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Öğe Assessment of Patients Who Underwent Nasal Reconstruction After Non-Melanoma Skin Cancer Excision(Lippincott Williams & Wilkins, 2015) Uzun, Hakan; Bitik, Ozan; Kamburoglu, Haldun Onuralp; Dadaci, Mehmet; Calis, Mert; Ocal, EnginBackground: Basal and squamous cell carcinomas are the most common malignant cutaneous lesions affecting the nose. With the rising incidence of skin cancers, plastic surgeons increasingly face nasal reconstruction challenges. Although multiple options exist, optimal results are obtained when like is used to repair like''. We aimed to introduce a simple algorithm for the reconstruction of nasal defects with local flaps, realizing that there is always more than one option for reconstruction. Patients and Methods: We retrospectively reviewed 163 patients who underwent nasal reconstruction after excision of non-melanoma skin cancer between March 2011 and April 2014. We analyzed the location of the defects and correlated them with the techniques used to reconstruct them. Results: There were 66 males and 97 females (age, 21-98 years). Basal cell carcinoma was diagnosed in 121 patients and squamous cell carcinoma in 42. After tumor excision, all the defects were immediately closed by either primary closure or local flap options such as Limberg, Miter, glabellar, bilobed, nasolabial, V-Y advancement, and forehead flaps. Conclusions: Obtaining tumor-free borders and a pleasing aesthetic result are major concerns in nasal reconstruction. Defect reconstruction and cosmesis are as important as rapid recovery and quick return to normal daily activities, and these should be considered before performing any procedure, particularly in elderly patients.Öğe 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, HakanBackground: 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.Öğe Long-Term Changes in Nipple-Areolar Complex Position and Inferior Pole Length in Superomedial Pedicle Inverted 'T' Scar Reduction Mammaplasty(Springer, 2015) Altuntas, Zeynep Karacor; Kamburoglu, Haldun Onuralp; Yavuz, Nurten; Dadaci, Mehmet; Ince, BilsevProper nipple-areolar complex position in reduction mammoplasty patients is a challenging problem regardless of the preferred technique. Postoperatively, the nipple-areolar complex is often not located at the most projected area of the breast. This retrospective observational study aimed to find the long-term measurements of the nipple-areolar complex position and inferior pole length after inverted T scar-superomedial pedicle reduction mammoplasty. Forty-eight female patients (96 breasts) were included in this study. The inclusion criteria were that no previous operation should have been done on any of the breasts and both NAC complexes should be at least 30 cm from the midclavicular point. Preoperatively, the distance from the midclavicular point to the new nipple was recorded. All patients were operated on with the inverted T pattern and superomedial pedicle technique. The resection weights, the distance from the midclavicular point to the nipple distance, and the distance from the NAC lower border to the inframammary fold were evaluated postoperatively with an average of 15-month follow-up. The mean preoperative distance from the midclavicular point to the nipple was 34.21 cm for the right breast and 34.26 cm for the left breast. The mean resection weight per breast was 1035 g for the right breast and 1081 g for the left breast. The descent of the NAC was 1.61 cm for the right breast and 1.79 cm for left breast (mean: 1.7 cm) at the end of the follow-up. Additionally, the inframammary length increased 3.31 cm for the right breast and 3.59 cm for the left breast (mean: 3.45 cm). In this study, we found that the new nipple-areolar complex does not go upward but goes downward. However, it was not located at the most projected area of the breast as it was set intra-operatively. This was because the lower pole of the breast sagged more than the nipple: clinically, we observed a nipple superior displacement of 1.75 cm (3.45 - 1.7 = 1.75). According to this calculation, we believe that the new nipple position should be marked at 1.5-1.75 cm below the most projected area of the breast after final shaping so that in the long term, the nipple-areolar complex would be at the proper position. 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 Nasal Tip Suspending Transfixion Suture(Springer, 2014) Bitik, Ozan; Uzun, Hakan; Kamburoglu, Haldun Onuralp; Dadaci, MehmetAnterior septal height is an important determinant of nasal tip projection. Accordingly, the anterior septal extension technique has proven itself to be a powerful tool for achieving long-lasting nasal tip projection in rhinoplasty. However, anterior septal extension does not protect against postoperative loss of nasal tip rotation unless an additional suspension strategy is used. A tip-suspending transfixion suture is the authors' strategy for supporting nasal tip rotation whenever an anterior septal extension technique is performed. Of 156 rhinoplasties performed by the authors between 2010 and 2012, a cohort of 22 droopy-tip rhinoplasties was extracted in which the described technique was used. The patients in this cohort were included in a retrospective nasal tip projection and rotation analysis. The nasolabial angle (NLA) and Goode ratio measurements were compared between preoperative, 3-week postoperative, and 1-year postoperative profile-view photographs. The NLA and the Goode ratio measurements were significantly higher in the 3-week postoperative group than in the preoperative group, indicating an effective gain in both tip projection and rotation. The NLA and the Goode ratio measurements did not differ statistically between the postoperative 3-week and postoperative 1-year groups, indicating long-term maintenance of nasal tip position. A tip-suspending transfixion suture is an easy method for securing nasal tip rotation when used in conjunction with an anterior septal extension. 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 Skin bridging secondary to ingrown toenail(Professional Medical Publications, 2014) Dadaci, Mehmet; Ince, Bilsev; Altuntas, Zeynep; Kamburoglu, Haldun Onuralp; Bitik, OzanIngrown toenails are painful conditions that especially affect young people and may become chronic if not treated. We describe a case of chronically inflamed ingrown toenail left untreated for three years. In the physical examination, skin bridging and epithelialization was observed in midline secondary to soft tissue hypertrophy of the lateral nail matrixes. Epithelized fibrous tissue was cut across the lateral nail matrix and left for secondary healing. Partial matrixectomy was applied and the remnants were cauterized in compliance with the Winograd procedure after removal of the nail. Our case is an advanced condition which is the second report in the literature. Skin bridging secondary to excess soft tissue hypertrophy can be observed in untreated bilateral Heinfert or Frost stage 3 ingrown nails. This rare case can be classified as advanced stage 3 disease or stage 4.