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ADIPOSE TISSUE DERIVED STEM CELLS AND THEIR USES IN PLASTIC SURGERY
(Wolters Kluwer Medknow Publications, 2013) Gundeslioglu, A. Ozlem; Altuntas, Zeynep; Ince, Bilsev; Dadaci, Mehmet; Aktan, Murad; Duman, Selcuk
Stem cell treatments have become one of the most studied area in recent years and and it is seen that they will take the place of organ transplants in the future. Adipose tissue derived stem cells are also widely used by other branches outside of Plastic Surgery as they can easily be obtained in large quantities and effective as much as haemopoetic stem cells. Publications related to soft tissue augmentation, wound healing, and tissue engineering have been reported in plastic surgery practice. However, there are still some question marks about their reliability and lack of standardization for obtaining and using stem cells. The purpose of this review is to give knowledge about the concept of fat tissue derived stem cells, their properties, their mechanisms, also their uses in Plastic Surgery and discuss reliability of them.
Assessing the Effect of Vitamin D Replacement on Basal Cell Carcinoma Occurrence and Recurrence Rates in Patients with Vitamin D Deficiency
(Springer, 2019) Ince, Bilsev; Yildirim, Mehmet Emin Cem; Dadaci, Mehmet
The study aimed to determine whether 25-OH vitamin D-3 deficiency is present in patients with diagnosed BCC, and the effect of vitamin D replacement on the rates of BCC recurrence in patients with 25-OH vitamin D-3 deficiency. In this prospective study, between 2012 and 2017, in the first stage, 25-OH vitamin D-3 levels of all patients diagnosed with BCC between 2012 and 2013 were evaluated. In the second stage between 2014 and 2015, we evaluated the 25-OH vitamin D-3 level of patients who had 25-OH vitamin D-3 level < 25 ng/mL. All the patients included in the second stage had BCC recurrence. In the third stage, the patients who were diagnosed 25-OH vitamin D-3 deficiency with BCC, between 2015 and 2017, were studied. The mean 25-OH vitamin D-3 level of the patients in the second stage was 10.12 ng/mL. Recurrence was observed in 9.64% of the patients in the second stage. The mean level of serum 25-OH vitamin D-3 in the third stage was 40.1 ng/mL, and 3.49% of these patients presented with recurrence. In all the patients as the initial diagnosis and following the 25-OH vitamin D-3 level in all the patients with BCC recurrence, maintaining 25-OH vitamin D-3 levels above 25 ng/mL can significantly reduce the recurrence rate.
Assessment of Outcomes After Limberg Flap Reconstruction for Scrotal Defects in Patients With Fournier's Gangrene
(H M P Communications, 2021) Dadaci, Mehmet; Yildirim, Mehmet Emin Cem; Yarar, Serhat; Ince, Bilsev
Background. Fournier's gangrene (FG) is a rarely encountered necrotizing fasciitis principally affecting skin and subcutaneous tissues of the genital region, perineum, and abdominal wall. The overall incidence of FG is 1.6 cases per 100 000 per year; the incidence in males is higher. Management techniques described in the literature have both advantages and disadvantages, and there is no gold standard treatment technique. Objective. This study evaluated whether the Limberg flap can be used reliably in scrotal defects with fewer complications than are seen with traditional techniques. The results of unilateral or bilateral Limberg flaps for scrotal reconstruction after FG were assessed. Materials and Methods. This retrospective, single-center study analyzed records from 29 male patients with scrotal defects after multiple debridements who were treated from January 2013 to January 2018. Twenty-one patients (72.4%) with hemiscrotal defects and 8 patients (27.6%) with defects involving greater than 50% of the scrotal surface were included in this study. Demographic data that were analyzed included smoking history, comorbid conditions, time of surgery, and time of follow-up. Flap dimensions were measured. Patients were evaluated in terms of flap viability and postoperative complications. Results. Mean age was 64 years (range, 47-80 years). The mean follow-up period was 16 months (range, 12-26 months). Dehiscence with seroma were detected in 4 patients (13.7%) on postoperative days 4 and 5. The average size of the flaps was 11 cm x 15 cm. Seroma and dehiscence were encountered in 4 patients (13.7%) during postoperative follow-ups. No postoperative infection was observed in any patient, and no partial or total flap loss was reported. Conclusions. These results suggest that use of the Limberg flap technique for scrotal reconstruction following FG has the important benefits of being easily harvested while providing tension-free repair and acceptable cosmetic results.
