were examined clinically and radiologically in comparison to the uninjured side and were rated according to the criteria reported by McLennon and Ungersma. Olerud and Molander ankle score was used to evaluate functional outcome. Results At the final follow-up, 15 out of 21 patients (9 women and 6 men; mean age, 48.2 years [range, 19–78 years]) were evaluated. The mean follow-up was 5.16 years (28–129 months). Five patients had an isolated lateral malleolar fracture; eight had lateral and medial malleolar fractures; and two had trimalleolar fractures. At the final follow-up, 11 patients were rated good functionally and four were fair, and all patients were rated good radiographically according to the criteria by McLennon and Ungersma. Mean Olerud and Molander ankle score was 93.3 (range, 80–100). Conclusions The compression cerclage system provides good functional and radiological outcomes in patients with lateral malleolus fractures. This method is useful, safe, and efficient with minimum hardware. It can be applied through limited soft-tissue stripping, which is especially important in patients with a high risk for wound complications.
The journal of bone and joint surgery, Nov 1, 2010
We present the results of 13 patients who suffered severe injuries to the lower leg. Five sustain... more We present the results of 13 patients who suffered severe injuries to the lower leg. Five sustained a traumatic amputation and eight a Gustilo-Anderson type IIIC open fracture. All were treated with debridement, acute shortening and stabilisation of the fracture and vascular reconstruction. Further treatment involved restoration of tibial length by callus distraction through the distal or proximal metaphysis, which was commenced soon after the soft tissues had healed (n = 8) or delayed until union of the fracture (n = 5). All patients were male with a mean age of 28.4 years (17 to 44), and had sustained injury to the leg only. Chen grade II functional status was achieved in all patients. Although the number of patients treated with each strategy was limited, there was no obvious disadvantage in the early lengthening programme, which was completed more quickly.
Acta Orthopaedica et Traumatologica Turcica, 2015
Objective: Thumb amputation is a major cause of hand dysfunction, and the treatment for distal th... more Objective: Thumb amputation is a major cause of hand dysfunction, and the treatment for distal thumb amputations remains controversial. Although finger reconstruction methods using distraction lengthening are known to restore finger length and function, we found no reports in the literature regarding phalangeal lengthening in thumb amputations. We aimed to evaluate proximal phalangeal lengthening in thumb amputations at or near the interphalangeal (IP) joint. Methods: We retrospectively evaluated patients who had undergone distraction lengthening of the proximal phalanx of the thumb. All patients underwent osteotomy, either during the initial procedure or as a second-stage procedure. Distraction began 10 days after osteotomy with the use of an external fixator that remained in place until ossification of the gap occurred without bone grafting. Patients were evaluated using the QuickDASH score. Results: Fourteen patients with a mean age of 27 years and a mean follow-up period of 7 years were enrolled. The mean phalangeal lengthening achieved was 20 mm. Ossification occurred at all distraction sites, and the fixators were maintained for a mean of 85 days. The mean healing index was 42.5 days/cm. All 14 patients achieved the desired amount of phalangeal lengthening without major complications such as nonunion, premature union, or gross infection. Conclusion: For reconstruction in cases of distal thumb amputations, distraction lengthening of the proximal phalanx can be used to improve absolute length, web space, and grip distance. The technique is safe and effective, improves functionality/cosmesis, and offers a low complication risk.
