Yazar "Gurler, Tahir" seçeneğine göre listele
Listeleniyor 1 - 9 / 9
Sayfa Başına Sonuç
Sıralama seçenekleri
Öğe 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 The Effect of Botulinum Toxin on Flap Viability of the Posterior Thigh Perforator Flap in Rats(Academic Press Inc Elsevier Science, 2021) Erdem, Mehmet; Tiftikcioglu, Yigit; Tatar, Burak Ergun; Kilic, Kubilay Dogan; Uyanikgil, Yigit; Gurler, TahirBackground: The use of perforator propeller flaps in lower limb reconstruction has increased recently. Many pharmacological agents are used to increase flap viability. Botulinum toxin has been used in various types of flaps in the literature. However, there is no study regarding the use of botulinum toxin in the lower limb propeller flaps. This study investigates the effect of botulinum toxin administration on flap survival for lower limb propeller flap in rats. Materials and methods: The study included 20 male Wistar albino rats, divided into two groups with a flap rotation of 90 degrees in group 1 and 180 degrees in group 2. in both groups, botulinum toxin was administered to the right thigh and a physiological saline solution was applied to the left thigh. Five days later, flaps were elevated over the posterior aspect of the right and left thighs and inset after 90 degrees and 180 degrees rotation was performed. Histopathological, immunohistochemical, and necrosis area analyses were performed. Results: Necrosis area, edema, polymorphonuclear leukocyte infiltration, and necrosis were found to be higher on the left side of the groups, whereas epidermal thickness, collagen density, vascularization, and hair root density were found to be higher on the right side of the groups. No significant difference was found between the right posterior thighs in either group on any parameter other than vascularization. Histopathologically and immunochemically statistically significant differences were found between the two groups. Conclusions: The present study found that botulinum toxin increases flap viability in lower limb perforator-based propeller flaps. (C) 2020 Elsevier Inc. All rights reserved.Öğe Electrochemotherapy with anti-PD-1 treatment induced durable complete response in heavily pretreated metastatic melanoma patient(Lippincott Williams & Wilkins, 2018) Karaca, Burcak; Yayla, Gokce; Erdem, Mehmet; Gurler, TahirMetastatic melanoma (MM) is one of the most lethal types of cancer. Although novel immunotherapeutics have been developed recently, still, these drugs fail to save the lives of a third of MM patients. Electrochemotherapy (ECT) is a local treatment of cancer based on a combination of electroporesis and low-dose chemotherapy. In this case report, we present the treatment history of a MM patient treated successfully with ECT and immunotherapy combination as a fifth-line treatment. Our patient was a 39 year-old woman who was diagnosed with nodulary melanoma stage II. Due to a local recurrence, she was given interferon- treatment. After 6 months, her disease relapsed in the axillary lymph nodes, and temozolamide treatment 150 mg/m2 was initiated. After six cycles on temozolamide, she progressed both in the axillary site and in the lungs. Her BRAF mutation analysis revealed V600E positivity. Hence, BRAF inhibitor-vemurafenib 24 tablets per day was initiated. Within 3 months, she responded dramatically both in the axillary site and in the lungs. At the ninth month of treatment, she progressed again, at which time ipilimumab 3 mg/kg was started as a fourth line treatment. However, shortly after, she progressed again and developed a solitary brain metastasis. She was operated and had whole brain radiotherapy. At that point, nivolumab, an antiprogrammed cell death ligand-1 blocker, was the only remaining option. She showed a biphenotypical response to nivolumab; a mass on the anterior axilla was progressing while the other lymph nodes had regressed. Owing to the accessibility of the subcutaneous lesion with external electrodes, ECT was performed using IGEA Cliniprator device through a hexagonal electrode on the progressive mass, while on nivolumab treatment. A complete response was achieved, with no evidence of disease at 4 years since her local recurrence. Eradication of symptomatic, refractory lesions using ECT meets an important clinical need. Whenever a disseminated disease presents with cutaneous/subcutaneous lesions, high efficacy of ECT should be deployed to augment tumor immunogenicity and complement systemic immunotherapies.Öğe Free Hand Perforator Concept in Osteocutaneous Free Fibula Flap Through Posterior Approach(Lippincott Williams & Wilkins, 2017) Tiftikcioglu, Yigit Ozer; Gur, Ersin; Gurler, TahirBackground: The fibula flap is a workhorse flap for bony reconstruction of oro-mandibular area and can be modified to include soft tissue for reconstruction of composite defects. However, the design of a reliable skin paddle that can be used for composite tissue reconstruction remains a challenge. The authors described the applicability of perforator concept for a more reliable free osteo-musculocutaneous fibula flap. Methods: Between 2013 and 2015, 29 patients underwent free fibula osteocutaneous flap reconstruction. Twenty-two patients have been operated due to squamous cell carcinoma and 7 patients due to gunshot injuries. Results: The mean harvesting time was 60 +/- 15 minutes. The range of width of the skin paddle was 3 to 12 cm and length was 6 to 23 cm. The range of length of bone was 5 to 18 cm. One patient had revision due to venous occlusion. All flaps have survived. Conclusion: The authors advocate approaching all components of flap individually using the perforator concept and dissection. Good exposure is mandatory for a reliable dissection. In our opinion, the posterior approach is more useful as it reveals all vascular relationships between the bone, muscle, skin paddle, and peronel vessels.