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Öğe Altering effects of caffeic acid phenethyl ester (CAPE) and ischemia/reperfusion injury: an experimental study in a rat TRAM flap model(Springer, 2020) Yegin, Mehmet Emre; Bilkay, Ufuk; Tiftikciodlu, Yigit Ozer; Uyanikgil, Yigit; Cavusodlu, Turker; Ercan, Gulinnaz; Gurdal, MehmetBackground Many studies have been performed since the discovery of ischemia-reperfusion injury (I/R) to find substances that reverse its effects on flaps. However, because of minor or major side effects these substances are mostly failed to be put in clinical practice. in this study, the mitigation effects of caffeic acid phenethyl ester (CAPE) were investigated for its protective effects on flap necrosis in a rat model. Methods Forty-two randomized male Sprague-Dawley rats weighing between 250 and 300 g were assigned to the regular flap (G1) (n = 14), ischemic flap (G2) (n = 14), and ischemic flap + CAPE (G3) (n = 14) groups. Bilateral pedicled TRAM flaps were designed for the first seven rats of each group,; bilateral-free TRAM flaps were designed for the remaining rats in each group and referred as subgroup 1 and 2 (S1 and S2), respectively. in G1, flaps were returned to their original locations without clamping or injection. in G2 and G3, a 2-h ischemia was performed. Before the ischemic process, intraperitoneal saline and CAPE solution was administered intraperitoneally in the second and third groups, respectively. on day 7 after the operation, all flaps were harvested and subjected to biochemical (malondialdehyde, superoxide dismutase, and catalase levels) and histological examinations (hematoxylin & eosin, Mallory-Azan, anti-VEGF, anti-BAX, anti Bcl-2, and anti-iNOS stainings), respectively. Enzyme levels and the Verhofstadt scores showed a statistically significant difference in flaps among the groups. Less injury was noted in G3 than in G2 (p < 0.01). Conclusions in this experimental model, CAPE was effective in protecting tissues against ischemia-reperfusion injury. Level of evidence: no ratableÖğe Augmentation of the Calf Region with Autologous Fat and Platelet-Rich Plasma-Enhanced Fat Transplants: A Comparative Study(Wolters Kluwer Medknow Publications, 2021) Bilkay, Ufuk; Bicer, Ahmet; Ozek, Zeyyat Cuneyt; Gurler, TahirBackground: Contour and volume deficiencies in the calf region, either unilateral or bilateral, may raise an esthetic concern in affected individuals. There are numerous methods described for volume augmentation or contour reshaping in this region including implant placement, autogenous tissue transfer, liposuction, and/or fat injections. The authors present their series of patients to whom they performed fat injections with or without platelet-rich plasma (PRP) enrichment for addressing this problem. Methods: Fifty-two patients who had undergone calf lipostructuring procedure(s) in our clinic were included in this retrospective study. The procedure was repeated with a fixed value of fat volume per leg until a satisfactory limit for both the patient and the senior author could be achieved. Regarding the analysis of outcome, the number of sessions needed to be repeated was recorded for each patient. Results: 125 cc of fat was injected per session per leg. Ten patients were treated with PRP enriched fat transplants while 42 were treated with fat only. The mean number of sessions was 2.76 (min. 2, max. 6). For the group treated with PRP-enriched fat grafts a mean 2.00 number of sessions had to be carried out while the mean was 2.95 for the patients in the fat-only group. The mean number of sessions to achieve our goal was significantly lower in the PRP-enriched fat injected group (P < 0.001). Conclusion: Addition of PRP significantly reduces the need of repeated operations to achieve the best possible outcome in lipostructuring around the calf region.