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Dr. Fatih Irmak Plastic Surgery

Istanbul, Turkey

Publications
Home 9 DR.Fatih Irmak 9 Publications

2019

Annals of Plastic Surgery

Tip Reinforcement Flap
An Original Technique for Improving Nasal Tip Support and Definition

Background: Middle crura support deficiency and shortmiddle crura can usually cause insufficient definition and projection of the tip and can sometimes result in a flat tip. The aim of this study was to investigate the effectiveness of a new technique involving a tip reinforcement flap to strengthen the middle crura and to achieve a well-projected and defined tip.

Methods: Twenty-nine patients who underwent primary open-approach rhinoplasty that included the use of tip reinforcement flaps were included in the study. Cartilage flaps that had been created fromthe excess cephalic portion of the lateral crura were prepared as medial crura-based cartilaginous flaps.

Results: There were 29 patients (17 women, 12 men) aged 18 to 44 years (mean age, 31 years). Follow-up time ranged between 3 and 25 months (mean, 21months). Preoperative and postoperative average of nasal tip length was 10.84 (±1.07) mm and 14.32 (±2.34)mm, respectively (P = 0.0214). Preoperative and postoperative average of nasolabial angle was 97.42° (±9.84°) and 107.99° (±12.16°), respectively (P = 0.0344). Preoperative and postoperative average of nasal projection ratio was 0.53 (±0.04) and 0.57 (±0.03), respectively (P = 0.4347). The tip reinforcement flap technique provided strengthening and extra support for themiddle crura and increased definition, projection, and stability to the domal area.

Conclusions: The tip reinforcement flap technique offers advantages for tip plasty in those caseswithmiddle crural deficiency, shortmiddle crura, andmiddle crural weakness. The technique also provides an additional projection, stabilization, and definition to the nasal tip while reducing lateral crural cephalic excess. This technique improves nostril-lobular disproportion and has the advantage of hiding extra support grafted into the folded flap. Complications such as graft visibility, malposition, and asymmetry, which may occur with the use of classic tip grafts, can be eliminated with the tip reinforcement flap technique.

    2019

    Journal of Plastic, Reconstructive & Aesthetic Surgery

    Comparison of piezosurgery, percutaneous osteotomy, and endonasal continuous osteotomy techniques with a caprine skull model

    Background: Osteotomy is a crucial step in rhinoplasty, which can have a significant impact on the outcome. In addition to previous percutaneous (external perforating) and en- donasal (internal) approaches, piezosurgery has been used in rhinoplasty practice since 2007. This experimental model was planned to compare the three osteotomy techniques.

    Materials and methods: This study was performed on a caprine skull osteotomy model. Three groups were created from 12 animals, namely, endonasal continuous, external perforating, and piezosurgery groups. All the groups were evaluated for bone gaps, comminuted fractures, and nasal mucosa damage.

    Results: There were no comminuted fractures and mucosal defects in any of the samples in the piezo osteotomy group. The average amount of bone gap at the osteotomy site and the nasal mucosa damage was lower in the piezo group than in the other groups. The time required for the osteotomy was shorter in the endonasal group, similar to that in the external and piezo groups.

    Conclusion: New techniques are constantly being developed to achieve better results in rhino- plasty. As a natural consequence to technological developments, new devices are being intro- duced to rhinoplasty practice. Piezo is one such device. We have found that piezo osteotom has resulted in lower amounts of nasal mucosal damage and comminuted fractures. We believe that piezo can safely be used in rhinoplasty practice until newer and more reliable technologies are being developed. © 2018 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by El-sevier Ltd. All rights reserved.

    2018

    Plast Reconstr Surg

    Use of Roof-Shaped Costochondral Cartilage for Correction of Saddle Nose Deformity.

    Background: Cartilage grafts are routinely used in secondary and posttraumatic rhinoplasty. However, in most cases, there are weak areas in the nasal bones and upper lateral cartilages. The purpose of this study was to seek a solution for the keystone area and dorsum of the nose in revision and posttraumatic rhinoplasty cases, and reconstruction of saddle nose deformity including upper lateral cartilage with a roof-shaped graft.

    Methods: A retrospective review of reconstructive rhinoplasties performed for saddle nose deformities was conducted. A part of the costochondral graft was carved and thinned (roof graft) for reconstruction of the keystone area and upper lateral cartilages, and another portion was used for making a neoseptal (reconstructed septum) graft and strut graft. The roof graft was capped onto the neoseptal graft with sutures, and this cartilage framework was adapted with fitting the cranial edge of the neoseptal cartilage between the nasal bones. Finally, the strut graft was fixed to the cartilage framework.

