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Öğe Dirsek Bölgesi Yumuşak Doku Defektlerinin Rekonstrüksiyonu Tedavi Algoritma Önerisi(2009) Duymaz, Ahmet; Karabekmez, Furkan Erol; Keskin, Mustafa; Tosun, Zekeriya; Savacı, NedimBACKGROUND: The reconstruction of soft tissue defects of the elbow area (including antecubital fossa and peri-olecranon area) should be performed with the most appropriate soft tissue and functional rehabilitation immediately. METHODS: Ten patients were included in this study. One had a brachial artery defect, another had postburn axillary contracture deformity, and a third had an ulnar bone body fracture in addition to their soft tissue defects, while the remaining seven had only soft tissue defect. Patients underwent surgical closure either by local arm fasciocutaneous flap (1), radial forearm flap (1), multiple Z-plasty (1), pedicled latissimus dorsi muscle flap (3), or with the antecubital fasciocutaneous island flap (4). RESULTS: The follow-up was 9 months to 4 years (mean: 19 months). All the flaps achieved wound closure without losing the range of motion at the elbow joint. CONCLUSION: Surgical closure of the antecubital fossa and peri-olecranon areas can be a challenge for plastic surgeons since this area includes numerous neuro-vascular bundles and a functional joint. Therefore, we describe herein an algorithm for the treatment of defects in these areas from the inspiration in our clinical experience and a literature review. Our algorithm will help to decide the most appropriate choice among all of the surgical options available.Öğe Dirsek bölgesi yumuşak doku defektlerinin rekonstrüksiyonu: Tedavi algoritma önerisi(2009) Duymaz, Ahmet; Karabekmez, Furkan Erol; Keskin, Mustafa; Tosun, Zekeriya; Savacı, NedimAMAÇ Dirsek bölgesi (antekübital fossa ve periolekranon bölgesi dahil) yumuşak doku defektlerinin rekonstrüksiyonu mümkün olan en kısa sürede ve en uygun doku ile yapılmalıdır. Daha sonra erken fonksiyonel rehabilitasyona başlanmalıdır. GEREÇ VE YÖNTEM On hasta çalışmaya dâhil edildi. Yedi hastada sadece yumuşak doku defekti varken kalan üç hastada yumuşak doku defektine ilave olarak 1 hastada brakiyal arter defekti, 1 hastada yanık sonrası aksiler kontraktür deformitesi, başka 1 hastada ulnar kemik cisim kırığı vardı. Hastalar lokal kol fasyokunatöz flep (1 hasta), radial önkol flebi (1 hasta), multipl Z-plasti (1 hasta), pediküllü latisimus dorsi kas flebi (3 hasta) ve antekübital fasyokütan ada flepleri (4 hasta) ile cerrahi kapama sağlandı. BULGULAR Takip süresi 9 ay ile 4 yıl arasındaydı (ortalama 19 ay). Tüm fleplerde başarıyla yara kapaması sağlandı. Onarım sonrası eklem hareket açıklığında kayıp olmadı. SONUÇ Antekübital fossa ve periolekranon bölgelerinin cerrahi kapaması bu bölgenin çok sayıda nörovasküler yapı ve fonksiyonel eklemler içermesinden dolayı plastik cerrahları zorlamaktadır. Bu nedenle, klinik deneyimlerimiz ve literatür incelemelerimiz ışığında bu bölge defektlerinin tedavisi için bir algoritma tanımladık. Algoritmamız birçok cerrahi seçenek arasında en uygun olanına karar vermede faydalı olacaktır.Öğe EARLY AND LATE TERM MICROSURGICAL FREE FLAP RECONSTRUCTION AND RISKS IN HIGH VOLTAGE ELECTRICAL INJURY(CARBONE EDITORE, 2013) Karabekmez, Furkan Erol; Duymaz, Ahmet; Tosun, Zekeriya; Keskin, Mustafa; Savaci, 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 osteomusculo-cutaneous flap, two patients had reams 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 Ekstensör pollisis longus tendon spontan kopmalarının iki olgu ışığında gözden geçirilmesi(2009) Duymaz, Ahmet; Karabekmez, Furkan Erol; Keskin, Mustafa; Tosun, ZekeriyaAmaç: Spontan ekstensör pollisis longus (EPL) kopması olan iki olguda ekstensör indisis proprius (EIP) tendonun EPL’a transferinin sonuçlarını değerlendirmek ve bu iki olgunun muhtemel etiyolojik faktörlerini tartışmak. Olgu sunumları: Ekmek fırınında işçi olarak çalışan ve pnömotik kompresör operatörü olan iki hastaya