The Journal of emergency medicine, Oct 1, 2011
Journal of Reconstructive Microsurgery, 2002
The most frequently encountered problems during vein grafting are diameter, length discrepancies ... more The most frequently encountered problems during vein grafting are diameter, length discrepancies and twisting of the anastomosed vein and recipient vessel. Diameter of the graft: Diameter of the graft: After performing an anastomosis, under high pressure, the widening of the graft's diameter leads turbulence of the blood flow. The diameter and size mismatch of the vein grafts is prone to thrombus formation and subsequent graft failure.(Figure 1) Length of the grafts: Length of the grafts: However the length of the vein graft did not alter the degree of the patency the determination of the length of the graft is difficult because of retraction of the recipient vessel ends and elongation of the graft itself. Vein grafts always elongate after reperfusion. Considerable experience is required for the determination of the length of the vein graft to bridge the defect. If the graft is harvested too short, tension over the anastomosis site occurs; if the graft is too long, recovery of the arterial ends' retraction and elongation of the graft under pressure cause kinking. A graft equal in length to the vascular gap will be too long after it is elongated by the blood pressure. Experimentally, the graft can be up to 35 percent longer than the replaced segment without kinking. Some techniques to prevent these difficulties have been presented. The graft should be just shorter than the length of the gap and should be sutured under slight tension and double-clamp anastomosis can be performed. The clamps are left in place, proximally and distally. After the completion of both anastomoses, the distal one is released first. Measuring the graft in situ or completing the proximal anastomosis first and allowing the blood to fill the graft are the techniques that can be used to assume the natural length of the graft, but re-shortening the graft or reanastomosing are the techniqual difficulties and time-wasting procedures.(Figure 2) Twisting and torsion of the graft: Twisting and torsion of the graft: Especially twisting and torsion of the graft may be a major problem in long grafts tunneled under closed sites. During the anastomosis, a very unremarkable torsion over the anastomosis site may be a reason of kinking and twisting of the graft. This neglected torsion effect combines on one point causing obstruction, when it goes under pressure. A method to prevent twisting is allowing the vein graft to perfuse with arterial blood for a short period transiently so that it will unwind and extend to its full length and performing the distal anastomosis later,but thrombosis of the graft is possible despite heparinzed saline perfusion because of the stasis of the arterial blood. Sometimes a catheterization just proximal than the proximal anastomosis is needed for heparinized saline wash. "Loop technique" is another solution to avoid twisting of long grafts, especially in free tissue transfers.(Figure 3
The Journal of Bone and Joint Surgery. British volume, 2010
We present the results of 13 patients who suffered severe injuries to the lower leg. Five sustain... more We present the results of 13 patients who suffered severe injuries to the lower leg. Five sustained a traumatic amputation and eight a Gustilo-Anderson type IIIC open fracture. All were treated with debridement, acute shortening and stabilisation of the fracture and vascular reconstruction. Further treatment involved restoration of tibial length by callus distraction through the distal or proximal metaphysis, which was commenced soon after the soft tissues had healed (n = 8) or delayed until union of the fracture (n = 5). All patients were male with a mean age of 28.4 years (17 to 44), and had sustained injury to the leg only. Chen grade II functional status was achieved in all patients. Although the number of patients treated with each strategy was limited, there was no obvious disadvantage in the early lengthening programme, which was completed more quickly.
Handchirurgie · Mikrochirurgie · Plastische Chirurgie, 2003
Haemangioma localised in the wrist originating from the sheath of the fifth deep flexor tendon an... more Haemangioma localised in the wrist originating from the sheath of the fifth deep flexor tendon and obstructing the movement of the tendon through the carpal tunnel as an unusual cause of trigger wrist is presented. Tumoural masses around the wrist can cause triggering by obstructing the movement of tendons through the carpal tunnel and the clinician should consider other causes of triggering for surgical treatment.
Handchirurgie · Mikrochirurgie · Plastische Chirurgie, 2003
Two total and one subtotal above-elbow amputations had replantation or revascularization for thei... more Two total and one subtotal above-elbow amputations had replantation or revascularization for their severely damaged upper extremities followed by functional latissimus dorsi island pedicle musculocutaneous flap to restore elbow flexion. The mean follow-up was 68 months (range: 14 to 121 months). At final follow-up examinations, the patients had sufficient range-of-motion of their elbows with good strength. Restoring elbow function eliminates one of the most important limiting factors for above-elbow replantations. Functional latissimus dorsi island pedicle musculocutaneous flap is very reliable, has minimal donor-site morbidity and offers a wider choice when deciding about arm replantation in the upper arm region by providing a chance of restoring functions.
