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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 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 Foreign body ınside the tunnel: a rare cause of acute cubital tunnel syndrome(THIEME MEDICAL PUBL INC, 2019) Yıldıran, Gökçe; Sütçü, Mustafa; Akdağ, Osman; Tosun, ZekeriyaForeign bodies are common entities found in hand surgery practice. However, they are a very rare cause of the acute cubital tunnel syndrome. A 48-year-old male patient was consulted for cubital tunnel symptoms after 2-day unconscious state in the intensive care unit. The ulnar nerve was explored, a piece of glass was removed inside the cubital tunnel, and the nerve was repaired. However, compression neuropathy symptoms due to the acute trauma are interesting. Nerve laceration with a foreign body should be considered in acute-onset cubital tunnel syndrome, in which the foreign body history of a trauma patient cannot be determined explicitly.Öğe An impulse control disorder that may cause tissue defects(2013) Akdağ, Osman; Sütçü, Mustafa; Karameşe, Mehtap; Karabekmez, Furkan; Tosun, ZekeriyaMany factors experience with tissue defects in plastic surgery, which is an impulse control disorder, trichotillomania and skin picking are rare causes. Trichotillomania is a chronic impulse control disorder characterized by people to pull out the hair from their scalp, eyelashes, eyebrows, or other parts of the body. This conscious or subconscious habit is most commonly performed by young children, adolescents and women. To cause tissue defects is extremely rare. Factors that plastic surgery is a rare skin defects, two cases have been presented in this psychiatric disorder.Öğe Increased Fat Graft Survival with Mesenchymal Stem Cell Recruiting Effect of PRP: In Vitro and In Vivo Study of Application Techniques(Selçuk Üniversitesi, 2022) Yıldıran, Gökçe; Çiçek, Gülsemin; Artaç, Hasibe; Uçaryılmaz, Hülya; Duman, Selcuk; Sütçü, Mustafa; Aktan, Tahsin Murad; Tosun, Zekeriya; Akdağ, Osman; Çelik, Z. EsinAim: Adding platelet-rich plasm (PRP) or mesenchymal stem cells are the most accepted methods to increase fat graft’s permanence. However, there is no consensus on timing and whether the effect of stem cells or PRP is observed more in the recipient area or in the donor area. It is aimed to present the application method and localization of PRP to be combined with fat graft to increase the survival. Material and Methods: in vitro part: Fat grafts were kept in a medium containing PRP. Cell output from the fat graft to the Petri dishes was examined every day. The time to recruit the maximum number of stem cells to the medium was determined (day 10). in vivo part: Eight group of rats were received PRP in different concentrations either to recipient or donor areas of fat grafts. After ten days, fat grafts were transferred to the recipient area. Ninety days after the transfer, histopathological examination and immunohistochemical staining were performed. Results: The group which had received the full-dose PRP to the recipient area showed the highest cellular integrity and vascularity (p< 0.05). Vascularity was superior in the half-dose PRP group compared to the control group (p< 0.05); cellular integrity did not increase. Donor site groups did not show increase in cellular integrity. Conclusion: Although PRP starts to increase fat graft permanence by increasing vascularity, it acts by preserving the cellular integrity of the fat cells as the concentrations increase. The PRP injection to the recipient area 10 days before fat grafting may provide higher survival rates.