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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 THE EFFECT OF ADIPOSE TISSUE STROMAL VASCULAR FRACTION COMBINED WITH PLATELET-RICH PLASMA ON IRRADIATION-INDUCED CAPSULAR CONTRACTURE AROUND SILICONE IMPLANTS(Medknow Publications & Media Pvt Ltd, 2014) Gundeslioglu, Ayse Ozlem; Inan, Irfan; Tezcan, Yilmaz; Toy, Hatice; Emlik, Dilek; Aktan, Murad; Duman, SelcukThe exact reason and pathogenesis of capsule formation around breast implant after cosmetic and reconstructive breast enhancement is still unclear. However, recent studies and clinical observations regarding the application of adipose-derived mesenchymal stem cells around implanted biomaterials have shown encouraging results. In this study, the effects of the adipose-derived stromal vascular fraction combined with platelet-rich plasma on capsule formation around silicone implants were investigated in irradiated rats. After implantation of silicones implants bilaterally on the rat dorsal area, both sides were irradiated with 10-Gy as single fraction electron beam irradiation. Following radiation, the mixture of stromal vascular fraction and platelet-rich plasma was injected to right sides of the animals. Left sides were injected with same amount of saline as a control. On day 30, capsule around the implants was evaluated in regarding the capsular thickness by ultrasonography, histopathology and immunohistochemical examination. The results demonstrated that there is no statistically significant difference between the treated and non-treated groups in ultrasonographic, histopathologic, and immunohistochemical evaluations. These preliminary results demonstrated that adipose-derived stem cells with platelet rich plasma do not have efficiency for integration of tissue and silicone implants and to reduce capsule formation and further studies are requiredÖğe Is It Necrotizing Fasciitis or Necrotizing Cellulitis After Varicella Zoster Infection? Two Case Reports(Lippincott Williams & Wilkins, 2014) Gundeslioglu, Ayse Ozlem; Selimoglu, Muhammed Nebil; Toy, HaticeNecrotizing fasciitis and necrotizing cellulitis are serious cutaneous complications in varicella patients. Differentiation of necrotizing cellulitis from necrotizing fasciitis can initially be challenging because of indistinct clinical course at the onset of infection and the lack of definitive diagnostic criteria. This paper reports 2 children with necrotizing cellulitis that developed after varicella infection to draw the attention of health care providers to necrotizing cellulitis that showed slower clinical course than necrotizing fasciitis and recovered with conservative treatment approaches without aggressive surgical intervention.Öğe Necrotizing Fasciitis of the Cervical Region following Extravasation Injury(Hindawi Ltd, 2012) Gundeslioglu, Ayse Ozlem; Ozen, Emine CigdemNecrotizing fasciitis is a rapidly progressive soft tissue infection that can cause local tissue destruction, necrosis, and life threatening severe sepsis. Necrotizing fasciitis in the head and neck region caused by an extravasation injury is rare. This paper reports a patient with necrotizing fasciitis of the cervical region caused by an extravasation injury which required an early surgical debridement.Öğe Neo-vascularisation of musculocutaneous and muscle flaps after division of the major vascular supply: An experimental study(Elsevier Sci Ltd, 2013) Gundeslioglu, Ayse Ozlem; Selimoglu, Nebil; Toy, Hatice; Koc, OsmanBackground and aim: Experimental studies have shown that musculocutaneous flaps are not dependent on a major pedicle for survival after 7-8 days, as revascularisation occurs from surrounding well-nourished tissue. However, muscle component loss in myocutaneous flaps after pedicle division has been reported. No study that examines the nature of the vascular ingrowth from underlying beds by blocking the peripheral cutaneous beds has been conducted in musculocutaneous and skin-covered muscle flaps. This study was designed to investigate the origin of the dominant source of neo-vascularisation after interruption of the major vascular supply in island musculocutaneous and island skin-covered muscle flaps by blocking neo-vascularisation from wound edges and the recipient bed. Method: Twenty-eight rats were divided into four experimental groups. In group I, a cutaneous maximus musculocutaneous island flap (MCIF) was raised, and the wound edges of the flap were blocked with a silastic sheet. In group II, an MCIF was raised, and the recipient bed was blocked with silastic. In group III, an island cutaneous maximus muscle flap (IMF) was raised as an island flap covered by a full-thickness skin graft (FTSG), and the wound margins were blocked with silastic. In group IV, an IMF was raised as an island flap covered by an FTSG, and the recipient bed was blocked with a silastic sheet. On the seventh postoperative day, vessel ligation was performed in each animal. Microangiographic studies and histopathological evaluations were performed 14 days after the first operation. Results: In microangiographic studies, neo-vascularisation was more prominent in groups II and IV (the groups in which the recipient beds were blocked) than in groups I and III (the groups in which the wound edges were blocked). Upon histopathological examination, the number of vessels was significantly lower in group I and group III than in group II and group IV (p < 0.001). Conclusions: Our findings revealed that neo-vascularisation from either the recipient bed or the wound edges was sufficient to ensure full flap survival in musculocutaneous flaps, and skin-grafted muscle flaps do not need major axial vessels 7 days after flap elevation in rats if the recipient bed or wound edges are well-vascularised. The results also indicated that revascularisation mainly comes from the peripheral wound edges and is independent of flap type. (C) 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.