Assessment of sensory outcomes after successful fingertip replantation with or without nerve repair according to amputation level
(Wiley, 2021) Dadaci, Mehmet; Yildirim, Mehmet Emin Cem; Kendir, Selcuk; Ince, Bilsev
Background Good sensory outcome in fingertip replantation is a major part of the success of reconstruction and using the finger. Although some sensorial outcomes have been reported in various series in the literature, there is no controlled study, which demonstrates the anatomical levels where nerve repair should or should not be performed. We aimed to assess sensorial outcomes of fingertip amputations with or without nerve coaptation according to amputation level. Methods Between January 2013 and July 2018, patients with Tamai Zone 1 and Zone 2 amputations underwent replantation. The patients were divided two main groups. Patients underwent nerve coaptation were grouped as Group 1, and those coaptation not performed as Group 2. In addition, subgroups were designed according to level of the amputation. Tamai zone 1 amputations were grouped as groups 1a and 2a. Tamai zone 2 amputations were grouped as groups 1b and 2b. The mean age was 30.8 +/- 30.8 years in Group 1a, 33.2 +/- 12.6 years in Group 1b, 34.1 +/- 13.6 years in Group 2a, 34.3 +/- 11.1 years in Group 2b. Type of injury were evaluated as clean cut (with knife, saw etc.), moderately crushed, and severely crushed and/or avulsion. In Group 1a, one prominent branch of the nerve was repaired, and in Group 1b, the nerve in both side was repaired. The mean duration of replantation in Group 1a was 1 h and 40 min (1 h and 15 min-2 h), whereas this time was 1 h and 15 min (1 h - 1 h and 35 min) in Group 2a. Then, 2 h 15 min (1 h and 55 min-2 h and 50 min) in Group 1b, and 2 h (1 h and 45-2 h 25 min) in Group 2b. Mean age, type of injury and length of follow-up were statistically compared. Sensorial outcome was evaluated by 2-point discrimination test and the Semmes-Weinstein test. Results According to the Semmes-Weinstein test, 33% of the fingers tested were normal, 58% had diminished light touch, 8% had diminished protective sensation, and 0% had loss of protective sensation in Group 1a; In Group 1b, these values were 35% (7/20), 55% (11/20), 10% (2/20), 0%; in Group 2a, 38% (6/16), 56% (9/16), 6% (1/16), 0%; in Group 2b, 25% (4/16), 44% (7/16), %25 (4/16), 6% (1/16), respectively Mean static two-point discriminations in Groups 1a, 1b, 2a, and 2b were 4.17 +/- 0.58, 4.55 +/- 0.69, 4.25 +/- 0.68, and 5.9 +/- 1.26 mm, respectively. The mean follow-up duration was 24 months in Group 1a, 24 months in Group 1b, 26 months in Group 2a, 21 months in Group 2b. Then, 17 (3 in Group 1a, 6 in Group 1b, 4 in Group 2a, 4 in Group 2b) of the 64 fingers were clean cut amputation, 45 (9 in Group 1a, 14 in Group 1b, 11 in Group 2a, 11 in Group 2b) were moderately crushed amputation, and 2 (1 in Group 2a, 1 in Group 2b) were severely crushed and/or avulsion injury. There was no statistically significant difference between groups 1a and 2a (p = .71). On the other hand, there was a statistically significant increase in sensory outcomes of patients in Group 1b compared to Group 2b (p = .009). There was no statistically significant between the groups in terms of mean age, type of injury and length of follow-up. Conclusion We think that nerve repair does not have a positive effect on sensorial recovery in Tamai Zone 1 amputations, but nerve coaptation should be performed in Tamai Zone 2 replantations if possible for better sensorial result.
