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Öğe Central Pedicle Reduction in Gigantomastia Without Free Nipple Graft(Lippincott Williams & Wilkins, 2016) Karacor-Altuntas, Zeynep; Dadaci, Mehmet; Ince, Bilsev; Karamese, Mehtap; Savaci, NedimBackground 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.Öğe Comparison of Bone Dust With Other Types of Bone Grafts for Cranioplasty(Lippincott Williams & Wilkins, 2014) Karamese, Mehtap; Toksoz, Mustafa Rasid; Selimoglu, Muhammed Nebil; Akdag, Osman; Toy, Hatice; Tosun, ZekeriyaPurpose: Split calvarial bone graft is preferred in the reconstruction of calvarial defects. However, it is not feasible for use in some challenging cases and in children. Particulate bone graft containing viable osteoblasts could be an attractive alternative. Materials and Methods: A total of 32 female rats were randomly separated into 4 groups. Full-thickness bone graft from rat calvaria was harvested in diameters of 8 x 8 mm. In group 1, the periosteum and skin were closed without any bone graft; bone dust particles were placed in group 2; bone fragments were placed in group 3; and full-thickness cranial bone graft was placed in group 4. After 12 weeks, all rats were killed. Degrees of resorption, foreign body reaction, and bone spicule length were assessed histologically, and an immunohistochemical study was used to show bone graft viability. Results: In graft viability, osteogenesis, and osteoblastic differentiation, groups 3 and 4 were similar and superior to groups 1 and 2. No osteoblastic activity and no viable bone dust were detected in groups 1 and 2. Resorption was observed in every preparate that contains bone tissue, and foreign body reaction was prominent in small bone groups, such as in group 2. Conclusions: In the full-thickness cranial bone graft group and the bone fragment group, the preservation of bone viability was obviously superior to the bone dust group and the periosteum-only group. In conclusion, bone dust behaved like the periosteum and could not create new bone, whereas bone particles behaved like the full-thickness cranial bone graft and were capable of preserving viability.Öğe The Effects of Adipose-Derived Mesenchymal Stem Cells and Adipose-Derived Mesenchymal Stem Cell-Originating Exosomes on Nerve Allograft Regeneration An Experimental Study in Rats(Lippincott Williams & Wilkins, 2023) Koplay, Tugba Gun; Yildiran, Gokce; Dursunoglu, Duygu; Aktan, Murad; Duman, Selcuk; Akdag, Osman; Karamese, MehtapIntroductionNerve regeneration has been the subject of many studies because of its complex mechanism and functional outcome. Mesenchymal stem cells and exosomes are promising factors in regeneration in many areas. Reconstruction of nerve defects is a controversial issue, and nerve allografts are promising alternatives with many advantages. In this study, it is aimed to evaluate the nerve regeneration in cellularized and decellularized nerve allografts and whether it is possible to accelerate this process with adipose-derived mesenchymal stem cells (ad MSC) or ad MSC-originating exosomes.MethodThis study was performed with 36 Lewis and 18 Brown Norway isogenic male rats aged 10 to 12 weeks and weighing 300 to 350 g. The Lewis rats were divided into 6 groups. Nerve allografts at a length of 12 mm that were obtained from the Brown Norway rats' proximal portion of both sciatic nerve branching points were coapted as cellularized in group A and decellularized in group B to the sciatic nerve defects of the Lewis rats. Group A received oral tacrolimus (0.2 mg/kg) for 30 days. Perineural saline (A1-B1), ad MSC (A2-B2), or ad MSC-originating exosomes (A3-B3) were applied to these groups. Walking track analysis, pinch-prick test and electromyelography were applied at the 8th and 16th weeks following surgery. Nerves were examined histopathologically at the 16th week.ResultsBetween cellularized groups, better results were shown in A3 about axon-myelin regeneration/organization (P = 0.001), endoneural connective tissue (P = 0.005), and inflammation (P = 0.004). Better results were shown in the B2 and B3 groups electromyelographicaly about latency period (P = 0.033) and action potential (P = 0.008) at late period, and histomorphologicaly at vascularization (P = 0.012).DiscussionIt is argued that regeneration is accelerated with decellularization of nerve allografts by removing the chondroidin sulfate proteoglycans. The positive effects of stem cells are derived by exosomes without the cell-related disadvantages. In this study, better results were obtained by decellularization and perineural application of ad MSC and/or ad MSC exosome.