Öğe A Salvage Operation for Total Penis Amputation Due to Circumcision(Korean Soc Plastic & Reconstructive Surgery, 2013) Ince, Bilsev; Gundeslioglu, Ayse OzlemCircumcision is one of the most common rituals in Jewish and Islamic cultures. It may also be performed for phimosis correction or the treatment of recurrent balanitis. Although circumcision is considered to be a technically easy and safe surgical procedure with no significant risk, it may lead to severe complications such as necrotizing fasciitis or total penis amputation. In this report, we present a case of penis amputation at two levels occurring with third-degree burns due to electrocautery during circumcision. Although penile replantation was attempted, it was unsuccessful due to burn damage to the veins. After restoration of the functional structures, the penis was buried in the inguinal area by reepithelization to maintain blood circulation. The recovery of the penis was successful. This case is presented as a novel example of groin flap surgery to achieve a functionally and aesthetically acceptable outcome in a salvage operation for a penis with significant traumatic injury, which has not been previously reported in the literature.Öğe Successful Microsurgical Revascularization of an Almost Totally Amputated Ear Lobe by Horse Bite(Lippincott Williams & Wilkins, 2014) Dadaci, Mehmet; Gundeslioglu, Ayse Ozlem; Ince, Bilsev; Altuntas, ZeynepTotal or subtotal amputation of the external ear related to horse bite is an uncommon situation. In our case, we report successful microsurgical revascularization of almost totally amputated ear of a 75-year-old male patient caused by a horse bite.Öğe TISSUE EXPANDER APPLICATIONS FOR EXTREMITIES(Medknow Publications & Media Pvt Ltd, 2013) Gundeslioglu, Ayse Ozlem; Ince, Bilsev; Dadaci, Mehmet; Inan, Irfan; Selimoglu, Muhammed Nebil; Toksoz, Mustafa Rasid; Ozen, Emine CigdemIntroduction: Tissue expanders have been frequently used in reconstructive surgery in order to obtain the necessary skin for the reconstruction of local or distant tissue defects because of their ability to form skin tissues of the same color, same sense and tissue quality with the defective field. Despite this fact, tissue expander applications for extremities have been shunned because of the high risk of complications. This study presents our approach to patients who had tissue expander applications for upper or lower extremities for various reasons, the technical details of the applications, and the results achieved from these patients alongside with literature. Material and Method: The data of a total of 15 patients who presented to our clinic between September 2010 and January 2013 and who had tissue expander applications for their extremities were retrospectively evaluated. The patients' data were evaluated regarding age, sex, etiological factor, the localization and size of the possible defect, the number, type, sizes, and volume of tissue expander applications, the size of the defect following excision, and complications. Results: 6 out of 15 patients covered by the study were male, while 9 were female. The mean age of the patients was 20.4 years (9-36). The tissue expander was applied to 11 fields for the upper extremities in 9 patients while it was applied to 8 fields for the lower extremities in 6 patients. 4 of the tissue expander applications for the upper extremities were applied for tattoo removal. The etiological reason for the lower extremities was traumatic scar or burn scar in all patients. The volumes of the used tissue expanders varied between 50 and 750 cc. The average expander volume was 168.3 cc (50-340 cc) for the upper extremities while it was 457.8 cc (60-750 cc) for the lower extremities. In 13 of 15 patients (86%) the expansion process was completed without any major complication. Conclusion: Although there is a widespread prejudice against tissue expander applications for extremities, it is possible to achieve successful results in cases where the appropriate implant was placed through the right technique and in cases where the expansion process was spread in time in mini volumes.Öğe Transfer of the Fifth Finger to Replace an Amputated Thumb: A Preliminary Study(Sage Publications Inc, 2015) Ince, Bilsev; Gundeslioglu, Ayse Ozlem; Cicekcibasi, Aynur Emine; Dadaci, Mehmet; Inan, Irfan; Buyukmumcu, MustafaAmputation of the thumb causes not only loss of significant functional use of the hand but also psychological and social problems. The procedures of toe-to-thumb transfer, pollicization, or metacarpal extension are recognized and well-documented options in thumb reconstruction. Although these techniques have been successfully applied, they have some disadvantages. This study aims to test the feasibility of the fifth finger for thumb reconstruction. The fifth finger was released following exploration of the digital artery, vein, nerve, and flexor and extensor tendons, including the flexor retinaculum. The digital vein and the extensor tendon of the fifth finger were separated at the level of the metacarpophalangeal joint. The proximal phalanx of the fifth finger was cut smoothly at the level of the metacarpophalangeal joint with a saw. The deep flexor tendons, digital arteries, and nerves were preserved. The proximal phalanx of the released fifth finger was fixed to the first metacarpal bone. The digital vein of the first finger was anastomosed to the digital vein of the fifth finger by microsurgery. Angiography was done after the transfer. Exploration till the flexor retinaculum enabled thumb transfer without any restriction of movement in all 10 cadaver fingers. The average total surgical time was 135 +/- 12 minutes. Flow from both radial and ulnar arteries was demonstrated in the transferred fifth finger by angiography. The technique appears to be feasible for thumb reconstruction by preserving digital arteries and nerves in a relatively short time, but further important aspects have to be assessed in further clinical studies.
