gokhan temiz - Academia.edu (original) (raw)

Papers by gokhan temiz

Turkish Journal of Plastic Surgery / Türk Plastik, Rekonstrüktif ve Estetik Cerrahi Dergisi, 2016

Objective: Meatal stenosis after hypospadias surgery causes difficulty in urination and intermitt... more Objective: Meatal stenosis after hypospadias surgery causes difficulty in urination and intermittent cessation in urinary stream at the early postoperative period. Increasing the duration of catheterization, meatotomy, and meatal revision surgeries are among the procedures applied for meatal stenosis. If the diagnosis of meatal stenosis is made at an earlier stage, it is easier to manage it, especially in the younger age group. We aimed to determine whether the uroflowmetry technique can be a guide for detecting and following meatal stenosis. Material and Methods: Forty-one cases with distal hypospadias operated with the Tubularized Incised Plate Urethroplasty (TIPU) technique were involved in this study. At the postoperative 1 st month, all the patients with or without complaints of meatal stenosis had uroflowmetries with an effort to provide an objective data for diagnosing stenosis at the early stages. The results of uroflowmetries were compared with the clinical signs of meatal stenosis. Results: The average maximum flow rate was found to be 11.3 mL/s (6.7-31.6), and the average voided quantity of urine was detected as 181.7 mL/s (71-283) as result of uroflowmetry. Ureteral stenosis was clinically diagnosed in three patients with intermittent urination, prolonged urination with poor flow, and with difficulty in starting urination. All patients were found to be similar. The uroflowmetry results were parallel to the clinical outcome in all patients. Conclusion: In the early stages, uroflowmetry can assist clinical observation as a non-invasive method. In addition, it makes it possible to perform earlier therapeutic interventions.

Hand and Microsurgery, 2015

Facial Plastic Surgery, 2016

The most important problem in fat transplantation is the unpredictable rates of resorption. Defer... more The most important problem in fat transplantation is the unpredictable rates of resorption. Deferoxamine (DFO) is an iron-chelating agent with many useful functions including stimulating angiogenesis and antioxidant nature. The purpose of the study is to evaluate the effects of DFO on fat graft viability in rat model. A total of 24 Wistar rats were divided into three groups and 0.5 g of the left inguinal fat pad was extracted. In control group, fat grafts were implanted to the parascapular area without performing any procedure. In sham group, they were implanted in 0.2 mL saline solution followed by serial saline injections for 1 month. In the study group, fat grafts were implanted in 0.2 mL saline solution and 300 mg DFO followed by serial DFO injections for 1 month. At the postoperative second month, fat grafts were taken back and sent for histopathologic examination. The weight measurements of biopsy specimens in the study group demonstrated significantly higher than in the other two groups. Inflammation and fibrosis rates were also found to be significantly higher in the study group compared with the other groups; however, no significant difference in the apoptosis rates was detected between the groups. Fat grafts enriched with DFO showed significant increase in fatty tissue content in the study group compared with the control and sham groups. DFO increases the fat graft survival in rats and it may be a useful addition in autologous fat grafting procedures to increase fat graft viability and obtain maximal long-term durability.

The Journal of Kartal Training and Research Hospital, 2016

Bu çalışmada multidisipliner yaklaşımla toraks duvarı tümörü nedeniyle rezeksiyon ve onarım yapıl... more Bu çalışmada multidisipliner yaklaşımla toraks duvarı tümörü nedeniyle rezeksiyon ve onarım yapılan hastaların geriye dönük olarak incelenerek bir rekonstrüksiyon algoritması oluşturulması planlandı. Gereç ve Yöntem: Hastanemizde 2006-2014 yılları arasında toraks duvarı tümörü nedeniyle ameliyat edilen 45 hasta çalışmaya dahil edildi. Hastaların yaşı, cinsiyeti, tümör lokalizasyonu, rezeksiyon sonrası oluşan defekt boyutları, kot rezeksiyonu yapılıp yapılmadığı, iskelet rekonstrüksiyon yöntemi, yumuşak doku onarımının hangi fleple yapıldığı, hastaların dosyalarından geriye dönük olarak tarandı. Bulgular: Onarılan en büyük defekt 325 cm 2 , en küçük defekt 36 cm 2 idi. Olguların %54'ünde titanyum mesh %32'sinde ise prolen mesh kullanıldığı saptandı. Yumuşak doku onarımında ise pektoralis majör kite flap (n=14), latissiumus kas-kas deri flebi (n=12), latisimus kas deri flebi ile kombine pektoral kite flep (n=5), vertikal rektus abdominus kas deri flebi (n=6), omentum flebi (n=3), transvers rektus abdominus kas deri flebi (n=3), serbest anterolateral uyluk flebi (n=2) ve lokal rotasyon flebi (n=1) kullanıldığı tespit edildi. Sonuç: Elde edilen veriler ışığında iskelet ve yumuşak doku rekonstrüksiyonu için algoritmalar oluşturuldu.

Hand and Microsurgery, 2015

In this study, an alternative method of assessing hand vascular flow using a modification of Alle... more In this study, an alternative method of assessing hand vascular flow using a modification of Allen's test is presented. This technique may be helpful for patients who have immobile hands due to severe trauma, patients scheduled for free tissue transfer reconstruction, patients under general anesthesia in intensive care units that require serial arterial blood gas analyses, and emergency coronary bypass candidates who decided to receive radial arterial grafts.