Öğe Early free flap coverage of high-tension electrical injury: Case report(1996) Alper, Mehmet; Görken, Cenk; Bilkay, Ufuk; Keçeci, Yavuz; Songür, EcmelBecause of the clinical concept of progressive tissue necrosis, immediate excision and coverage of high-tension electrical injuries has been a controversial subject. Recent research has cast doubt on this concept. in this paper, a large defect of the scalp caused by high-tension electrical injury and covered successfully by a latissimus dorsi myocutaneous free flap is presented.Öğe The Effect of Melatonin on a Dorsal Skin Flap Model(Taylor & Francis Inc, 2014) Kerem, Hakan; Akdemir, Ovunc; Ates, Utku; Uyanikgil, Yigit; Sezer, Ebru Demirel; Bilkay, Ufuk; Turgut, Mehmet; Sozmen, Eser; Songur, EcmelBackground: Melatonin (Mel) has a very potent antioxidant activity, depending mainly on its capacity to act as an electron donor. Recently, the antioxidant property of Mel has been much emphasized. In this study, the dorsal skin flap model was used to investigate the effect of Mel in flap viability in rats. Material and Methods: Totally 28 Wistar Albino rats were divided into four groups: control group (C) (n = 7), local treatment group (L) (n = 7), systemic low-dose melatonin treatment group (LT) (n = 7), and systemic high-dose melatonin treatment group (HT) (n = 7). The necrosis rate of the skin flaps was observed seven days after the operation by a blinded observer. Oxidative stress was assessed by determining malondialdehyde (MDA) level, and effects of melatonin on antioxidant enzymes such as superoxide dismutase (SOD) and catalase (CAT) were measured. Vascularity, epithelial thickness, and fibroblast proliferation of dorsal skin flaps were assessed histologically. Results: Amount of MDA were found significantly lower (p < .05), and the flap viability, CAT, SOD, vascularity, fibroblast proliferation, and epithelial thickness were found significantly higher (p < .05) in groups HT than in groups C, L, and LT statistically. Conclusion: Our results showed that the usage on different doses of melatonin could play an important role in the process of flap viability and further studies will focus on these areas of interest.Öğe The evaluation of flap growth and long-term results of pediatric mandible reconstructions using free fibular flaps(Wiley-Blackwell, 2015) Temiz, Gokhan; Bilkay, Ufuk; Tiftikcioglu, Yigit Ozer; Mezili, Candan Tevfik; Songur, EcmelCurrently, 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. (c) 2014 Wiley Periodicals, Inc. Microsurgery 35:253-261, 2015.Öğe The evaluation of flap growth and long-term results of pediatric mandible reconstructions using free fibular flaps(Wiley-Blackwell, 2015) Temiz, Gokhan; Bilkay, Ufuk; Tiftikcioglu, Yigit Ozer; Mezili, Candan Tevfik; Songur, EcmelCurrently, 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. (c) 2014 Wiley Periodicals, Inc. Microsurgery 35:253-261, 2015.Öğe The evaluation of flap growth and long-term results of pediatric mandible reconstructions using free fibular flaps(Wiley-Blackwell, 2015) Temiz, Gokhan; Bilkay, Ufuk; Tiftikcioglu, Yigit Ozer; Mezili, Candan Tevfik; Songur, EcmelCurrently, 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. (c) 2014 Wiley Periodicals, Inc. Microsurgery 35:253-261, 2015.Öğe Free-tissue transfers for reconstruction of oromandibular area in children(Wiley-Liss, 2008) Bilkay, Ufuk; Tiftikcioglu, Yigit Ozer; Temiz, Gokhan; Ozek, Cuneyt; Akin, YalcinIntroduction: Currently, free-tissue transfers are commonly used for various reconstructive purposes in adults. However, there is a lack of large series of free flap reconstruction in children, especially for reconstruction of oromandibular defects. Our study aims to share our experience in free-flap reconstruction of some challenging pediatric cases. Materials and methods: Pediatric free-flap