EPL’a EIP tendon transferi yapıldı. Eller; bilek 45 derece ekstansiyonda, başparmak metkarpofalengeal (MF) eklemi tam ekstansiyonda, diğer parmak MF eklemleri 60–70 derece fleksiyonda, başparmak interfalengeal eklemi 10–15 derece fleksiyonda olacak tarzda 4 hafta immobilize edildi. Daha sonra her iki hastaya aynı rehabilitasyon programı uygulandı. Değerlendirme ameliyat sonrası parmak hareket açıklığı ile yapıldı. Bulgular: Her iki hastanın iki yıllık takiplerindeki sonuçları mükemmeldi. Sonuç: Spontan EPL tendon kopmasının mekanizmasını açıklamak için birçok etiyoloji ileri sürülse de kesin neden hala bilinmemektedir. Ancak olgularımızdaki gibi bazı meslekler predispozan faktör olabilirler. Spontan EPL kopmasında başparmak ekstansiyonunu sağlamak için en uygun rekonstrüksiyon seçeneği EIP tendon transferidir. Tendon transferi sırasında en uygun gerginliği sağlayacak pozisyon; başparmağın tam ekstansiyon, bileğin nötraldeki pozisyonudur.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 kıvrılm asıdır. Bu çalışmanın amacı; involüsyonel ve paralitik ektrop i yon onarımında kullanılabilecek kolay ve etkin bir yöntem olan Kuhnt Szymanowski tekniğinin Smith modifikasyonunun etkinliğinin ve estetik olarak kabul edilebilirliğinin değerle n dirilme sidir . 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 olgul arında Kuhnt Szymanowski tekniğinin Smith modifikasyo nu nun uygun bir cerrahi yöntem olduğu kanaatindeyiz.Öğe Huge deforming brown tumour at the maxilla and mandible in a patient with secondary hyperparathyroidism(ELSEVIER SCI LTD, 2008) Karabekmez, Furkan Erol; Duymaz, Ahmet; Keskin, Mustafa; Tosun, Zekeriya[Abstract not Available]Öğe Is it a chemical burn or an irritant contact dermatitis?(ELSEVIER SCI LTD, 2009) Duymaz, Ahmet; Karabekmez, Furkan Erol; Keskin, Mustafa; Tosun, Zekeriya[Abstract not Available]Öğe Kanin in vivo modelde CD-HA uygulamasının otogreft ve allogreft fleksör tendon rekonstrüksiyonuna etkisi(Selçuk Üniversitesi Tıp Fakültesi, 2009) Karabekmez, Furkan Erol; Tosun, ZekeriyaBu çalışmanın amacı karbodiimid'den derive edilmiş hyaluronik asit (cd-HA) jelatinin ekstrasinovyal otogreft ve intrasinovyal allogreft tendonlara olan histolojik etkisini in-vivo modelde araştırmaktır. Çalışmada14 köpeğin bir ön ekstremiteleri 2. ve 5. parmak 28 FDP tendonları kullanıldı. 6 köpeğin 12 tendonuna otogreft ile greftleme yapıldı. 8 köpeğin de 16 tendonuna allogreft ile greftleme yapıldı. Her köpeğin bir tendonuna cd-HA jelatinli diğerine kontrol tendonu ile greftleme yapıldı. Otogreft donörü için aynı hayvanların arka ayak perenous longus (PL) tendonları kullanılırken allogreft donörü için ayrı donör köpekler kullanıldı. Greftlemeden 6 hafta sonra köpekler sakrifiye edilerek greftler incelendi ve histolojik örnekler alındı. Örneklerden hazırlanan HE boyalı kesitlerde tenositler randomize olarak sayılarak ortalamalar gruplar arasında karşılaştırıldı. Allojen cd-HA uygulanan grup tenosit sayısı ortalamaları kontrol grubuna göre fazlaydı ancak fark anlamlı değildi (p=0,2). Otojen cd-HA uygulanan grup kontrol grubuna göre daha fazla tenosit ortalamasına sahipti ancak fark anlamlı değildi (p=0,1). Buna karşın gerek kontrol gruplarında (p=0,02), gerek cd-HA uygulanan gruplarda (p=0,03), gerekse tüm grup karşılaştırıldığında (p=0,003) otojen gruplar allojen gruplara göre daha fazla tenosit ortalamasına sahipti ve farklar istatistiksel olarak anlamlıydı. Ekstrasinovyal otogreftler greftlemenin 6. haftasında intrasinovyal allogreftlere göre birim alanda daha fazla tenosit içermektedir. Cd-HA uygulanan tendonlarda birim alana düşen tenosit sayısı daha fazla olsa da fark anlamlı değildir. Cd-HA jelatin yüzey modifikasyonunun tendon greftlerinin histolojik yapısına ve tenosit sayısına bir etkisi yoktur.