Indian Journal of Dermatology, 2016

Glomus tumor is a common lesion of the subungual area of the hand fingers. However, glomus tumors... more Glomus tumor is a common lesion of the subungual area of the hand fingers. However, glomus tumors located outside the hand region are rare and the diagnosis is often difficult due to their low incidence and lack of distinct clinical features in the physical examination. The presented article contains five cases of extradigital glomus tumors with a short review of the literature. Five cases of extradigital glomus tumor were included in the study. All lesions were purple colored subcutaneous nodules with sharp pain by digital palpation. All lesions were examined with ultrasound imaging were operated under local anesthesia using loupe magnification. Among five patients, only one patient was female with a mean age of 35. Two lesions were located at the arm region, two at the crural region and one at the sternal area. The smallest nodule was 0.5 cm and the biggest lesion was 2 cm in diameter. In all the cases, the early postoperative period was uneventful without any surgical complication or acute recurrence. The postoperative 1(st) year examination of all patients revealed complete resolution of the pain and no recurrence was encountered. Glomus tumor should be kept in mind in the differential diagnosis of all painful subcutaneous lesions especially for those with purple reflection on the skin surface. In this manner, patients with extradigital glomus tumors may be diagnosed earlier and unnecessary and wrong treatments may be prevented.

Aesthetic plastic surgery, Jan 29, 2015

In recent studies, collagen organization was blamed for the formation of capsular contracture whi... more In recent studies, collagen organization was blamed for the formation of capsular contracture which is still a challenging problem after silicone implant-based breast operations. In this study, effects of different concentrations of collagenase enzyme derived from Clostridium histolyticum on the capsular tissue formation around the silicone implants were investigated. The injectable form of collagenase has a routine clinical use in the treatment of both Dupuytren's and Peyronie's diseases. Thirty-two Wistar albino rats were randomized into four groups. A 2 × 1 × 0.3-cm-sized silicone block was inserted inside a dorsal subcutaneous pocket in all groups. After 2 months of insertion, capsule thicknesses around the implants were detected under ultrasonography. This was followed by injection of isotonic saline, 150, 300, and 600 IU in Gr-1, 2, 3, and 4, respectively. All the animals were sacrificed at the end of the first week for histologic sampling to determine fibroblast proli...

Plastic and Reconstructive Surgery - Global Open, 2015

he use of microvascular anastomosis techniques is an essential part of many surgical procedures, ... more he use of microvascular anastomosis techniques is an essential part of many surgical procedures, such as free tissue transfer, tissue transplantation, and replantation of amputated limbs. 1,2 During this process, the vessel walls are manipulated with various types of surgical tools, and repetitive contact occurs between the vessel walls and the chemicals added to the environment to prevent thrombosis and vasoconstriction. 3 The arterial wall is composed of 3 distinct layers. The outer layer is a connective tissue layer called adventitia. The muscular layer is located inside the adventitia and has the ability to contract and relax. The inner layer is called endothelium and covers Evaluation of the Effects of Bile on the Arterial Tonus in a Rabbit Model

Annals of Plastic Surgery, 2015

The aim of this study was to investigate the reliability and outcomes of the facial artery perfor... more The aim of this study was to investigate the reliability and outcomes of the facial artery perforator and separately elevated depressor anguli oris (DAO) muscle chimeric flap for the reconstruction of partial or total lower lip defects. Eleven patients with malignant skin tumors located at the lower lip were operated between 2013 and 2015. After the excision of the tumor with adequate clear margins using margin controlled excision technique, an appropriate flap fitting to the resultant defect based on the perforators of the facial artery and DAO muscle was prepared and placed into the defect. The DAO muscle activity was tested with electromyography in the postoperative first year examination. Besides 1 patient with transient venous insufficiency, all the flaps healed well without a partial or total flap loss. The mean follow-up period was 10 months. No new primary tumor or recurrence was observed. Although in 1 patient, transient asymmetric smiling and mild drooling was observed, the overall oral competence results were found to be quite satisfactory. The electromyography evaluation of DAO muscle of 5 patients who reached the postoperative first year examination showed action potential results in normal limits with a slight decrease. All patients were satisfied with the final esthetic and functional result. The facial artery perforator and depressor angel oris muscle chimeric flap is a valuable option for reconstruction of lower lip defects providing esthetically and functionally good results.