interventions (<18-year-old) that were performed between 2000 and 2006 in our clinic were retrospectively evaluated. Eighteen free-tissue transfers were performed in 17 pediatric cases. Epidemiologic data, etiology, defects, preferred free flaps, and results have been compared and analyzed. Results: A total of 17 patients (18 free flaps) were analyzed. Mean age was 10.4 years. The etiology was tumor in 11 cases, traffic accident in 5 cases, and gunshot in 1 case. Double-flap transfer was performed to one patient with a devastating shotgun wound and single flap transfers to others. A total of 8 osseous flaps, 7 osteocutaneous flaps, and 3 septocutaneous flaps were transferred. Total superficial flap necrosis was encountered in one flap (5.8%) while partial superficial necrosis was seen on two flaps (11.7%). Sixteen of the 17 cases reconstructed, including the three cases with complications, resulted in good functional and cosmetic outcome. One case was lost in the sixth postoperative month due to septisemia during chemotherapy. All the surviving 16 cases acquired bony fusion, mastication, and speech in addition to good cosmetic results. Conclusion: Pediatric free-tissue transfers are increasing due to the development of better equipment, finer surgical technique, and a better understanding of the unique characteristics of pediatric cases. In our opinion, high success rates with good cosmetic and functional results can be obtained if the specific requirements of the pediatric procedures are met. (C) 2008 Wiley-Liss, Inc.Öğe Hydrofluoric acid burn: case report(1996) Görken, Cenk; Gürler, Tahir; Bilkay, Ufuk; Özek, Cüneyt; Songür, EcmelHydrofluoric acid is one of the strongest of all inorganic acids. It may cause insidious burns that can be very destructive. If the burns are not treated appropriately, the continued action of the free fluoride ion leads to liquefaction necrosis of the af¬fected soft tissue, bony erosion and potentially lethal hypocalcemia. in this paper a hydrofluoric acid burn of face and right pectoral area that is successfully treated with both topical and injectable agents is presented.Öğe Management of Nasal Deformity in Osteogenesis Imperfecta(Lippincott Williams & Wilkins, 2010) Bilkay, Ufuk; Tiftikcioglu, Yigit Ozer; Mezili, CandanOsteogenesis imperfecta (OI) is a rare hereditary disorder of collagen synthesis that results in weak bones that are easily fractured resulting in deformities. Osteogenesis imperfecta refers to a wide array of genetic disorders with variable phenotypic presentation. In general, type I is the mildest form of disease; types IV, III, and II, respectively, increase in severity. There is lack of knowledge about the feasibility of nasal surgery in patients with bony disorders in the literature. Although rhinoplasty is one of the most frequent procedures all over the world, there are only very few case reports about OI patients undergoing rhinoplasty. The authors could find 2 old case reports, published in 1965 and 1977. The only recent publication that could be found was published in 2000, but it was about a follow-up case that had been operated 15 years ago. A 24-year-old woman with OI who has been operated on because of severe airway obstruction and cosmetic reasons is presented. Open rhinoplasty was performed, keeping in mind that bones and cartilages are more fragile, and they heal late in OI. Therefore, greenstick fractures were preferred instead of median osteotomies, and cartilages were fixed to each other at multiple points with nonabsorbable sutures. There were no complications in the postoperative period, and the patient was very satisfied with her breathing and appearance. Current literature is reviewed in accordance with our experience with this unique case. In conclusion, good cosmetic and functional rhinoplasty results may be obtained in OI cases with careful case selection, limited mobilization of the nasal bones, and careful fixation of the nasal cartilages with nonabsorbable sutures.