    Result: A significant improvement in nasal shape and overall appearance was achieved in all cases, and 71.42 percent of patients recovered from nasal obstruction. No gross absorption, graft exposure, or recurrence of deformities was observed.

    Conclusions: Surgical correction of a saddle-shaped nose should be an acceptable and uncomplicated technique, and the cosmetic result should be totally acceptable. There are many management options for a saddle-shaped nose. Use of roof grafts (shrunk gull-wing grafts) with neoseptal and strut grafts enables simulation of the internal nasal valve and results in a natural nasal position.

    Our surgical approach to gynaecomastia and a comparison of techniques

    Purpose: Surgical treatment of gynecomastia comprises of gland resection, liposuction or liposuction and combined gland resection.In our study we retrospectively analyzed 50 gynecomastia patients who presented our hospital. We are presenting our approach and the preferred method of treatment in all stages of gynecomastia with a simplified and easy-to-understand algorithm.

    Method: Fifty patients presented with gynecomastia between 2002-2010 and they were grouped according to the choice of surgical method chosen. Patients were classified according to Simon classification. Six patients were Simon 1, 28 patients Simon 2a, 14 patients Simon 2b and 2 patients Simon 3.

    Results: Our study summarized that Simon 1 and 2a patients showed satisfying results with liposuction only if there wasn’t any prominent fibroglandular tissues, and Simon 2b patients mostly required gland resection in addition to liposuction, and Simon 3 patients required skin resection and gland resection resembling reduction mammoplasty.

    Conclusion: The main goals of surgery of gynecomastia patients should include providing the patients with a non-feminine looking naval area and adequate size nipple areolas with the least amount of hypertrophic scar formation. Following our simple algorithm we accomplished those in a significant amount of the patients.

    2012

    The Medical Bulletin of Şişli Etfal Hospital

    Inferior dermal flap in breast reconstruction with tissue expanders

    A surgical case, in which inferior dermal flap was used to cover a tissue expander for breast reconstruction, is reported. In spite of the skin necrosis on the seventh postoperative day, flap coverage successfully protected the tissue expander from exposition.

    2017

    BMJ Case Reports

    Comparison of aesthetic outcome with round and three-armed star flap umbilicoplasty

    Background: The umbilicus is an indicative aesthetic component of the abdomen. Many umbilicoplasty techniques have been defined and the most commonly used method is the round incision technique. In this paper, we present a new umbilicoplasty technique involving the use of a three-armed star flap and compare it with the round technique.

    Methods: Forty-eight female patients who underwent umbilicoplasty during abdominoplasty and free deep inferior epigastric perforator flap (DIEP) procedures between February 2011 and December 2016 were included in the study. Twenty patients had round umbilicoplasty, whereas in the remaining 28 patients the three armed star flap technique was used. Aesthetic outcomes of both techniques were evaluated by a questionnaire which was completed by the patients and two independent surgeons.

    Results: The mean follow-up period was 22months. Hypertrophic scarring was seen in one patient with the three armed star flap technique and in two patients with the round technique and a cicatricial ring formation occurred in one patient with the round technique. The patient and surgeon questionnaire
    scores were significantly higher in the 3-armed star flap group. (p<.05)

    Conclusion: In this study, round umbilicoplasty technique has been compared with the three armed star flap technique. Patient satisfaction surveys and evaluation by two independent surgeons revealed better
    cosmetic results with the new technique. We believe that this new technique could be preferred over the round technique since it prevents stenosis, circular scar contraction and provides a natural contour between the umbilicus and abdomen.

      2019

      JOURNAL OF PLASTIC SURGERY AND HAND SURGERY

      2019

      THE MEDICAL BULLETIN OF

      Approach to Patients with Malignant Melanoma of Unknown Primary Origin

      Objectives: Although, malignant melanoma accounts for 3% of skin cancers, it is responsible for 75% of deaths associated with skin cancer. In our study, all melanoma cases diagnosed and treated at our clinic were reviewed retrospectively, and the cases of unknown primary origin among them were examined in detail in terms of diagnosis and treatment.

      Methods: The malignant melanoma patients treated at the inpatient services of our clinic in the period between January 1991 and April 2017 were screened in the records retrospectively. These patients were evaluated for age, sex, tumor type, Breslow, metastasis, and treatment. Among these patients, 4 cases of unknown primary origin were examined in detail.

      Results: During the period between January 1991 and April 2017, 173 patients received inpatient care at our clinic due to malignant melanoma. As regards to the melanoma subtypes, nodular type in 45 patients, acral lentiginous type in 43 patients, superficial spreading type in 63 patients, lentigo maligna melanoma in 15 patients, subungual type in 7 patients, and either unidentified melanoma or other subtypes in 10 patients were identified.