Öğe Indications for transoral endoscopic-assisted methods in condylar process fractures(WOLTERS KLUWER MEDKNOW PUBLICATIONS, 2020) Akdağ, Osman; Sütçü, Mustafa; Yıldıran, Gökçe Ünal; Bilirer, AhmetObjective: Endoscopic-assisted mandibular subcondylar fracture repair is a different way of performing open reduction internal fixation and also includes surgical equipment and manipulations other than those used in the classical methods. The criteria for patient selection should be different from that of the classical methods. Materials and Methods: Between April 2012 and June 2017, treatment protocols which were applied to 56 patients with mandibular subcondylar fracture were evaluated retrospectively. The first step of this study was to evaluate why patients with mandibular subcondylar fractures were not operated endoscopically. In 34 patients, methods other than endoscopic methods were used. Characteristics of these patients and fractures were demonstrated. Results: Twenty-four patients were followed conservatively. Twenty-two patients were treated with transoral endoscopic method while ten patients were treated with the conventional open surgery. This open surgical treatment was reported by determined the patient records for why the endoscopic method was not preferred. The determined criteria were; condyle with excessive medial deviation, patient age, fracture type, general condition/anesthesia risk, and time of injury. Conclusion: In accordance with clinical experience, some criteria have been defined for patient selection preoperatively in mandibular subcondylar fractures. It believes that with the right patient selection, it will be possible to achieve better results and reduce complications.Öğe Long-Term outcomes of digital nerve repair accompanied by digital artery Injury in flexor zone 2(THIEME MEDICAL PUBL INC, 2020) Yıldıran, Gökçe; Sütçü, Mustafa; Akdağ, Osman; Tosun, ZekeriyaObjectives Better healing results of any tissue or area is closely linked with a well-blood supply in reconstructive surgery. Peripheric nerve healing is closely related to blood supply as well. We aimed to assess whether there was any difference between digital nerve healing with and without extrinsic blood supply. Methods We assessed 48 patients with unilateral digital nerve injury at zone 2. Twenty-four of them had unrepairable arterial injury and other 24 had no arterial injury. The 24 patients in the "unrepaired artery group" (UA) and 24 patients in the "intact artery group" (IA) were compared. Results Mean follow-up time was 17.7 months. The mean two-point discrimination (2PD) was 5.29 mm in IA group and 5.37 mm in UA group. One neuroma in IA group and two neuromas in UA group were determined. We found no statistically significant difference between these groups in terms of neuroma, 2PD, and cold intolerance. The results of British Medical Research Council sensory recovery clinical scale were comparable for these two groups. Conclusion Digital nerve healing is related to numerous factors. We hypothesized that blood flow may be one of these factors; however, at this zone digital artery repair is not the foremost determinant for digital nerve healing. Further researches should be done for upper injury levels. Despite this result, we argue not to leave the digital artery without repairment and we propose to repair both artery and nerve to achieve the normal anatomical integrity and to warrant finger blood flow in possible future injuries.Öğe Periferik sinir kesisinde farklı onarım zamanlarında melatoninin sinir iyileşmesine olan etkisinin incelenmesi(Selçuk Üniversitesi Tıp Fakültesi, 2010) Sütçü, Mustafa; Keskin, MustafaTravma sonucu meydana gelen periferik sinir hasarı, fiziksel olduğu kadar psikososyal ve ekonomik problemlere de yol açan ciddi bir durumdur. İyileşme süreci oldukça uzundur ve ciddi fonksiyon kayıplarına neden olmaktadır. Günümüzde bile mükemmel duyusal ve fonksiyonel olarak geri dönüşü sağlayabilecek bir tedavi şekli ortaya konamamıştır. Periferik sinir cerrahisinde onarım zamanlamasının önemi herkesçe kabul görmektedir. Bununla birlikte pek çok farmakolojik ajan deneysel olarak, hücre ölümünü azaltmak ve sinir iyileşmesini hızlandırmak amacıyla kullanılmıştır. Ancak hali hazırda klinik kullanıma giren bir ajan mevcut değildir. Bu bilgiler ışığında deneysel olarak oluşturulan siyatik