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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 the Effect of Platelet-Rich Plasma and Simvastatin on Healing of Critical-Size Calvarial Bone Defects(Lippincott Williams & Wilkins, 2016) Seyhan, Nevra; Keskin, Suat; Aktan, Murat; Avunduk, Mustafa Cihad; Sengelen, Meltem; Savaci, NedimObjective: In previous studies, it has been shown that both simvastatin (chlolesterollowering drug) and platelet-rich plasma (PRP) were capable of promoting bone formation. The aim of this study was to compare the effects of PRP and simvastatin on healing of critical-size bone defects. Methods: A total of 33 rats (3 for PRP preparation) were used in the experiment. Critical-size defect 8-mm diameter was created in 30 rats' calvarium. Rats were divided into 3 groups. Each group contained 10 animals. In Group A the defect was filled with phosphate-buffered saline only, in Group B with 0.5 mL PRP, and in Group C with 0.1 mg simvastatin. The defects were evaluated by radiographic analysis at 8th and 16th weeks. The animals were sacrificed 16 weeks after the surgery. Histological examination was performed to assess the new bone-forming area. Vessels, fibroblasts, osteoblasts, and osteoclasts were marked in 524749.1-mu m(2) area and counted with using Clemex Vision Lite 3.5 Image Analysis program. The results were statistically analyzed.Öğe 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, NedimAndrogenetic 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.Öğe 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, NedimBackground: 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.Öğe EARLY AND LATE TERM MICROSURGICAL FREE FLAP RECONSTRUCTION AND RISKS IN HIGH VOLTAGE ELECTRICAL INJURY(Carbone Editore, 2013) Karabekmez, Furkan Erol; Duymaz, Ahmet; Tosun, Zekeriya; Keskin, Mustafa; Savaci, NedimThe aim of the study is to discuss and compare the early and late micro vascular flap reconstruction's outcomes, importance, risks, advantages and disadvantages with review of our 13 high voltage electrical burn injury cases. Medical records have been reviewed for electrical burns in last three years. 13 cases fitting the criterion were included into the study. Four of them have been hospitalized for late complication such as severe contracture; nine of them have been hospitalized for acute treatment. Five patients had latissimus dorsi muscle flap, three patients had parascapular flap, two patients had latissimus dorsi and scapula osteomusculo-cutaneous flap, two patients had reams abdominis musculocutaneous flap, and one patient had parascapular and scapular flap. Early reconstruction applied group showed a significant difference regarding to flap failure rates. Electrical injuries are more complex than regular burn injuries related with heat, and the reconstruction of these cases also should be special. One of the most important factor for free flap viability in electrical injury cases is surgery timing. All of the complications were seen in the patients who had surgery at 12th and 19th days after the electrical injury. No complication has seen in the group of patients who had surgery on late term period. However microsurgical reconstruction should be considered to cover exposed bony tissues on the extremities in the short term period in order to prevent possible limb shortening procedures.Öğe The Effect of Combined Use of Platelet-Rich Plasma and Adipose-Derived Stem Cells on Fat Graft Survival(Lippincott Williams & Wilkins, 2015) Seyhan, Nevra; Alhan, Dogan; Ural, Ali Ugur; Gunal, Armagan; Avunduk, Mustafa Cihad; Savaci, NedimBackground Free fat grafts have an unpredictable survival rate that limits their successful use. To increase the viability of fat grafts, it is important to minimize the reabsorption rate. Objective Our aim was to investigate whether the combined use of platelet-rich plasma (PRP) and adipose derived stem cells (ADSCs) would contribute an improvement in lower resorption rates of fat grafts. Methods Inbred Fischer 344 rats were randomized into 4 groups (n = 10). Fat grafts were mixed with Dulbecco modified Eagle medium in group A, with PRP in group B, with ADSC in group C, and with PRP + ADSC in group D and were injected to the scalp. In vitro growth factor (vascular endothelial growth factor, transforming growth factor-, and fibroblast growth factor) levels were compared using enzyme-linked immunoassay method. After 12 weeks weight, volume and histology of the transplants were evaluated. Results The mean weight and volume of the fat grafts were highest in group D. Histopathological investigations revealed that the number of viable adipocytes and blood vessels were highest in group D. The level of growth factors was significantly higher in stem cell plus PRP group. Conclusion Adipose-derived stem cells combined with PRP can enhance the survival of transplanted fat tissue.