Mehmet Bozkurt

Following intramuscular drug injections, livedoid dermati-tis (also known as embolia cutis medicamentosa or NicolauSyndrome), characterized by pain, skin discoloration,and cutaneous necrosis, may rarely be observed. In thepresent study, we present a 32-year-old male patient ...

Abstract This study was designed to evaluate the efficacy of epineural tubulization (ENT) with or without intratubal application of adipose-derived mesenchymal stem cells (ASCs) in the rat model of sciatic nerve transection. After formation of 1-cm defect in the left sciatic nerve and ENT, 32 adults female Wistar albino rats were separated into 4 groups (n = 8 for each) including ENT per se (group 1; ENT group) and ENT plus intratubal ASC injection groups killed on day 21 (group 2; ENT-ASC-21-day group), 60 days (group 3; ENT-ASC-60-day group), and 120 days (group 4; ENT-ASC-120-day group). Functional (sciatic function index, hip circumference, withdrawal reflex latency, muscle weight ratio), electrophysiological, histomorphometric, and immunohistochemical analyses were performed in each group. Sciatic function index was significantly higher (−51.98 ± 5.94, P < 0.01) and withdrawal reflex latency was shorter (−6.21 ± 2.14, P < 0.01), in the group 4 as compared with all other groups on day 21. Amplitude of contraction was significantly lower in the group 4 as compared with all other groups (0.22 ± 0.05 vs 0.34 ± 0.07, 0.50 ± 0.11, and 0.61 ± 0.16, P < 0.01 for each). Immunohistochemical analysis revealed presence of green fluorescent protein, vimentin-stained cells, and single neural progenitor cells indicating that induction of neuronal differentiation by ASCs and direct involvement of ASCs within the axonal structure alongside extension of ASCs to the muscular layer of the group 4. In conclusion, our findings revealed that use of ENT plus intratubal ASC injection in a rat sciatic nerve transection model was associated with satisfactory functional outcome and improved peripheral axonal regeneration along with stem cell neural differentiation.

This experimental study was designed to investigate and compare the effects of different anesthesia techniques on rat cremaster muscle flap microcirculation. Fifty male Sprague-Dawley rats (130-150 g body weight) were divided into five experimental groups containing ten animals each. Group I, group II, and group III were designated as inhalation, epidural, and spinal anesthesia groups, respectively. Group IV was designated as a combination group for inhalation and epidural anesthesia. Group V was a combination group of inhalation and spinal anesthesia. Group III and group V showed significant increases in the number of rolling and sticking leucocytes and in RBC volume (peripheral stasis) when compared with group I. Blood flow and velocity significantly increased without peripheral stasis in groups II and IV when compared with group I. Although there was no statistically significant difference in the numbers of rolling, sticking, and transmigrating leucocytes or in functional capillary perfusion, group IV had better flow hemodynamics in the peripheral microcirculation when compared with group I. The inhalation and epidural anesthesia combination was determined to be the ideal anesthesia technique for improved peripheral microcirculation. Spinal anesthesia, either separately or in combination with inhalation anesthesia, has adverse effects on microcirculation.

Background: The purpose of this study was to evaluate skin graft integrity after external beam irradiation in a rat model. Methods: Forty-eight male Wistar rats were randomly assigned to 8 groups (A, B, C, D, Ac, Bc, Cc and Dc). A rectangular full-thickness skin graft was raised and reapplied to its original bed on the dorsum of each rat. Groups Ac, Bc, Cc and Dc were the control groups and were not given postoperative irradiation. After grafting, 25 Gy unfractioned cobalt60 irradiation was administered to groups A, B, C and D on postoperative days 10, 20, 30 and 40, respectively. Histological samples were obtained 8 weeks after grafting. Dermal and epidermal thickness were measured by the KS-400 image analysis program. Results: The difference in the epidermal and/or dermal thickness between the irradiated groups was not found to be significant. Furthermore, when histological features and the image analysis of the irradiated groups were compared with each other, there were no signif...