Miksomalar en sik kalpte izlenir ancak, daha az oranda ciltalti, aponorotik doku, kemik, genitour... more Miksomalar en sik kalpte izlenir ancak, daha az oranda ciltalti, aponorotik doku, kemik, genitouriner sistem ve deri gibi diger dokularda da gorulebilir. Kalp disi yumusak dokulardan kokenli miksomalardan olan “cizgili kaslarin miksomasi” gorece enderdir. Olgumuz, sag ust kolda zamanla olusan sislik ve hareket kisitliligi yakinmasiyla basvuran 59 yasinda kadin hastadir. Fizik muayenesinde deltoid kas bolgesinde siskinlik ve palpasyonda ele gelen yumusak kitle izlenmistir. Magnetik rezonans anjiografisinde deltoid kas icinde hiperintens, duzgun sinirli; icerisinde hipointens septalarin izlendigi kitle saptanmistir. Makroskopik incelemesinde, 5.5x4x3 cm olculerinde, cevresinde kirmizi kas secilebilen yumusak doku parcasina kesit yapildiginda cevre kas dokusundan duzgun sinirla ayrilan 3.2x3x2.5 cm boyutlarda parlak beyaz renkte, jelatinoz alanlar iceren lezyon izlenmistir. Mikroskopik incelemede, tumorun genis mukoid alanlar icinde dar sitoplazmali, hiperkromatik piknotik gorunumlu ce...
JBJS Essential Surgical Techniques, 2005
Journal of the American Podiatric Medical Association, 2016
Background Lateral malleolar fractures (Weber type B or OTA 44-B) account for 60% of all ankle fr... more Background Lateral malleolar fractures (Weber type B or OTA 44-B) account for 60% of all ankle fractures. To achieve anatomic restoration, surgical stabilization provides better results than conservative treatment. Various fixation methods are available to treat these fractures; however, the best method is still unknown. Our objectives were to present a new, useful, and efficient surgical technique for stabilizing lateral malleolar fractures and to analyze the outcomes of patients treated with the compression cerclage system. Methods The surgical technique consists of a Kirschner wire that is passed percutaneously and perpendicular to the fracture line, and a cerclage wire that is passed in a semi-circular fashion over the ends of the Kirschner wire on the lateral side of the bone, leaving loops on each side to allow bilateral compression while twisting both wires. We retrospectively evaluated patients treated with this technique, with or without additional fractures. Follow-up of &...
J Emerg Med, 2011
Massive subcutaneous emphysema and pneumomediastinum in acute bronchiolitis: a pediatric case wit... more Massive subcutaneous emphysema and pneumomediastinum in acute bronchiolitis: a pediatric case with a history of chronic lung disease of infancy
Acta Orthopaedica et Traumatologica Turcica, Oct 1, 2016
The aim of this study was to determine long term follow up of the patients who had femoral head o... more The aim of this study was to determine long term follow up of the patients who had femoral head osteonecrosis and had been treated with free vascularized fibular grafting. Patients and methods: We retrospectively reviewed 28 hips of 21 patients who had undergone free vascularized fibular grafting for the treatment of osteonecrosis of femoral head. There were 16 male and 5 female patients. The mean age of the patients at the time of surgery was 30.7 years (between 15 and 53 years). The mean follow-up time was 7.6 years (between 5 years and 9.2 years). Results: During follow-up, one patient died because of leukemia, and one patient was lost. The remaining 26 hips of 19 patients were evaluated. According to the Ficat classification, at the time of surgery, 17 hips were in grade 2 and 9 hips were in grade 3. The post-operative Harris hip scores in grade II disease were excellent in 12 patients, good in 3 patients, and fair in 1 patient. In grade III disease, 1 patient was excellent, 5 patients were good, and 1 patient was fair. There was a significant increase in HHS scores (61 ± 9.7 vs 84 ± 17.8, p < 0.001). Conclusion: Free vascularized fibular grafting yields extremely good results, particularly in pre-collapse stages of disease in young patients. The operation time does not mark increased if the surgical team is "familiar" with the procedure, and the residual fibular defect of the donor site does not impair the functions of daily living.