Öğe Parry-Romberg Syndrome Facial Atrophy and Its Relationship With Other Regions of the Body(LIPPINCOTT WILLIAMS & WILKINS, 2009) Duymaz, Ahmet; Karabekmez, Furkan Erol; Keskin, Mustafa; Tosun, ZekeriyaParry-Romberg syndrome (PRS) is an uncommon disorder and characterized by a slowly, an acquired progressive atrophy involving skin, loft tissue, cartilage, and bony structures. Accompanying atrophies of the other parts of the body are rarely reported. The aim of this study is to report a case that had contralateral lower extremity atrophy with PRS, and to review he related etiologic features, physiopathology, and mechanism. The patient who admitted for his facial atrophy also had atrophy of his contralateral extremity. This extremity was also short in length when compared with other extremity. To obtain detailed information regarding the severity of involvement routine laboratory investigations including antinuclear antibody (ANA), magnetic resonance imagine (MRI) of the craniofacial region and lower extremities, MR angiography of the lower extremities and brain, 3-dimension computed tomography (CT) scan of the craniofacial region were performed. Normal or negative laboratory findings included results of blood count, renal and hepatic function biochemical test's, rheumatoid factor, C-reactive protein, anti-dsDNA antibody except ANA that were positive, His lower extremity and brain MR angiography were normal. in the 3-dimensional cranial CT, there was no abnormality or defect in the bony structures. His brain MRI showed no pathologic changes, and his facial MRI demonstrated noteworthy atrophy to the sternocleidomastoid, masseter, pterygoid muscles, and subcutaneus soft tissues on the right side of the face. Additionally, MR investigation of his lower extremities revealed decreased volume in muscles and bony structures of the effected extremity compared, with the other extremity, but pathologic evidence of fatty degeneration associated with muscle atrophy was not demonstrated. The patient had isolated contralateral lower extremity involvement combined with hemifacial atrophy (without affecting any other part of the body). Although more accepted theory is the sympathic nervous system dysfunction, autoimmunity may play a roll in the etiology of our case as ANA abnormality was found in multiple tests.Öğe Preventing Negative Effects of Smoking on Microarterial Anastomosis(Lippincott Williams & Wilkins, 2010) Tosun, Zekeriya; Karabekmez, Furkan Erol; Duymaz, Ahmet; Özkan, Adem; Keskin, Mustafa; Avunduk, Mustafa CihatAlthough microsurgery has rapid expanded, problems related to microarterial anastomosis continue. Cigarette smoking is one of the major risks for anastomosis by increasing platelet adhesion, and its effects on endothelial cells. Aim of this article is to study the negative effects of cigarettes on microarterial anastomosis line, and to investigate the protective effects of recombinant human erythropoietin (rHuEPO). Ninety-six Sprague-Dawley male rats were divided into 3 groups: group 1 was the control. Rats in groups 2 and 3 were exposed to cigarette smoke starting 21 days prior to surgery for 3 times a day. In group 3, additional 150 IU/kg rHuEPO was given via subcutaneously every 48 hours after microvascular anastomosis, femoral arterial samples, and blood samples were taken for assessment at 1st, 3rd, 5th, and 7th day. Intimae/media ratios were calculated for morphologic analyses. On morphologic analysis of femoral arteries there were statistically significant differences for all 3 groups at 1st, 3rd, 5th, and 7th days (P < 0, 05). The group that made differences was group 2, according to one-way analysis of variance within 3 groups in all days. Smoking decreases endothelial cells healing and causes more thromboses. rHuEPO can prevent these negative effects of smoking.