Reconstruction of the total canalicular obstruction with destroyed medial canthal area is a challenging procedure for ophthalmic, plastic, and reconstructive surgeons. In the case presented, a supratrochlear artery--based island flap combined with a buccal mucosal graft was used for reconstruction of the medial canthal area. The medial canthal area was scarred significantly and demonstrated a medial ectropion and complete canalicular obstruction. To our knowledge, it is the first time for combined reconstruction of the medial canthal area and lacrimal drainage system in 1 stage, with island median forehead flap based on supratrochlear artery and buccal mucosal graft. During the 2-year follow-up period, no complication was encountered and the patient healed uneventfully.

To investigate the effects of pharmacological delay with insulin-like growth factor-1 (IGF-1) on skin flap survival. Thirty Sprague-Dawley rats were submitted to dorsal skin flap (3x9 cm). Seven days before the surgery, the animals were subdivided into three groups of 10 rats. In group 1 (controls), no injection was done. Seven days before the elevation, saline had been injected to the marked skin flap area in group 2 (sham group), and group 3 (experimental group) underwent a pharmacological delay with subcutaneous IGF-1 injections. On the seventh postoperative day, flap area was analyzed for survival. Tissue samples were obtained for histological and biochemical evaluations. Survival rates were 43.55 ± 16%, 21.40 ± 8%, and 43.12 ± 14% in groups 1, 2, and 3, respectively. Differences between group 2 and other groups were statistically significant. No significant difference was detected between all three groups for tissue or plasma vascular endothelial growth factor (VEGF) levels. Th...

Van der Woude syndrome is a congenital abnormality characterized by labial cysts, accessory salivary glands, pits, fistulas and paramedian sinuses of the lower lips, and is frequently associated with cleft lip and palate. This disease is the most common syndromic cleft abnormality. The disease is characterized by a single gene abnormality where craniofacial morphogenesis is affected. It has an autosomal dominant inheritance with involvement of 1q32-41 chromosomal locus. However, the gene expression profile is variable and the disease may present in some individuals with sinuses of the lower lips only. We present results of analysis of genetic penetrance in the pedigree of five cases with Van der Woude syndrome together with a review of the literature.

Traumatic nasal deformities have a wide spectrum of presentations, which further complicates their management and preoperative planning. Although many methods and algorithms have been proposed for management of specific posttraumatic nasal deformities such as twisted, deviated, saddle or short nose, these algorithms usually focus on a specific deformity in isolation from the remainder of the nose. The aim of this study is to present an algorithm for traumatic nasal deformities and to evaluate the functional and aesthetic outcomes of this new algorithm by a preoperative and postoperative quality-of-life questionnaire. Patients with traumatic nasal deformity were operated on according to our surgical algorithm. Preoperative and postoperative Rhinoplasty Outcome Evaluation (ROE) scores, which is a rhinoplasty outcome survey, were evaluated. A total of 120 patients were included the study. The mean preoperative ROE score was 3.3 ± 1.9 and mean postoperative ROE score was 20.4 ± 3.2. The...

To the Editor: Tissue expansion is a frequently used technique in plastic surgery due to its unique ability to provide skin with similar quality and texture. However, the utilization of tissue expanders may be troublesome in scarred or adherent skin, especially in patients with severe burn injury due to the difficulty of the dissection of the appropriate expander pocket. This article offers a useful method to overcome this problem by intraoperative immediate expansion of the skin using silicone urinary catheter to create an appropriate pocket for osmotic expander. The technique was performed in 3 patients with facial severe burn injury; 2 of them were operated for ear reconstruction and 1 patient was operated for nasal reconstruction. In ear reconstruction patients, the expander pocket was planned at the retroauricular area and in the nasal reconstruction patient, the pocket was planned at the lateral side of the alar base. The common ground of these 3 patients was the unavailability of healthy and unscarred local tissue for expansion. A skin incision was performed 5 mm superior and parallel to the superior border of the desired pocket. A subcutaneous pocket was dissected to be able to insert the balloon (with 30-cc volume) of a 18F silicone urinary catheter (Zhongshan World Medical Instruments Co Ltd, Zhongshan city, China) with blunt dissection and undermining. The balloon was inflated and deflated with saline solution for 8 to 10 cycles over a period of 10 minutes until achieving an appropriate pocket volume for the selected osmotic expander. After that, the osmotic expander was placed to the dissected pocket and the incision was closed in 2 layers (Fig. 1). In all patients, an appropriate level of expansion was achieved providing enough local skin for the coverage of prepared ear cartilage framework and for the reconstruction of nasal ala. No major or minor complications such as expander exposure, wound dehiscence, or infection were observed. Immediate tissue expansion has been reported to provide sufficient expansion of the skin using for wound closure. According to the study of Auletta et al 16% to 36% of skin expansion may be achieved by immediate intraoperative expansion which was not possible with tissue undermining alone. The dissection of an appropriate sized expander pocket is extremely important in severe burn patients due to their scarred and adherent skin, and also an oversized pocket is advised. In the light of these data, we performed immediate expansion of the burned skin tissue using silicone urinary catheter to create a suitable pocket for the placement of osmotic tissue expander in patients with severe facial burn injuries. The aim of this method is to achieve more pliable skin by breaking the stiffness and the inelasticity of the burned skin; rather than to expand it which facilitates enough space for osmotic expanders with larger volumes. However, it should be noted that the presented method provides enough expansion and pocket volume for expanders with small to intermediate volumes, especially smaller than 30 cc. Intraoperative pulsed expansion of the skin with silicon urinary catheter used for achieving suitable pocket for tissue expanders is an easy, cheap, and useful option in patients with adherent and scarred skin such as severe burn patients. Mehmet Bozkurt, MD Emre Güvercin, MD Gaye Taylan Filinte, MD Hakan Şirinoğlu, MD Gökhan Temiz, MD Plastic, Reconstructive and Aesthetic Surgery Clinic Dr. Lütfi Kirdar Kartal Training and Research Hospital Istanbul, Turkey emree_16@yahoo.com

