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Öğe Early and late term microsurgical free flap reconstruction and risks in high voltage electrical injury(Acta Medica Mediterranea, 2013) Karabekmez, Furkan Erol; Duymaz, Ahmet; Tosun, Zekeriya; Keskin, Mustafa; Savacı, NedimThe aim of the study is to discuss and compare the early and late micro vascular flap reconstruction's outcomes, importance, risks, advantages and disadvantages with review of our 13 high voltage electrical burn injury cases. Medical records have been reviewed for electrical burns in last three years. 13 cases fitting the criterion were included into the study. Four of them have been hospitalized for late complication such as severe contracture; nine of them have been hospitalized for acute treatment. Five patients had latissimus dorsi muscle flap, three patients had parascapular flap, two patients had latissimus dorsi and scapula osteomusculocutaneous flap, two patients had rectus abdominis musculocutaneous flap, and one patient had parascapular and scapular flap. Early reconstruction applied group showed a significant difference regarding to flap failure rates. Electrical injuries are more complex than regular burn injuries related with heat, and the reconstruction of these cases also should be special. One of the most important factor for free flap viability in electrical injury cases is surgery timing. All of the complications were seen in the patients who had surgery at 12th and 19th days after the electrical injury. No complication has seen in the group of patients who had surgery on late term period. However microsurgical reconstruction should be considered to cover exposed bony tissues on the extremities in the short term period in order to prevent possible limb shortening procedures.Öğe Ektropion düzeltilmesinde etkin bir yöntem: Kuhnt Szymanowski tekniğinin Smith modifikasyonu(2013) Akdağ, Osman; Karabekmez, Furkan Erol; Sütçü, Mustafa; Duymaz, Ahmet; Karameşe, Mehtap; Tosun, ZekeriyaAmaç: Ektropiyon göz kapağı kenarının dışa doğru kıvrılmasıdır. Bu çalışmanın amacı; involüsyonel ve paralitik ektropiyon onarımında kullanılabilecek kolay ve etkin bir yöntem olan Kuhnt Szymanowski tekniğinin Smith modifikasyonunun etkinliğinin ve estetik olarak kabul edilebilirliğinin değerlendirilmesidir. Yöntem: Alt göz kapağında ektropiyon şikayeti ile kliniğimize başvuran ve Kuhnt Szymanowski tekniğinin Smith modifikasyonu ile tedavi edilen 5 hasta klinik ve fotoğrafik olarak incelendi. Bulgular: Hiçbir olguda majör bir komplikasyon ya da nüks gözlenmedi. Ortalama 10 ay olan takip süresi sonunda tüm hastalar cerrahi sonuçtan memnundu. Sonuç: Alt göz kapağında horizontal gevşekliğin daha ön planda olduğu involüsyonel ve paralitik ektropiyon olgularında Kuhnt Szymanowski tekniğinin Smith modifikasyonunun uygun bir cerrahi yöntem olduğu kanaatindeyiz.Öğe Foot and ankle reconstruction with vertically designed deep inferior epigastric perforator flap(Wiley, 2018) Akdağ, Osman; Karameşe, Mehtap; Yıldıran, Gökçe Ünal; Sütçü, Mustafa; Tosun, ZekeriyaIntroductionThe deep inferior epigastric perforator (DIEP) flap is one of the most commonly utilized flaps of reconstructive surgery. Although the horizontal flap design is the most commonly used, this flap can be vertically designed to avoid drawbacks such as excessive tissue dissection, relatively reduced flap perfusion, and scarification of the contralateral flap opportunity. The aim of this report is to present our case series for foot and ankle reconstruction with vertical designed DIEP flap. Patients and methodsThe free vertically designed DIEP flaps (VDIEP) were used in eight patients (7 male, 1 female) whose age is in a range of 20-66 years for soft tissue reconstructions in the ankle and foot region over a five-year period. The range of defects' size was from 8 x 5 cm to 15 x 7 cm and the causes were electrical burn, trauma and diabetic foot infections. ResultsFlap dimensions varied from 10 x 6 cm to 17 x 9 cm. All the flaps had two or more perforators, and all flaps survived completely. There were no early or late complications. We followed up the patients for 10 months in average. We observed no functional problems, especially in main motions of foot and ankle like eversion, inversion, flexion or extension except one patient. Donor site scars were acceptable in all patients. ConclusionsThe VDIEP flap may be an option for selected lower extremity soft tissue reconstructions, and it may be an alternative to classically designed abdominal flaps.Öğe Intra-articular platelet-rich plasma injection for the treatment of temporomandibular disorders and a comparison with arthrocentesis(Churchill Livingstone, 2015) Hancı, Mustafa; Karameşe, Mehtap; Tosun, Zekeriya; Aktan, Tahsin Murad; Duman, Selçuk; Savacı, NedimBackground: Temporomandibular joint (TMJ) internal derangements are progressive painful conditions and cause joint dysfunction, joint sound, malocclusion, and locking of the mouth. Conservative and invasive techniques can be used for the treatment of TMJ internal derangements. The objective of the present study was to examine the benefit of an intra-articular platelet-rich plasma (PRP) injection and to compare this with arthrocentesis. Methods: Twenty patients (female: male; 15: 5; age 26, 3 +/- 9.3 years) for a total of 32 joints with reducible anterior disc dislocation, as confirmed by Magnetic Resonance Imaging (MRI), were divided into two groups. PRP was used for the study group, and arthrocentesis was used for the control group. Pain intensity, maximal interincisal opening, and TMJ sounds were assessed and compared for evaluation of treatment success. Results: There was a statistically significant reduction in pain intensity and joint sound and an increase in mouth opening in the study group when compared with the control group. Conclusions: This study shows that intra-articular PRP injection for the treatment of reducible disc displacement of the TMJ is a more effective method than arthrocentesis. (C) 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.