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Öğe Cleft Lip Nose Correction Combining Open Rhinoplasty With the Dibbel Technique(Lippincott Williams & Wilkins, 2015) Gundeslioglu, Ayse Ozlem; Altuntas, Zeynep; Inan, Irfan; Bilgen, Fatma; Jasharllari, Lorenc; Karaibrahimoglu, AdnanCleft lip nose rhinoplasty is a challenging procedure because of the different presentation and severity of the deformity. Due to this presentation type, there is still no standard procedure correcting all the components of the deformity although a number of techniques have been published in literature. In this study, the effectiveness of the combination of open rhinoplasty and the Dibbel technique with nasal sill augmentation was evaluated. We hereby report our experience with 7 patients who had unilateral cleft lip nose deformity with slumped lower lateral cartilage and underprojected and deformed dome, operated on between September 2010 and April 2013 by 1 surgeon. The mean age of the patients at the time of surgery was 24.5 years (18-38 years) and the patients were followed up for an average of 18.5 months (6-31 months). All patients were operated on with open rhinoplasty and Dibbel technique combination with nasal sill augmentation. Frontal, lateral, oblique, and basilar photographs were obtained preoperatively and postoperatively for each patient. Nasal projection, columella height, nasolabial angle, nasal sill symmetry, and base width were measured on the photographs for comparison of preoperative and postoperative results. All patients' medial and lateral cantus distances were used for photographic standardization. The results demonstrated that there was a statistically significant increase in nasal projection (2.13 +/- 0.28mm preoperatively versus 2.31 +/- 0.08mm postoperatively; P = 0.018), columella height (1.07 +/- 0.25mm preoperatively versus 1.21 +/- 0.18mm postoperatively; P = 0.028), nostril apex height (1.11 +/- 0.15mm preoperatively versus 1.22 +/- 0.11mm postoperatively, P< 0.028), nasolabial angle (77.71 +/- 8.74mm preoperatively versus 91.33 +/- 6.49mm postoperatively; P< 0.05), and nasal sill symmetry (0.42 +/- 0.15mm preoperatively versus 0.27 +/- 0.07mm postoperatively; P< 0.05), and a significant decrease of alar width (2.35 +/- 0.44mm versus 2.16 +/- 0.32mm postoperatively; P = 0.018) on the affected side in response to surgery. The results of this study demonstrated that the Dibbel technique and open rhinoplasty combination with nasal sill augmentation is an effective and safe method for the correction of cleft lip nose deformity in respect to nasal symmetry.Öğe Comparison between knot and Winograd techniques on ingrown nail treatment(2015) İnce, Bilsev; Dadacı, Mehmet; Bilgen, Fatma; Yarar, SerhatObjective: The aim of this study was to compare the Winograd and knot techniques based on efficiency, complication rate, surgery time, and amount of local anesthetic required. This study also aimed to determine the etiology of ingrown nails, whether due to involvement of the nail or soft tissue.Methods: Seventy-five patients with a total of 90 ingrown nails (stages 2 and 3) who presented at our clinic between 2012-2014 were included in this study. Patients were divided into 2 groups: those treated with the knot technique and those treated with the Winograd technique. Patients in both groups were evaluated for the amount of local anesthetic required, intraoperative pain, effectiveness of preventing/stopping hemorrhage, surgery time, complications, postoperative nail size, recurrence, nail deformities, and secondary surgery rates.Results: The mean surgical time, relapse rate, number of additional surgeries required, and amount of local anesthetic were significantly greater in the Winograd group than in the knot group. The mean nail diameter was significantly decreased, with a mean of 3 mm in the Winograd group. No statistically significant differences were found between the groups in the incidence of infection, intraoperative pain, hematoma, or nail deformity.Conclusion: This study demonstrated that the knot technique, consisting of wedge excision of soft tissue without affecting the nail itself, is a simple technique to treat ingrown nails with a lower complication rate and shorter surgical time. We believe that successful treatment of ingrown nails depends only on excision of soft tissue, with no need to operate on