Assessment of survival rates compared according to the Tamai and Yamano classifications in fingertip replantations
(Medknow Publications & Media Pvt Ltd, 2016) Dadaci, Mehmet; Ince, Bilsev; Altuntas, Zeynep; Bitik, Ozan; Kamburoglu, Haldun Onuralp; Uzun, Hakan
Background: The fingertip is the most frequently injured and amputated segment of the hand. There are controversies about defining clear indications for microsurgical replantation. Many classification systems have been proposed to solve this problem. No previous study has simultaneously correlated different classification systems with replant survival rate. The aim of the study is to compare the outcomes of fingertip replantations according to Tamai and Yamano classifications. Materials and Methods: 34 consecutive patients who underwent fingertip replantation between 2007 and 2014 were retrospectively reviewed with respect to the Tamai and Yamano classifications. The medical charts from record room were reviewed. The mean age of the patients was 36.2 years. There were 30 men and 4 women. All the injuries were complete amputations. Of the 34 fingertip amputations, 19 were in Tamai zone 2 and 15 were in Tamai zone 1. When all the amputations were grouped in reference to the Yamano classification, 6 were type 1 guillotine, 8 were type 2 crush and 20 were type 3 crush avulsions. Results: Of the 34 fingertips, 26 (76.4%) survived. Ten (66.6%) of 15 digits replanted in Tamai zone 1 and 16 (84.2%) of 19 digits replanted in Tamai zone 2 survived. There were no replantation failures in Yamano type 1 injuries (100%) and only two failed in Yamano type 2 (75%). Replantation was successful in 14 of 20 Yamano type 3 injuries, but six failed (70%). The percentage of success rates was the least in the hybridized groups of Tamai zone 1-Yamano type 2 and Tamai zone 1-Yamano type 3. Although clinically distinct, the survival rates between the groups were not statistically significantly different. Conclusions: The level and mechanism of injury play a decisive role in the success of fingertip replantation. Success rate increases in proximal fingertip amputations without crush injury.
An Assessment of the Effects of Serum Vitamin D Levels on Snoring in Patients Who Have Undergone Septorhinoplasty
(Wolters Kluwer Medknow Publications, 2018) Ince, Bilsev; Sakarya, Mehmet Emin; Dadaci, Mehmet
Background/Aim: The aim of the study was to determine the clinical and radiological effects of septorhinoplasty and the change in serum Vitamin D levels on snoring. Patients and Methods: Sixty patients who attended with complaints of snoring, difficulty in breathing through the nose, and nasal deformity were included in this prospective study. Patients who only underwent septorhinoplasty were defined as Group 1, patients who underwent septorhinoplasty and were administered Vitamin D were defined as Group 2, and patients who were administered Vitamin D without undergoing septorhinoplasty were defined as Group 3. Results: In Groups 2 and 3, changes in the anteroposterior diameter of the air column, column of the airspace, and thickness of the soft palate and the uvula were statistically significant. Snoring decreased significantly at every postoperative follow-up in all three groups. This decrease was significantly higher in Group 2 than in Groups 1 and 3. Conclusions: We determined that one reason for snoring may be Vitamin D deficiency. Replacement of Vitamin D with removal of the upper respiratory tract problems may prevent snoring in patients with snoring and Vitamin D deficiency.
Base Nasal Bone Resection versus Oblique Nasal Bone Resection: A Comparative Study of the Outcomes for the Deviated Nose
(Lippincott Williams & Wilkins, 2017) Ince, Bilsev; Dadaci, Mehmet
Background: The aim of this study was to compare the techniques used for resection of the long side of the base and the top of the bone based on the patient's perspective, surgeon's approach, aesthetic results, complications, and need for secondary surgery in patients with asymmetric nasal bones. This study also aimed to determine the perspective of another plastic surgeon who did not perform rhinoplasty in comparison with the perspective of the primary plastic surgeon. Methods: One hundred sixty-six patients with nasal bone asymmetry between 2010 and 2015 were included in this study. Patients were divided into two groups: group 1, those treated with wedge resection of the bony nasal pyramid from the base of the nasal bone; and group 2, those treated with an oblique hump resection. Three different plastic surgeons and plastic surgery nurses who had no information regarding the randomization, patients, and primary plastic surgeon evaluated the surgical results. Results: The mean secondary surgery rate was significantly greater in group 2 than in group 1. The mean satisfaction ratio was significantly decreased with different plastic surgeons than with the primary plastic surgeon. Base nasal bone resection was more successful than oblique hump resection in patients with greater than or equal to 0.5-cm nasal bone asymmetry. Conclusions: Surgeons who did not perform the rhinoplasties can evaluate the results differently from the primary surgeon. Performing base bone resection may reduce the secondary surgery rate in patients with greater than or equal to 0.5-cm nasal bone asymmetry.
