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Öğe Akrilik Plak Yardımıyla Greftsiz Ankyloglossia Tedavisi: Olgu Sunumu(2003) Hoşnuter, Mübin; Tosun, Zekeriya; Özkan, Adem; Şentürk, Sadık; Savacı, NedimAnkyloglossia dilin ağız tabanına yapışık olması ya da aradaki bağın normalden daha kısa olması halini anlatan bir terimdir. Bu durum dil hareketlerini ve dilin fonksiyonlarını engelleyerek emme güçlüğü, meme başı yaraları, erken sütten kesilme ve hatta konuşma bozukluğu gibi önemli problemlere yol açabilmektedir. Eriten tanı ve minör bir cerrahi girişimle kolayca tedavi edilebilen anlcyloglossia olgularında, çocukların genellikle 0-1 yaş döneminde olması nedeniyle postoperatif bakım problemleriyle karşılaşılmaktadır. Bunlar arasında enfeksiyon, greft maserasyonu ve sekonder yapışıklıklar sayılabilir. Buyazıda, dilin ağız tabanına tam yapışık olduğu ankyloglossia vakalarında tedaviyi vepostoperatif bakımı kolaylaştırmak, buna ek olarak sekonder komplikasyonlan en aza indirmek amacıyla özel olarak planlanmış bir akrilikplak tanıtılmakta ve kullanım sonuçlan bir olgu üzerinde tartışılmaktadır.Öğe An alternative to free flap for ankle and heel defects: Delayed reverse-flow sural Island flap(Turkish Society of Plastic Reconstructive, and Aesthetic Surgery, 2015) Karameşe, Mehtap; Yıldıran, Gökçe; Akdağ, Osman; Selimoğlu, Muhammed Nebil; Abacı, Malik; Tosun, ZekeriyaIn ankle and heel region, tissue defects can be occurred due to diabetes, osteomyelitis, trauma and tumor excisions and these defects should be repaired with flaps. Reverse-flow sural island flap is a reliable alternative for repairing these regions' defects. Delayed reverse-flow sural island flap procedure was applied for 11 smoker or diabetic patients who have tissue defects due to trauma. While we haven't seen flap failure in any patient, we also didn't have any difficulty except 2 minor problems. Besides clinical results, patient satisfaction was evaluated with "patient satisfaction rate scale". In this article, it is reported our ankle and heel reconstruction cases with delayed reverse-flow sural island flap as an alternative of free flap and their satisfaction rate.Öğe Altın İmplantla Lagoftalmus Tedavisi Teknik Detaylarının Olgular Eşliğinde Gözden Geçirilmesi(2016) Yıldıran, Gökçe; Akdağ, Osman; Karameşe, Mehtap; Abacı, Malik; Tosun, ZekeriyaAmaç: Üst gözkapağına altın ağırlık yerleştirilmesi, lagoftalmi tedavisinde genel kabul görmüş bir yöntemdir. İngilizce literatürde "custom-made" olarak geçen şekilde kişiye özel yapılabileceği gibi, hazır ticari form olarak veya kuyumcu aracılığıyla da temin edilebilir. İstenmeyen postoperatif sonuçları önlemek için kliniğimizde uygulanan algoritmanın paylaşılması amaçlanmıştır.Gereç ve Yöntemler: 2012-2014 yılları arasında lagoftalmi için altın implantla tedavi planlanan yedi hasta için preoperatif ağırlık testi, oturur pozisyonda bekletme, delikler açıldıktan sonraki ağırlığın saptanması, altın ağırlığın iki kez denenmesi ve sterilizasyon işlemleri uygulandı. Erken ve geç komplikasyonlar, altın gramajı ve maliyet değerlendirildi.Bulgular: Hastaların hiçbirinde erken veya geç komplikasyona rastlanmadı. Gözkapağında tam kapanma elde edildi. Hastaların estetik değerlendirmeleri, hekim değerlendirmesinden daha iyi olarak saptandı.Sonuç: Altın implant tedavisinin başarısını belirleyen en önemli etken altının ağırlığıdır. Maliyet etkin ve hasta memnuniyeti yüksek olan kuyumcu aracılığı ile temin yönteminde basit preoperatif kriterlere dikkat edilerek postoperatif morbiditeyi azaltmak ve başarıyı artırmak mümkündürÖğe Analysis of unilateral complex orbital fractures with a new treatment algorithm(TAYLOR & FRANCIS LTD, 2015) Karameşe, Mehtap; Akdağ, Osman; Selimoğlu, Muhammed Nebil; Koplay, Tuğba Gün; Bakbak, Berker; Koplay, Mustafa; Tosun, ZekeriyaThe aim of this study is to investigate preoperative and postoperative properties, the management of unilateral complex orbital fractures, and to offer an algorithm for orbital fractures. For this research study, 248 patients with orbital trauma were evaluated according to an offered algorithm. Diplopia, enophthalmos, dystopia, infraorbital nerve dysfunction, and ocular movement limitations were documented for clinical assessment. Orbital rim displacement and an orbital volume check with computed tomography (CT) were used for indication of surgery. The injured orbital volume was compared with the healthy orbital volume in the preoperative and postoperative periods. In total, 58 patients required operations among the 248 patients, according to the algorithm. The preoperative mean injured orbital volume measurements of the operated patients were statistically different than the healthy orbital volume measurements (30.13 cm(3) +/- 2.69 cm(3) and 27.15 cm(3) +/- 1.29 cm(3), respectively). In the postoperative period, there was no difference between the injured and healthy orbital volume. In conclusion, an algorithm may facilitate the approach to unilateral complex orbital fractures. Ophthalmic examination, rim displacement, and the measurement of orbital volume using computed tomography are key points of orbital fractures with regard to management.Öğe Applicability of self-inflating tissue expanders in pediatric patients with head and neck defects(SPRINGER, 2015) Karameşe, Mehtap; Akdağ, Osman; Yıldıran, Gökçe Ünal; Selimoğlu, Muhammed Nebil; Tosun, ZekeriyaBackground Self-inflating tissue expanders have been used successfully in breast reconstruction, alopecia, scars, and anophthalmos. The expanders contain an osmotic active hydrogel and a silicon shell. The purpose of this study was to analyze our clinical experience using self-inflating tissue expanders in the treatment of alopecia and cleft palate defects in pediatric patients. Methods Twenty-eight self-inflating tissue expanders were used in 13 patients with alopecia or large cleft palate defects. Expander dimensions were determined by the size of the defect in the scalp and by using a sizer for the palate. In some patients, it was necessary to use more than one expander. A visual analog scale (VAS) and Children's Hospital of Eastern of Ontario Pain Scale (CHEOPS) were used to determine pain levels. Results Sufficient tissue was gained in nine patients (69.2%) and 11 of the 16 defects were repaired successfully (68.75%). We observed four implant extrusions as a major complication (14.2 %). Three of these four extrusions were seen in cleft palate expansions. Pain levels were as low as 5 points with CHEOPS in patients younger than 5 years old and 40mmwith VAS in patients older than 5 years of age. Conclusions Self-inflating tissue expanders comfortably ensure sufficient tissue in patients with alopecia; however, there is high risk of extrusion in cleft palate applications. Level of Evidence: Level V, therapeutic study.Öğe Calciphylaxis: Cutaneous Necrosis in Chronic Renal Failure(Lippincott Williams & Wilkins, 2002) Şentürk, S.; Hoşnuter, Mübin; Tosun, Zekeriya; Savacı, Nedim[Abstract not Available]Öğe Calciphylaxis: Cutaneous Necrosis in Chronic Renal Failure [3](2002) Şentürk, Sadık; Hoşnuter, Mübin; Tosun, Zekeriya; Savacı, Nedim[Abstract not Available]Öğe Camouflaging Cleft Lip Scar Using Follicular Unit Extraction Hair Transplantation Combined with Autologous Fat Grafting(LIPPINCOTT WILLIAMS & WILKINS, 2018) Akdağ, Osman; Evin, Nuh; Karameşe, Mehtap; Tosun, ZekeriyaBackground: The scar that occurs after cleft lip surgery poses a serious cosmetic problem. One of the methods used to solve this problem in adult male patients is hair transplantation. However, satisfactory results with this method cannot always be achieved because of possible graft loss. The corrective feature of fat grafting has been reported in many studies. The authors' aim with this report is to share their results with hair transplantation combined with fat grafting in patients with cleft lip. Methods: This study included 20 patients who had both a scar and alopecia in the cleft lip area. The patients underwent fat grafting from the periumbilical region by means of miniature liposuction harvesting cannulas. Three months after fat injection, hair transplantation was performed with hair from the submental area and scalp using the folliculate unit extraction technique. Patients were followed for 12 months. Survival rate of transplanted hair and patient satisfaction were analyzed after the procedures. Results: After this camouflaging technique with fat grafting and hair transplantation, the scar was hidden quite well. The graft survival rate was also better compared with results from similar studies. Patient and observer satisfaction results with the scar tissue were significantly improved, which was confirmed statistically. Conclusions: This study demonstrates that this combined camouflaging technique is a very effective treatment in male patients with cleft lip who have serious secondary upper lip scars. The authors present a series of patients treated with this technique, which resulted in a high level of patient satisfaction.