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Öğe A new and practical instrument for antihelix scoring: Gillies skin hook(Medknow Publications & Media Pvt Ltd, 2016) Özkaya, Özay; Bingol, Derya; Egemen, Onur; Akan, Mithat; Tasasız, KadirThe patient was presented with prominent ear on the right side unilaterally. Operation was planned beyond written informed consent were taken from patient. He was 23 years old. On the physical examination, we observed underdeveloped antihelical fold and prominent concha. The helix to mastoid distance was measured 25 mm in the upper third, 30 mm in the middle third at its widest point and 22 mm in the lower third. The concha was deep and conchamastoid angle was increased and measuring 80°. The concha scaphal angle was 125°. We used Furnas conchal-mastoid sutures and Mustardé scapha-conchal sutures in the operation. The cartilage was firm and to break strength for reshaping and forming the anti-helical fold, we scored antihelix with Gillies skin hook (Figure 1).Öğe A rare condition to keep in mind: Pyoderma gangrenosum after breast reduction(Wolters Kluwer Medknow Publications, 2019) Bahadırlı, Nilüfer; Sütçü, Mustafa; Akan, Mithatyoderma gangrenosum is a rare inflammatory disease, characterized by ulcers with purple-colored borders and elythematous halo. Clinically, the patient has fever and severe local pain. Pyoderma gangrenosum can occur after any surgical procedure and the diagnosis is usually delayed. It is important for surgeons and infectologists to be watchful about this rare condition because if misdiagnosed, it has serious results including severely painful ulcerations, prolonged therapy, repeated hospitalizations, psychological trauma, and extensive scarring. The authors report a postsurgical pyoderma gangrenosum case after reduction mammoplasty. This report emphasizes on the importance of awareness about this uncommon disease and its diagnosis.Öğe A simple styrofoam frame designed to protect split-thickness skin graft donor site(2013) Askeroğlu, Ufuk; Barutça Asfuroğlu, Seda; Kayadibi, Turgut; Üsçetin, İlker; Akan, MithatThe most disturbing process and requirement of the early postoperative period of split-thickness skin graft procedure for the patient is keeping the donorsite open. Hence there are various kinds of donor site dressings and procedures have been described for this purpose, for the fast recovery of the donor site it should be kept open and must be protect from trauma at the same time. Donor site protection as one of the most important point after surgery, can be achieved with easy to design, hand-made and cost effective methods such as styrofoam frame with increasing patient life quality.Öğe Applications of triangular glanular flap in hypospadias repairs for different purposes(Informa Healthcare, 2014) Filinte, Gaye Taylan; Akan, Mithat; Temiz, Gökhan; Ayçiçek Çardak, Gülçin Nujen; Gönüllü, ErsinHypospadias 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 patients. Meatal stenosis, demonstrated after hypospadias repair, is a challenge for both the surgeon and the patient. A distal triangular glanular flap is planned to avoid this challenge. Besides, it helps to carry the meatus more distally. Promising results support the use of the glanular flap while longer follow-up is required for better evaluation.Öğe Bone dust and diced cartilage combined with blood glue: A practical technique for dorsum enhancement(Springer, 2014) Örero?lu, Ali Rıza; Çakır, Barış; Akan, MithatThe combination of dorsal nasal reconstruction and camouflage of surface irregularities is an important step in rhinoplasty. We hereby present our technique of delivering diced cartilage in combination with bone dust to the nasal dorsum using the patient's blood as a carrier. We advocate use of an autologous material (blood) as a scaffold for graft delivery, dismissing the use of a foreign material or fascial wrapping of the graft. Using the patient's blood for this purpose not only stabilizes the graft into a malleable structure that is easily applicable to the nasal dorsum, it also decreases the potential for reaction against foreign material. Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.Öğe Histologic and biomechanical evaluation of the effects of social stress and the antidepressant fluoxetine on tendon healing in rats(Georg Thieme Verlag, 2015) Öztürk, Muhammed Beşir; Egemen, Onur; Basat, Salih Onur; Bozdağ, Ergün; Sakız, Damlanur; Akan, MithatImpaired wound healing in humans under psychological stress and the positive effects of antidepressant drugs on wound healing were also shown in the literature. However, there are currently no studies regarding the effects of antidepressant drugs on tendon healing. The aim of this study was to compare tendon healing under normal conditions versus social stress. We also aimed to perform a histological and biomechanical analysis of the effects of the antidepressant drug fluoxetine on tendon healing. Sixty Sprague Dawley rats were divided into six groups. A social stress regimen was used to stress the rats. The use of fluoxetine in the social stress group yielded significantly better biomechanical results and the collagen organizations of the fluoxetine group were more similar to the normal tendon collagen organization. Fluoxetine seems to inhibit the negative effects of stress on tendon healing and seems to improve tendon healing.Öğe New otoplasty approach: A laterally based postauricular dermal flap as an addition to mustarde and furnas to prevent suture extrusion and recurrence(Springer, 2014) Başat, Salih Onur; Askero?lu, Ufuk; Aksan, Tolga; Alleyne, Brendan J.; Yazar, Memet; Orman, Ça?daş; Üsçetin, Ïlker; Akan, MithatProminent ear is the most common deformity of the external ear. The major causes can be an underdeveloped antithetical fold, concha hypertrophy, and prominence of the ear lobule. Since Ely's first aesthetic correction of the prominent ear in 1881, more than 200 different techniques have been described, but the choice of procedure still remains the surgeon's preference. This report presents the laterally based posterior auricular dermal flap technique as an adjunct to the conventional cartilage-sparing otoplasty. An elliptical skin incision was planned according to the classic prominent ear correction technique. Instead of the excision, skin was deepithelialized. From the inferior border of the incision, the dermal flap was incised and elevated in a medial-to-lateral direction. The posterior auricular dermal flap was used to support and cover the suture material. This method was used in the treatment of 17 consecutive patients. After a follow-up period of 6-32 months (mean 16 months), the patients were evaluated in terms of the recurrence and suture line problems. No suture line problems or recurrences were observed at the end of the follow-up period. Use of the posterior auricular dermal flap both prevents suture extrusion and decreases recurrences. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.Öğe Preventing suture extrusion and recurrence in mustarde and furnas otoplasties by using laterally based postauricular dermal flap, long-term results(Lippincott Williams & Wilkins, 2016) Başat, Salih Onur; Ceran, Fatih; Askeroğlu, Ufuk; Aksan, Tolga; Orman, Çağdaş; Yazar, Memet; Üsçetin, İlker; Akan, Mithat; Bozkurt, MehmetBackground:Prominent ear deformity (PD) is an unacceptable condition of pinna that affects 5% of the population and is associated with emotional stress, behavioral disturbances, and social restrictions in relationships. Conchal hypertrphy, inadequate formation of antihelical fold, earlobe placement ahead than it should be, or various combinations of these changes are main characteristics of PD. Many surgical techniques have been described for the PD.The authors' aim was to present laterally based postauricular dermal flap combination with cartilage-sparing methods and effectiveness of this technique in suture extrusion prevention and reducing the rate of recurrence with long-term results.Methods:Forty-one patients had bilateral and 6 patients had unilateral PD, a total of 47 patients with a mean age of 14.48 were operated by using this combined procedure. A laterally based supraperichondrial dermal flap was prepared from a deepithelized elliptical postauricular incision. Mustarde