      Conclusion: The ideal treatment of a melanoma patient is multidisciplinary, with plastic surgery having a central role.

        2019

        SCIE

        Neck Dissection Indications in Lower Lip
        Squamous Cell Carcinoma Cases: Our Experience in 96 Cases

        Objective: Squamous cell carcinoma (SCC) is the most common lip carcinoma and nodal status is the single most important prognostic factor. Though surgery is the first choice of treatment in early-stage cases, elective neck dissection to treat an eventual occult metastasis is still a matter of discussion.

        Methods: A total of 96 patients with lower lip SCC who were operated on in a single clinic between January 2005 and July 2017 were included in this study. Patients who did and did not undergo elective neck dissection after tumor resection according to risk and nodal status were studied in terms of age, gender, tumor size, and neck dissection type.

        Results: Among 96 patients, 74 were classified as T1-2N0 according to the American Joint Committee on Cancer staging system, and 30 underwent elective neck dissection. Among these 30 patients, 6 were diagnosed with metastasis. A total of 51 of the 96 members of the study group underwent elective supraomohyoid neck dissection. In all, 23 patients were diagnosed with metastasis.

        Conclusion: Lower lip SCC is a cancer with a relatively good prognosis, but regional lymph node metastasis decreases the survival rate substantially. In selected cases, staging the tumor via supraomohyoid neck dissection or sentinel lymph node biopsy is adequate to detect occult metastasis and prevent late lymph node metastasis.

        2019

        The Medical Bulletin of Sisli Etfal Hospital

        Predicting Morbidity and Mortality in Patients with Lower Extremity Necrotizing Fasciitis

        Objectives: Necrotizing fasciitis (NF) is a rare but limb- and life-threatening soft-tissue infection. It is among the most challenging surgical infections faced by surgeons, and is often accompanied by severe systemic toxicity. The aim of this study was to evaluate the predictive power of serum lactate and creatinine levels for mortality and morbidity in lower extremity NF.

        Methods: A retrospective cohort analysis of 87 patients with lower extremity NF was performed to evaluate the management techniques and the amputation and survival rates according to serum lactate and creatinine levels as well as the time between the onset of symptoms and surgery.

        Results: The mean time between the onset of symptoms and surgery was 3.7 days. As the time between the onset of symptoms and surgery increased, the rate of amputation and mortality significantly increased (p<0.001). In all, 66% of the mortality in the group was seen among the 12 patients who had a serum creatinine level greater than 2 mg/dL at the time of presentation. In 12 of 14 patients (85.7%) who underwent mputation/disarticulation, the mean serum lactate level was 5.7 mmol/L (range: 5.1-8.7 mmol/L), and the mean serum creatinine level was 1.92 mg/dL (range: 1.4 to.3.3 mg/dL). The high levels of serum creatinine and lactate were found to be statistically significant in terms of predicting mortality and amputation (p<0.001).

        Conclusion: Based on the results of this study, it was determined that risk factors for mortality include age, late presentation, increased serum creatinine and lactate levels, and that these factors can predict the rate of death from NF at the time of presentation.

          2019

           Turk J Dermatol

          Squamous Cell Carcinoma of the Hand: Clinical Presentation, Surgical Treatment, Outcome and Survival Rate: a Series of 129 Cases

          Objective: Despite its relative high frequency; the recurrence, metastasis and long-term survival rates of hand squamous cell carcinoma have not been well defined. The aim of this study was to review a large cohort of patients with hand squamous cell carcinomas and to evaluate the management techniques, outcomes of treatment modalities and survival rates.

          Methods: A retrospective review of all surgically excised primary squamous cell carcinoma of the hand operated between 2006 and 2011 was included in this multi-center study. Patients were evaluated regarding age, anatomic location of the tumor, gender, treatment modality, survival, and recurrence rate. In addition, recurrence and survival rates were also categorized according to the tumor size.

          Results: A total of 129 patients were evaluated. Tumors smaller than 2 cm had a recurrence rate of 9.7% and a metastatic rate of 6.5%; tumors larger than 2 cm had a recurrence rate of 16.7% and a metastatic rate of 33% during 5-year follow-ups.

          Conclusion: In contrast to squamous cell carcinoma of the face, those occurring on the hand are malignancies with a worse clinical course, greater tendency for recurrence, metastatic spread, and functional deficiency which might require amputation and complex soft tissue reconstruction.

          2019

          JPRAS

          Comparison of piezosurgery, percutaneous osteotomy, and endonasal continuous osteotomy techniques with a caprine skull model

          Background: Osteotomy is a crucial step in rhinoplasty, which can have a significant impact on the outcome. In addition to previous percutaneous (external perforating) and endonasal (internal) approaches, piezosurgery has been used in rhinoplasty practice since 2007. This experimental model was planned to compare the three osteotomy techniques.