Central Pedicle Reduction in Gigantomastia Without Free Nipple Graft
(Lippincott Williams & Wilkins, 2016) Karacor-Altuntas, Zeynep; Dadaci, Mehmet; Ince, Bilsev; Karamese, Mehtap; Savaci, Nedim
Background 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.
COMMENTS ON VACUUM ASSISTED CLOSURE THERAPY FOR TREATMENT OF COMPLEX WOUNDS IN REPLANTED EXTREMITIES
(Wiley-Blackwell, 2014) Dadaci, Mehmet; Ince, Bilsev; Arslan, Abdullah
[Abstract Not Availabe]
A Comparison Between Hyaluronic Acid Filler and Dermofat Grafts With or Without Tie-Over Dressing for Lip Augmentation
(Lippincott Williams & Wilkins, 2024) Ince, Bilsev; Zuhour, Moath; Kadiyoran, Cengiz; Avunduk, Mustafa Cihat; Dadaci, Mehmet
BACKGROUND There are many different autologous grafts used for lip augmentation, such as fat, fascia, or dermofat grafts (DFG). However, filling with synthetic materials such as hyaluronic acid (HA) fillers is the most preferred method.OBJECTIVE The authors aimed to compare DFG with HA fillers regarding cost, permanence, complication rate, gained volume, and satisfaction rate. The authors investigated the effect of tie-over dressings on the viability of DFG.PATIENTS AND METHODS Patients who received hyaluronic acid fillers were referred to as Group H. Patients who received grafts without tie-over and with tie-over dressings formed Groups D1 and D2, respectively. The lip index (LI) was used for volume comparisons. The viable area of the grafts was measured using ultrasound imaging.RESULTS At postoperative month 6, the only significant difference was found between Group D1 and Group D2 (p < .05). At the postoperative first year, Groups D1 and D2 had a statistically higher LI value compared with Group H. Group D2 had a higher viable area than Group D2 (p < .05). Group H and Group D2 showed higher satisfaction scores than Group D1 (p < .05).CONCLUSION Dermofat grafts with or without tie-over dressings can be considered a reliable and inexpensive choice for patients who seek a more permanent procedure. Tie-over dressings increase the predictability of DFG and reduce the need for overcorrection.
Comparison of the Efficacy of Homologous and Autologous Platelet-Rich Plasma (PRP) for Treating Androgenic Alopecia
(Springer, 2018) Ince, Bilsev; Yildirim, Mehmet Emin Cem; Dadaci, Mehmet; Avunduk, Mustafa Cihat; Savaci, Nedim
Androgenetic alopecia (AGA), the most common cause of hair loss in both sexes, accounts for 95% of all cases of hair loss. Although the literature has suggested that both nonactivated (n-PRP) and activated autologous (a-PRP) PRP can be used to treat AGA, we did not find any study investigating the use of homologous PRP (h-PRP) for this purpose. Also, to the best of our knowledge, there are no studies comparing the efficacy of h-PRP, a-PRP, or n-PRP on AGA therapy. The aim of this study was to compare the increase in hair density, average number of platelets, complications, preparation, and duration of application in the treatment of AGA using a-PRP, n-PRP, and h-PRP. Between 2014 and 2015, we studied male patients who had experienced increased hair loss in the last year. Patients were divided into three groups: Group 1 received n-PRP, Group 2 received active PRP, and Group 3 received h-PRP. For Group 1, PRP was prepared by a single centrifugation prepared from the patient's own blood. For Group 2, the PRP was prepared from the patient's own blood, but a second centrifugation was applied for platelet activation with calcium chloride. For Group 3, the PRP was prepared from pooled platelets with the same blood group as the patient from the blood center. PRP was injected at 1, 2, and 6 months. The hair density (n/cm(2)) of each patient before and after injection was calculated. Each patient was assigned a fixed evaluation point at the time of application to calculate hair density. At 2, 6, and 12 months after the first treatment, the increase in hair density was calculated as 11.2, 26.1, and 32.4%, respectively, in Group 1; 8.1, 12.5, and 20.8%, respectively, in Group 2; and 16.09, 36.41, and 41.76%, respectively, in Group 3. The increase in hair density was statistically significantly greater in Group 1 than in Group 2 and more so in Group 3 than in both groups among all controls (p < 0.05). The efficacy of both PRPs was determined in AGA treatment in our study. However, it was determined statistically that the increase in hair density with h-PRP was greater than with autologous PRP groups. We believe that h-PRP therapy can be used in patients with AGA presenting with hair loss.