and Furnas suture techniques were used solely for PD correction. The dissected laterally based dermal flap was fixed to the mastoid bone with sutures in stretched position after reshaping the auricular cartilage with sutures.Results:The average helix-mastoid distance was (mm) 16.282.36, concha-mastoid angle was 25.71 +/- 0.96 degrees on 12-month measurements. The helix-mastoid distance showed an increase of 1 to 3mm, in the concha-mastoid angle measurements of 1 degrees to 2 degrees. Statistically significant changes were observed between the average preoperative, postoperative 1. month, postoperative 12. month helix-mastoid distances (mm), and month concha-mastoid angle (degrees) measurements (P=0.0001).Conclusions:The laterally based postauricular dermal flap technique is an effective method to prevent suture extrusion and recurrence which are the most important complications of otoplasty procedure and easy to apply.Öğe Quantification of the surgical margin shrinkage in lip cancer: Determining the relation between the surgical and histopathologic margins(Lippincott Williams & Wilkins, 2014) Egemen, Onur; Bingöl, Derya; Orman, Çağdaş; Sayılgan, Ayşe Tülay; Özkaya, Özay; Akan, MithatLip carcinoma is one of the most common cancers of the head and neck region. Lower lips are more frequently affected. Squamous cell carcinoma accounts for more than 95% of the cases. The aim of treatment is to achieve the highest cure rates with adequate excision with clear surgical margins while leaving the smallest defect sizes behind for reconstruction. Excised tissue is known to shrink when removed, in relation with its retractile properties. In this study, the evaluation of the amount of shrinkage in excised lip cancer specimens and determination of the relation between surgical and histopathologic margins were aimed. The study included 21 consecutive excised lip specimens for the treatment of squamous cell carcinoma of the lip. The volume of the specimen, tumor length, and margin distance measurements were measured and recorded step by step from before surgical excision to histopathologic evaluation. Specimens were evaluated in a standardized fashion by the same pathologist after 48 hours of fixation. For data analysis, Number Cruncher Statistical System 2007 and Power Analysis and Sample Size 2008 Statistical Software (Kaysville, UT) were used. The surgical margins of the excised lip specimen shrink up to 41% to 47.5% from before excision to histopathologic evaluation. The most significant step was the excision step, followed by the formalin fixation step. The histopathologic process itself and the duration of formalin fixation did not result a significant change in surgical margins. The tumor tissue itself did not show a significant shrinkage.Öğe Recurrent ameloblastoma in the free fibula flap: Review of literature and an unusual case report(Springer, 2015) Başat, Salih Onur; Örero?lu, Ali Rıza; Orman, Ça?daş; Aksan, Tolga; Üsçetin, İlker; Akan, MithatAmeloblastoma is the second most common odontogenic tumor of the oral cavity with the primary site being the mandible. The ratio of maxillomandibular involvement however is 5:1 in favor of the mandible. The most common complaint is a painless swelling over the mandibular area. Despite its benign nature, ameloblastoma has a high local recurrence rate, with the most recurrences seen within 5 years after operation. Biopsy and radiological evaluation may be helpful in differentiating the subtypes of ameloblastoma. Differentiation is important because some subtypes are more aggressive than the others. Preoperative planning may be done according to this classification, which can help decrease the recurrence rate. In our case, a 26-year-old female patient with recurrent ameloblastoma which developed on the fibular flap is presented. The free fibular flap and the left parasymphyseal part of the mandible were totally excised. Ameloblastoma was confirmed on pathological examination. We reconstructed the left mandibular site with a reconstruction plate and recurrence was not seen during follow up period.