Öğe Intra-articular platelet-rich plasma injection for the treatment of temporomandibular disorders and a comparison with arthrocentesis(Churchill Livingstone, 2015) Hanci, Mustafa; Karamese, Mehtap; Tosun, Zekeriya; Aktan, Tahsin Murad; Duman, Selcuk; Savaci, NedimBackground: Temporomandibular joint (TMJ) internal derangements are progressive painful conditions and cause joint dysfunction, joint sound, malocclusion, and locking of the mouth. Conservative and invasive techniques can be used for the treatment of TMJ internal derangements. The objective of the present study was to examine the benefit of an intra-articular platelet-rich plasma (PRP) injection and to compare this with arthrocentesis. Methods: Twenty patients (female: male; 15: 5; age 26, 3 +/- 9.3 years) for a total of 32 joints with reducible anterior disc dislocation, as confirmed by Magnetic Resonance Imaging (MRI), were divided into two groups. PRP was used for the study group, and arthrocentesis was used for the control group. Pain intensity, maximal interincisal opening, and TMJ sounds were assessed and compared for evaluation of treatment success. Results: There was a statistically significant reduction in pain intensity and joint sound and an increase in mouth opening in the study group when compared with the control group. Conclusions: This study shows that intra-articular PRP injection for the treatment of reducible disc displacement of the TMJ is a more effective method than arthrocentesis. (C) 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.Öğe ORBITAL VENOUS MALFORMATION COMPLIATING WITH PERGNANCY: CASE REPORT(Medknow Publications & Media Pvt Ltd, 2012) Karamese, Mehtap; Selimoglu, M. Nebil; Toksoz, Mustafa Rasid; Sutcu, Mustafa; Keskin, MustafaIntroduction: One of the reason of orbital masses are vascular malformation. Vascular malformation grows up during pregnancy. Case: Here, we presented a 32-years-old patient with venous hemangioma which became symptomatic during pregnancy and required surgical intervention. Conclusion: In this case, we discussed here the terminology of venous malformation and cavernous hemanjioma. Progress and treatment of venous malformations during pregnancy are also discussed.Öğe A SAFE METHOD IN RHINOPHYMA SURGERY : EXCISION WITH PLASMA BLADE(Medknow Publications & Media Pvt Ltd, 2011) Toksoz, M. Rasid; Selimoglu, M. Nebil; Karamese, Mehtap; Abaci, Malik; Tosun, Zekeriya[Abstract Not Availabe]Öğe VACUUM THERAPY AND PECTORALIS MAJOR MUSCLE FLAP COMBINATION IN TREATMENT OF STERNAL INFECTIONS: A CASE REPORT(Medknow Publications & Media Pvt Ltd, 2014) Karamese, Mehtap; Akdag, Osman; Yildiran, Gokce Unal; Selimoglu, Muhammed Nebil; Gormus, Niyazi; Tosun, ZekeriyaWound infections subsequent to cardiac surgery are challenging surgeons because of being life-threatening situations and these infections are among conditions that require multidisciplinary approach. Antibiotherapy, surgical debride-ments, regional or free flap surgeries are used by multidisciplinary approach in the treatment of sternal wound infections. Beside these known alternatives, some other methods are advanced for wound care. However; sternal instability, ventricular rupture and pneumonia may be mortal in many patient as the course of the disease. In this article, a negative pressure wound therapy and reconstruction with pectoralis major muscle flap was introduced for postoperative mediastinitis occurred in a diabetic, coronary bypass patient. A wound therapy, that controls infection and supplies wound care as an effective treatment alternative for highly mortal mediastinis cases.