Öğe Marjolin Ulcers Arising on Extremities(Lippincott Williams & Wilkins, 2010) Tiftikcioglu, Yigit Ozer; Ozek, Cuneyt; Bilkay, Ufuk; Uckan, Ali; Akin, YalcinMarjolin ulcer, epidermoid carcinoma arising on nonhealing scar tissue, is well known for its aggressiveness compared with other forms of squamous cell carcinoma. It is thought to be even more aggressive when it arises on an extremity. Therefore, Marjolin ulcer located on an extremity is unique in its aggressiveness and calls for immediate attention and extensive surgery. We have treated 81 patients with extremity lesions between 1982 and 2003, 62 of which have been followed up for at least 5 years. The cases that were lost to follow-up and our more recent cases have not been included in this study. Medical records of these 62 patients were reviewed retrospectively. All the lesions were carcinomas arising on old burn scars. The mean age was 48.0 years. The average interval between burn and carcinoma was 35.9 years. Male to female ratio was approximately 1:2. About 72.6% of the patients were treated with wide local excision only and 21.0% of the patients had wide excision together with regional lymph node dissection. Only 6.4% of the cases have been treated with amputation combined with regional lymph node dissection. Postoperative regional lymph metastasis was seen in 40.3% of the patients and 41.9% of the patients have developed lung metastasis during the follow-up. Presence of metastasis, high histologic grade, and tumor size were found to have a direct effect on survival rates. The mean survival was 4.55 for the whole study group. The 5-year survival rate was 42.9% in upper extremity and 58.3% in lower extremity groups. Estimated mean time of survival for the disease has been calculated to be 7.76 years using statistical analysis. We suggest that tumor size is an important prognostic factor in addition to histologic grade. Treatment algorithm is reviewed, and the importance of adequate surgery is emphasized.Öğe New alternative in treatment of callus(Wiley, 2011) Akdemir, Ovunc; Bilkay, Ufuk; Tiftikcioglu, Yigit Ozer; Ozek, Cuneyt; Yan, Hede; Zhang, Feng; Akin, YalcinThe pathological transformation of the skin into a thick and hard callus due to repetitive trauma or friction is commonly known as corn. Although a variety of medical and operative treatment choices have been proposed, an ideal treatment method is yet to be defined. Effectiveness of tangential excision together with topical cantharidin has been evaluated. We used Canthacur-PS as an adjunct to excision in an outpatient setting. Canthacur-PS is a commercially available topical solution that includes 1% cantharidin, 30% salicylic acid and 5% podophyllin. The treatment has been applied to 72 patients. We found that 65 patients (90.3%) had corn on their feet and seven patients (9.7%) on their hands. Thick, hard and hyperkeratotic skin area was scraped with the help of a no. 15 blade. The solution was applied on and around the periphery (up to 1-2 mm) of the lesion with a cotton swab, and kept closed for 5 days with an antibiotic dressing. All the patients had been followed up for at least 1 year and evaluated by clinical examination and patient satisfaction query. One session of treatment succeeded in 57 (79.2%) corn patients. Two sessions in nine corn patients (12.5%), three sessions in five corn patients (6.9%) and four sessions in one patient (1.4%) were needed. Only one recurrence (1.4%) was seen. No scar formation or other side-effects were seen. Our findings show that this treatment method is a simple, minimally invasive and reliable treatment for calluses.