Öğe The effects of melatonin on the healing of burn wounds in pinealectomized rats(Turkish Assoc Trauma Emergency Surgery, 2021) Sari, E. Cigdem Karadag; Savaci, NedimBACKGROUND: The present study aims to investigate the favorable effects of melatonin on burn wound healing in rats. METHODS: In this study, forty Wistar-albino-type male rats were divided into four groups. Group 1 was the control group, Group 2 rats were treated using exogenous melatonin, Group 3 rats were pinealectomized, and Group 4 rats were pinealectomized then treated with exogenous melatonin. In all groups, a deep second-degree burn was created on the backs of the rats with a metal plate heated in boiling water. We monitored the progress of burn healing for seven days. At the end of them, we evaluated hydroxyproline levels, type III collagen, edema, inflammatory infiltration, congestion, vascular proliferation, fibrosis, the thickness of the zone of stasis and the epithelium to assess the progress of healing. RESULTS: The zone of stasis was less thick in Group 2 than the other groups (p=0.009). Type III collagen dyeing (p=0.031), fibrosis (p=0.011) and edema (p=0.031) were higher in Group 2 than the other groups. Congestion was higher in the control group than Group 4 (p=0.031). Other evaluated parameters showed no significant differences among the groups. CONCLUSION: In this study, it was noted that once total melatonin levels exceeded a certain threshold, a preventive effect was exerted on burn wound damage progression by reducing the zone of stasis. Melatonin may also prevent the development of hypertrophic scarring. Melatonin may be a potential therapeutic option that can supplement traditional treatment in burn wounds; however, further studies with higher doses of exogenous melatonin administered over longer periods are needed to further evaluate the effects noted in this study.Öğe The effects of melatonin on the healing of burn wounds in pinealectomized rats(Turkish Assoc Trauma Emergency Surgery, 2021) Sari, E. Cigdem Karadag; Savaci, NedimBACKGROUND: The present study aims to investigate the favorable effects of melatonin on burn wound healing in rats. METHODS: In this study, forty Wistar-albino-type male rats were divided into four groups. Group 1 was the control group, Group 2 rats were treated using exogenous melatonin, Group 3 rats were pinealectomized, and Group 4 rats were pinealectomized then treated with exogenous melatonin. In all groups, a deep second-degree burn was created on the backs of the rats with a metal plate heated in boiling water. We monitored the progress of burn healing for seven days. At the end of them, we evaluated hydroxyproline levels, type III collagen, edema, inflammatory infiltration, congestion, vascular proliferation, fibrosis, the thickness of the zone of stasis and the epithelium to assess the progress of healing. RESULTS: The zone of stasis was less thick in Group 2 than the other groups (p=0.009). Type III collagen dyeing (p=0.031), fibrosis (p=0.011) and edema (p=0.031) were higher in Group 2 than the other groups. Congestion was higher in the control group than Group 4 (p=0.031). Other evaluated parameters showed no significant differences among the groups. CONCLUSION: In this study, it was noted that once total melatonin levels exceeded a certain threshold, a preventive effect was exerted on burn wound damage progression by reducing the zone of stasis. Melatonin may also prevent the development of hypertrophic scarring. Melatonin may be a potential therapeutic option that can supplement traditional treatment in burn wounds; however, further studies with higher doses of exogenous melatonin administered over longer periods are needed to further evaluate the effects noted in this study.Öğe Ethyl Alcohol Versus Botulinum Toxin A: A Comparative Study of the Visual and Histopathological Outcomes in the Rabbit Anterior Auricular Muscle Model(Lippincott Williams & Wilkins, 2020) Ince, Bilsev; Uyanik, Orkun; Oltulu, Pembe; Ismayilzade, Majid; Dadaci, Mehmet; Savaci, NedimBACKGROUND Botulinum toxin has long been known for its paralytic effects at the neuromuscular junction. Although it has been widely used for vascular and nervous tissues, there has been no study of the aesthetic effects of the application of ethanol to muscle tissues to date. OBJECTIVE The authors aimed to demonstrate the effects of the application of ethanol to muscle tissues after an intramuscular injection and to compare the effects of botulinum toxin A (BTA) and ethanol. METHODS AND MATERIALS: A total of 28 rabbits were divided into 4 groups (n = 7 each). Botulinum toxin A (5 units) and different concentrations of ethanol (5 cc) were injected into the left and right anterior auricular muscles of all rabbits, respectively. Ear ptosis was assessed, and histopathological examination was performed after all rabbits were euthanized in the eighth week. RESULTS Muscle function was affected earlier in ethanol-treated ears than in botulinum-treated ears; however, the ptotic effect lasted for a significantly shorter duration in ethanol-injected ears than in BTA-applied ears. CONCLUSION Ethanol can block muscle function reversibly and can serve as an alternative to BTA, particularly when rapid results are desirable.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 PLATELET RICH PLASMA (PRP), PLATELET POOR PLASMA (PPP), PLATELER RICH FIBRINE (PRF) CONCEPTS, THEIR BIOLOGICAL ROLES ON WOUNG HEALING AND CLINICAL APPLICATIONS IN PLASTIC SURGERY(Medknow Publications & Media Pvt Ltd, 2014) Altuntas, Zeynep; Gundeslioglu, A. Ozlem; Ince, Bilsev; Dadaci, Mehmet; Savaci, NedimThe better understanding of the biology of wound healing shows that platelets and especially the growth factors they contain play a main role on hemostasis and healing. Studies show that autologous platelet rich plasma increases wound healing. Its clinical applications are also increasing and recently its effects on tissue regeneration have been discussed. In this study, the different PRP concepts, and their effects on wound healing and clinical applications in plastic surgery were discussed.
