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Öğe Central Pedicle Reduction in Gigantomastia Without Free Nipple Graft(LIPPINCOTT WILLIAMS & WILKINS, 2016) Karacor-Altuntas, Zeynep; Dadaci, Mehmet; Ince, Bilsev; Karamese, Mehtap; Savaci, NedimBackground Various pedicle techniques have been described in breast reduction surgery. However, in cases of massive hypertrophy, the free nipple graft technique is still being performed by some surgeons out of fear of losing the nipple-areolar complex (NAC). As such, we evaluated patients with severe gigantomastia who underwent the central pedicle horizontal scar reduction mammaplasty technique. Methods The records of 257 patients who underwent the central pedicle reduction technique were retrospectively reviewed. The demographic properties of the patients and the distances from the midclavicular point to the nipple were recorded. Patients whose distance from the midclavicular point to both nipple areolar complexes (NACs) was 38 cm or greater were included in this study. Resection weights and postoperative complications were evaluated. Results The distance from the midclavicular point to both NACs was 38 cm or greater in 53 patients (106 breasts). The age range of the patients was 17 to 73 years, and the mean body mass index was 39.6 kg/m(2). The range of distances from the midclavicular point to the nipple was 38 to 52 cm. The weight of the breast tissue excised ranged between 1450 and 2785 g. None of the patients experienced total nipple loss postoperatively, and all of the patients were satisfied with the aesthetic results. Conclusion We were able to reduce all of the breasts safely, without using the free nipple grafting technique, even in very large breasts. This study shows that the central pedicle horizontal scar reduction technique is a very safe and effective method for use in massive reductions. Therefore, we strongly recommend using the central pedicle reduction mammaplasty technique in cases of gigantomastia.Öğe Close Range Gun Shot Injuries of the Hand With the "Mole Gun"(LIPPINCOTT WILLIAMS & WILKINS, 2009) Keskin, Mustafa; Beydes, Tolga; Tosun, Zekeriya; Savaci, NedimIntroduction: A mole gun is a handmade weapon used as a trap to kill moles by farmers. Their action is based on a simple hammer mechanism: when the moles put their head through the metal ring to get hold of the food, they trigger the mechanism. The hammer strikes the primer, which ignites the gunpowder, propelling the pellets from the barrel. The purpose of this study was to report our experiences in a group of patients who accidentally suffered injuries by mole guns to the hand. Method: Since 2000, 20 patients had attended the clinic with mole gun shot injuries to the hand. Results: The mean age of patients was 38 years. Thirteen cases involved skin defects over the dorsum of the hand associated with extensor tendon and bone injuries. The skin defect was covered with posterior interosseous artery (PIA) flap in 12 cases. In one case, the PIA pedicle was found to be injured so radial forearm flap was used. The main intervention time for these cases was 6.2 days. All flaps except two PIA flap survived uneventfully. One flap was completely lost while other survived with distal necrosis. In remaining seven cases the thumb was the main injured part; it had complete disruption of its arterial supply and was managed with amputation with or without matarcarpal removal. These cases were managed immediately. Conclusion: The risk of injury to the PIA by pellets is low in such close range shots to the hand and PIA flap could be used to cover the defects. In such cases, initial debridement should be minimal and the soft tissue, tendon, and bone injury can be managed in the same stage during the first week of injury.Öğe Contact with wet cement: an unrecognized cause of chemical burn(TURKISH ASSOC TRAUMA EMERGENCY SURGERY, 2012) Seyhan, Nevra; Keskin, Mustafa; Savaci, NedimChemical burns account for a small percentage of admissions to burn units. Wet cement is a poorly recognized cause of chemical burn. As the construction industry is growing, individuals will likely have more contact with this material and be more prone to its harmful effects. Wet cement can cause severe full-thickness burns with prolonged contact, but this property is not well known among professional users. The lack of information about the potential hazards of wet cement makes it an important problem that must be considered more seriously as a risk factor for chemical burn. Increasing public knowledge of the necessary preventive measures is crucial for avoiding this type of chemical burn injury. Here, we report a case with full-thickness burn that occurred while working with wet cement without proper protection.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 Formation of osteocartilaginous exostosis resulting from the raising of a lateral supramalleolar flap(INFORMA HEALTHCARE, 2012) Keskin, Mustafa; Karalezli, Nazim; Tosun, Zekeriya; Savaci, NedimAn osteocartilaginous exostosis developed in a 4-year-old boy in whom a distally-based lateral supramalleolar adipofascial flap had been used to cover a defect in the dorsum of the foot. The bony exostosis was first noticed four months after the operation. It was excised with no complications and there has been no recurrence after two years follow-up. The exostosis was thought to result from stripping the perichondrium over the epiphyseal plate while the flap was being raised. This unique complication has not to our knowledge been reported after harvest of a flap before.