          Materials and methods: This study was performed on a caprine skull osteotomy model. Three groups were created from 12 animals, namely, endonasal continuous, external perforating, and piezosurgery groups. All the groups were evaluated for bone gaps, comminuted fractures, and nasal mucosa damage.

          Results: There were no comminuted fractures and mucosal defects in any of the samples in the piezo osteotomy group. The average amount of bone gap at the osteotomy site and the nasal mucosa damage was lower in the piezo group than in the other groups. The time required for the osteotomy was shorter in the endonasal group, similar to that in the external and piezo groups.

          Conclusion: New techniques are constantly being developed to achieve better results in rhinoplasty. As a natural consequence to technological developments, new devices are being introduced to rhinoplasty practice. Piezo is one such device. We have found that piezo osteotomy has resulted in lower amounts of nasal mucosal damage and comminuted fractures. We believe that piezo can safely be used in rhinoplasty practice until newer and more reliable technologies are being developed.

          2019

          The Medical Bulletin of Sisli Etfal Hospital

          Management and Treatment of Pressure Ulcers: Clinical Experience

          Objectives: Pressure ulcers are a common healthcare problem, particularly among hospitalized patients who need long-term treatment; however, preventive medicine can reduce the prevalence. A multidisciplinary approach is fundamental to providing proper care, and the general health status and cooperation of the patient determine treatment modalities. Simple methods can prevent pressure ulcers and their recurrence. The aim of this study was to share clinical experience and evaluate the approach and treatment modalities used for pressure ulcers.

          Methods: Fifty-two patients hospitalized with the indication of pressure ulcers were evaluated retrospectively. Age, sex, localization of the decubitus ulcer, treatment method, comorbid diseases, and any postoperative complications were analyzed.

          Results: Thirty-five patients were male and 17 were female. The mean age was 50.3 years. The most common accompanying disease was diabetes mellitus and the most common etiology was paraplegia. Pressure ulcers were localized on the sacral area in 45 patients, the ischial area in 23, the trochanteric area in 11 patients, and other parts of the body (scapular, lumbar) in 3 patients. Fasciocutaneous rotation flaps, myocutaneous flaps, and perforator flaps were the most used reconstruction techniques. No major complication was observed.

          Conclusion: The most important point with regard to pressure ulcers is prevention. Healthcare system expenses can be significantly reduced by preventing the formation of decubitus ulcers. The progression of pressure ulcers can be easily controlled if the necessary care and treatment are provided in the early period. The role of the plastic surgeon in advanced stages is to perform reconstruction in appropriate cases and to educate patients and their caregivers with the aim of preventing recurrence.

          2018

          Hand Microsurg

          Benign soft tissue tumors of the hand:
          A retrospective review of 17-year experience

          Objective: Tumors of the hand are common and mostly benign. Benign soft tissue tumors of the hand can arise from the skin, tendons, vessels, nerve and subcutaneous tissue. Tumors can be removed by surgical excision for cosmetic reasons and a possibility of malignancy. The objective of this retrospective study was to evaluate the types of benign soft tissue tumors of the hand in comparison to the literature.

          Materials and Methods: We conducted a retrospective review of all surgically excised benign soft tissue tumors of the hand at the University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital between March 2000 and October 2017. A total of 426 patients (208 males and 218 females) were included in this study. The mean age was 39.4 years (range, 4-61 years). 426 patients were evaluated according to their ages, genders, anatomic location and histopa­thology of tumors and their treatment modalities.

          Results: The most common benign tumor of the hand was pyogenic granuloma (25%). The other diagnosed benign tumors of the hand with the decreasing percentage were ganglion cysts (15%), giant cell tumors of the tendon sheaths (GCTTS) (15%), other hand tumors (13%), hemangiomas (8%), neurinomas and schwannomas (6%), fibromas and fibroli­pomas (5%), epidermal cysts (3%), glomus tumors (2%) and arteriovenous malformations (2%).

          Conclusion: A comprehensive history and detailed physical examination performed by specialists are essential in the di­agnosis of the tumor. The vast majority of hand tumors are benign, and if a tumor of the hand is suspected, a biopsy should be performed before definitive treatment.

          2018

           Turk J Dermatol

          Management of the Hand Tumors

          Background: Tumors of the hand are usually benign in nature, and therefore, treatment is usually nonessential. Indications for the surgical treatment are cosmetic concern and potential for malignancy. Since malignant hand tumors are seen very rarely, suspicious findings should be assessed thoroughly, and the diagnosis should be established as well. The purpose of this article is to evaluate those lesions that commonly arise in the hand region including lipomas, ganglion cysts, and glomus tumors as well as malignant tumors such as soft‑tissue sarcomas and squamous cell carcinomas.