Journal of Craniofacial Surgery, 2015

To the Editor: Intracranial penetration of bony segments in maxillofacial injuries is a rarely en... more To the Editor: Intracranial penetration of bony segments in maxillofacial injuries is a rarely encountered condition and the most common form of this phenomenon is the penetration of the mandibular condyle into the middle fossa by fracturing the skull base and the penetration of frontal bone and sinus fractures into the anterior cranial fossa. Although rare cases of zygomaticosphenoid disjunction were presented before, intracranial penetration in zygomatic bone fracture was never reported before. In this report, a zygomatic bone fracture with intracranial penetration and its treatment in a young male patient are presented. A 17-year-old boy was referred to the emergency room after a vehicle injury resulting cerebral contusion and zygomatic bone fracture. He was transferred to the intensive care unit for close monitoring of his neurological status. The patient’s neurological status got stable after 2 weeks of initial trauma and he was consulted to the plastic surgery department for the treatment of his severe facial fracture. Theexamination revealed severedepression in theright zygomatic area with hypoesthesia of the infraorbital area. The globe movements were normal and no horizontal or vertical dystopia was encountered. The axial and coronal computerized tomography and its three-dimensional reconstruction demonstrated a severely displaced tetrapod fracture of the right zygoma with an unusual finding. The frontal process of the zygomatic bone was found to be inferolaterally displacedandenteredinto themiddlecranial fossaapproximately1 cmby penetrating the greater wing of the sphenoid bone (Fig. 1A). The patient was operated under general anesthesia and the complex zygomatic fracture was exposed using the bicoronal, subciliary, and intraoral approaches. The frontal process of the zygomatic bone was located in the infra temporal fossa penetrating the skull base (Fig. 1B). It was tightly attached at the entrance point with firm fibrous callus tissue and was totally immobile. The extracranial part of the fragment was separated from the intracranial part using the saw and no cerebrospinal fluid leakage was observed at the skull base after the osteotomy. The intracranial part of the fragment was left unmobilized to prevent any cerebral injury (Fig. 1C). After this maneuver, the other areas of tetrapod fracture were reducted and fixed using plates and screws conventionally. The defect located at the superolateral orbital area resulted due to the fractured and intracranially displaced frontal process was reconstructed with split thickness cranial bone graft (Fig. 1D). In the postoperative period, no complication was encountered except a mild frontal branch paralysis of the facial nerve, which spontaneously resolved in 1 week. The early postoperative period was uneventful in neurological fashion and the patient was perfectly healthy in his long-term neurological follow-up examinations. Patient’s malar projection and orbital contour were quite satisfactory at the end of the postoperative third month. The preferred treatment approach for maxillofacial fractures is considered as open reduction and internal fixation in extracranial fashion. However, in some complex facial fractures, intracranial approach may also be considered. In severely displaced fractures with intracranial penetration, intracranial approach provides better visualization, easier manipulation, and preciser fixation. However, intracranial approach has some major risks such as brain damage, dura laceration, or postoperative cerebrospinal fluid leakage leading to central nervous system infections. Furthermore, it requires a craniotomy and should be performed with the neurosurgery team. In the presented case, the patient was referred to the plastic surgery department after 3 weeks from the initial trauma, and in his referral his neurological status was completely normal. In the operation, the frontal process of the zygoma, which entered the middle cranial fossa, was found to be strongly attached to the surrounding bony structures without causing any neurological symptom. Therefore, we decided to detach the extracranial segment of the penetrated frontal process by cutting it with the saw and left the intracranial segment untouched. This maneuver resulted in a bone deficit in the superolateral orbital area, which we reconstructed with a cranial bone graft. Because the sacrificed bony segment was not a part of a joint or functional segment, its reconstruction with bone graft did not cause any morbidity or loss of function. In our opinion, performing intracranial approach in the treatment of maxillofacial fractures can be justified in a few specific conditions. The most important condition is a fracture segment, which penetrates the cranium and causes neurological symptoms. One other indication is fractures, which may lead to severe late-term complications such as frontal sinus fractures carrying risk for cerebrospinal leakage and intracranial infection.…

Plastic and Reconstructive Surgery - Global Open, 2015

B reast hypoplasia (BH) may have a congenital or acquired etiology, and most cases are syndromic ... more B reast hypoplasia (BH) may have a congenital or acquired etiology, and most cases are syndromic and idiopathic. Congenital cases may be associated with Jeune and Poland syndromes. The acquired causes include burns, irradiation in childhood period, cutaneous hemangiomas, childhood traumas, and infections, which result in breast scars. 1,2 Breast implants, autologous tissues, or both are options in the BH reconstruction. For secondary deformities such as traumatic or postinfectious scars, Z-plasties, scar excisions, or relaxations, skin grafts and flaps can be used in addition to basic breast reconstruction techniques. 3 In this study, we present a case of right BH due to breast infection, which resulted in a fibrotic scar. The patient was treated with a combination of subcutaneous scar releasing and multiple fat grafting. CASE REPORT A 21-year-old woman was admitted to our clinic because of hypoplasia and deformity in her right breast. It was learned from her history that she had an infection in her right breast when she was 1 year old and was treated with antibiotics. After this treatment, she had a remaining fibrotic scar on her right breast. Additionally, she had noticed BH in her right breast relative to her left breast after puberty. On physical examination, right BH with an oblique fibrotic scar from medial right breast to right axilla was observed (Figs. 1 and 2). The size of this scar was 20 × 0.5 cm and it had a continuation extending to the subcutaneous area and affected the right breast growth. Both breasts were Tanner grade 5, right areola-nipple/midclavicular distance (AN/MC) was 18 cm, and left AN/MC

Archives of Clinical and Experimental Surgery (ACES), 2015

The utilization of stem cell therapies is a trending topic in plastic surgery and fat tissue is t... more The utilization of stem cell therapies is a trending topic in plastic surgery and fat tissue is the most commonly used stem cell source. Stem cell injection has become popular in the treatment of burn wound, especially in the late term scar modulation. However, insufficient amounts of fat tissue in the pediatric age group is a major limitation. The present study reports the utilization of tibial bone marrow aspiration as a source of mesenchymal stem cells in the pediatric age group with the simultaneous usage of x-ray examination to avoid epiphyseal damage.