Öğe Reconstruction of a "Double Pathology" on a Soft Palate Hairy Polyp and Cleft Palate(LIPPINCOTT WILLIAMS & WILKINS, 2009) Karabekmez, Furkan Erol; Duymaz, Ahmet; Keskin, Mustafa; Tosun, ZekeriyaHairy polyps of the head and neck are rare congenital tumors that nay cause upper aerodigestive tract impairment in newborn. Although cleft palate is a common congenital anomaly, hairy polyp with cleft palate is extremely rare in the newborn. We aimed to present the planning of reconstruction in a patient who has an incomplete cleft palate and defect due to hairy polyp excision on soft palate in this report. A 9-month-old child was admitted to our clinic due to cleft palate. In the clinical examination, incomplete cleft palate plus a defect on the posterior side of the left soft palate was observed. On the history, the patient had been operated urgently at the newborn period for a hairy polyp localized on the left;oft palate which had obstructed the airway. Wardill-Kilner-Veau technique was modified for the reconstruction of the defect on the soft palate and incomplete cleft palate. No complication was seen on postoperative period. The speech ability was evaluated on the late postoperative controls after 3 years and adequate speech intelligibility was obtained. A case of hairy polyp of nasopharynx with incomplete cleft palate in a neonate and its reconstruction techniques are discussed. The etiology of hairy polyp, hamartoma, teratoma, dermoid cyst and epignathus, their nomenclature, histopathology, clinical features, and management in neonates are also discussed briefly.Öğe The reconstruction of soft tissue defects in the elbow area: a treatment algorithm proposal(TURKISH ASSOC TRAUMA EMERGENCY SURGERY, 2009) Duymaz, Ahmet; Karabekmez, Furkan Erol; Keskin, Mustafa; Tosun, Zekeriya; Savaci, NedimBACKGROUND The reconstruction of soft tissue defects of the elbow area (including antecubital fossa and peri-olecranon area) should be performed with the most appropriate soft tissue and functional rehabilitation immediately. METHODS Ten patients were included in this study. One had a brachial artery defect, another had postburn axillary contracture deformity, and a third had an ulnar bone body fracture in addition to their soft tissue defects, while the remaining seven had only soft tissue defect. Patients underwent surgical closure either by local arm fasciocutaneous flap (1), radial forearm flap (1), multiple Z-plasty (1), pedicled latissimus dorsi muscle flap (3), or with the antecubital fasciocutaneous island flap (4). RESULTS The follow-up was 9 months to 4 years (mean: 19 months). All the flaps achieved wound closure without losing the range of motion at the elbow joint. CONCLUSION Surgical closure of the antecubital fossa and peri-olecranon areas can be a challenge for plastic surgeons since this area includes numerous neuro-vascular bundles and a functional joint. Therefore, we describe herein an algorithm for the treatment of defects in these areas from the inspiration in our clinical experience and a literature review. Our algorithm will help to decide the most appropriate choice among all of the surgical options available.Öğe Reconstruction with galeal frontalis flap of depressed forehead region in progressive hemifacial atrophy(LIPPINCOTT WILLIAMS & WILKINS, 2008) Duymaz, Ahmet; Karabekmez, Furkan Erol; Tosun, Zekeriya; Keskin, Mustafa; Karamese, Mehtap; Savaci, NedimParry-Romberg syndrome is characterized by progressive hemifacial atrophy that is the lack of tissue (generally soft tissue and rarely bone and muscle) in the atrophic area of the face. The etiology and the incidence of this pathologic process are uncertain, but it is relatively rare and self-limited. The objective of this study is to present 21-year-old female patient with progressive hemifacial atriophy who was reconstructed with composite galeal frontalis flap. Although many reconstructive methods have been described, reconstruction of both eyebrow deficiency and forehead atrophy with composite galeal frontalis flap was not described before.Öğe Squamous Cell Carcinoma on Cutaneous Leishmaniasis Lesion(WILEY-BLACKWELL PUBLISHING, INC, 2008) Karabekmez, Furkan Erol; Duymaz, Ahmet; Keskin, Mustafa; Tosun, ZekeriyaThe authors have indicated no significant interest with commercial supporters.