PubMed, 2004
Objectives: We evaluated the results of lengthening of the phalanges by callus distraction in tra... more Objectives: We evaluated the results of lengthening of the phalanges by callus distraction in traumatic amputations of the fingers. Methods: We treated traumatic amputations of 16 fingers of 13 male patients (mean age 27.7 years; range 12 to 43 years) by callotasis of the phalanges. Callus distraction was performed with a rate of 1 mm/day using a unilateral dynamic external fixation device. The mean follow-up period was 42 months (range 12 to 80 months). Results: The mean lengthening was 24 mm (range 18 to 26 mm) and 21 mm (range 18 to 26 mm) for the thumbs and the other fingers, respectively. The achieved thumb length provided adequate depth and width of the first web space and enabled functional improvement in the ability of gripping, and pulp-to-pulp and pulp-to-side pinching. In the absence of flexor pollicis longus, the mean strength of the thumbs was 7 kg (range 5 to 9 kg), amounting to 65% of the normal side. Lengthening of the other fingers resulted in improved functioning of the hand. The mean healing index (number of months per centimetre of lengthening) was 1.7 months/cm (range 1.6 to 2.1 months/cm) and 1.6 months/cm (range 1.4 to 1.9 months/cm) in the thumbs and the other fingers, respectively. Pin tract infections were observed in four phalanges. Conclusion: Callotasis of the proximal phalanx of the thumb is an effective reconstruction method to compensate for the loss of distal phalanx and to alleviate functional problems due to shortness. It may also be applied to the phalanges of the other fingers in patients who do not accept ray resection with or without transposition.
The journal of hand surgery, Oct 1, 2003
Handchirurgie Mikrochirurgie Plastische Chirurgie, 2003
Two total and one subtotal above-elbow amputations had replantation or revascularization for thei... more Two total and one subtotal above-elbow amputations had replantation or revascularization for their severely damaged upper extremities followed by functional latissimus dorsi island pedicle musculocutaneous flap to restore elbow flexion. The mean follow-up was 68 months (range: 14 to 121 months). At final follow-up examinations, the patients had sufficient range-of-motion of their elbows with good strength. Restoring elbow function eliminates one of the most important limiting factors for above-elbow replantations. Functional latissimus dorsi island pedicle musculocutaneous flap is very reliable, has minimal donor-site morbidity and offers a wider choice when deciding about arm replantation in the upper arm region by providing a chance of restoring functions.
Journal of Reconstructive Microsurgery, 2003
The role of side branches, when the parent arterial trunk is stretched, with emphasis on preventi... more The role of side branches, when the parent arterial trunk is stretched, with emphasis on preventing the effects of avulsion injury, was investigated in an experimental model. In ten New Zealand rabbits, the femoral arteries were isolated with and without side branches in the left and right legs, respectively, and controlled longitudinal traction was applied. The elongation of the arteries just before avulsion rupture at each side, with and without side branches, was compared, by measuring the initial and final length from the inguinal ligament to the mid-point of the distance between the inguinal ligament and the saphenous bifurcation. Side branches were observed to be tethered in a way that resisted elongation of the trunk artery. Arteries without side branches in the right legs elongated more, as they lacked the fixating and protective support provided by the side branches. Comparison of the two legs, with and without side branches, showed an average of 50 percent more arterial elongation, resulting in severe injury to the arteries without side branches. In the light of these results, the authors suggest performing microsurgical arterial anastomosis after resection past a minimum of two unruptured branch points of the avulsed part, in order to obtain a safer arterial segment for a better patency rate.