Journal of surgical education, Jan 27, 2015

Basic microsurgical education is provided by accredited courses. An additional training activity ... more Basic microsurgical education is provided by accredited courses. An additional training activity for the maintenance of the skill is needed even if the surgeon routinely performs microsurgical operations. Both ethical considerations and time limit necessitate a novel and easy training system that can be combined to surgical loupes for continued microsurgical education. Nowadays, different useful synthetic and cadaveric animal models based on different organs and vessels were defined for this issue. Most of them only include a nonperfused or a manually perfused cannula or angiocatheter that penetrates the vessel to simulate vascular patency. Also, there are some models designed to work only in living animals. Some of them use perfusator devices that are used in cardiothoracic surgery or intravenous anesthesia. In this study, a cheap and useful training system that may easily be equipped at the work environment is

Journal of plastic surgery and hand surgery, 2014

Hypospadias is a congenital anomaly of the penis with an ectopic, ventrally-placed meatus due to ... more Hypospadias is a congenital anomaly of the penis with an ectopic, ventrally-placed meatus due to insufficient development of the anterior urethra. Tubularisation of glanular flaps without plate incision is performed with addition of a triangular flap in order to move the meatus more distally and avoid meatal stenosis. Subcoronally, mid-shaft, and coronally placed 41 hypospadias cases were treated with the tubularisation of the glanular flaps without incision of the urethral plate, a technique similar to TIP technique. Triangular flaps were added at the most distal end of one of the glanular flaps in all cases for different purposes. A medially-based triangular flap was elevated at the distal end of the right-sided longitudinal flap to carry the last suture more distally. The flap increased meatal diameter and carried the last suture more distally. No meatal stenosis was observed for an average of 18.02 (12-30) months. The final localisation of the meatus was satisfactory in all pati...

Microsurgery, 2014

Currently, the free fibular flap is well accepted as the first choice for mandibular reconstructi... more Currently, the free fibular flap is well accepted as the first choice for mandibular reconstruction. Achieving functional results in pediatric patients requires a different approach than that employed for mature patients. Because the pediatric craniofacial skeleton continues to grow, reconstruction is more challenging, and the long-term results can be different from those of adult patients. In this study, we sought to measure flap growth objectively in our series. Ten pediatric patients who underwent reconstruction with free fibular flaps were retrospectively reviewed. Flap growth was evaluated by comparing the intraoperative photographs with photographs of the control panoramic mandibular radiographs taken using photo-anthropometric techniques. The measurements were converted to proportionality indices (PI), and these indices were compared. Subsequent complications and functional results were also evaluated. The mean patient age was 11.8 years, and the mean follow up was 57.7 months. The mean preoperative PI value was 10.74 ± 2.47. The mean postoperative PI value was 12.52 ± 2.34. The mean difference between the preoperative and postoperative PI values was -1.78±0.53. These photo-anthropometric data clearly illustrated the growth of the fibular flaps (P = 0.001). None of these patients exhibited nonunion of the fractures; however, one patient experienced a delayed union, one had chronic temporomandibular joint pain, and one had chronic temporomandibular joint luxation. In two patients, the inter-incisive measurements were below the third percentile, and two additional patients had grade 2 eating abilities, which can be regarded as poor. All of the patients had symmetric mandibular contours. Free fibular flaps continue to grow in pediatric patients. This flap is a "workhorse" flap in children because it adapts to the craniofacial skeleton via its ability to grow, and this ability results in subsequent good cosmetic and functional results. © 2014 Wiley Periodicals, Inc. Microsurgery, 2014.

Journal of Plastic, Reconstructive & Aesthetic Surgery, 2015

The pectoralis major muscle flap is the most commonly used option for chest wall reconstruction. ... more The pectoralis major muscle flap is the most commonly used option for chest wall reconstruction. However, its utilization should be avoided in chest wall tumors infiltrating the muscle. This article presents the utilization of the caudal part of the pectoralis major muscle as a pedicled flap in cases requiring the resection of the cranial part of the muscle due to tumor infiltration. Fourteen patients with a mean age of 60.3 years were operated for malignant thoracic wall tumors between 2011 and 2014. All tumors were located on the upper thoracic area with a mean defect size of 16.6 × 12 cm. During tumor resection, the thoracoacromial vessels and pectoral branch were preserved and dissected until reaching the pectoralis muscle. After the resection of the cranial part of the muscle, the caudal part is prepared as a pedicled island flap and used for the coverage of the resultant defect. The mean postoperative follow-up period was 10.9 months. All flaps survived without any partial or total flap loss. A case of local recurrence, two cases of hematoma requiring drainage, and two cases of local wound-healing problems were the encountered complications. The pectoral kite flap is a versatile and reliable option for the coverage of small to medium upper chest wall defects with minimal morbidity, and it gives the reconstructive surgeon the opportunity to use the non-infiltrated caudal part of the pectoralis muscle instead of an unnecessary resection of the whole muscle.

Burns, 2014

Lagophthalmos is a critical problem in patients with severe periocular burn causing corneal expos... more Lagophthalmos is a critical problem in patients with severe periocular burn causing corneal exposure which may result in corneal ulcers and even loss of vision. Many surgical techniques were described to overcome this problem with different rates of success. This article presents a simple but useful technique involving the V-Y advancement of the eyelid or eyelids in vertical direction for the prevention of cicatricial ectropion and eyelid contraction.

Journal of Plastic, Reconstructive & Aesthetic Surgery, 2015

ABSTRACT Temporomandibular joint dislocations are usually reducted by internal maneuvers. Convent... more ABSTRACT Temporomandibular joint dislocations are usually reducted by internal maneuvers. Conventional techniques depend on an inferoposterior movement after placing the thumbs over the third molar teeth or retromolar trigone. In this article a simple method called as “The Lever Technique" for the external reduction of temporomandibular joint dislocation is presented. The Lever technique is a simple, safe and useful technique for the treatment of acute and recurrent temporomandibular joint dislocations. However this maneuver should be used for patients with enough bone stocks to prevent any pathologic fractures.