          Material and Methods: A retrospective review of all 528 surgically removed primary skin and soft‑tissue tumors of the hand at our department between 1996 and 2016 was performed.

          Results: A total of 528 patients were evaluated in this study. The most common benign tumor of the hand was pyogenic granuloma (24%), and the most common malign tumor of the hand was squamous cell carcinoma (65.2%). Malignant tumors incidence was higher in males, whereas benign tumors incidence was higher in females.

          Conclusions: A careful history and physical examination performed by a specialist can narrow down the possibilities regarding the type of tumor. The vast majority of hand tumors tend to be benign. In contrast to skin cancers in general, those occurring on the hand frequently have a worse prognosis, with a greater propensity for recurrence, metastatic spread, and functional deficit.

          2018

          Acta Cir. Bras.

          Preoperative subcutaneous sildenafil injection increases random flap survival in rats

          Purpose: To investigate the effect of subcutaneous sildenafil on random flap survival.

          Methods: Fourteen Wistar rats, which were divided in to two groups, were used for this experimental study. Rats in the sildenafil group received subcutaneous sildenafil injections daily for seven days before flap elevation. At the end of the treatment period, 9×3 cm dorsal skin flaps were elevated and reinserted back into their place in all of the animals. Necrotic and whole flaps areas were recorded on graph papers. Seven days after the flap elevation samples for histological examination were taken and angiographies were performed to visualize the flap vascularization.

          Results: The calculated average percentage of necrotic flap areas were 18.29% and 42.26% in the sildenafil and control group respectively.(p=0.0233). In selected angiography images, vessels were found to be more prominent in the sildenafil group. The average number of capillary formations under light microscopy was higher in the sildenafil group (p= 0.0286).

          Conclusion: The subdermal high dose sildenafil has a positive effect on flap survival.

          2018

          Annals of Plastic Surgery

          A New Technique in Management of Depressed Posttracheostomy Scars

          Background: The goals of tracheostomy scar revision are filling of the depressed area, providing easy sliding of skin over the trachea. There are various techniques described to correct this situation. In this article, amodification of split sternocleidomastoid (SCM) muscle flap used in the correction of posttracheostomy defects is described.

          Methods: Thirteen patients who had depressed scars after tracheostomy are included in this study. The mean patient age was 44 years (range, 27–56 years). All patients who suffered from tracheal tug, dysphagia, and bad appearance are included in the study. The area with the depressed scar is de-epithelialized after incising around the depression. Bilateral SCM muscles are split in the coronal plane toward superior half of the muscle while leaving the posterior part of the muscle attached to the bone. After elevation, both SCMmuscle flaps are overlapped in the midline.

          Results: The mean follow-up period of the patients was 11 months (range, 5–20 months). Tracheal tug and dysphagia complaints were resolved in all patients. The depressed area due to the scar was either reduced or completely recovered in all the patients. Apart from 1 hematoma case, none of the early or late complications such as infection, wound dehiscence, skin necrosis, seroma, recurrence, or neck contracture was seen.

          Conclusions: We think that this technique, which gives functionally and aesthetically satisfying results, can be used safely in depressed scars formed after tracheostomy and treatment of functional impairment due to this procedure.

          2018

          JOURNAL OF PLASTIC SURGERY AND HAND SURGERY

          Subdermal nitrous oxide delivery increases skin microcirculation and random flap survival in rats

          Random skin flaps are essential tools in reconstructive surgery. In this study, we investigated the effect of subdermal nitrous oxide (N2O) application on random flap survival. In this experimental study, we used 21 female rats in three groups. In the N2O and air groups, gases were administrated under the proposed dorsal flap areas daily for seven days. Following the treatment period, flaps were raised and inserted back into their place from the dorsal skin. In the control group, the flaps were elevated and inserted back to
          their place without any pretreatment. Calculation of necrotic flap areas, histological examination and microangiography was performed to evaluate the results 7 days after the flap surgery. The average of necrotic flap area in the N2O, air and control group was 13.45%, 37.67% and 46.43%, respectively. (N2O vs air p¼.044; N2O vs control p¼.003). The average number of capillary formations identified in the histological analysis was 7.0 ± 1.58, 3.75 ± 2.36 and 4.4 ± 0.54 in the N2O, air and control group, respectively. (N2O vs air p¼.017; N2O vs control p¼.037). The average number of capillary structures identified in the angiography images were 6.3 ± 1.52, 1.6 ± 1.15 and 1.3 ± 0.57 in the N2O, air and control group, respectively. (N2O vs air p¼.04; N2O vs control p¼.02). We conclude that subdermal N2O application increases random flap survival through an increase in the skin microcirculation and could be promising for future clinical applications.