Journal of Reconstructive Microsurgery, 2002
In our clinic we consider three factors to evaluate the replantation or revascularization chance ... more In our clinic we consider three factors to evaluate the replantation or revascularization chance of below-knee amputations: A stable knee that can control joint motions; Preservation of the sensibility of the sole; Leg-length discrepancy that can be restored in the future. MATERIALS AND METHODS: MATERIALS AND METHODS: Between 1991 and 2000, four patients with four total and two sub-total below-knee amputations had replantation or revascularization for their severely damaged lower extremities. All of them had extensive debridement, vascular repair, bone shortening and nerve repair for sensibility of their soles. One of the replanted extremities was failured and had to be below-knee amputated because of the sepsis. After bony consolidation, four legs were lengthened; for elimination of the length discrepancy in three cases and for obtaining balanced body proportion in one case in which the other leg was also amputated. In all operations unilateral dynamic axial external fixator was used. The lengthenings were performed from the proximal tibial metaphysis with a subperiosteal osteotomy. The mean follow-up period was 56 months (range 21-124 months). CASE REPORTS AND RESULTS: CASE REPORTS AND RESULTS: Case1: Case1: A male aged 20 years had bilateral below knee amputations with a MESS score of 19 in a car accident. He had bilateral replantations of his lower extremities with end-to-end anastomises of tibialis anterior arteries performed by two different surgical teams. He had a 7-cm. of length difference between two extremities and valgus deformity of the ankle of his shortened left leg. 9 months after the replantation, following the bony consolidation, his left leg was lengthened 6 cm. by external fixator in 6 months' time and the valgus deformity was corrected by osteotomy of the distal tibia and fixating with K-wires. He also had arthrodesis of his right ankle. After the treatment the patient can walk with short heel wedge support for his left foot while wearing ordinary shoes. Case 2: Case 2: A male aged 44 years had subtotal amputation of his right distal cruris with a MESS score of 19 after a train accident. He had revascularization with end-to-end anastomises of tibialis anterior artery. He had 5-cm. of length difference. 12 months later, the patient injured from a second car accident resulting the fracture of his tibia at the revascularization site. Both the lengthening from the metaphysis of proximal tibia and also treatment of the fracture of the distal tibia were performed with a dynamic axial fixator in the same period. Lengthening of 5 cm. was performed in 5 months' time. Arthrodesis was performed to stabilize his ankle. The patient could walk with a short heel wedge support while wearing ordinary shoes. Case 3: Case 3: A male aged 21 years had bilateral below-knee total amputations in a car accident with a MESS score of 20 for each side. Bilateral replantation of the amputated parts were performed, but early failure of the right lower extremity was obtained and below knee amputation was performed at the 28th day, because of the sepsis. He had an unbalanced body proportion with below knee amputated right and shortened, replanted left lower extremities. After 8 months his left leg was lengthened for 7 cm. in 6 months' time and a balanced proportional body was obtained. The patient could walk with a right below knee prosthesis. Case 4: Case 4: A male aged 19 had below knee subtotal amputation of his right leg after a car accident and the revascularization of the tibialis anterior artery was performed by grafting the saphene vein. Arthrodesis of the ankle was also performed during revascularization. Bony consolidation was obtained after 5 months. His 5 cm. shortened lower extremity was lengthened 5 cm. in 6 months' time. He had arthrodesis of his MP joints and tenotomies of the flexor tendons as stabilizing procedures. He had a fracture of the tibia from the lengthening site that was treated conservatively. He could walk wearing ordinary shoes. CONCLUSION: CONCLUSION: The Mangled Extremity Severity Score (MESS) is a guide for the salvage decision and bone and soft tissue shortening increases the score, decreasing the possible replantation chance. While a score of less than 7 points suggests that salvage should be attempted, bone loss more than 6 centimeters adds 6 points to the score. Evaluation of the injury according to MESS would cause the surgeon to avoid salvage surgery with a shortened extremity because of the debridement of the soft tissue and bone. But shortness is an avoidable problem and does not form a contraindication for replantation or revascularization as below knee traumatic total or subtotal amputations can be salvaged by replantation or revascularization following extensive debridement with deliberate shortening. The restoration of the leg length discrepancy can be performed after bony consolidation. We think the amount of limb shortening is not a major criterion in evaluating a traumatic total or subtotal below-knee amputation for salvage replantation or revascularization. A knee that has stable joint motions and possibility of preservation of sensibility of the sole broadens the scope of indications for limb salvage even with deliberate shortening that can be restored by lengthening and length discrepancy is not a contraindication for limb salvage.