Journal of Plastic, Reconstructive & Aesthetic Surgery, 2014

Archives of Clinical and Experimental Surgery (ACES), 2014

Turkish Journal of Plastic Surgery / Türk Plastik, Rekonstrüktif ve Estetik Cerrahi Dergisi, 2016

Objective: Meatal stenosis after hypospadias surgery causes difficulty in urination and intermitt... more Objective: Meatal stenosis after hypospadias surgery causes difficulty in urination and intermittent cessation in urinary stream at the early postoperative period. Increasing the duration of catheterization, meatotomy, and meatal revision surgeries are among the procedures applied for meatal stenosis. If the diagnosis of meatal stenosis is made at an earlier stage, it is easier to manage it, especially in the younger age group. We aimed to determine whether the uroflowmetry technique can be a guide for detecting and following meatal stenosis. Material and Methods: Forty-one cases with distal hypospadias operated with the Tubularized Incised Plate Urethroplasty (TIPU) technique were involved in this study. At the postoperative 1 st month, all the patients with or without complaints of meatal stenosis had uroflowmetries with an effort to provide an objective data for diagnosing stenosis at the early stages. The results of uroflowmetries were compared with the clinical signs of meatal stenosis. Results: The average maximum flow rate was found to be 11.3 mL/s (6.7-31.6), and the average voided quantity of urine was detected as 181.7 mL/s (71-283) as result of uroflowmetry. Ureteral stenosis was clinically diagnosed in three patients with intermittent urination, prolonged urination with poor flow, and with difficulty in starting urination. All patients were found to be similar. The uroflowmetry results were parallel to the clinical outcome in all patients. Conclusion: In the early stages, uroflowmetry can assist clinical observation as a non-invasive method. In addition, it makes it possible to perform earlier therapeutic interventions.

Hand and Microsurgery, 2015

Facial Plastic Surgery, 2016

The most important problem in fat transplantation is the unpredictable rates of resorption. Defer... more The most important problem in fat transplantation is the unpredictable rates of resorption. Deferoxamine (DFO) is an iron-chelating agent with many useful functions including stimulating angiogenesis and antioxidant nature. The purpose of the study is to evaluate the effects of DFO on fat graft viability in rat model. A total of 24 Wistar rats were divided into three groups and 0.5 g of the left inguinal fat pad was extracted. In control group, fat grafts were implanted to the parascapular area without performing any procedure. In sham group, they were implanted in 0.2 mL saline solution followed by serial saline injections for 1 month. In the study group, fat grafts were implanted in 0.2 mL saline solution and 300 mg DFO followed by serial DFO injections for 1 month. At the postoperative second month, fat grafts were taken back and sent for histopathologic examination. The weight measurements of biopsy specimens in the study group demonstrated significantly higher than in the other two groups. Inflammation and fibrosis rates were also found to be significantly higher in the study group compared with the other groups; however, no significant difference in the apoptosis rates was detected between the groups. Fat grafts enriched with DFO showed significant increase in fatty tissue content in the study group compared with the control and sham groups. DFO increases the fat graft survival in rats and it may be a useful addition in autologous fat grafting procedures to increase fat graft viability and obtain maximal long-term durability.

The Journal of Kartal Training and Research Hospital, 2016

Bu çalışmada multidisipliner yaklaşımla toraks duvarı tümörü nedeniyle rezeksiyon ve onarım yapıl... more Bu çalışmada multidisipliner yaklaşımla toraks duvarı tümörü nedeniyle rezeksiyon ve onarım yapılan hastaların geriye dönük olarak incelenerek bir rekonstrüksiyon algoritması oluşturulması planlandı. Gereç ve Yöntem: Hastanemizde 2006-2014 yılları arasında toraks duvarı tümörü nedeniyle ameliyat edilen 45 hasta çalışmaya dahil edildi. Hastaların yaşı, cinsiyeti, tümör lokalizasyonu, rezeksiyon sonrası oluşan defekt boyutları, kot rezeksiyonu yapılıp yapılmadığı, iskelet rekonstrüksiyon yöntemi, yumuşak doku onarımının hangi fleple yapıldığı, hastaların dosyalarından geriye dönük olarak tarandı. Bulgular: Onarılan en büyük defekt 325 cm 2 , en küçük defekt 36 cm 2 idi. Olguların %54'ünde titanyum mesh %32'sinde ise prolen mesh kullanıldığı saptandı. Yumuşak doku onarımında ise pektoralis majör kite flap (n=14), latissiumus kas-kas deri flebi (n=12), latisimus kas deri flebi ile kombine pektoral kite flep (n=5), vertikal rektus abdominus kas deri flebi (n=6), omentum flebi (n=3), transvers rektus abdominus kas deri flebi (n=3), serbest anterolateral uyluk flebi (n=2) ve lokal rotasyon flebi (n=1) kullanıldığı tespit edildi. Sonuç: Elde edilen veriler ışığında iskelet ve yumuşak doku rekonstrüksiyonu için algoritmalar oluşturuldu.

Hand and Microsurgery, 2015

In this study, an alternative method of assessing hand vascular flow using a modification of Alle... more In this study, an alternative method of assessing hand vascular flow using a modification of Allen's test is presented. This technique may be helpful for patients who have immobile hands due to severe trauma, patients scheduled for free tissue transfer reconstruction, patients under general anesthesia in intensive care units that require serial arterial blood gas analyses, and emergency coronary bypass candidates who decided to receive radial arterial grafts.