Van der Woude syndrome (VWS) is a congenital disease characterized by labial cysts, accessory salivary glands, congenital lower lip pits, fistula, and paramedian sinuses, and is often accompanied by cleft lip and palate. VWS is an autosomal dominant craniofacial syndrome, which represents only lower lip pits due to variable gene expression. The principles of VWS surgery include excision of lower lip pits and accessory glands, reconstruction of the lip and nose, and correction of accompanying anomalies. In this article, we present a technique with dermal allograft reconstruction to prevent deformities after excision of the accessory gland in the lower lip pit.

Botulinum toxin type-A (Bot-A) is a commonly used drug for both cosmetic and therapeutic purposes. The effects of Bot-A on skin and muscle flaps and the related mechanisms have been described previously. In this study, we used a rat transverse rectus abdominis musculocutaneous (TRAM) flap model to examine the effects of Bot-A on the skin island, which is perfused by the rectus abdominis muscle according to the angiosome concept. Forty female rats were divided into five groups, including control and sham groups. In the control group, a TRAM flap was raised and sutured back after inserting a silicone sheath underneath the flap. In the sham group, the flap was raised 1 month after injecting saline into the muscle. In the chemical delay group, the flap was raised 1 month after injecting 10 IU of Bot-A. In the surgical delay group, the flap was raised 2 weeks after ligating the cranial epigastric artery. In the surgical and chemical delay group, a Bot-A injection was performed initially, a cranial epigastric artery was ligated after 2 weeks, and a TRAM flap was raised after the first month. In all groups, laser Doppler examination, photographic documentation, and analysis of the flap survival rates were performed. In the histopathological evaluation, the diameter measurements of the caudal epigastric vessels, vascular density measurements using CD31 stain, and apoptotic rate estimation using the Tunnel method were performed. The necrosis ratios, arterial cross-sectional diameters, and microvascular density measurements were significantly superior compared to those of control and sham groups; however, there was no significant difference between the delay groups. There was also no difference in the laser Doppler measurements between the groups and the zones of the TRAM flaps. An injection of Bot-A increases muscular circulation and flap survival of TRAM flaps in rats.

... Titre du document / Document title. Burn injury caused by flammable flying toy balloons. Auteur(s) / Author(s). KüLAHCI Yalcin ; ÖZTüRK Serdar ; BOZKURT Mehmet ; ZOR Fatih ; SENGEZER Mustafa ; Revue / Journal Title. Burns ISSN 0305-4179 CODEN BURND8 ...