The Journal of Hand Surgery, 2003
Handchirurgie Mikrochirurgie Plastische Chirurgie, 2003
Haemangioma localised in the wrist originating from the sheath of the fifth deep flexor tendon an... more Haemangioma localised in the wrist originating from the sheath of the fifth deep flexor tendon and obstructing the movement of the tendon through the carpal tunnel as an unusual cause of trigger wrist is presented. Tumoural masses around the wrist can cause triggering by obstructing the movement of tendons through the carpal tunnel and the clinician should consider other causes of triggering for surgical treatment.
Journal of the American Podiatric Medical Association, Sep 2, 2016
Background Lateral malleolar fractures (Weber type B or OTA 44-B) account for 60% of all ankle fr... more Background Lateral malleolar fractures (Weber type B or OTA 44-B) account for 60% of all ankle fractures. To achieve anatomic restoration, surgical stabilization provides better results than conservative treatment. Various fixation methods are available to treat these fractures; however, the best method is still unknown. Our objectives were to present a new, useful, and efficient surgical technique for stabilizing lateral malleolar fractures and to analyze the outcomes of patients treated with the compression cerclage system. Methods The surgical technique consists of a Kirschner wire that is passed percutaneously and perpendicular to the fracture line, and a cerclage wire that is passed in a semi-circular fashion over the ends of the Kirschner wire on the lateral side of the bone, leaving loops on each side to allow bilateral compression while twisting both wires. We retrospectively evaluated patients treated with this technique, with or without additional fractures. Follow-up of &lt;24 months and bilateral ankle fractures were the exclusion criteria. Fractures were examined clinically and radiologically in comparison to the uninjured side and were rated according to the criteria reported by McLennon and Ungersma. Olerud and Molander ankle score was used to evaluate functional outcome. Results At the final follow-up, 15 out of 21 patients (9 women and 6 men; mean age, 48.2 years [range, 19–78 years]) were evaluated. The mean follow-up was 5.16 years (28–129 months). Five patients had an isolated lateral malleolar fracture; eight had lateral and medial malleolar fractures; and two had trimalleolar fractures. At the final follow-up, 11 patients were rated good functionally and four were fair, and all patients were rated good radiographically according to the criteria by McLennon and Ungersma. Mean Olerud and Molander ankle score was 93.3 (range, 80–100). Conclusions The compression cerclage system provides good functional and radiological outcomes in patients with lateral malleolus fractures. This method is useful, safe, and efficient with minimum hardware. It can be applied through limited soft-tissue stripping, which is especially important in patients with a high risk for wound complications.
The journal of bone and joint surgery, Nov 1, 2010
We present the results of 13 patients who suffered severe injuries to the lower leg. Five sustain... more We present the results of 13 patients who suffered severe injuries to the lower leg. Five sustained a traumatic amputation and eight a Gustilo-Anderson type IIIC open fracture. All were treated with debridement, acute shortening and stabilisation of the fracture and vascular reconstruction. Further treatment involved restoration of tibial length by callus distraction through the distal or proximal metaphysis, which was commenced soon after the soft tissues had healed (n = 8) or delayed until union of the fracture (n = 5). All patients were male with a mean age of 28.4 years (17 to 44), and had sustained injury to the leg only. Chen grade II functional status was achieved in all patients. Although the number of patients treated with each strategy was limited, there was no obvious disadvantage in the early lengthening programme, which was completed more quickly.