Öğe Malignant triton tumor of the oral cavity: A rare occurrence(Springer Verlag, 2012) Seyhan, Nevra; Tosun, Zekeriya; Avunduk, Mustafa Cihat; Savacı, NedimMalignant peripheral nerve sheath tumors (MPNST) arise fromSchwann cells or within existing neurofibromas and, as agroup, account for approximately 5–10% of all soft tissuesarcomas [1]. Although MPNST may consist of tissues such asglandular epithelium, squamous cell, cartilage, or bones, thosewhich possess only skeletal muscle differentiation are referredto as malignant triton tumor (MTT). The tumor consists of twocell lines, rabdomyoblasts and Schwann cells.Öğe Management of temporomandibular joint ankylosis with temporalis fascia flap and fat graft(Churchill Livingstone, 2013) Karameşe, Mehtap; Duymaz, Ahmet; Seyhan, Nevra; Keskin, Mustafa; Tosun, ZekeriyaAim: Temporomandibular joint (TMJ) ankylosis is a serious problem that restricts jaw mobility and causes disturbances in facial and mandibular growth. The purpose of this paper is to present an easy and versatile method for the treatment of TMJ ankylosis to decrease postoperative complications such as re-ankylosis. Material and method: Eleven patients who presented with ankylosis of the TMJ underwent surgical release. After performing gap arthroplasty through a preauricular approach, the temporalis fascia flap was transposed to the gap. An autogenous fat graft was then obtained from the abdomen and used as interpositional material. The follow-up time was 3-5 years. Results: Re-ankylosis did not occur in any of the patients, and all had satisfactory mouth opening. Conclusion: Surgical treatment of TMJ ankylosis with gap arthroplasty, interposition of the temporalis fascia flap and fat grafting is an effective and easily procedure for preventing of re-ankylosis. The autogenous nature and close proximity to the joint are the main advantages of the temporalis fascia flap when compared with other interpositional materials, and the fat graft provides additional support by reducing pressure.Öğe Nadir bir donuk etkeni: Kuru buz(2013) Akda?, Osman; Sütçü, Mustafa; Karabekmez, Furkan Erol; Karameşe Şen, Mehtap; Tosun, ZekeriyaDonuklar sıklıkla askeri personellerde, yüksek rakımlı ve soğuk iklim yapısına sahip yerlerde yaşayanlarda ya da dağcılık, kayak ve benzeri sporlarla uğraşan kişilerde görülür.1 Bunun dışında alkol bağımlısı psikiyatrik hastalar ve düşkün kimselerde risk altındadır.2 Kuru buz (veya karbondioksit karı), katı karbondioksittir. Katı sudan çok daha yoğundur ve donma noktası da çok daha düşüktür (? 78,5 °C). Kuru buz kaynaklı donuklar dikkatsizlik ve bilgi eksikliği sonucu sık olmayan sayıda karşımıza çıkmaktadır.Öğe Reverse adipofascial radial forearm flap surgery for soft-tissue reconstruction of hand defects(2016) Akdağ, Osman; Karameşe, Mehtap; Nebilselimoğlu, Muhammed; Akatekin, Ahmed; Abacı, Malik; Sütçü, Mustafa; Tosun, ZekeriyaObjective: The reverse radial forearm flap has been used for soft-tissue hand defect surgical procedures worldwide. One of the major drawbacks of this flap, however, is donor site morbidity, as the donor site is closed with a skin graft. Problems with skin graft donor areas include adhesion, contracture, and wound-healing complications. In this study, only the adipofascial component of a reverse radial forearm flap was used to prevent these problems; in addition, a skin graft was applied over the flap instead of over the donor site. Methods: Between January 2011 and December 2013, a total of 13 hand defects were reconstructed with a reverse adipofascial radial forearm flap. Patients were evaluated for functional results using total active motion criteria and disability of the arm, shoulder, and hand scores, operation time, hospitalization time, and patient satisfaction. Results: All flaps and grafts placed on flaps survived completely and donor sites healed without complications. The total active motion criteria and the disability of the arm, shoulder, and hand score demonstrated that the functional outcomes were successful. Patient satisfaction scores using the visual analog scale had a mean of 88.3 (SD = 2.95) mm. Operation time for the flap surgery was 126.1 (SD = 21.80) minutes, and patients were discharged at an average of 6.3 (SD = 1.44) days. Conclusion: Use of an adipofascial component in reverse radial forearm flap surgery is appropriate for reducing problems with donor site skin grafts. Patients’ functional outcomes denoted that the reverse adipofascial radial forearm flap is a reliable and effective method to cover soft-tissue defects of the hand.Öğe Rhabdomyosarcoma in an adult hand(Informa Healthcare, 2013) Seyhan, Nevra; Keskin, Mustafa; Tosun, Zekeriya; Savacı, NedimRhabdomyosarcoma (RMS) is a malign tumour which arises from cells committed to a skeletal muscle lineage. It constitutes 4%–8% of all childhood malignancies but is rare in adults. The rare pleomorphic subtype occurs almost exclusively in adults and most often involves the extremities. RMS of the hand or foot comprise a minority of extremity cases. An adult patient with rhabdomyosarcoma in the hand, which is very rare, is presented in this article. General characteristics of the tumour and the treatment strategies are discussed.