sinir kesisinde farklı onarım zamanlarında melatoninin sinir iyileşmesine olan etkisini araştırmak ve bu etkileri stereolojik olarak değerlendirerek kantitatif veriler elde etmek amacıyla bu çalışma planlandı. Çalışmada toplam 80 adet Wistar cinsi dişi rat kullanıldı. Onarım zamanları 0. saat, 12. saat, 24. saat ve 1. hafta olarak belirlendi. İlk dört gruba (Grup 1, 2, 3, ve 4) sinir kesisi sonrası 12 hafta boyunca intraperitoneal olarak Melatonin verildi ve belirlenen zamanlarda onarım yapıldı. İkinci dört gruba (Grup 5, 6, 7 ve 8) siyatik sinir kesisini takiben belirlenen zamanlarda onarım yapıldı. 12. hafta sonunda miyelinli akson sayıları değerlendirildi. Erken onarım yapılan gruplarda istatistiksel olarak anlamlı düzeyde fark tespit edildi (p<0.05). Melatonin verilen gruplardan elde edilen akson sayılarının verilmeyenlere göre istatistiksel olarak anlamlı düzeyde farklı olduğu tespit edildi (p<0.05). Ayrıca Melatoninin onarım zamanlarına göre akson sayıları arasındaki farkı ortadan kaldırdığı gözlendi. Sonuç olarak periferik sinir kesilerinde erken onarım sinir iyileşmesinde iyi sonuçlar alınmasında etkilidir ancak yeterli değildir. Çalışmamızda erken onarıma ek olarak melatonin kullanımı deneysel olarak akson rejenerasyonunu artırmıştır. Ayrıca erken dönemde sinir onarımının mümkün olmadığı durumlarda melatonin uygulaması bekleme sürecinde akson yaşayabilirliğini artırarak ve güçlü antioksidan etkisiyle kesilen sinirdeki hasarı azaltarak akson rejenerasyonuna pozitif yönde katkıda bulunabilmektedir.Öğe Posterior interosseous flap versus reverse adipofascial radial forearm flap for soft tissue reconstruction of dorsal hand defects(Türkish Assoc Trauma Emergency Surgery, 2018) Akdağ, Osman; Yıldıran, Gökçe; Sütçü, Mustafa; Karameşe, MehtapOur objective was to compare the outcomes of dorsal hand defect reconstruction using a posterior interosseous artery flap (PIAF) and a reverse adipofascial radial forearm flap : From 2008 to 2013, 23 patients who underwent hand soft tissue defect reconstruction with PIAF (11 patients) and patients) were included in this retrospective study. Reconstruction methods were compared in terms of functionality with disability of the arm, shoulder, and hand (DASH) score and range of motion (ROM) and aesthetically with scar assessment. Operation times, length of hospital stay, and donor site problems were compared. RESULTS: We found no statistically significant differences between PIAF and RARFF in terms of ROM, DASH score, and length of hospital stay. Statistically significant differences were found in operation time, scar assessment, and donor site problems between PIAF and RARFF patients. : RARFF showed better results than PIAF in dorsal hand defects, but in RARFF, the major arteries of the hand are sacrificed.Öğe Pull-through technique combined with liposuction in gynecomastia [Jinekomastide liposakşın ve pull-through tekni?i kombinasyonu](Turkish Society of Plastic Reconstructive, and Aesthetic Surgery, 2011) Karameşe, Mehtap; Keskin, Mustafa; Sütçü, Mustafa; Akdağ, Osman; Tosun, Zekeriya; Savacı, NedimGynecomastia is defined as a benign enlargement of the male breast. If breast enlargement does not resolve after a reasonable waiting period then surgical intervention is indicated. Removal of pathological glandular breast tissue may result with undesirable scar formation. Pull-through technique with combined liposuction is preferred for minimal incision site require and minimal postoperative scar formation. In this study, we presented our results of pull-through technique combined liposuction in cases with glandular gynecomastia in adolescent.