the nail bedÖğe Disastrous Complications Following Rhinoplasty: Soft Tissue Defects(Lippincott Williams & Wilkins, 2020) Bilgen, Fatma; Ince, Bilsev; Ural, Alper; Bekerecioglu, MehmetBackground: Rhinoplasty has become one of the most frequently performed worldwide aesthetic procedures thanks to the successful results obtained by plastic surgeons. In this study, soft tissue defects, encountered as an undesirable and fearsome complication following rhinoplasty, its causes and precautions are presented by authors. Materials and Methods: Eight patients operated between December 2015 and December 2018 were enrolled in this study. According to the causes of soft tissue defects observed following rhinoplasty; patients were examined in 5 groups consisting of excessive subcutaneous adipose tissue defatting, improper dissection plane, compression of cast, splint and strip materials, pressure applied to skin by cartilage grafts, and overresection. Results: Herein, while subcutaneous excessive defatting and intense cigarette smoking was responsible of the necrosis in the first patient we defined, high pressure on skin due to tight bandaging or external splint materials lead to skin necrosis in our patients 2, 3, and 4. The 5th and 6th patients were candidates of a revision rhinoplasty; however, both resulted with necrosis probably by reason of inaccurate dissection and/or possible diminished vascularity by previous rhinoplasty operations. In the 8th patient, necrosis was observed due to the compression of the bulky autologous cartilage graft used in the skin. Conclusion: In conclusion, skin necrosis is a rare but bothersome complication of rhinoplasty. The importance of atraumatic techniques and appropriate dissection plane during the rhinoplasty operation as well as the importance of the effect and control of the postoperative applied splint and bandage materials is so obviously seen.Öğe Effect of Dermal Thickness on Scars in Women with Type III-IV Fitzpatrick Skin(Springer, 2015) Ince, Bilsev; Dadaci, Mehmet; Oltulu, Pembe; Altuntas, Zeynep; Bilgen, FatmaBoth patients and physicians desire minimal scarring after surgical procedures. The removal of foreign bodies from around the wound, prevention of infection, and wound closure without tension is recommended for reducing scarring. The reasons underlying the differing appearance of scars between different anatomical regions of the same individual are not fully understood. Moreover, to our knowledge, the relationship between incision width and dermal thickness in different anatomical regions has yet to be investigated. Hence, in the present study, we aimed to determine the effect of dermal thickness on scar formation. Fifty patients who were treated and followed up for breast hypertrophy between 2010 and 2013 were retrospectively investigated. In all patients, a 2 x 2-cm skin biopsy specimen was obtained from the medial right breast at the horizontal line of the T scar. A routine superomedial pedicle breast reduction was subsequently performed. The extracted excision materials and skin biopsy specimens were examined pathologically. Dermal thickness was measured from the starting point of the subcutaneous tissue to the end point of the epidermis, at four different sites. The average dermal thickness was then calculated for each patient. The skin color of all patients was determined according to the Fitzpatrick classification. Scar width was measured in three different regions, including a combination of the vertical and horizontal portions of the T scar and the flap confluence. After the measurements, the scars were evaluated for vascularity, pigmentation, elasticity, thickness, and height by two plastic surgeons and a clinical nurse, who were blinded to patient data. The mean age of the 50 female patients was 40.8 years (range 18-65 years). The average follow-up period was 16 months (range 12-18 months). An average of 987.5 g (range 505-1621 g) of breast and fatty tissue was removed. The average dermal thickness was 4.99 mm (range 3.5-6.8 mm). The most common skin type was Fitzpatrick type IV (33 patients). The average total scar score was 14 (range 8-25). The total scar score was not significantly associated with dermal thickness. The scar width in patients with a dermal thickness of < 0.5 cm was narrower than that in patients with a dermal thickness of a parts per thousand yen0.5 cm. Scar vascularity and noticeability were observed less often in patients with Fitzpatrick skin type III, regardless of scar width. The study findings show that increased dermal thickness is a risk factor for wide scar formation. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.Öğe The effect of different application timings of hyperbaric oxygen treatment on nerve regeneration in rats(Wiley-Blackwell, 2016) Ince, Bilsev; Arslan, Abdullah; Dadaci, Mehmet; Oltulu, Pembe; Bilgen, FatmaBackgroundThe aim of the study was to determine the effect of different application timings of hyperbaric oxygen treatment (HBO) on nerve regeneration in rats. Materials and MethodsA total of forty 12-week-old female Wistar albino rats were used. The sciatic nerve was transected. The nerve ends were then realigned and repaired using standard microsurgical techniques. Animals were randomly assigned to four groups: 1) No hyperbaric oxygen, sectioned and repaired; 2) HBO started at postoperative first hour, sectioned and repaired; 3) HBO started at postoperative first week, sectioned, and repaired; and 4) HBO started at postoperative second week, sectioned, and repaired. All rats in all groups were evaluated with gait analysis at 8 and 16 weeks postoperatively. Sciatic function index was calculated. Sciatic nerve samples were taken after gait analysis at 16th week. Foreign body reaction, the intensity of the inflammatory cells and types, repair-associated vascular proliferation in the field, axonal vacuolar degeneration of the fibers from the cut line transition density and switching layout, and myelinization density with perineural sheath were evaluated histopathologically. ResultsAt the 16th week, group 2 demonstrated the best gait analysis results. Gait analysis was better for group 3 than groups 1 and 4 (P<0.05). No significant differences were observed among the groups in inflammation (P>0.05). Fibrosis was statistically less in group 2 than that in other groups (P<0.05); however, no significant differences were observed among groups 1, 3, and 4 (P>0.05). ConclusionsOur results suggest that initiating HBO early after nerve repair will make a positive impact on recovery. (c) 2016 Wiley Periodicals, Inc. Microsurgery 36:586-592, 2016.Öğe Extensor mechanism variation of the index finger(2016) Dadacı, Mehmet; İnce, Bilsev; Bilgen, Fatma; Altuntaş, ZeynepThe extensor indicis proprius (EIP) tendon and extensor digitorum communis (EDC) tendons are the main extensor tendons of the second finger. Different variations of extensor tendons are frequently reported. In our report, we describe a variation of the index finger extensor mechanism in a healthy subject.Öğe Glial heterotopia of the lip: A rare presentation(Wolters Kluwer Medknow Publications, 2016) Dadaci, Mehmet; Bayram, Fazli Cengiz; Ince, Bilsev; Bilgen, FatmaGlial heterotopia represents collections of normal glial tissue in an abnormal location distant to the central nervous system or spinal canal with no intracranial connectivity. Nasal gliomas are non-neoplastic midline tumours, with limited growth potential and no similarity to the central nervous system gliomas. The nose and the nasopharynx are the most common sites of location. Existence of glial heterotopia in the lip region is a rare developmental disorder. We report a case of large glial heterotopia in the upper lip region in a full-term female newborn which had intracranial extension with a fibrotic band. After the surgery, there was no recurrence in the follow-up period of 3 years. When glial heterotopia, which is a rare midline anomaly, is suspected, possible intracranial connection and properties of the mass should be evaluated by magnetic resonance imaging. By this way, lower complication rate and better aesthetic results can be achieved with early diagnosis and proper surgery.Öğe A Heterotopic Digital Replantation in an 18-Month-Old Child(Wolters Kluwer Medknow Publications, 2018) Dadaci, Mehmet; Ince, Bilsev; Bilgen, Fatma; Yarar, SerhatIn multiple digital amputations, it is not always possible to replant the same amputated part. In these cases, heterotopic digital replantation is a suitable option in terms of cosmetic and functional outcomes. In our report, we described a heterotopic digital replantation in an 18-month-old male child who had multiple digital amputation as a result of placing his hand in the ventilator. Heterotopic replantation is an important method that should be kept in mind in multiple finger amputations which can enable a good cosmetic and functional result, especially in cases where the stump of the amputated finger is not suitable/veya convenient.