To test a new approach of donor conditioning with recipient bone marrow cells (BMC) to induce tolerance in vascularized composite allograft (VCA) transplantation. Lewis rats' (recipients) BMC were stained with PKH-26. The ACI rats (donors) were conditioned with 80 × 10(6) Lewis BMC, 24 or 72 hours before VCA (groin flap) transplantation. Forty-eight VCA were performed between ACI donors and Lewis recipients. In groups I and II, donors were preconditioned (24 and 72 hours before transplantation, respectively), and recipients received 7-day anti-αβ-TCR/cyclosporine-A post-transplantation. In groups III and IV, donors were preconditioned (24 and 72 hours before transplantation, respectively), and recipients received no systemic immunosuppression. In group V, recipients received 7-day anti-αβ-TCR/cyclosporine-A post-transplantation. In group VI, recipients received no systemic immunosuppression. Assessment included evaluation of transplant viability and induction of donor-specific c...

Purpose The most important problem in fat transplantation is the durability, which is closely associated with the applied technique. This study includes the comparison of different centrifugation speeds on the survival of autogenous fat grafts in rats. Materials and methods Forty-nine Sprague-Dawley rats were divided into seven groups and the left inguinal fat pad was extracted and re-implanted under the scalp after performing appropriate preparation processes. In the first group the fatty tissue was re-implanted in en-bloc fashion and in the second group it was re-implanted after trimming. After trimming, centrifugation with a G-force of 111.8 (1000 rpm) was performed in the third group, 447.2 (2000 rpm) in the fourth group, 1006.2 (3000 rpm) in the fifth group, 1788.8 (4000 rpm) in the sixth group, and 2795 (5000 rpm) in the seventh group for 4 minutes. The fat grafts were taken after 3 months and histopathological and statistical evaluations were performed. Results The rate of vi...

In this study, an easy and useful method used for the drainage of seroma and hematoma formations occurring after operations requiring extensive tissue undermining is presented. The method utilizes the trocar of the conventional suprapubic urinary catheterization system in combination with the catheter of the negative pressure vacuum drainage system. It provides quick, safe, and painless seroma and hematoma evacuation and can easily be performed in office setting. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

Composite tissue allotransplantation (CTA) is emerging as a potential treatment for complex tissue defects. A major drawback for CTA remains the requirement of lifelong immunosuppression. Up to date numerous experimental CTA models have been introduced to the transplantation literature. After the first hand transplantation in 1998, the clinical applicability of CTA has attracted a lot of attention. This article will outline the historical background of CTA and our experience in different CTA models.

We presented a case of a newborn male with aplasia cutis congenita on the lower limb. The case was treated with conservative method. As for the conservative treatment, daily hydrodebridement with 1/200 diluted povidone-iodine and serum physiologic was performed, followed by closure of the wound with a dexpanthenol chlorhexidine fusidic acid-impregnated sterile gauze bandage. the followup that occured after three weeks, the wound was completely epithelialized, but a hypopigmented scar remained in the limb.

The pectoralis major muscle flap is the most commonly used option for chest wall reconstruction. However, its utilization should be avoided in chest wall tumors infiltrating the muscle. This article presents the utilization of the caudal part of the pectoralis major muscle as a pedicled flap in cases requiring the resection of the cranial part of the muscle due to tumor infiltration. Fourteen patients with a mean age of 60.3 years were operated for malignant thoracic wall tumors between 2011 and 2014. All tumors were located on the upper thoracic area with a mean defect size of 16.6 × 12 cm. During tumor resection, the thoracoacromial vessels and pectoral branch were preserved and dissected until reaching the pectoralis muscle. After the resection of the cranial part of the muscle, the caudal part is prepared as a pedicled island flap and used for the coverage of the resultant defect. The mean postoperative follow-up period was 10.9 months. All flaps survived without any partial or total flap loss. A case of local recurrence, two cases of hematoma requiring drainage, and two cases of local wound-healing problems were the encountered complications. The pectoral kite flap is a versatile and reliable option for the coverage of small to medium upper chest wall defects with minimal morbidity, and it gives the reconstructive surgeon the opportunity to use the non-infiltrated caudal part of the pectoralis muscle instead of an unnecessary resection of the whole muscle.

This was a case of a 21-year-old female patient with a very rare and unexpected symptom "diplopia occurring due to the idiopathic sixth nerve palsy" encountered after 2 weeks following bimaxillary surgery performed for the correction of class III malocclusion deformity.