Computer-Assisted versus Conventional Freehand Mandibular Reconstruction with Fibula Free Flap: A Systematic Review and Meta-Analysis
(Lippincott Williams & Wilkins, 2020) Ince, Bilsev; Ismayilzade, Majid; Dadaci, Mehmet; Zuhal, Erdem
[Abstract Not Availabe]
Disastrous Complications Following Rhinoplasty: Soft Tissue Defects
(Lippincott Williams & Wilkins, 2020) Bilgen, Fatma; Ince, Bilsev; Ural, Alper; Bekerecioglu, Mehmet
Background: 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.
Does Estradiol Level in Platelet-Rich Plasma Improve Efficacy of Androgenic Alopecia Treatment?
(Oxford Univ Press Inc, 2020) Ince, Bilsev; Kendir, Munur Selcuk; Kilinc, Ibrahim; Avunduk, Mustafa Cihat; Dadaci, Mehmet; Savaci, Nedim
Background: Although some studies in the literature report that autologous and homologous platelet-rich plasma (PRP) can be employed in the treatment of androgenic alopecia (AGA), no study, to the authors' knowledge, has examined the estrogen concentration of prepared PRP. Objectives: The authors aimed to determine the presence of estrogen in PRP and to investigate the effect of estrogen concentration of PRP on AGA treatment. Methods: Between 2017 and 2018, 30 male patients with hair loss complaints were included in this prospective study. Autologous PRP was injected in patients in Group 1. Homologous PRP with high estrogen levels was injected in the patients in Group 2. PRP was injected in both groups 4 times at 0,1, 3, and 6 months. The obtained photographs were evaluated and hair densities of each patient at controls were calculated. Results: The mean estrogen level measured in PRP was statistically significantly higher in Group 2. In both groups, the increase in hair density was observed from the first month, but this increase was statistically significantly higher in all controls in Group 2. In Group 2, there was a statistically significant increase in the 1st and 3rd months compared with the previous control, but there was no difference between the 6th and 12th months and the 3rd month. Conclusions: Increased hair density is greater and earlier in the group receiving estrogen-rich PRP than in the group utilizing autologous PRP. The authors think that estrogen-rich PRP may be employed in the treatment of AGA in the presence of an appropriate donor.
Does hyperbaric oxygen therapy facilitate peripheral nerve recovery in upper extremity injuries? A prospective study of 74 patients
(Springer Heidelberg, 2022) Ince, Bilsev; Ismayilzada, Majid; Arslan, Abdullah; Dadaci, Mehmet
Purpose Several experimental studies have investigated the effects of hyperbaric oxygen therapy (HBOT) on peripheral nerve regeneration. However, to the best of our knowledge, clinical studies to evaluate the effects of HBOT on peripheral nerve recovery are seldom performed. The aim of our study was to investigate the efficacy of HBOT following primary nerve repair in patients with upper extremity nerve injuries. Methods Patients admitted to our hospital between 2015 and 2019 with ulnar and median nerve injuries were included in the study. Patients were randomized based on their application dates and divided into two different groups. Patients who received HBOT following standard epineural nerve repair were included in group 1, while patients who only underwent epineural nerve repair were included in group 2. All patients were followed up at 3, 6, and 12 months post-treatment and evaluated through electroneuromyography analysis of the traumatized nerve, injured nerve-related muscle strength, and two-point discrimination test. Results Impulse transmission of injured nerves to the end organ was faster in group 1. Further, ENMG parameters demonstrated that injured nerves of patients in group 1 recovered faster. Patients in group 1 also reached higher power score and had significantly more rapid motor recovery than patients in group 2. Conclusion This prospective study of upper extremity injuries demonstrated the favorable effects of HBOT on nerve recovery both clinically and electrophysiologically following nerve repair. One HBOT session each day for 5 days after surgical treatment can decrease morbidity and facilitate recovery.