Indian Journal of Dermatology, 2016

Glomus tumor is a common lesion of the subungual area of the hand fingers. However, glomus tumors... more Glomus tumor is a common lesion of the subungual area of the hand fingers. However, glomus tumors located outside the hand region are rare and the diagnosis is often difficult due to their low incidence and lack of distinct clinical features in the physical examination. The presented article contains five cases of extradigital glomus tumors with a short review of the literature. Five cases of extradigital glomus tumor were included in the study. All lesions were purple colored subcutaneous nodules with sharp pain by digital palpation. All lesions were examined with ultrasound imaging were operated under local anesthesia using loupe magnification. Among five patients, only one patient was female with a mean age of 35. Two lesions were located at the arm region, two at the crural region and one at the sternal area. The smallest nodule was 0.5 cm and the biggest lesion was 2 cm in diameter. In all the cases, the early postoperative period was uneventful without any surgical complication or acute recurrence. The postoperative 1(st) year examination of all patients revealed complete resolution of the pain and no recurrence was encountered. Glomus tumor should be kept in mind in the differential diagnosis of all painful subcutaneous lesions especially for those with purple reflection on the skin surface. In this manner, patients with extradigital glomus tumors may be diagnosed earlier and unnecessary and wrong treatments may be prevented.

Aesthetic plastic surgery, Jan 29, 2015

In recent studies, collagen organization was blamed for the formation of capsular contracture whi... more In recent studies, collagen organization was blamed for the formation of capsular contracture which is still a challenging problem after silicone implant-based breast operations. In this study, effects of different concentrations of collagenase enzyme derived from Clostridium histolyticum on the capsular tissue formation around the silicone implants were investigated. The injectable form of collagenase has a routine clinical use in the treatment of both Dupuytren's and Peyronie's diseases. Thirty-two Wistar albino rats were randomized into four groups. A 2 × 1 × 0.3-cm-sized silicone block was inserted inside a dorsal subcutaneous pocket in all groups. After 2 months of insertion, capsule thicknesses around the implants were detected under ultrasonography. This was followed by injection of isotonic saline, 150, 300, and 600 IU in Gr-1, 2, 3, and 4, respectively. All the animals were sacrificed at the end of the first week for histologic sampling to determine fibroblast proli...

Plastic and Reconstructive Surgery - Global Open, 2015

he use of microvascular anastomosis techniques is an essential part of many surgical procedures, ... more he use of microvascular anastomosis techniques is an essential part of many surgical procedures, such as free tissue transfer, tissue transplantation, and replantation of amputated limbs. 1,2 During this process, the vessel walls are manipulated with various types of surgical tools, and repetitive contact occurs between the vessel walls and the chemicals added to the environment to prevent thrombosis and vasoconstriction. 3 The arterial wall is composed of 3 distinct layers. The outer layer is a connective tissue layer called adventitia. The muscular layer is located inside the adventitia and has the ability to contract and relax. The inner layer is called endothelium and covers Evaluation of the Effects of Bile on the Arterial Tonus in a Rabbit Model

Annals of Plastic Surgery, 2015

The aim of this study was to investigate the reliability and outcomes of the facial artery perfor... more The aim of this study was to investigate the reliability and outcomes of the facial artery perforator and separately elevated depressor anguli oris (DAO) muscle chimeric flap for the reconstruction of partial or total lower lip defects. Eleven patients with malignant skin tumors located at the lower lip were operated between 2013 and 2015. After the excision of the tumor with adequate clear margins using margin controlled excision technique, an appropriate flap fitting to the resultant defect based on the perforators of the facial artery and DAO muscle was prepared and placed into the defect. The DAO muscle activity was tested with electromyography in the postoperative first year examination. Besides 1 patient with transient venous insufficiency, all the flaps healed well without a partial or total flap loss. The mean follow-up period was 10 months. No new primary tumor or recurrence was observed. Although in 1 patient, transient asymmetric smiling and mild drooling was observed, the overall oral competence results were found to be quite satisfactory. The electromyography evaluation of DAO muscle of 5 patients who reached the postoperative first year examination showed action potential results in normal limits with a slight decrease. All patients were satisfied with the final esthetic and functional result. The facial artery perforator and depressor angel oris muscle chimeric flap is a valuable option for reconstruction of lower lip defects providing esthetically and functionally good results.