Free radicals are chemicals that play roles in the etio-pathogenesis of ischaemia-reperfusion injury. Various antioxidants have been used in an attempt to mitigate the damage induced by these chemicals. In the present study, the antioxidative effects of grape seed extract (proanthocyanidin), tomato extract (lycopene), and vitamin C (ascorbic acid) on a composite re-established-flow inferior epigastric artery based rectus abdominis muscle-skin flap model on which experimental ischaemia was induced were investigated. The rats have been administered antioxidants for 2 weeks prior to the surgery and for 2 more weeks thereafter. Macroscopic, histopathological, and biochemical analyses were carried out at the decision of the experiment. It was found that flap skin island necrosis was significantly reduced in the proanthocyanidin, lycopene, vitamin C groups (p < 0.001). Statistical analyses showed significant decreases in inflammation, oedema, congestion, and granulation tissue in the p...

Postoperative flap monitoring is a key component for successful free tissue transfer. Tissue oxygen saturation measurement (TOx) with near-infrared spectrophotometry (NIRS) is a method used for this purpose. The aim of this study was to identify external variables that can affect TOx. Patients who had breast reconstruction with free flaps were monitored prospectively and intra-operative details were recorded. Flap TOx was recorded with NIRS pre-extubation, postextubation, and then every four hours for 36 hours. At each of these time points, blood oxygen saturation (SO2), amount of supplemental oxygen, and blood pressure were recorded. Thirty flaps were monitored. Initially, a significant trend over time was detected such that for every increase of 24 hours, TOx decreased on average by 2.1% (P = 0.025). However, when accounting for SO2 levels, this decrease was no longer significant (P = 0.19). An increase by 1% in SO2 produced an increase in TOx reading of 0.36 (P = 0.007). The amount of supplemental O2, systolic blood pressure, and diastolic blood pressure did not have a significant impact on TOx (P > 0.05). The TOx values were highest in the free TRAM flaps and were lower in decreasing order in the muscle-sparing TRAM, DIEP, and SIEA flaps (P > 0.05). The TOx values did not significantly correlate with vessel size, perforator number, or perforator row. Postoperative flap TOx was found to correlate with SO2 and was not significantly dependent on blood pressure, supplemental O2, or surgical variables. Careful interpretation of oximetry values is essential in decision making during postoperative flap monitoring. © 2014 Wiley Periodicals, Inc. Microsurgery 35:123-128, 2015.

Mortality and morbidity in burn cases can be reduced with early diagnosis. Many markers are used for early diagnosis of burn complications like sepsis. In this current study, the relationship between numerical/morphologic granulocyte abnormalities and complications was investigated in pediatric burns. It was aimed to introduce histopathologic marker(s) for burn-related complications. Thirty-two pediatric burn cases hospitalized between December 2006 and December 2009 were included in the study. A total of 192 complete blood count and peripheral blood smear results were analyzed comparatively. Findings were used to identify any correlation among white blood cell count and peripheral blood smear changes (the appearance of immature granular cells, toxic granulation, purple granules and Döhle bodies) and complications such as bacteriemia, sepsis, wound infections, severe anemia, and graft failure. White blood cell count changes and the appearance of immature granular cells were not suitable for use as a diagnostic marker for complications. Nevertheless, there was a statistically significant correlation between the appearance of toxic granulation, purple granules and Döhle bodies and subsequent complications (p: <0.0001, 0.041, 0.001, respectively). Toxic granulation, purple granules and Döhle bodies appear to be helpful in predicting burn-related complications. Therefore, peripheral blood smear is a suitable test for predicting future complications.

Tissue losses that may occur in certain burn wounds may heal spontaneously without requiring any surgical intervention. However, this spontaneous healing is usually observed in smaller and superficial burn wounds, whereas surgical intervention may be indispensable in the tissue damages that occur in deeper and larger-scale burns treated using classical methods. Although surgery is frequently applied in the treatment of burn wounds, the variety of methods that enhance spontaneous healing are increasing in number. For this purpose, these methods involve the prevention of the wound from drying and maintaining a physiological and aseptic moisturization. On the other hand, especially in burn wounds with extensive tissue loss, the lack of adequate skin donor areas gives rise to the need for a cover material alternative to the skin. For these reasons, efforts to develop equivalent materials that may replace the original skin are progressing rapidly nowadays. The increase in the variety and advantages of the materials, which are developed using state-of-the-art bioengineering methods in the light of modern technologies, is quite promising.