Öğe Reconstruction of Total Lower Lip Defects Using Radial Forearm Free Flap with Subsequent Tongue Flap(Lippincott Williams & Wilkins, 2010) Keskin, Mustafa; Sütçü, Mustafa; Tosun, Zekeriya; Savacı, NedimSubtotal and total reconstruction of the lower lip is a challenge for the plastic surgeon. Large defects extending to the chin area can be difficult to manage with only local flaps, and free flaps are better suited. In an attempt to restore the lower lip with the vermilion, the authors used the radial forearm free flap with anteriorly based ventral tongue flap in 5 patients. The tongue flap is used 3 months after the free flap procedure, and this flap is divided 3 weeks later. The tongue flap transfer, adaptation, and division are done under local anesthesia. In all patients, the aesthetic result was excellent compared with the complexity of the reconstructed defect. Patient compliance was uneventful. Although it is a 3-stage reconstruction, combination of radial forearm flap with the tongue flap offers functional and fine aesthetic results.Öğe Role Of Active Range Of Motion İn Hand And Wrist Joint Photography: A Preliminary Analysis(LIPPINCOTT WILLIAMS & WILKINS, 2019) Yıldıran, Gökçe; Sütçü, Mustafa; Akdağ, Osman; Işık, Cemil; Tosun, ZekeriyaIntroduction: Hand photography is effective and advantageous for assessing functional deficits and improvements related to surgery. In this study, it is aimed to investigate whether the correct active range of motion (ROM) is masked by the passive ROM in a wrist joint. Method: Eleven patients who were treated for unilateral wrist fractures were included in the study. Photography was performed in all patients by the same surgeon according to the conventional hand surgery photography approach and the active ROM photography approach. Differences between the noninjured side and injured side were assessed. Results: No differences were found between the active ROM and passive ROM during the extension and flexion movements in the noninjured side group. However, in the injured side group, the results from the photographs obtained with the conventional method were significantly better than the results from the photographs obtained when the wrist was actively moved. Conclusion: These findings suggest that photographs of wrists during passive motion may affect the results of a treatment or study by showing false positivity. We propose obtaining images of active ROM instead of passive ROM in hand photography.Öğe Surgical treatment of complex metacarpophalangeal joint dislocation(WOLTERS KLUWER MEDKNOW PUBLICATIONS, 2020) Sütçü, Mustafa; Yıldıran, Gökçe; Akdağ, OsmanDorsal dislocations of the metacarpophalangeal joint (MPJ) are relatively uncommon injuries. Complex dislocations of metacarpophalangeal dorsal dislocations are characterized with extended MPJ without flexion and flexed distal joints. Complex dislocation injuries usually require surgical reduction. A 25-year-old male patient was admitted with pain, swelling, and tingling following a hyperextension injury. X-rays demonstrated dorsal dislocation of the proximal phalanx of the index finger without fracture. Open surgical reduction was planned via volar approach. Treating a complex MPJ dislocation with closed reduction is rarely successful. Especially, the volar approach is useful in open dislocations, and anatomy of the volar structures can be best explored and demonstrated.Öğe Yenidoğanda Seyreltilmemiş Antiseptik Solüsyona Bağlı Kimyasal Yanık(2007) Keskin, Mustafa; Sütçü, Mustafa; Tosun, Zekeriya; Savacı, NedimSetrimid (% 15'lik) ve klorheksidin glukonat (% 1,5'lik) maddelerinin karışımından oluşan ve kolay bulunabilen "savlon" seyreltilerek kullanıldığında güvenli ve etkili bir antiseptikdir. Antiseptik ve dezenfektan olarak rutin uygulamada 1/100'lük sulandırılması önerilmektedir. Hazırlamak için 1 litre su, 10 ml savlon ile karıştırılır. Daha yüksek konsantrasyonlarda veya seyreltilmeden kullanıldığında cilt irritasyonu ve cilt yanığı kaçınılmazdır. Yenidoğanda göbek pansumanı için yedi gün boyunca seyreltilmemiş savlon kullanımına bağlı gelişen kimyasal yanık sunulmuş ve tedavi ve patogenezisi tartışılmıştır. Bu tür solüsyonlar hastalara önerildiğinde belirtilen oranlarda seyreltilmesi konusunda uyarılmalı, hatta mümkünse yeni doğanlarda başka antiseptikler tercih edilmelidir.