Journal of Craniofacial Surgery, 2015

To the Editor: Intracranial penetration of bony segments in maxillofacial injuries is a rarely en... more To the Editor: Intracranial penetration of bony segments in maxillofacial injuries is a rarely encountered condition and the most common form of this phenomenon is the penetration of the mandibular condyle into the middle fossa by fracturing the skull base and the penetration of frontal bone and sinus fractures into the anterior cranial fossa. Although rare cases of zygomaticosphenoid disjunction were presented before, intracranial penetration in zygomatic bone fracture was never reported before. In this report, a zygomatic bone fracture with intracranial penetration and its treatment in a young male patient are presented. A 17-year-old boy was referred to the emergency room after a vehicle injury resulting cerebral contusion and zygomatic bone fracture. He was transferred to the intensive care unit for close monitoring of his neurological status. The patient’s neurological status got stable after 2 weeks of initial trauma and he was consulted to the plastic surgery department for the treatment of his severe facial fracture. Theexamination revealed severedepression in theright zygomatic area with hypoesthesia of the infraorbital area. The globe movements were normal and no horizontal or vertical dystopia was encountered. The axial and coronal computerized tomography and its three-dimensional reconstruction demonstrated a severely displaced tetrapod fracture of the right zygoma with an unusual finding. The frontal process of the zygomatic bone was found to be inferolaterally displacedandenteredinto themiddlecranial fossaapproximately1 cmby penetrating the greater wing of the sphenoid bone (Fig. 1A). The patient was operated under general anesthesia and the complex zygomatic fracture was exposed using the bicoronal, subciliary, and intraoral approaches. The frontal process of the zygomatic bone was located in the infra temporal fossa penetrating the skull base (Fig. 1B). It was tightly attached at the entrance point with firm fibrous callus tissue and was totally immobile. The extracranial part of the fragment was separated from the intracranial part using the saw and no cerebrospinal fluid leakage was observed at the skull base after the osteotomy. The intracranial part of the fragment was left unmobilized to prevent any cerebral injury (Fig. 1C). After this maneuver, the other areas of tetrapod fracture were reducted and fixed using plates and screws conventionally. The defect located at the superolateral orbital area resulted due to the fractured and intracranially displaced frontal process was reconstructed with split thickness cranial bone graft (Fig. 1D). In the postoperative period, no complication was encountered except a mild frontal branch paralysis of the facial nerve, which spontaneously resolved in 1 week. The early postoperative period was uneventful in neurological fashion and the patient was perfectly healthy in his long-term neurological follow-up examinations. Patient’s malar projection and orbital contour were quite satisfactory at the end of the postoperative third month. The preferred treatment approach for maxillofacial fractures is considered as open reduction and internal fixation in extracranial fashion. However, in some complex facial fractures, intracranial approach may also be considered. In severely displaced fractures with intracranial penetration, intracranial approach provides better visualization, easier manipulation, and preciser fixation. However, intracranial approach has some major risks such as brain damage, dura laceration, or postoperative cerebrospinal fluid leakage leading to central nervous system infections. Furthermore, it requires a craniotomy and should be performed with the neurosurgery team. In the presented case, the patient was referred to the plastic surgery department after 3 weeks from the initial trauma, and in his referral his neurological status was completely normal. In the operation, the frontal process of the zygoma, which entered the middle cranial fossa, was found to be strongly attached to the surrounding bony structures without causing any neurological symptom. Therefore, we decided to detach the extracranial segment of the penetrated frontal process by cutting it with the saw and left the intracranial segment untouched. This maneuver resulted in a bone deficit in the superolateral orbital area, which we reconstructed with a cranial bone graft. Because the sacrificed bony segment was not a part of a joint or functional segment, its reconstruction with bone graft did not cause any morbidity or loss of function. In our opinion, performing intracranial approach in the treatment of maxillofacial fractures can be justified in a few specific conditions. The most important condition is a fracture segment, which penetrates the cranium and causes neurological symptoms. One other indication is fractures, which may lead to severe late-term complications such as frontal sinus fractures carrying risk for cerebrospinal leakage and intracranial infection.…

Plastic and Reconstructive Surgery - Global Open, 2015

B reast hypoplasia (BH) may have a congenital or acquired etiology, and most cases are syndromic ... more B reast hypoplasia (BH) may have a congenital or acquired etiology, and most cases are syndromic and idiopathic. Congenital cases may be associated with Jeune and Poland syndromes. The acquired causes include burns, irradiation in childhood period, cutaneous hemangiomas, childhood traumas, and infections, which result in breast scars. 1,2 Breast implants, autologous tissues, or both are options in the BH reconstruction. For secondary deformities such as traumatic or postinfectious scars, Z-plasties, scar excisions, or relaxations, skin grafts and flaps can be used in addition to basic breast reconstruction techniques. 3 In this study, we present a case of right BH due to breast infection, which resulted in a fibrotic scar. The patient was treated with a combination of subcutaneous scar releasing and multiple fat grafting. CASE REPORT A 21-year-old woman was admitted to our clinic because of hypoplasia and deformity in her right breast. It was learned from her history that she had an infection in her right breast when she was 1 year old and was treated with antibiotics. After this treatment, she had a remaining fibrotic scar on her right breast. Additionally, she had noticed BH in her right breast relative to her left breast after puberty. On physical examination, right BH with an oblique fibrotic scar from medial right breast to right axilla was observed (Figs. 1 and 2). The size of this scar was 20 × 0.5 cm and it had a continuation extending to the subcutaneous area and affected the right breast growth. Both breasts were Tanner grade 5, right areola-nipple/midclavicular distance (AN/MC) was 18 cm, and left AN/MC

Archives of Clinical and Experimental Surgery (ACES), 2015

The utilization of stem cell therapies is a trending topic in plastic surgery and fat tissue is t... more The utilization of stem cell therapies is a trending topic in plastic surgery and fat tissue is the most commonly used stem cell source. Stem cell injection has become popular in the treatment of burn wound, especially in the late term scar modulation. However, insufficient amounts of fat tissue in the pediatric age group is a major limitation. The present study reports the utilization of tibial bone marrow aspiration as a source of mesenchymal stem cells in the pediatric age group with the simultaneous usage of x-ray examination to avoid epiphyseal damage.