Acta Orthopaedica et Traumatologica Turcica, 2015
Objective: Thumb amputation is a major cause of hand dysfunction, and the treatment for distal th... more Objective: Thumb amputation is a major cause of hand dysfunction, and the treatment for distal thumb amputations remains controversial. Although finger reconstruction methods using distraction lengthening are known to restore finger length and function, we found no reports in the literature regarding phalangeal lengthening in thumb amputations. We aimed to evaluate proximal phalangeal lengthening in thumb amputations at or near the interphalangeal (IP) joint. Methods: We retrospectively evaluated patients who had undergone distraction lengthening of the proximal phalanx of the thumb. All patients underwent osteotomy, either during the initial procedure or as a second-stage procedure. Distraction began 10 days after osteotomy with the use of an external fixator that remained in place until ossification of the gap occurred without bone grafting. Patients were evaluated using the QuickDASH score. Results: Fourteen patients with a mean age of 27 years and a mean follow-up period of 7 years were enrolled. The mean phalangeal lengthening achieved was 20 mm. Ossification occurred at all distraction sites, and the fixators were maintained for a mean of 85 days. The mean healing index was 42.5 days/cm. All 14 patients achieved the desired amount of phalangeal lengthening without major complications such as nonunion, premature union, or gross infection. Conclusion: For reconstruction in cases of distal thumb amputations, distraction lengthening of the proximal phalanx can be used to improve absolute length, web space, and grip distance. The technique is safe and effective, improves functionality/cosmesis, and offers a low complication risk.
The Journal of emergency medicine, Oct 1, 2011
Journal of Reconstructive Microsurgery, 2002
The most frequently encountered problems during vein grafting are diameter, length discrepancies ... more The most frequently encountered problems during vein grafting are diameter, length discrepancies and twisting of the anastomosed vein and recipient vessel. Diameter of the graft: Diameter of the graft: After performing an anastomosis, under high pressure, the widening of the graft's diameter leads turbulence of the blood flow. The diameter and size mismatch of the vein grafts is prone to thrombus formation and subsequent graft failure.(Figure 1) Length of the grafts: Length of the grafts: However the length of the vein graft did not alter the degree of the patency the determination of the length of the graft is difficult because of retraction of the recipient vessel ends and elongation of the graft itself. Vein grafts always elongate after reperfusion. Considerable experience is required for the determination of the length of the vein graft to bridge the defect. If the graft is harvested too short, tension over the anastomosis site occurs; if the graft is too long, recovery of the arterial ends' retraction and elongation of the graft under pressure cause kinking. A graft equal in length to the vascular gap will be too long after it is elongated by the blood pressure. Experimentally, the graft can be up to 35 percent longer than the replaced segment without kinking. Some techniques to prevent these difficulties have been presented. The graft should be just shorter than the length of the gap and should be sutured under slight tension and double-clamp anastomosis can be performed. The clamps are left in place, proximally and distally. After the completion of both anastomoses, the distal one is released first. Measuring the graft in situ or completing the proximal anastomosis first and allowing the blood to fill the graft are the techniques that can be used to assume the natural length of the graft, but re-shortening the graft or reanastomosing are the techniqual difficulties and time-wasting procedures.(Figure 2) Twisting and torsion of the graft: Twisting and torsion of the graft: Especially twisting and torsion of the graft may be a major problem in long grafts tunneled under closed sites. During the anastomosis, a very unremarkable torsion over the anastomosis site may be a reason of kinking and twisting of the graft. This neglected torsion effect combines on one point causing obstruction, when it goes under pressure. A method to prevent twisting is allowing the vein graft to perfuse with arterial blood for a short period transiently so that it will unwind and extend to its full length and performing the distal anastomosis later,but thrombosis of the graft is possible despite heparinzed saline perfusion because of the stasis of the arterial blood. Sometimes a catheterization just proximal than the proximal anastomosis is needed for heparinized saline wash. "Loop technique" is another solution to avoid twisting of long grafts, especially in free tissue transfers.(Figure 3
The Journal of Bone and Joint Surgery. British volume, 2010
We present the results of 13 patients who suffered severe injuries to the lower leg. Five sustain... more We present the results of 13 patients who suffered severe injuries to the lower leg. Five sustained a traumatic amputation and eight a Gustilo-Anderson type IIIC open fracture. All were treated with debridement, acute shortening and stabilisation of the fracture and vascular reconstruction. Further treatment involved restoration of tibial length by callus distraction through the distal or proximal metaphysis, which was commenced soon after the soft tissues had healed (n = 8) or delayed until union of the fracture (n = 5). All patients were male with a mean age of 28.4 years (17 to 44), and had sustained injury to the leg only. Chen grade II functional status was achieved in all patients. Although the number of patients treated with each strategy was limited, there was no obvious disadvantage in the early lengthening programme, which was completed more quickly.