Öğe Osteogenic capacities of tibial and cranial periosteum: A biochemical and histologic study(Lippincott Williams & Wilkins, 2008) Bilkay, Ufuk; Tokat, Cenk; Helvaci, Evren; Ozek, Cuneyt; Zekioglu, Osman; Onat, Taner; Songur, EcmelThe periosteum has an important role in bone regeneration. The purpose of this study was to evaluate and compare the osteogenic capacities of tibial and cranial periosteum. To achieve this, 44 New Zealand male rabbits were divided into two groups, each consisting of 22 rabbits. In group 1, periosteal flaps were prepared on the tibia of the posterior cruris of each side. In group 2, bilateral periosteal flaps were prepared on the cranial region. New bone formation was estimated quantitatively by measuring the alkaline phosphatase and osteocalcin levels, because they are the indicators of osteoblastic activity. At weeks 1, 2, 4, and 8, biopsies were taken from five animals of each group for biochemical analyses, and at weeks 2 and 8, biopsies were taken for histologic evaluation. Higher alkaline phosphatase and osteocalcin levels were evaluated in group 1, and more bone formation was observed in group 1. The results showed that osteogenic capacity is higher in tibial periosteum than cranial periosteum.Öğe Perios ada flebinde alloplastik materyaller ile osteogenaz (Tavşan modelinde deneysel bir çalışma)(Ege Üniversitesi, 1999) Bilkay, Ufuk[Abstarct Not Available]Öğe Pitanguy Ligamentous Flap: A New Method to Prevent Supratip Deformity in Rhinoplasty(Lippincott Williams & Wilkins, 2020) Ercin, Burak Sercan; Bicer, Ahmet; Bilkay, UfukBackground: A supratip deformity (SD) is an iatrogenic convexity that occurs in the cephalic region of the nasal tip. SD is still a major problem after rhinoplasty surgery. Objectives: With the method we have described a ligamentous flap was used to create a supratip transition, with adjustable sharpness, while the refinements of the tip rotation and definition were ensured. the aim of the study is to present the results of this technique, which, to the best of our knowledge, has been described here for the first time. Methods: Our ligamentous flap technique was applied to 24 patients between August 2017 and March 2018. All of the patients were evaluated in terms of the formation of an SD, a hanging columella, tip projection, and the loss of rotation at the postoperative followups. the photos of patients were evaluated by another independent plastic surgeon and patients themselves at 3 months after the surgery. Results: There were no early or late complications, such as an infection, excessive bleeding, or prolonged edema. Moreover, SDs, hanging columellas, tip projections, and rotational losses, which would require revisions, were not detected in any of the patients. Postoperative scores given by the patients and surgeons were significantly higher than the preoperative values (P< 0.05). Only 2 patients required minor revisions due to dorsal irregularities in the upper 1/3 of the nasal segment. Conclusion: the early results of this Pitanguy composite flap technique, which can be easily applied in every case with thin or thick skin in an open rhinoplasty, are promising. However, there is a need for an evaluation of the long-term results, as well as the advantages and disadvantages in a larger case series.Öğe Random trombosit süspansyon preparasyonlarının yara iİyileşmesine etkisi(Ege Üniversitesi, 2008) Akhund-Zada, İlyas; Bilkay, UfukKronik yaralar hasta, hekim ve sağlık sistemi için büyük psikoljik, fizik ve mali yük oluşturmaktadır. Trombosit Türevli Büyüme Faktörünün (PDGF-platelet derived growth factor) ve onun kaynağı olan trombositlerle zengin plazma (PRP-platelet rich plasma), yara tedavisi için birçok klinik alanda kullanılmaktadır. Standart prosedürün hasta kanının ılımlı miktarda gereksinimi, sığır trombini kullanımı, yarada enfeksiyon geliştirilmesi gibi bazı dezavantajları mevcuttur. Yapılan araştırmada kan bankasından alınan