          2018

           Turk J Dermatol

          Squamous Cell Carcinoma of the Hand: Clinical Presentation, Surgical Treatment, Outcome and Survival Rate: A Series of 129 Cases

          Objective: Despite its relative high frequency; the recurrence, metastasis and long-term survival rates of hand squamous cell carcinoma have not been well defined. The aim of this study was to review a large cohort of patients with hand squamous cell carcinomas and to evaluate the management techniques, outcomes of treatment modalities and survival rates.

          Methods: A retrospective review of all surgically excised primary squamous cell carcinoma of the hand operated in our clinic between 2006 and 2011 was included in the study. Patients were evaluated regarding age, anatomic location of the tumor, gender, treatment modality, survival, and recurrence rate. In addition, recurrence and survival rates were also categorized according to the tumor size.

          Results: A total of 129 patients were evaluated. Tumors smaller than 2 cm had a recurrence rate of 9.7 % and a metastatic rate of 6.5 %; tumors larger than 2 cm had a recurrence rate of 16.7 % and a metastatic rate of 33 % during 5-year follow-ups.

          Conclusion: In contrast to squamous cell carcinoma of the face, those occurring on the hand are malignancies with a worse clinical course, greater tendency for recurrence, metastatic spread, and functional deficiency which might require amputation and complex soft tissue reconstruction.

          2018

          JOURNAL OF PLASTIC SURGERY AND HAND SURGERY

          Beneficial effects of Salvia miltiorrhiza in the healing of burn wounds: an experimental study in rats

          Introduction: Burn healing is a complicated process and very few treatments can positively alter its effects. The aim of this study was to investigate the effects Salvia miltiorrhiza (SM -Danshen), a traditional Chinese medicine, on burn wound healing.

          Material and methods: Twenty rats were included in this study and divided into two groups. 3 × 2 cm wide burn areas were created in the dorsal skin of all the animals with thermal contact. Intraoral 1 ml/day saline and 1 g/kg/day SM were given in control and experiment groups, respectively. Fourteen days following the burn injury burn zones were evaluated with indocyanine green-SPY imaging device, and multiple samples were collected for histopathological evaluation. Standard photographs were taken for the evaluation of necrotic skin areas.

          Results: Neovascularization was increased in the SM group when compared with the control group (p = 0.0406). SPY studies revealed a meaningful increase in the tissue perfusion in the SM group (p = 0.0286). The average amount of necrotic area in the control and experiment group on the postoperative 14th day was 71.6% (±16.51) and 42.5% (±10.64) respectively (p = 0.0002).

          Conclusion: Our study shows that SM can decrease the amount of necrosis in burn wounds by increasing tissue perfusion and neovascularization.

          2017

          The Medical Bulletin of Sisli Etfal Hospital

          The case of malignant melanoma with extensive local recurrence and in-transit metastasis in the lower extremity

          Malignant melanoma (MM) is the third most common skin cancers seen around the world and our country with an increasing incidence and the highest mortality rate of skin cancer. Objective in the treatment of patients with malignant melanoma is adequate surgical management of primary melanoma and regional lymph node metastasis, and rarely distant metastasis. Early diagnosis and adequate surgical resection is the primary basis for treatment of malignant melanoma. Local recurrence (LR) is melanoma occurring within 2cm of the surgical scar of wide local excision of the primary tumor with pathologic evidence of complete initial resection and in-transit metastasis (ITM) is any lesion greater than 2 cm from the original lesion but between the original lesion and regional lymph node basin. The incidence of LR/ITR of malignant melanoma and the mortality rate of MM increase with age. We present 85-year-old female patient in this case report which was in the bottom of her feet, tm thickness 4.75 mm and wide local excision of malignant melanoma and inguinal dissection was performed. She didn’t come her follow-up and 2 years later she was presented with a lot of in-transit metastasis and local recurrence in all right lower extremity. Recent studies showed that older patients (>65) with thicker tumors (>4mm) have higher risk for local and in-transit recurrence and presented age related altered lymphatic function reduce nodal positivity and increased in-transit disease in older patients. Such higher-risk patients should receive aggressive clinical follow-up evaluation, particularly within the first 18 months of diagnosis for early recurrence.

          2017

          The Medical Bulletin of Sisli Etfal Hospital

          Soft Tissue Reconstruction with Reverse Flow Sural Flap in Pilon Fractures

          Prevalence of muscular and tendinous variations of the flexor digitorum superficialis and palmaris longus muscle absence: a population study Objective: Studies in different ethnic groups, showed wide variations in terms of the absence of the palmaris longus tendon. The aim of our study is, to document the percentage of the absence of the palmaris longus muscle and flexor digitorum superficialis muscle variations among the Turkish population.