Öğe The Importance of Maintaining the Structural Integrity of the Lateral Crus in Tip Rhinoplasty(SPRINGER, 2009) Keskin, Mustafa; Tosun, Zekeriya; Savaci, NedimA novel technique for maintaining nasal tip support and external nasal valve integrity is proposed. The procedure involves mobilizing the lateral crus to a more cranial position after altering its shape from convexity to a more flat shape. With the described technique, the lower lateral cartilage is dissected free from the skin in a retrograde fashion after an intercartilaginous incision. The ligament between the lateral crus and the upper lateral cartilage is cut. The vestibular mucosa is not freed. With this maneuver, the lateral crus usually flattens sufficiently. When the convexity flattens, an extra millimeter of cartilage at the cephalic end is gained in the horizontal dimension. When the cut vestibular mucosa is sutured back to its place, the cephalic end of the lateral crus is advanced over the upper lateral cartilage. This technique allows durable support to maintain patency of the nasal valve. No bridges are burned because no cartilage is excised. The surgeon is left with the flexibility to modify the result on the operating table. The technique was successfully used for 48 consecutive patients over a 3-year period. All the operations were primary rhinoplasties performed using a closed technique. The mean age of the patients was 32 years. For 72% of the patients, septoplasty also was performed. None of these patients had to undergo reoperation. The authors emphasize the importance of the lateral crus in rhinoplasty and demonstrate that good results at the tip of the nose can be accomplished without cephalic trimming, averting related complications in selected cases.Öğe Intra-articular platelet-rich plasma injection for the treatment of temporomandibular disorders and a comparison with arthrocentesis(CHURCHILL LIVINGSTONE, 2015) Hanci, Mustafa; Karamese, Mehtap; Tosun, Zekeriya; Aktan, Tahsin Murad; Duman, Selcuk; Savaci, 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 Lower Eyelid Reconstruction With Tarsoconjunctival Flap in a Xeroderma Pigmentosum Patient(2012) Seyhan, Nevra; Tosun, Zekeriya; Keskin, Mustafa; Savaci, NedimXeroderma pigmentosum is an autosomal recessive genetic disorder of DNA repair in which the ability to repair damage caused by ultraviolet light is deficient. This disorder leads to multiple basal cell carcinomas and other skin malignancies at a young age. The eye is the second most commonly affected organ. We present a case of xeroderma pigmentosum with basal cell carcinoma totally infiltrating the lower eyelid. The reconstruction after excision has been planned with a tarsoconjunctival flap (modified Hughes procedure). This procedure had evolved over the years since it had been first described by Hughes. Some important modifications have led the flap to be used with much success. Our aim is to show that the tarsoconjunctival flap is a reliable option in the reconstruction of total lower eyelid defects, with good functional and esthetic outcomes.Öğe Perioral electrical burn in children: case report(TURKISH ASSOC TRAUMA EMERGENCY SURGERY, 2008) Keskin, Mustafa; Tosun, Zekeriya; Duymaz, Ahmet; Savaci, NedimPerioral electrical burns are rarely seen household injuries that cause both functional and aesthetic deformities requiring special consideration for reconstruction. The cause is usually a child younger than 3 years old biting an electrical cord. An eleven-month-old girl admitted to the emergency room with perioral electrical burn after biting an electrical cable of a television. Her burn area included 60% of the lower lip, down to the mentum, and including left commissure, distal part of the tongue and the floor of the mouth. On the 8th day following the burn, the burned necrotic tissues separated from the healthy living tissues and a bleeding from the labial artery was observed. To reconstruct the lip defect, an inferior-based nasolabial flap from the lateral side was used. The mucosa of the flap was dissected and advanced to form the lower lip vermillion. With this case presentation, the principles and options for perioral electrical burns are presented.Öğe Polyurethane spray foam burn(ELSEVIER SCI LTD, 2008) Keskin, Mustafa; Beydes, Tolga; Tosun, Zekeriya; Savaci, Nedim[Abstract not Available]Öğe Pyoderma gangrenosum in a battered child(LIPPINCOTT WILLIAMS & WILKINS, 2006) Keskin, Mustafa; Tosun, Zekeriya; Ucar, Canan; Savaci, NedimPyoderma gangrenosum is an uncommon cutaneous ulceration, which continues to be a difficult disorder to diagnose and treat. A pediatric case of pyoderma gangrenosum with no associated systemic disorder is presented. The disease was precipitated by physical trauma. The disease was controlled with systemic corticosteroid therapy and then the wound was successfully covered with a split-thickness skin graft from the thigh without any healing problem at the donor site. Although pathergy is well described in the etiopathogenesis of the disease, this is the first case reported that was precipitated after physical assault.