The effect of a gap concept on peripheral nerve recovery in modified epineurial neurorrhaphy: An experimental study in rats
(Wiley, 2022) Ismayilzade, Majid; Ince, Bilsev; Zuhour, Moath; Oltulu, Pembe; Aygul, Recep
Background: Several factors such as surgical approach that only consider topographic anatomy; inadequate fascicular alignment, extraepineurial sprouting in the repair zone; contact of axons with the suture area are the disadvantages of epineurial neurorrhaphy. Accordingly, axonal mismatch, neuroma, and unfavorable nerve recovery become inevitable. Neurotropism is the theory clarifying appropriate matching of the nerve fibers independently without needing surgical approach. The studies comparing the primary nerve repair with the nerve defects bridged in different ways demonstrated better outcomes of nerve recovery in the groups with a nerve gap. In this study, we aimed to demonstrate the effects of the gap concept in primary nerve repair bridged by own epineurium. We hypothesized that this technique will provide better results in terms of peripheral nerve recovery and will significantly eliminate the occurrence of a neuroma, which is quite possible in epineurial neurorrhaphy. Materials and Methods: A total of 35 Wistar female rats weighing 200 similar to 250 g were randomly divided into five groups each with seven rats. Sham controls constituted Group 1, while the rats with epineural neurorrhaphy were included in Group 2. The remaining three groups were the study groups. In Group 3, after the sciatic nerve transection, epineurium of the distal segment was sleeved and preserved. A 2-mm axonal segment was removed from the epineurium free distal ending and no any procedure was applied to the proximal ending of the transected sciatic nerve. Epineuriums of the both sides were approximated and repaired. In Group 4, a 2-mm axonal segment was removed from the proximal ending of the sciatic nerve after preservation of epineurium and no any procedure was applied to the distal part of sciatic nerve. Epineuriums of the both sides were approximated and repaired. In addition, in Group 5, after epineuriums were sleeved in the both distal and proximal stumps, a 1-mm nerve segment was removed from both endings and epineuriums were Correspondence repaired in the middle bridging a 2-mm axonal gap again. After a 3 months follow-up period Sciatic Functional Index (SFI) was measured by walking track analysis; the area under the evoked compound muscle action potential (CMAP) and latency periods were calculated via electromyographic (EMG) analysis; and histopathological evaluation were performed to compare the parameters of edema, fibrosis, inflammation, vascularization, axonal degeneration, axonal density, myelination, disorganization, and neuroma occurrence. Vascular structures and nerve fibers were counted at x200 magnification: +1, +2, and +3 indicated the presence of 0-15, 16-30, and >30 structures, respectively. For uncountable parameters (edema, disorganization, myelination, fibrosis, and inflammation): +1 indicated mild, +2 indicated moderate, and +3 indicated severe. Results: The differences between the groups with axonal gap repair and epineural neurorrhaphy were not significant regarding to SFI. The areas under CMAP were as follows: 27.9 +/- 5.9 (Delta = 12.1%) in Group 1; 16.5 +/- 5.5 (Delta = 6.3%) in Group 2; 14.1 +/- 6.2 (Delta = 4.8%) in group 3; 13.8 +/- 2.3 (Delta = 9.2%) in Group 4, and 22.5 +/- 18.3 (Delta = 2.2%) in Group 5. Group 5 (1 mm gap in the distal +1 mm gap in the proximal segments) had a significantly better result in terms of the area under CMAP with the value of 22.5 +/- 18.3 m/Mv (p = .031). Axonal density was 0.9 +/- 0.6 (Delta = 2.2%) in Group 2, 2.4 +/- 0.3 (Delta = 5.1%) in Group 3, 2.8 +/- 0.1 (Delta = 7.7%) in Group 4, and 2.8 +/- 0.2 (Delta = 4.8%) in Group 5. Myelination was 1.1 +/- 0.5 (Delta= 3.4%) in group 2, 2.2 +/- 0.2 (Delta = 6.7%) in group 3, 2.4 +/- 0.4 (Delta = 6.0%) in Group 4, and 2.7 +/- 0.3 (Delta = 4.6%) in Group 5. Disorganization was 2.3 +/- 0.4 (Delta = 4.1%) in Group 2, 1.2 +/- 0.2 (Delta = 7.7%) in Group 3, 1.3 +/- 0.2 (Delta = 6.5%) in Group 4, and 1 +/- 0.3 (Delta = 5.9%) in Group 5. And, neuroma occurrence was found 2.2 +/- 0.6 (Delta = 2.8%) in Group 2 and 0.3 +/- 0.2 (Delta= 0.1%) in Group 4 while neuroma was not encountered in Group 3 and Group 5. Comparison between the epineurial neurorrhaphy group and the groups with axonal defect revealed the statistically significant results in the factors of axonal density (p =.001), myelination (p = .028), disorganization (p = .016) and neuroma (p = .001). Conclusions: Creating axonal gap bridged by own epineurium showed favorable results comparing with epineurial neurorrhaphy. Resection of a 1 mm axonal segment from the proximal and distal stumps following the epineurial sleeve procedure and performing the epineurium- only repair can facilitate the nerve regeneration. The feasibility of the described technique has been demonstrated in a small rat model and must be further validated in larger animals before clinical testing.