Öğe Saphenous vein sparing superficial inguinal dissection in lower extremity melanoma(Hindawi Limited, 2014) Öztürk, Muhammed Beşir; Akan, Arzu Atalay; Özkaya, Özay; Egemen, Onur; Örero?lu, Ali Rıza; Kayadibi, Turgut; Akan, MithatAim. The classic inguinal lymph node dissection is the main step for the regional control of the lower extremity melanoma, but this surgical procedure is associated with significant postoperative morbidity. The permanent lymphedema is the most devastating long-term complication leading to a significant decrease in the patient's quality of life. In this study we present our experience with modified, saphenous vein sparing, inguinal lymph node dissections for patients with melanoma of the lower extremity. Methods. Twenty one patients (10 women, 11 men) who underwent saphenous vein sparing superficial inguinal lymph node dissection for the melanoma of lower extremity were included in this study. The effects of saphenous vein sparing on postoperative complications were evaluated. Results. We have observed the decreased rate of long-term lymphedema in patients undergoing inguinal lymphadenectomy for the lower extremity melanoma. Conclusion. The inguinal lymphadenectomy with saphenous vein preservation in lower extremity melanoma patients seems to be an oncologically safe procedure and it may offer reduced long-term morbidity.Öğe The outcome of coronoidectomy in bilateral coronoid process hyperplasia(Taylor & Francis Ltd, 2018) Özkaya, Özay; Çolak, Özlem; Sütçü, Mustafa; Akan, MithatObjective: Coronoid process hyperplasia (CPH) of the mandible is a rare condition that can be defined as an abnormal bony elongation of histologically normal bone with the symptoms of progressive, painless difficulty in opening the mouth. The purpose of this study is to evaluate the outcomes of five patients with CPH treated by coronoidectomy, relative to post surgery jaw function. Methods: Five patients with CPH were included in this study. The diagnosis of CPH was confirmed by radiographic and clinical examination of the mandible. All five patients underwent bilateral intraoral coronoidectomy under general anesthesia. The mean maximum interincisal mouth opening for the patients was determined by measurements taken pre-surgery, intraoperative, and at longest follow-up. All five patients underwent postsurgical physical therapy directed towards jaw function. Results: All the patients with limited mouth openings presented with a preoperative maximum interincisal mouth opening of 12.4 mm (range 9-20.3 mm), which was increased to 37 mm (range 22-52 mm) in the operating room after bilateral intraoral coronoidectomy and 42 mm (range 32-52 mm) during the late follow-up. Conclusions: Patients with limited jaw function related to bilateral CPH can benefit by undergoing bilateral coronoidectomies and physiotherapy.Öğe The use of dermal automesh for incidental hernia repair in abdominoplasty: Clinical, biochemical, and radiological results(Informa Healthcare, 2015) Özkaya Mutlu, Özay; Egemen, Onur; Akan, Arzu; Akan, Mithat; Karahangil, Mehmet; Filinte, Gaye; Bozdağ, Ergün; Sünbüloğlu, Emin; Kurtul, HülyaAbdominal wall hernias are often diagnosed on clinical examination or encountered intraoperatively during an abdominoplasty. The aim of this study is to evaluate the long-term results of the use of dermal automesh for the repair of incidental hernias during abdominoplasty operations, and to perform a comparative analysis of the biomechanical strengths of dermal automesh vs biological tissue graft. Between 2008 - 2012, dermal automesh was used in 12 patients for hernia repair. After repair of hernia, dermal automesh was applied over the repaired area in an onlay fashion. Postoperative follow-up was performed by physical examination and magnetic resonance imaging (MRI) of the abdominal wall. Biomechanical test was performed with prepared samples from excised abdominal panniculus for tensile strength and yield power. Mean age was 45 years (range = 36 - 54 years). Total follow-up was 26 (14 - 52) months. MRI studies showed that there were no hernias or defects of the anterior abdominal wall. The tensile strength of the dermal mesh was measured as 15.9 +/- 6.0 Mpa (6.4 - 24.5), maximum load before yield measured 680 +/- 175.2 N (336.0 - 856.0). In conclusion, dermal automesh is a useful option for surgeons who encounter undiagnosed hernias during abdominoplasties.