Öğe A case of renal cell carcinoma mimicking parotid tumor(Turkish Society of Plastic Reconstructive, and Aesthetic Surgery, 2015) Akatekin, Ahmet; Karameşe, Mehtap; Akdağ, Osman; Abacı, Malik; Tosun, ZekeriyaIntroduction: Renal cell carcinoma is a malignant tumor which arising from the renal cortex. Tumor has some symptoms such as flank pain, macroscopic hematuria, and a palpable abdominal mass. Rarely a group patients have metastasizes which cause paraneoplastic syndromes. Cutaneous metastases are quite rare. Case: In this article we will be discussed a rare renal cell carcinoma metastases case which mimicking parotid tumor. Results: After pathological examination, patient were diagnosed with renal cell carcinoma and for the primary tumor treatment, he was referred to the urology clinic. Conclusion: Clinics which are dealing with tumor, are very important to the pathological examination. Patients should be considered as a systemic and the surgeon should focus on other systemic point.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 Çocuklarda görülen, perioral elektrik yanığı: Olgu sunumu(2008) Keskin, Mustafa; Tosun, Zekeriya; Duymaz, Ahmet; Savacı, NedimNadir görülen bir ev içi yaralanma olan perioral elektrik yanıkları estetik ve fonksiyonel açıdan deformiteye yol açmaktadırlar. Bu yüzden bölgenin rekonstrüksiyonu da özellik arz etmektedir. Perioral elektrik yanıkları genelde üç yaş altı çocuklarda elektrik kablosunun ısırılması ile meydana gelir. Acil servise getirilen 11 aylık kız çocuğunda; prize takılı televizyonun elektrik kablosunu ısırma sonucu perioral elektrik yanığı saptandı. Dudağın %60’ını kapsayan, altta mentuma uzanan, sol kommissürü içine alan, üst dudağın sol yarısının ıslak mukozasına uzanan ve dilin distalini ve ağız tabanını kapsayan yanık alan mevcut idi. Yanığın meydana gelmesini takiben sekizinci günde çevre sağlam doku ile yanıklı doku tamamen birbirinden ayrıldı ve alt labial arterden kanama meydana geldi. Alt dudak defektini kapatmak için defekt lateralinden, inferior pediküllü, nazolabial flep kullanıldı. Flebin mukoza tabakası diseke edilip, ilerletilerek alt dudak vermillonu oluşturuldu. Bu olgu ile birlikte perioral elektrik yanıklarında tedavi prensipleri ve seçenekleri sunuldu.Öğe Comparison of Bone Dust With Other Types of Bone Grafts for Cranioplasty(LIPPINCOTT WILLIAMS & WILKINS, 2014) Karameşe, Mehtap; Toksöz, Mustafa Raşid; Selimoğlu, Muhammed Nebil; Akdağ, Osman; Toy, Hatice; Tosun, ZekeriyaPurpose: Split calvarial bone graft is preferred in the reconstruction of calvarial defects. However, it is not feasible for use in some challenging cases and in children. Particulate bone graft containing viable osteoblasts could be an attractive alternative. Materials and Methods: A total of 32 female rats were randomly separated into 4 groups. Full-thickness bone graft from rat calvaria was harvested in diameters of 8 x 8 mm. In group 1, the periosteum and skin were closed without any bone graft; bone dust particles were placed in group 2; bone fragments were placed in group 3; and full-thickness cranial bone graft was placed in group 4. After 12 weeks, all rats were killed. Degrees of resorption, foreign body reaction, and bone spicule length were assessed histologically, and an immunohistochemical study was used to show bone graft viability. Results: In graft viability, osteogenesis, and osteoblastic differentiation, groups 3 and 4 were similar and superior to groups 1 and 2. No osteoblastic activity and no viable bone dust were detected in groups 1 and 2. Resorption was observed in every preparate that contains bone tissue, and foreign body reaction was prominent in small bone groups, such as in group 2. Conclusions: In the full-thickness cranial bone graft group and the bone fragment group, the preservation of bone viability was obviously superior to the bone dust group and the periosteum-only group. In conclusion, bone dust behaved like the periosteum and could not create new bone, whereas bone particles behaved like the full-thickness cranial bone graft and were capable of preserving viability.