random trombosit süspansiyonları esasında yeni PRP uygulama yönteminin geliştirilmiştir. Etkinliği kronik yaraları olan kontrol ve çalışma olmak üzere iki grup arasında tedavi süresi, epitelizasyon, yara zemininin dinamiği ve mikrobiyolojik durumu açısından değerlendirilmiştir. Geliştirdiğimiz yöntem standart PDGF uygulamasının yüksek maliyet, yarada enfeksiyon gelişme riski, otojen kan gereksinimi ve her hastaya uygulanamama gibi dezavantajlarından yoksun olup klinik koşullarda kronik yaraların tedavisi için başarıyla kullanılabilmektedir.;PDGF, Random Platelet Suspension, Chronic Wound.;PDGF, Random Trombosit Süspansiyonu, Kronik Yara.Öğe Reconstruction of the distal third of the nose with composite ear-helix free flap(Lippincott Williams & Wilkins, 2007) Ozek, Cuneyt; Gurler, Tahir; Uckan, Ali; Bilkay, UfukFull-thickness defects of the nose result in severe esthetic and functional problems. Regardless of the etiology of such defects, the complexity of the reconstruction process of full-thickness defects of this region is not correlated with the size of the defect. Local flaps are frequently used for reconstruction but often yielding facial scarring and bulky alae. Composite helical grafts are used for relatively small defects but defects of more than 2.0 cm in diameter require vascularized tissue transfer. Composite free flap from the root of the auricular helix has been used to reconstruct an anatomically diverse set of defects of the distal third of the nose, with satisfactory success in our series of 6 patients.Öğe Simultaneous Autologus Mandible and Temporomandibular Joint Reconstruction(Lippincott Williams & Wilkins, 2017) Tiftikcioglu, Yigit Ozer; Gur, Ersin; Bilkay, UfukAblative surgery of mandible often necessitates combined reconstruction of the mandible and the temporomandibular joint. Fibula-free flaps with gap arthroplasty or osseochondral grafts are common procedures in the authors' practice. In search for a better reconstructive option free fibula flap is used together with a metatarsal bone flap for the vascular reconstruction of the mandibular body and the condyle at the same time. The 2 osseous-free flaps have been fused and used as a combined flow through double-free flap. The literature has been reviewed for other reconstructive options, but no alternatives providing autologous reconstruction of both the mandible and the condyle with vascular tissue have been found. This is a preliminary report of this new technique which the authors humbly think is very promising.Öğe TRAM pediküllü flep modelinde, iskemi/reperfüzyon hasarına caffeic-acid-phenethyl ester (CAPE) maddesi etkisinin araştırılması(Ege Üniversitesi, 2018) Bilkay, Ufuk; Yeğin, Mehmet Emre; Tiftikçioğlu, Yiğit Özer; Uyanıkgil, Yiğit; Çavuşoğlu, Türker; Ercan, Gülinnaz; Gürdal, MehmetGünümüz Plastik ve Rekonstrüktif Cerrahi uygulamasında, doku kayıplarının onarımı için serbest ve pediküllü flepler sık sık kullanılmaktadır. Operasyon sonrası flep cerrahisinde yaşanan problemlerin başında I/R bulunmaktadır. Bu çalışmada, sıçan modelinde TRAM flebinin serbest ve pediküllü uygulamalarında, I/R sonucu gelişen flep kaybına, CAPE'in azaltıcı etkisi araştırılmıştır. Çalışmadaki amaç; CAPE' in I/R gelişme olasılığı olan dokulara uygulandığında dokularda oluşabilecek anormal değişikliklere engel olabileceği, hasarın yayılmaması için aktive olacak içsel mekanizmaların, moleküllerin etkilerini arttırıp arttırmadığı ve ayrıca, flep damarlanmasını arttırarak dokunun iskemiye direncini arttırıp artırmayacağının tespit edilmesidir. Çalışmada 42 adet sıçan randomize olarak, Pedikül/Serbest kontrol, Pedikül/Serbestİskemi, Pedikül/Serbest-İskemi-CAPE adı altında 14 hayvandan oluşan üç gruba ayrıldı. Her gruptaki ilk yedi hayvan pediküllü, sonraki yedi hayvan serbest TRAM flebi tasarlanarak toplamda altı alt-gruba ayrıldı. Tüm hayvanların