Journal of surgical education, Jan 27, 2015

Basic microsurgical education is provided by accredited courses. An additional training activity ... more Basic microsurgical education is provided by accredited courses. An additional training activity for the maintenance of the skill is needed even if the surgeon routinely performs microsurgical operations. Both ethical considerations and time limit necessitate a novel and easy training system that can be combined to surgical loupes for continued microsurgical education. Nowadays, different useful synthetic and cadaveric animal models based on different organs and vessels were defined for this issue. Most of them only include a nonperfused or a manually perfused cannula or angiocatheter that penetrates the vessel to simulate vascular patency. Also, there are some models designed to work only in living animals. Some of them use perfusator devices that are used in cardiothoracic surgery or intravenous anesthesia. In this study, a cheap and useful training system that may easily be equipped at the work environment is

Journal of plastic surgery and hand surgery, 2014

Hypospadias is a congenital anomaly of the penis with an ectopic, ventrally-placed meatus due to ... more Hypospadias is a congenital anomaly of the penis with an ectopic, ventrally-placed meatus due to insufficient development of the anterior urethra. Tubularisation of glanular flaps without plate incision is performed with addition of a triangular flap in order to move the meatus more distally and avoid meatal stenosis. Subcoronally, mid-shaft, and coronally placed 41 hypospadias cases were treated with the tubularisation of the glanular flaps without incision of the urethral plate, a technique similar to TIP technique. Triangular flaps were added at the most distal end of one of the glanular flaps in all cases for different purposes. A medially-based triangular flap was elevated at the distal end of the right-sided longitudinal flap to carry the last suture more distally. The flap increased meatal diameter and carried the last suture more distally. No meatal stenosis was observed for an average of 18.02 (12-30) months. The final localisation of the meatus was satisfactory in all pati...

Microsurgery, 2014

Currently, the free fibular flap is well accepted as the first choice for mandibular reconstructi... more Currently, the free fibular flap is well accepted as the first choice for mandibular reconstruction. Achieving functional results in pediatric patients requires a different approach than that employed for mature patients. Because the pediatric craniofacial skeleton continues to grow, reconstruction is more challenging, and the long-term results can be different from those of adult patients. In this study, we sought to measure flap growth objectively in our series. Ten pediatric patients who underwent reconstruction with free fibular flaps were retrospectively reviewed. Flap growth was evaluated by comparing the intraoperative photographs with photographs of the control panoramic mandibular radiographs taken using photo-anthropometric techniques. The measurements were converted to proportionality indices (PI), and these indices were compared. Subsequent complications and functional results were also evaluated. The mean patient age was 11.8 years, and the mean follow up was 57.7 months. The mean preoperative PI value was 10.74 ± 2.47. The mean postoperative PI value was 12.52 ± 2.34. The mean difference between the preoperative and postoperative PI values was -1.78±0.53. These photo-anthropometric data clearly illustrated the growth of the fibular flaps (P = 0.001). None of these patients exhibited nonunion of the fractures; however, one patient experienced a delayed union, one had chronic temporomandibular joint pain, and one had chronic temporomandibular joint luxation. In two patients, the inter-incisive measurements were below the third percentile, and two additional patients had grade 2 eating abilities, which can be regarded as poor. All of the patients had symmetric mandibular contours. Free fibular flaps continue to grow in pediatric patients. This flap is a "workhorse" flap in children because it adapts to the craniofacial skeleton via its ability to grow, and this ability results in subsequent good cosmetic and functional results. © 2014 Wiley Periodicals, Inc. Microsurgery, 2014.

Journal of Plastic, Reconstructive & Aesthetic Surgery, 2015

The pectoralis major muscle flap is the most commonly used option for chest wall reconstruction. ... more The pectoralis major muscle flap is the most commonly used option for chest wall reconstruction. However, its utilization should be avoided in chest wall tumors infiltrating the muscle. This article presents the utilization of the caudal part of the pectoralis major muscle as a pedicled flap in cases requiring the resection of the cranial part of the muscle due to tumor infiltration. Fourteen patients with a mean age of 60.3 years were operated for malignant thoracic wall tumors between 2011 and 2014. All tumors were located on the upper thoracic area with a mean defect size of 16.6 × 12 cm. During tumor resection, the thoracoacromial vessels and pectoral branch were preserved and dissected until reaching the pectoralis muscle. After the resection of the cranial part of the muscle, the caudal part is prepared as a pedicled island flap and used for the coverage of the resultant defect. The mean postoperative follow-up period was 10.9 months. All flaps survived without any partial or total flap loss. A case of local recurrence, two cases of hematoma requiring drainage, and two cases of local wound-healing problems were the encountered complications. The pectoral kite flap is a versatile and reliable option for the coverage of small to medium upper chest wall defects with minimal morbidity, and it gives the reconstructive surgeon the opportunity to use the non-infiltrated caudal part of the pectoralis muscle instead of an unnecessary resection of the whole muscle.

Burns, 2014

Lagophthalmos is a critical problem in patients with severe periocular burn causing corneal expos... more Lagophthalmos is a critical problem in patients with severe periocular burn causing corneal exposure which may result in corneal ulcers and even loss of vision. Many surgical techniques were described to overcome this problem with different rates of success. This article presents a simple but useful technique involving the V-Y advancement of the eyelid or eyelids in vertical direction for the prevention of cicatricial ectropion and eyelid contraction.

Journal of Plastic, Reconstructive & Aesthetic Surgery, 2015

ABSTRACT Temporomandibular joint dislocations are usually reducted by internal maneuvers. Convent... more ABSTRACT Temporomandibular joint dislocations are usually reducted by internal maneuvers. Conventional techniques depend on an inferoposterior movement after placing the thumbs over the third molar teeth or retromolar trigone. In this article a simple method called as “The Lever Technique" for the external reduction of temporomandibular joint dislocation is presented. The Lever technique is a simple, safe and useful technique for the treatment of acute and recurrent temporomandibular joint dislocations. However this maneuver should be used for patients with enough bone stocks to prevent any pathologic fractures.

Journal of Plastic, Reconstructive & Aesthetic Surgery, 2014

Archives of Clinical and Experimental Surgery (ACES), 2014