Öğe Compartmentalization of Inoperable High-Flow Vascular Malformation(2009) Keskin, Mustafa; Toksoz, Rasid; Özbek, Orhan; Tosun, Zekeriya; Savacı, NedimA high-flow vascular malformation of the face is a rare entity, and it can cause severe disfigurement and can even be potentially fatal as a result of massive hemorrhage. The authors describe a high-flow vascular malformation case that was successfully treated by compartmentalization and sclerotherapy with polidocanol. Two weeks later, the necrotic tissues were debrided and the resulting defect was covered with a skin graft. The resulting aesthetic outcome was more than anticipated by the patient. With this technique, it was possible to treat what was considered an untreatable vascular malformation using a standard technique.Öğe Cylindroma of the Foot(Lippincott Williams & Wilkins, 2002) Tosun, Zekeriya; Hoşnuter, M.; Şentürk, S.; Avunduk, Mustafa Cihat; Savacı, Nedim[Abstract not Available]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 DMEM ve HAMS F-12 sıvıları ile deri grefti yaşayabilirliğinin araştırılması(Selçuk Üniversitesi Tıp Fakültesi, 2000) Tosun, Zekeriya; Savacı, NedimKlasik bir bilgi olarak deri greftleri izotonik serum içinde saklanmakta ve gerek otogreft, gerekse allogreft olarak kullanılabilmektedir. Saklanan bu greftlerin hücre yaşayabilirliğinin maksimum düzeyde tutulması klinik başarıyı artıracaktır. Ayrıca greft total keratinosit sayısını gündeme getirerek önemli bir parametre çalışıldı. Yaşlan 25-35 arasında değişen 26 hastaya ait pannükülektomi materyalleri steril şartlarda elde edilmiştir. 6 materyal mantar kontaminasyonu sebebiyle çalışmaya dahil edilmedi. 36 ml'ye bir (1) cm2 parça gelecek şekilde ve DMEM, Ham's F-12 solüsyonları içinde +4 °C'ye sabitlenmiş buzdolabına konularak 3 hafta saklanmıştır. DMEM ve Ham's F-12 solüsyonları dokular için besleyici özelliğe sahip sıvılardır. Bu sürenin sonunda materyaller PBS ile yıkanarak Tripsin EDTA ile muamele edildi. Epidermis dermişten ayrılarak manyetik karıştırıcı ile karıştırıldı. Bu süspansiyona tripan blue boyası ile viabilite testi yapıldı. DMEM ve Ham's F-12 ile elde edilen sonuçlar birbirine yakın ancak izotonik seruma göre oldukça yüksek bulunmuştur. Bu çalışma ile allogreft ve oto greft saklanmasında viabilitenin yeri olduğu ve başarılı olarak kullanılabileceği gösterilmiş oldu.Öğe Doğumsal dev nevüslere hangi gözle bakmalı ?(1995) Yenidünya, M. Oğuz; Tosun, Zekeriya; Hoşnuter, Mübin; Savacı, Nedim[Abstract not Available]Öğe Dupuytren-Like Contracture of the Foot: Ledderhose Disease(THIEME MEDICAL PUBL INC, 2016) Akdağ, Osman; Yıldıran, Gökçe; Karameşe, Mehtap; Tosun, ZekeriyaIntroduction Plantar fibromatosis is a rare hyperproliferative disease of plantar aponeurosis and is also called Ledderhose disease. Case properties and treatment are discussed in this report. Case Report A 30-year-old man presented with painful bilateral plantar nodules. He had multiple and bilateral fixed and solid nodules on the plantar and medial side of his feet measuring 1 cm each. Ultrasound was performed and hypoechoic homogeneous nodules were detected. The patient underwent surgery, and the nodes were removed via a plantar incision with 2-cm safety distance. Discussion Ledderhose disease is a rare, hyperproliferative disorder of the plantar aponeurosis. The nodules are slow growing and found in the medial part of the plantar fascia. The precise etiology remains unknown. The treatment options are conservative management, steroid injections, radiotherapy, and surgery. Conclusion The main cause of this disease remains uncertain. Related conditions should be evaluated, and a patient who presents with Dupuytren or Peyronie disease should also be investigated for Ledderhose disease.Öğe Ear Lobe Reconstruction with a Posterior Ear Flap(TAYLOR & FRANCIS AS, 2000) Savacı, Nedim; Tosun, Zekeriya; Hoşnuter, MübinWe describe a technique for reconstruction of the ear lobe. Although there are many procedures that aim to reconstruct the ear lobe naturally, the aesthetic results of using a posterior ear flap are better because the scar tissue that remains behind the ear is invisible.