Handchirurgie · Mikrochirurgie · Plastische Chirurgie, 2003
Haemangioma localised in the wrist originating from the sheath of the fifth deep flexor tendon an... more Haemangioma localised in the wrist originating from the sheath of the fifth deep flexor tendon and obstructing the movement of the tendon through the carpal tunnel as an unusual cause of trigger wrist is presented. Tumoural masses around the wrist can cause triggering by obstructing the movement of tendons through the carpal tunnel and the clinician should consider other causes of triggering for surgical treatment.
Handchirurgie · Mikrochirurgie · Plastische Chirurgie, 2003
Two total and one subtotal above-elbow amputations had replantation or revascularization for thei... more Two total and one subtotal above-elbow amputations had replantation or revascularization for their severely damaged upper extremities followed by functional latissimus dorsi island pedicle musculocutaneous flap to restore elbow flexion. The mean follow-up was 68 months (range: 14 to 121 months). At final follow-up examinations, the patients had sufficient range-of-motion of their elbows with good strength. Restoring elbow function eliminates one of the most important limiting factors for above-elbow replantations. Functional latissimus dorsi island pedicle musculocutaneous flap is very reliable, has minimal donor-site morbidity and offers a wider choice when deciding about arm replantation in the upper arm region by providing a chance of restoring functions.
Miksomalar en sik kalpte izlenir ancak, daha az oranda ciltalti, aponorotik doku, kemik, genitour... more Miksomalar en sik kalpte izlenir ancak, daha az oranda ciltalti, aponorotik doku, kemik, genitouriner sistem ve deri gibi diger dokularda da gorulebilir. Kalp disi yumusak dokulardan kokenli miksomalardan olan “cizgili kaslarin miksomasi” gorece enderdir. Olgumuz, sag ust kolda zamanla olusan sislik ve hareket kisitliligi yakinmasiyla basvuran 59 yasinda kadin hastadir. Fizik muayenesinde deltoid kas bolgesinde siskinlik ve palpasyonda ele gelen yumusak kitle izlenmistir. Magnetik rezonans anjiografisinde deltoid kas icinde hiperintens, duzgun sinirli; icerisinde hipointens septalarin izlendigi kitle saptanmistir. Makroskopik incelemesinde, 5.5x4x3 cm olculerinde, cevresinde kirmizi kas secilebilen yumusak doku parcasina kesit yapildiginda cevre kas dokusundan duzgun sinirla ayrilan 3.2x3x2.5 cm boyutlarda parlak beyaz renkte, jelatinoz alanlar iceren lezyon izlenmistir. Mikroskopik incelemede, tumorun genis mukoid alanlar icinde dar sitoplazmali, hiperkromatik piknotik gorunumlu ce...
JBJS Essential Surgical Techniques, 2005
Journal of the American Podiatric Medical Association, 2016
Background Lateral malleolar fractures (Weber type B or OTA 44-B) account for 60% of all ankle fr... more Background Lateral malleolar fractures (Weber type B or OTA 44-B) account for 60% of all ankle fractures. To achieve anatomic restoration, surgical stabilization provides better results than conservative treatment. Various fixation methods are available to treat these fractures; however, the best method is still unknown. Our objectives were to present a new, useful, and efficient surgical technique for stabilizing lateral malleolar fractures and to analyze the outcomes of patients treated with the compression cerclage system. Methods The surgical technique consists of a Kirschner wire that is passed percutaneously and perpendicular to the fracture line, and a cerclage wire that is passed in a semi-circular fashion over the ends of the Kirschner wire on the lateral side of the bone, leaving loops on each side to allow bilateral compression while twisting both wires. We retrospectively evaluated patients treated with this technique, with or without additional fractures. Follow-up of &...
J Emerg Med, 2011
Massive subcutaneous emphysema and pneumomediastinum in acute bronchiolitis: a pediatric case wit... more Massive subcutaneous emphysema and pneumomediastinum in acute bronchiolitis: a pediatric case with a history of chronic lung disease of infancy