          Methods: The study group constituted of adult patients who presented to department of Plastic, Reconstructive and Aesthetic Surgery various reasons, other than a history of hand trauma and chronic illnesses. A total of 533 (1066 hands) were included in the study. Among 533 people, the ability of isolated flexion of the proximal interphalangeal joint of all fingers (except thumb) and the presence of palmaris longus muscle were investigated.

          Results: For 533 Turkish individuals (272 men and 261 women), aged between 18 and 66 years old, the overall prevalence of absence of palmaris longus muscle was 21.8% among Turkish population. The overall prevalence variations of the flexor digitorum superficialis of the fifth digit was 23.7% in the Turkish population.

          Conclusions: In operative techniques, where tendon grafting and tendon transfers are utilized, pre-operative consultation of the patient gains importance since the lack of palmaris longus tendon possibility determined. Variations and deficiency of fifth digits’ flexor digitorum superficialis muscle function can not be proven on clinical examinations, so hand surgeons should be aware about flexor digitorum superficialis muscle variations in preoperative examinations and intraoperative dissections.

          2017

          Turk J Plast Surg

          Management of Hand Burns

          Objective: The hand is one of the most frequently affected body parts by burn injuries with a rate of 80% among all burn wounds. Early and effective treatment ensures the best chance of survival as well as a good functional prognosis. The aim of this study was to determine the epidemiology, variation, relationship between etiology and hospital stay, clinical features, and management of hand burns.

          Material and Methods: This retrospective study was conducted the University of Health Sciences; Şişli Hamidiye Etfal Application and Research Center, Departmant of Plastic, Reconstructive and Aesthetic Surgery and the Intensive Burn Care Unit between April 2009 and April 2014. Burns were assessed based on etiology, anatomical location, percentage of total body surface area affected, and depth of injury. Treatment was categorized as conservative, elective operative, or urgent operative.

          Results: In the study period, 788 patients were admitted to our Burn Unit. Of these, 240 were females (30.5%) and 548 were males (69.5%). The most common type of burn injury in this study was thermal injury (695 cases; 88.2%), followed by electrical injury (67 cases; 8.5%), and chemical, frictional or unknown injuries (26 cases; 3.3%). Majority (more than 85%) of the patients had second-degree burns, and some had third-degree burns.

          Conclusions: Burns commonly affect the hands, and many functional problems may develop if appropriate basic treatments are neglected. The best treatment for burns is prevention. Appropriate indoor arrangement and simple but effective measures that can be taken at home can significantly reduce burn trauma exposure.

          2017

          The Medical Bulletin of Sisli Etfal Hospital,

          Soft Tissue Reconstruction with Reverse Flow Sural Flap in Pilon Fractures

          Objective: Pilon fractures are usually caused by high-energy traumas and associated with surrounding soft tissue damage. In addition to the patient’s medical state and comorbidities, the poor vascular supply of the distal tibia makes the reconstruction challenging in most of the cases.

          Material and Methods: Eight patients with pilon fractures (AO types 43A-C) who were treated by the orthopaedics clinic between January 2012 and August 2015 were included in the study. These patients were consulted to our clinic due to full thickness soft tissue defect at the affected site during the operation, and were treated with reverse flow sural flap. Patients were analyzed retrospectively in terms of age, etiology, size of defect and postoperative complications.

          Results: Between January 2012 and August 2015, 8 patients (4 females, 4 males) aged between 7 and 88 years (mean age:46 years) underwent soft tissue reconstruction with reverse flow sural flap, due to tissue defect occurred after the pilon fracture. In the postoperative period, complications such as wound dehiscence, flap loss and infection were not encountered in any patients except one, who developed partial soft tissue necrosis and healed by secondary intention.

          Conclusion: Pilon fractures are among the most difficult fractures of the ankle to treat, and have a high complication rate. Sural flap is a reliable way to reconstruct distal tibial defects in single or multiple-stage approaches.

          2015

          Indian Journal of Plastic Surgery

          How were lipofilling cannulae designed and are they as safe as we believe?

          Background: Most practitioners in plastic surgery believe that blunt tipped cannulae are safer. Interestingly, there is no study about their safety, and the problem is exactly this. As the use of blunt tipped cannulae is somehow difficult, some surgeons try other extreme alternatives, such as sharp and cutting tipped injection needles. But, they can cause complications such as vessel damage. According to these hypotheses, we tried to design a cannula which would ease the application of lipofilling and which would minimise the trauma. Contrary to the injection needle, the tips of the cannula would be blunter, and trauma would be diminished.