Effect of cineole, alpha-pinene, and camphor on survivability of skin flaps
(Tubitak Scientific & Technological Research Council Turkey, 2018) Ince, Bilsev; Dadaci, Mehmet; Kilinc, Ibrahim; Oltulu, Pembe; Yarar, Serhat; Uyar, Mehmet
Background/aim: The aim of this study was to determine the specific component of Rosmarinus officinalis (RO) responsible for increased flap survival and how RO displays its efficacy. Materials and methods: Rectangular random-pattern flaps were elevated from the back of each rat. Group I was the control group. In group II 0.1 mL of cineole, in group III 0.1 mL of alpha-pinene, in group IV 0.1 mL of camphor, in group V 0.1 mL each of alpha-pinene and cineole, in group VI 0.1 mL each of alpha-pinene and camphor, in group VII 0.1 mL each of cineole and camphor, and in group VIII, 0.1 mL each of alpha-pinene, cineole, and camphor was orally administered once a day before surgery. The luminal area of the largest blood vessel in the proximal flap was measured. Interleukin-1, tumor necrosis factor alpha, thiobarbituric acid reactive substances, and vascular endothelial growth factor values were measured. Results: The mean percentage of the viable surface area was significantly greater in groups VIII, III, and V. The mean percentage of vessel diameter was significantly greater in groups V, VIII, and VII. Conclusion: We suggest that alpha-pinene and cineole were the components of RO that were responsible for increased flap survival. The most effective of feature of RO was the antiinflammatory effects.
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, Fatma
Both 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.
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, Fatma
BackgroundThe 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.
The effect of dobutamine treatment on salvage of digital replantation and revascularization
(Springer Heidelberg, 2023) Ince, Bilsev; Uyanik, Orkun; Ismayilzade, Majid; Yildirim, Mehmet Emin Cem; Dadaci, Mehmet
PurposeOne of the most common causes of a failure after replantation and revascularization surgeries is 'no reflow' from proximal artery that occurs, especially following crush and avulsion injuries. In this study, we aimed to evaluate the effect of dobutamine treatment on salvage of replanted and revascularized digits.MethodsThe patients with no reflow phenomenon detected in the salvage operations of replanted/revascularized digits between the years 2017 and 2020 were included in the study. Dobutamine treatment was infused at a rate of 4 & mu;g & BULL;kg(-1)& BULL;min(-1) intraoperatively and of 2 & mu;g & BULL;kg(-1) min(-1) postoperatively. Demographic data (age, sex), digit survival rate, ischemia time, and level of injury were retrospectively analysed. Pre-infusion, intraoperative and postoperative values of cardiac index (CI), mean arterial pressure (MAP), and heart rate (HR) were recorded.ResultsThe phenomenon of 'no reflow' was encountered in 35 digits of 22 patients who underwent salvage surgery due to vascular compromise. The survival rate in the revascularization group was 75%, while it was 42.1% in the replanted digits. Metaphysis level of proximal phalanx was the most common localization for 'no reflow' phenomenon. The least values of CI, MAP and HR to obtain sufficient perfusion in salvaged digits were as follows: 4.2 l.min(-1).m(-2), 76 mm Hg, and 83 beat & BULL;min(-1), respectively.ConclusionsIt was demonstrated that dobutamine infusion at a rate of 4 & mu;g & BULL;kg(-1)& BULL;min(-1) intraoperatively and at 2 & mu;g & BULL;kg(-1)& BULL;min(-1) postoperatively has favorable effects on the vascular compromise derived from no reflow of proximal artery.

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