Öğe How Surgery Affects Patients with Jaw Osteonecrosis? A Quality of Life Analysis Study(Galenos Yayincilik, 2022) Bicer, Ahmet; Ibrahimli, Nargiz; Canbolat, Ozan Can; Gurler, TahirObjective: Osteonecrosis of the jawbone, especially when associated with osteomyelitis, is a debilitating condition predominantly affecting patients treated for osteoporosis, cancer with bone metastases, and rheumatoid arthritis. Oral pathologies may significantly alter the patients' quality of life and sense of health. Surgery including complete debridement of the necrotic bone followed by packing the dead space with antiseptic agents and meticulous repair of the overlying mucosa is gaining popularity on conservative treatment options. Materials and Methods: In this before and after study 11 patients referred to our clinic between 2018 and 2020 with a diagnosis of maxillary or mandibular osteonecrosis with complete preoperative and postoperative analyses available were included. The patients were assessed with General Oral Health Assessment (GOHA) index preoperatively and postoperatively. These scores were compared with each other to exhibit the effect of our surgical strategy, which also outlined. The effects of patients' demographic and medical backgrounds on the quality of life were also investigated. Results: Neither demographic, nor medical backgrounds of the patients were not found to significantly alter the GOHA index scores of the patients (p>0.05). However, surgical treatment was found to significantly improve the scores (preoperative mean: 38.87, +/- 6.44; postoperative mean: 31.0, +/- 8.28; p<0.05). Conclusion: To obtain optimal results in the management of the patients with jawbone osteonecrosis, the treatment strategy should be based on the patient characteristics and careful radiographical examinations. Alterations of predisposing medications and introduction of proper antibiotics in the setting of associated osteomyelitis should be made before surgery. Oral/dental rehabilitation should be started immediately after mucosal healing is assured.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 Surgical treatment of advanced palmoplantar melanoma(2023) Gurler, Tahir; Yegin, Mehmet Emre; Mammadov, Vasif; İbrahimli, Nargiz; Topaloğlu, Ege; Gür, Ersin; Tiftikcioğlu, Yigit ÖzerAim: Palmoplantar melanoma is a rare and aggressive subtype of malignant melanoma. Not like other subtypes, sunlight is not the primary etiologic factor. We aim to expand the knowledge on this rare and neglected malignant melanoma subtype and add our findings to the literature. Materials and Methods: Malignant Melanoma patients admitted to our hospital between 2008 and 2020 were retrospectively analyzed. Twenty-seven patients with plantar and one with palmar melanoma were identified and included in our study. Data about gender, age at the diagnosis, histopathological features, sentinel lymph node localization, performed surgeries, sentinel lymph node biopsy (SLNB) and regional lymph node dissection results, recurrence, survival time, primary tumor localization, and systemic metastases were collected. Results: 26 plantar and one palmar melanoma patients were operated on in this period. Six patients died during follow-up. Twenty-three patients were treated with wide excisions, and four were treated with amputations. The defect was reconstructed with a skin graft in all cases with excisions. In 6 patients with suspicious lymph nodes in the preoperative imaging, lymph node dissection was added to the treatment. Other patients had sentinel lymph node biopsies and continued with dissection if a metastatic node was encountered. Conclusion: Our findings are congruent with the current literature. Skin grafting may enhance the success of palmoplantar melanoma follow-up and demands attention.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.Öğe Who needs extra time? Amniotic membrane wrapped pauci-suture model for rapid anastomoses(*)(Taylor & Francis Ltd, 2019) Ercin, Burak Sercan; Bicer, Ahmet; Yigitturk, Gurkan; Cinar, Celal; Cavusoglu, Turker; Uyanikgil, Yigit; Gurler, TahirAn ideal anastomosis method will obtain the highest post-anastomotic vessel patency and will repair the vessel anatomically with minimal thrombosis in an easier, faster and cheaper fashion. To achieve these goals an anastomosis model using an amniotic membrane is introduced. The study was performed on the femoral arteries of 22 Wistar Albino rats (11 control group, 11 experimental group). In the experiment group, the microvascular anastomosis was completed with three sutures and a patch of amniotic membrane which was wrapped around the anastomotic site. The conventional anastomosis technique with eight sutures was performed in the control group. The effects of the model on the patency and histological structure of the vessels were evaluated. As a result, normal patency was determined radiologically and macroscopically in all of the anastomoses. No thrombosis or aneurysm was detected in any of the anastomoses. In the angiographic study, vessel patency was detected in both the control and experimental groups. The average time to complete the arterial anastomosis was 18.14 (+/- 2.84) and 10.39 (+/- 2.45) minutes in the control and the experiment groups respectively. In the histological studies, anti-eNOS staining revealed that endothelin levels were significantly higher in the experimental group. This method describes a new anastomosis model in microvascular surgery with promising results that call for additional experimental studies and further clinical implementations. We believe that this experimental technique can be put into clinical practice as an alternative to the conventional microvascular anastomosis technique.