          Objectives: After designing such a cannula, we compared it with the most frequently used Coleman type cannulae with regard to ease in utilisation, and safety. We also tried to evaluate the potential for trauma, of the regularly used cannulae.

          Materials and Methods: In the first part, the penetration capacity of all cannulae was measured and compared, and in the second part, the tissue damage was evaluated in an experimental model.

          Results: According to the statistical and histological findings, the pointed-tip cannulae, blunted to a certain degree, can be applied easily through the tissues. The surgeon works more comfortably and we have noted that these cannulae cause less tissue damage.

          2014

          SURGICAL ONCOLOGY AND RECONSTRUCTION

          Use of Platelet-Rich Plasma Solution Applied
          With Composite Chondrocutaneous Graft
          Technique: An Experimental Study in Rabbit Model

          Purpose: Composite chondrocutaneous grafts have been used widely for patients with cleft lip nasaldeformity, alar defects, and septal perforations; however, the graft viability can be easily compromised. The aim of the present study was to extend the safe length of the composite chondrocutaneous grafts by enhancement of angiogenesis and re-epithelialization through platelet-rich plasma (PRP) and to investigate the changes that occur when PRP is administered to the graft and the recipient site.

          Materials and Methods: Composite grafts of critical sizes (1.5, 2.0, and 2.5 cm) were planned on the rabbit ears on 1 side. Group A consisted of grafts pretreated with PRP, group B consisted of recipient beds pretreated with PRP, and group C was the control group in which defects 1.5, 2.0, and 2.5 cm in size were formed on the right ears of the rabbits. On postoperative day 7, matching size chondrocutaneous grafts were adapted to the defect areas without PRP. In all groups, graft viability was evaluated 7 days after graft adaptation in group C and 14 days after PRP administration in groups A and B. Wound healing was scored histopathologically and immunohistologically using hematoxylin and eosin, CD34, and smooth muscle actin staining. The terminal transferase fluorescein-dUTP nick end labeling assay was performed to quantitatively demonstrate the apoptosis ratio among the groups.

          Results: In groups A, B, and C, the mean graft survival of the 2.0-cm equilateral triangle-shaped composite grafts was 65.43% _ 15.7%, 78.12% _ 12.8%, and 41.31% _ 37.4%, respectively (P = .0364).

          Conclusions: PRP pretreatment accelerated composite graft survival in the 2.0-cm equilateral triangle grafts by increasing epithelial regeneration and fibrosis, inducing neovascularization, and ameliorating apoptosis rates.

          2013

          The Journal of Craniofacial Surgery

          Predicting Skin Deficits Through Surface Area
          Measurements in Ear Reconstruction and Adult Ear Surface Area Norms

          Ear reconstruction is one of the most challenging procedures in plastic surgery practice. Many studies and techniques have been described in the literature for carving a well-pronounced framework. However, just as important as the cartilage framework is the ample amount of delicate skin coverage of the framework. In this report, we introduce an innovative method of measuring the skin surface area of the auricle from a three-dimensional template created from the healthy ear. The study group consisted of 60 adult Turkish individuals who were randomly selected (30 men and 30 women). The participant ages ranged from 18 to 45 years (mean, 31.5 years), and they had no history of trauma or congenital anomalies. The template is created by dividing the ear into aesthetic subunits and using ImageJ software to estimate the necessary amount of total skin surface area required. Reconstruction of the auricle is a complicated process that  requires experience and patience to provide the auricular details. We believe this estimate will shorten the learning curve for residents and surgeons interested in ear reconstruction and will help surgeons obtain adequate skin to drape over the well-sculpted cartilage frameworks by providing a reference list of total ear skin surface area measurements for Turkish men and women.

          2012

          The Journal of Craniofacial Surgery

          Severe Symmetrical Facial Lipoatrophy in a Patient With Discoid Lupus Erythematosus

          Acquired partial lipodystrophy is a rare disorder, and it is characterized by the absence of subcutaneous fat from the face, the neck, the trunk, and the upper extremities. The etiology of acquired partial lipodystrophy includes scleroderma and discoid lupus erythematosus. Literature review reveals studies involving 10 patients until today with lipoatrophy due to or after the onset of discoid lupus erythematosus; all are female patients. We want to report a young male patient with progressive symmetrical facial lipoatrophy. In addition, he has discoid lupus erythematosus and celiac disease. Fat grafting and adjuvant oral coenzyme Q10 tablets (Deka-none; Deka Pharmaceuticals, Istanbul, Turkey) were administered for treatment. To our knowledge, this case involves the first male patient in the literature presenting with symmetrical facial lipoatrophy with very prominent periorbital lipoatrophy and bitemporal hollowing symptoms.
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