Öğe Reconstruction of Defects of the Dorsum of the Nose With Bilateral Transposition Flaps(2000) Tosun, Zekeriya; Hoşnuter, Mübin; Savaci, NedimTransposition flaps are old but are the method of choice in reconstruction of defects of the dorsum of the nose. Eleven consecutive patients with such defects were treated with 22 transposition flaps. The nasal defects resulted from tumour (n = 9), trauma (n = 1), and keratoacanthoma (n = 1). The dissection is rapid, easy and the complication rate is low.Öğe Reconstruction of Defects of the Dorsum of the Nose With Bilateral Transposition Flaps - Case Reports(Taylor & Francis As, 2000) Tosun, Zekeriya; Hoşnuter, Mübin; Savaci, NedimTransposition flaps are old but are the method of choice in reconstruction of defects of the dorsum of the nose. Eleven consecutive patients with such defects were treated with 22 transposition flaps. The nasal defects resulted from tumour (n = 9), trauma (n = 1), and keratoacanthoma (n = 1). The dissection is rapid, easy and the complication rate is low.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 Rhabdomyosarcoma in an adult hand(INFORMA HEALTHCARE, 2013) Seyhan, Nevra; Keskin, Mustafa; Tosun, Zekeriya; Savaci, 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.Öğe Seventeen years of experience with reduction mammaplasty avoiding a vertical scar(SPRINGER, 2008) Keskin, Mustafa; Tosun, Zekeriya; Savaci, NedimBackground It is important to reshape the breast with the least scar possible. This has led us to develop a technique for large breasts where the vertical scar was eliminated. Methods The new nipple is positioned at 19-21 cm. The level of the new inframammary line (IML) is marked 6 cm below the new areola. All the area between the marked IML and the present sulcus is de-epithelialized. The upper flap is undermined beginning from the new IML. The tissue excision is performed medially and laterally leaving a central pedicle that also carries the nipple-areola complex (NAC). The dermoglandular pedicle is shaped conically with breast-shaping sutures. The NAC is passed under the upper apron flap through its new opening. Results We retrospectively reviewed 145 patients who were operated on over the past 17 years. The mean age of the patients was 41 years. The mean distance preoperatively from midclavicle to nipple was 35.3 cm. The average weight of breast tissue excised was 1073 g per side. Seventeen patients (11%) suffered from minor complications. Conclusion This technique works especially well in breast reduction cases where a large mass excision is required. The horizontal scar is obvious only when the patient is lying down and cannot be seen by the patient herself. There is no risk of destroying the circular feature of the areola, which is pulled inferiorly by the vertical scar in the other techniques.Öğe Simultaneous occurrence of facial fibrous dysplasia and ameloblastoma(CHURCHILL LIVINGSTONE, 2009) Keskin, Mustafa; Karabekmez, Furkan E.; Ozkan, Birkan T.; Tosun, Zekeriya; Avunduk, Mustafa C.; Savaci, NedimBackground: Both fibrous dysplasia (FD) and ameloblastoma are benign but locally aggressive tumours of the cramofacial region. In this case report, we present the unique synchronous occurrence of these two tumours in the facial skeleton. Case report: A 16-year-old woman presented with complaints of swelling of the upper right face and at the inferior border of the mandible. She was diagnosed as FD of the maxilla, temporal bone and sphenoid sinus together with ameloblastoma of the mandible after surgery and histopathological evaluation. Conclusion: The case that we present here is unique in that two separate pathological conditions, FD of the upper face, and ameloblastoma of the mandible coexisted. Although cases of synchronous or metachronous occurrence of FD and ameloblastoma with other pathology have been previously described, this to our knowledge, is the first reported case of true coexistence of FD and ameloblastoma. (c) 2008 European Association for Cranio-Maxillofacial SurgeryÖğe Subdermal fibrous hamartoma of infancy in the hand(INFORMA HEALTHCARE, 2007) Keskin, Mustafa; Tosun, Zekeriya; Toy, Hatice; Savaci, NedimA fibrous hamartoma of infancy presented in a 4-month-old girl as three separate masses on her right hand. Magnetic resonance imaging showed that the lesions had indistinct margins, and were infiltrating to the overlying subcuticular layer; there was pathological contrast enhancement and high signal intensity in the bony medulla. The masses were successfully excised. The radiological and physical appearance of fibrous hamartomas in a child may suggest malignancy, but the lesion is typically benign and treatment by local excision is usually successful.Öğe An Unusual Association of Cleft Lip/Palate and Upper Extremity Anomalies(Lippincott Williams & Wilkins, 2006) Tosun, Zekeriya; Hosnuter, Mübin; Karaçor, Zeynep; Savaci, NedimLetters to the Editor and Viewpoints are welcome. Letters to the Editor discuss material recently published in the Journal. Letters will have the best chance of acceptance if they are received within 8 weeks of an article’s publication. Letters to the Editor may be published with a response from the authors of the article being discussed. Discussions beyond the initial letter and response will not be published. Letters submitted pertaining to published Discussions of articles will not be printed. Letters to the Editor are not usually peer reviewed, but the Journal may invite replies from the authors of the original publication. All Letters and Viewpoints are published at the discretion of the Editor.