Öğe Tümör nüksünün ilk bulgusu aksiller ve inguinal dev lenfadenopatilerde cerrahi tedavi yaklaşımımız ve cerrahinin sağ kalıma etkisi(AVES Yayıncılık, 2015) Özkaya, Özay; Tasasız, Kadir; Egemen, Onur; Akan, Mithat; Özcan, DenizCerrahi ve onkolojik tedavisi tamamlanmış hastalarda, malign tümor nüksünün ilk bulgusu olarak karşımıza çıkabilen lenf nodu tutulumlarında yapılacak olan cerrahi tedavinin hastanın sağkalımına etkisi tartışmalıdır. Bu çalışmada, primer kanser tedavisi sonrasında nüksün ilk bulgusu olarak, aksiller ve inguinal bölgede tümör invazyonu olan dev lenfadenopati nedeniyle kliniğimize konsülte edilen dört hasta,retrospektif olarak incelenerek, tedavi yaklaşımlarımız ve yapılan prosedürlerin sağkalım oranına etkisini araştırılması amaçlanmıştır.Gereç ve Yöntemler: Olguların sağkalım süreleri, metastatik dev lenfadenopati eksizyonu ve postoperatif onkolojik tedavilerin tamamlanması sonrasında radyolojik yöntemler ve klinik veriler izlenerek değerlendirildi.Bulgular: Dev lenfadenopati nedeniyle 1 hastaya aksiller bölgeye, bölge 1,2,3 lenf nodu disseksiyonu, diğer 3 hastaya genişletilmiş inguinal lenf nodu disseksiyonu uygulandı. Disseksiyon materyali patoloji sonucu primer tümör metastazı ile uyumlu geldi. Postoperatif dönemde onkolojik tedavi süreçleri başlandı. Olguların yaklaşık 20 aylık toplam takip süreleri içerisinde nüks ve metastaza rastlanmadı.Sonuç: Dev metastatik lenf nodu tutuumu sonrası değerlendirdiğimiz olgularda, primer tümör tipi, klinik seyirler ile birlikte lenf nodu tutulumuna yönelik uyguladığımız cerrahi prosedürler sonrası sağkalım değerlendirilmiştir. 5 yıllık ortalama sağkalım için henüz net bir katkı sağlandığı söylenmesede devam etmekte olan mevcut takip süresince nüks izlenmemiş olması umut vericidir.Öğe Venöz tromboemboliyi yeterince tanıyor muyuz? Türk plastik, rekonstrüktif ve estetik cerrahların venöz tromboemboli proflaksisine yaklaşımı ve profilakside tercih edilen yöntemler: Anket çalışması(2013) Özkaya, Özay; Öztürk, Muhammed Beşir; Egemen, Onur; Öreroğlu, Ali Rıza; Üsçetin, İlker; Tasasız, Kadir; Akan, MithatGiriş: Derin ven trombozu (DVT) ve pulmoner emboli (PE) diğer cerrahi branşlarda olduğu gibi günümüz Plastik Rekonstrüktif ve Estetik cerrahi operasyonlarında da hastalar için önemli bir mortalite ve morbidite nedenidir. Bu çalışmada, Türk Plastik Cerrahların Venöz tromboemboli (VTE) farkındalık düzeyini belirlemek, uygulamakta oldukları VTE proflaksi protokolleri hakkında bilgi edinmek, ülkemizdeki VTE risk faktörlerinin sıklığını belirlenmesi amaçlarıyla uygulanan VTE anketinin sonuçlarının sunulması ve verilerin literatür ile karşılaştırılması amaçlandı. Gereç ve Yöntem: Çalışmamızda, Plastik Cerrahi prosedürlerine yönelik DVT ile ilgili 7 sorudan ve 2 sayfadan oluşan bir anket hazırlandı. Bu anket formu basılı ve elektronik olarak hazırlanarak, Türk Plastik Rekonstrüktif ve Estetik Cerrahi Derneğinin düzenlediği iki kongrede Türkiye’de çalışan Plastik Cerrahi uzman hekimlerine sunuldu. Ayrıca, anketin elektronik formatı, derneğin forum sayfası üzerinden Plastik Cerrahlara ulaştırılarak sonuçlar e-posta üzerinden toplandı. Bulgular: 57 elektronik, 42 basılı olmak üzere toplam 99 anket değerlendirildi. Anket sonuçlarının değerlendirilmesinde, katılımcıların % 90’in DVT proflaksi uyguladığı, %10 ise uygulamadığı saptandı. Katılımcıların %94’ü preoperatif risk faktörlerini tüm hastaları için sorgularken, %6’sı risk faktörü sorgulaması yapmamaktaydı. Risk grubu sorgulayan cerrahların, en sık karşılaştıkları risk faktörü 93% oranıyla geçirilmiş DVT hikayesi olarak saptanmıştır. Sonuç: VTE‘ye bağlı mortalilite ve morbidite oranlarının azaltılmasında en etkili ve ucuz yöntemin proflaksi olduğunu unutulmamalıdır. Bu bakımdan ülkemiz Plastik cerrahi hasta populasyonuna ait risk faktörlerinin ve toplumdaki edinsel ya da konjenital hiperkoagulabilite oranlarının belirlenmesi ile VTE profilaksisi konusunda kendi branşımıza ait bir protokol oluşturulması gerektiğini düşünmekteyiz.