ksifoid-pubis arası mesafeleri ölçülerek kaydedildi. Sıçanların karnından 4x2 cm ebatta deri ve 4 cm uzunluğunda rektus kas dokusunu içeren, orta hat sınır kabul edilerek iki tarafa ayrılan muskülokütan flepler kaldırıldı. Tüm gruplardaki flepler, bulundukları alt gruba göre kaldırıldı. Grup 1'deki flepler, enjeksiyon ve iskemi yapılmadan yerlerine iade edildi. İkinci gruba ise, klemplemeden 30 dakika önce 2cc intraperitoneal SF enjekte edildi. Üçüncü gruba, klemplemeden 30 dakika önce CAPE (10 mmol/kg, i.p.) enjekte edildi. Arter-ven klemplendikten sonraki ikinci saatte; flepte iskemik bulgular görüldükten sonra flep pedikülündeki superior epigastrik ven ve arter açıldı. Tüm gruplardaki flepler, yedinci gün sonunda (Her hayvandan ikişer adet olmak üzere toplam 84 adet flep) alınarak, hayvanların deri ve kas dokuları sağ taraflı biyokimyasal, sol taraflı histolojik tetkik yapılması için kullanıldı. Makroskopik inceleme yapıldıktan sonra nekroz alanları hesaplandı. Bu alanların karşılaştırmasında, 3. grubun, 2. gruba göre daha az nekroz gösterdiği görüldü. (p<0.01) Histolojik değerlendirme için tüm deneklerin sol TRAM fleplerinden doku örnekleri alındı. H&E ve Mallory Azan ile boyanmış bütün preperatlar, derideki yara yeri iyileşmesini değerlendirmek için nekroz, ödem, PMN infiltrasyonu, kollajen yoğunluğu, damarlanma, sağlıklı sebase gland yoğunluğu açısından histopatolojik olarak Verhofstad Skorlaması ile değerlendirilmiştir. Ayrıca, iNOS, VEGF, BAX ve BCL-2, doku örneklerinde yapılan immünohistokimyasal örneklerle değerlendirilmiştir. Preperatlara Verhofstad skorlaması yapılarak skorların ortalamaları hesaplandığında; 3. grubun, 2. gruba göre daha az I/R skoru aldığı görüldü. (p<0.01) Deneklerin sağ TRAM fleplerinde çalışılan biyokimyasal veriler toplandı. Alınan dokularda SOD, MDA ve CAT düzeyleri, ELISA yöntemi ile belirlendi. Sonuçlara göre, MDA artışı en fazla olan 2. grup en yüksek I/R oranına sahip gruptur. 3. grup, 2. gruba göre daha düşük MDA seviyeleri ve yüksek SOD ve CAT seviyeleri göstermiş olup; istatistiksel olarak da CAPE işe yararlığı gösterilmiştir. (p<0.01) Bu bulgular ışığında, I/R gelişmesini önlemek amacıyla dokulara cerrahi öncesi CAPE uygulamasının, reperfüzyon sonrasında gelişen ve dokulara zarar veren patolojik süreçlere anlamlı etkisinin olduğu ve farmakolojik önkoşullama amacıyla kullanılabileceği kanaatine varıldı.;CAPE, iskemi-reperfüzyon, serbest flep, TRAM.;CAPE, ischemia-reperfusion injury, free-flap, TRAM.Öğe A Useful Tool for Various Problems in Nasal Tip: The Cephalic Transdomal Suture(Lippincott Williams & Wilkins, 2022) Bilkay, Ufuk; Bicer, Ahmet; Ercin, Burak Sercan; Durukan, Kutay; Ozek, Zeyyat Cuneyt; Gurler, TahirSurgical manipulation of the nasal tip is a critical point in functional and aesthetic rhinoplasty procedure. Cephalic strip excision from the lower lateral cartilages, elongation or shortening the caudal septum, structural grafting for supporting the medial and lateral crura are major structural moves in building a durable cartilaginous framework. However, it is suture techniques that make up the final touch in fine tuning of the shape, projection, definition, and angulation (rotation) of the nasal tip over this framework. Problems with fine-tuning of the nasal tip include inadequate or excessive definition, or projection resulting with bulbous or boxy appearance can be overcome reversibly with correctly placed sutures. One of the most decisive sutures in this context is transdomal sutures. Incorrect placement of which can result with too narrow or too wide nostril apices, as well as a cephalic malposition deformity of the lower lateral cartilages, botching an otherwise perfectly executed rhinoplasty procedure. In this article, cephalad placement of the transdomal sutures, and its relevance is disclosed in 223 consecutive cases of primary rhinoplasty.