Öğe A novel technique for distal fingertip replantation: Polypropylene suture guided interpositional vein graft(Taylor & Francis Ltd, 2015) Dadaci, Mehmet; Ince, Bilsev; Altuntas, Zeynep; Bitik, Ozan; Uzun, Hakan; Bilgen, FatmaBackground: Despite current advances in microsurgery, fingertip replantation is still controversial, mainly due to its difficulty and cost. The purpose of this study is to describe a new technique of interposition vein graft guided by polypropylene suture in distal fingertip replantation. Methods: A total of eight consecutive Tamai zone 1 fingertip replantations performed by the same author were included. All replantations were performed using interposition vein graft guided by polypropylene suture. This technique involved a vein graft of similar to 2 cm, with appropriate calibration, obtained from the volar part of the forearm and a 2-0 polyprolene suture passed through the interposition vein graft. Then, a polypropylene suture guide carrying the vein graft was inserted into the artery. The anastomosis was easily performed with the aid of 10-0 or 11-0 nylon in a bloodless medium and without encountering the posterior wall problem. Results: Average surgery time was 2.5 hours (range = 2-3 hours). Among eight Tamai zone 1 replantations, six were successful (75%). There were two replantations lost because of arterial failure. Conclusion: This technique may ease fingertip replantations and increase the success rate for Tamai zone 1 injuries.Öğe Parotid duct cyst in a child(Medknow Publications & Media Pvt Ltd, 2015) Dadaci, Mehmet; Tuncbilek, Gokhan; Ince, Bilsev; Bilgen, Fatma[Abstract Not Availabe]Öğe Pleomorphic Fibroma of Tendon Sheath in Palmar Area(Medknow Publications & Media Pvt Ltd, 2016) Dadaci, Mehmet; Ince, Bilsev; Bilgen, Fatma; Altuntas, Zeynep; Sodali, Tuba; Bitik, OzanTendon sheath fibromas are slowly growing, firm, immobile, and painless masses that are frequently seen in fingers. They are commonly observed in middle-aged males. In our report, we discuss a case of a painless mass in the palmar area that was diagnosed as a pleomorphic fibroma of tendon sheath on histopathologic examination in light of the literature.Öğe Rarely seen complications of circumcision, and their management(2016) İnce, Bilsev; Dadacı, Mehmet; Altuntaş, Zeynep; Bilgen, FatmaAmaç: Dinsel veya tıbbi nedenlerle uygulanan sünnet; glans penisi örten prepisyum adı verilen sünnet derisinin belirli şekil ve uzunlukta cerrahi yolla kesilerek alınması ve penis uç kısmının açığa çıkarılması işlemidir. Yaygın olarak uygulanan basit cerrahi bir işlem olarak kabul edilen sünnetin ülkelerin kayıt sistemleri ile ilgili olarak literatürde %50'ye varan erken ve geç dönem komplikasyon oranları bildirilmektedir.Bu çalışmada kliniğimize sünnet sonrası ortaya çıkan komplikasyonlar nedeniyle başvuran hastalara yapılan tedavi ve komplikasyonları azaltma yolları incelenmiştir.Gereç ve yöntemler: 2010-2013 yılları arasında kliniğimize erken dönem sünnet komplikasyonu nedeniyle başvuran olgular retrospektif olarak incelendi. Bunlardan majör komplikasyon olarak kabul edilen fazla cilt eksizyonu, cilt nekrozu ve glans total amputasyonu bulunan olgular çalışmaya dahil edilirken minör komplikasyonlardan kanama, hematom ve enfeksiyon gelişen olgular çalışmaya dahil edilmedi. Bulgular: Fazla cilt eksizyonu yapılan hastalarda tam kalınlıkta deri grefti ile onarım yapıldı. Cilt nekrozu debride edildikten sonra tam kat cilt defekti olan olgularda defektin büyüklüğüne göre primer veya tam kalınlıkta deri grefti ile onarım yapılırken parsiyel kayıplarda sekonder iyileşme beklendi. Glans amputasyonu olan olguda kasık flebi ile onarım yapıldı.Sonuç: Ülkemizde bildirilen sünnet komplikasyonlarının çoğundan, eğitimsiz kişilerce uygulanan sünnetler sorumludur. Buna toplu sünnet şölenleride eklendiğinde oran giderek artmaktadır. Cerrahi komplikasyonları dışında hepatit B/C, AİDS başta olmak üzere çeşitli hastalıkların bulaşmasına da zemin hazırlar. Sünnet, hastane koşullarında, uygun steril koşullarda, uzman kişilerce yapıldığında komplikasyon oranlarının azalabileceği cerrahi bir işlemdir. Ehil olmayan kişilerce yapıldığında çocuk, tekrarlayan psikososyal ve cerrahi travmalara maruz kalabilirÖğe Transient Hair Loss after Finger Replantation(Korean Soc Plastic & Reconstructive Surgery, 2015) Dadaci, Mehmet; Ince, Bilsev; Bilgen, Fatma; Altuntas, Zeynep[Abstract Not Availabe]Öğe Use of Systemic Rosmarinus Officinalis to Enhance the Survival of Random-Pattern Skin Flaps(2016) İnce, Bilsev; Bilgen, Fatma; Gündeşlioğlu, Ayşe Özlem; Dadacı, Mehmet; Kozacıoğlu, SümeyyeBackground: Skin flaps are commonly used in softtissue reconstruction; however, necrosis can be a frequent complication. Several systemic and local agents have been used in attempts to improve skin flap survival, but none that can prevent flap necrosis have been identified. Aims: This study aims to determine whether the use of systemic Rosmarinus officinalis (R. officinalis) extract can prevent flap necrosis and improve skin flap recovery. Study Design: Animal experimentation. Methods: Thirty-five Wistar albino rats were divided in five groups. A rectangular random-pattern flaps measuring 8×2 cm was elevated from the back of each rat. Group I was the control group. In Group II, 0.2 ml of R. officinalis oil was given orally 2h before surgery. R. officinalis oil was then applied orally twice a day for a week. In Group III, R. officinalis oil was given orally twice a day for one week before surgery. At the end of the week, 0.2 mL of R. officinalis oil was given orally 2 h before surgery. In Group IV, 0.2 mL of R. officinalis oil was injected subcutaneously 2 h before surgery. After the surgery, 0.2 mL R. officinalis oil was injected subcutaneously twice a day for one week. In Group V, 0.2 mL R. officinalis oil was injected subcutaneously twice a day for one week prior to surgery. At the end of the week, one last 0.2 mL R. officinalis oil injection was administered subcutaneously 2 h before surgery. After the surgery, 0.2 mL R. officinalis oil was injected subcutaneously twice a day for one week. Results: The mean percentage of viable surface area was significantly greater (p>0.05) in Groups II, III, IV, and V as compared to Group I. Mean vessel diameter was significantly greater (p>0.05) in Groups II, III, IV, and V as compared to Group I. Conclusion: We have determined that, in addition to its anti-inflammatory and anti-oxidant effects, R. officinalis has vasodilatory effects that contribute to increased skin flap survival.Öğe Versatility of delayed reverse-flow islanded sural flap for reconstructing pretibal defects among high-risk patients(K Faisal Spec Hosp Res Centre, 2014) Ince, Bilsev; Daaci, Mehmet; Altuntas, Zeynep; Sodali, Tugba; Bilgen, Fatma; Evrenos, Mustafa KursatBACKGROUND AND OBJECTIVE: Reconstructing defects related to the leg soft tissue may be quite difficult because the soft tissue over the bone is rather thin and the tendons lie right under the skin. Distal pedicle sural neurocutaneous flap with its long pedicle composed of skin, subcutaneous tissue and fascia is suitable for superficial defects. This study aimed to determine the usability of the delayed reverse-flow (distally based) islanded sural flap for correcting tibial and ankle defects. DESIGN AND SETTINGS: A prospective clinical trial conducted from 2012 to 2013 in Plastic & Reconstructive and Aesthetic Surgery clinic, Necmettin Erbakan University, Turkey. METHOD: Eleven patients with pretibial defects and a visible open bone who underwent reconstruction with reverse-flow islanded sural flap between 2012 and 2013 were included in the study. All patients who had defects between the middle of the tibia and the foot underwent surgery in 2 sessions under spinal anesthesia. In the first session, necrotic tissues were debrided and cultures were taken, and the flap was delayed. Reconstruction was performed in the second session. RESULTS: The biggest flap was 16x11 cm and the smallest one was 5x6 cm. The longest pedicle was 27 cm long and the shortest one 21 cm. A total of 6 patients were smokers and 3 had diabetes mellitus. One patient had partial necrosis of the flap, and the necrosis was healed secondarily. No complications were seen in other patients. CONCLUSION: Delayed reverse-flow islanded sural flaps can be used as an easy, quick, and secure surgical alternative to free flaps for correcting in leg defects involving an exposed bone between the middle portion of the tibia and the heel.
