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Öğe 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, MehmetBACKGROUND 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.Öğe 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, RecepBackground: 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.Öğe Effect of methylprednisolone loaded poly lactic-co-glycolic acid (PLGA) bioabsorbable nanofibers on tendon healing and adhesion formation(Elsevier, 2023) Zuhour, Moath; Gunes, Cansu; Findik, Siddika; Dundar, Mehmet Akif; Gok, Orhan; Altuntas, ZeynepBackground: Nanomaterials have been widely used in many fields such as vaccination and drug delivery. Beside its behavior as a degradable physical barrier, it can provide a controlled drug release. Tendon healing is a process full of complications, one of which is adhesion caused by excessive fibrosis.Aim: In this study, we aimed to prevent adhesion formation by using methylprednisolone (MP) loaded Poly lactic-co-glycolic acid (PLGA) mats. We used PLGA mats as both, biodegradable physical barrier to reduce the contact between surrounding tissues and healing tendon and as a drug delivery vehicle to release the antifibrotic MP with a controlled pattern.Methods: MP-loaded PLGA nanofiber mats were produced using electrospinning technique under optimized pa-rameters. To find the optimal MP dose, the drug was loaded in 15%, 25% and 35% concentrations. In vitro analysis included FT-IR, antibacterial, water absorption, biodegradability and drug release behavior tests. 70 rats' tendons were used for this study. After scarification of the rats, tendons were analyzed in terms of macroscopic, histopathological and biomechanical evaluation.Results: The neat PLGA and 15%, 25%, and 35% MP-loaded nanofibers lost 47%, 83%, 88%, and 97% of their initial weights at the end of the 8 weeks' degradation process. Within the first 24 h, mats including higher drug concentrations showed more initial release burst effect than samples loaded with lower concentrations. Cumu-lative drug release at 24 h was 29.5%, 27.6%, and 24.7% for PLGA nanofiber samples containing 15%, 25%, 35% MP, respectively. Macroscopically, When the groups were compared, no statistically significant difference was found between group 1 (no surgical intervention) and group 5 (25% MP/PLGA) in terms of length, characteristics and degree of the adhesion. Comparing to other groups statistically significant atrophic effect was found in group 6 (35% MP/PLGA).Conclusion: 25% MP-loaded PLGA reduces the formation of adhesions macroscopically comparable to tendons that didn't receive any surgical intervention. Microscopically, it provides better tendon healing compared to tendons that received only surgical repair or surgery + neat PLGA. Methylprednisolone did not only add an antibacterial effect to PLGA but also increased the hydrophilic property and degradation rate of PLGA. Increased steroid concentration also leads to atrophy at the healing tendons which can be prevented by modifying the PLGA design.Öğe Fournier's Gangrene as a Possible Surgical Complication of COVID-19: Two Case Reports and Literature Review(Wolters Kluwer Medknow Publications, 2022) Zuhour, Moath; Dadaci, Mehmet; Baycar, Zikrullah; Ince, Bilsev; Soylu, ArdaFournier's gangrene (FG) is a rare form of necrotizing fasciitis affecting the perineal, perianal, or genital areas. The infection is usually seen in diabetic, alcoholic, or immunosuppressed patients. Urgent debridement and broad-spectrum antibiotics are the first-line therapy, where in some cases soft tissue reconstruction is required. We report two patients who developed FG during COVID-19 infection. None of the patients had a history of diabetes mellitus, alcoholism, or immune deficiency. The only reported health condition was COVID-19 infection. Emergent debridement and elective reconstruction were performed for both of the patients. High index of suspicion is required during the examination of the perineum and the genitalia of suspected patients with COVID-19 infection for early diagnosis and prevention of further complications. Larger studies are required to indicate the exact incidence of FG in patients with COVID 19 infection.Öğe The Impact of Surgical Procedures During Septorhinoplasty on the Intraoperative Pain Response(Oxford Univ Press Inc, 2021) Ince, Bilsev; Zuhour, Moath; Yusifov, Merve; Erol, Atilla; Dadaci, MehmetBackground: During septorhinoplasty, many different surgical procedures are employed to bring the nose to the desired shape and solve breathing complaints. As a matter of course, intraoperative pain response occurs due to these procedures. Objectives: With this study, the authors aimed to evaluate the intraoperative pain formed during septorhinoplasty surgery with numerical values and to determine which stage of surgery is more painful. Methods: Between April 2019 and March 2020, a total of 30 female patients who were planned to undergo septorhinoplasty were included in this prospective study. Standard anesthesia and analgesia were applied to all patients. During surgery, state entropy measure was utilized to evaluate the depth of anesthesia, and Surgical Pleth Index was employed to evaluate the response of the central nervous system to pain nociception. Results: The age of the patients ranged from 18 to 42 years (average, 25.3+/-6.1 years). The average value of state entropy recorded during the surgery for all patients was found to be 45.43+/-5.37. The mean beginning Surgical Pleth Index value recoded from all of the patients was 23.4 +/- 8.84 compared with the beginning value; the values recorded during periost dissection, lateral osteotomy, and lower turbinate lateralization were statistically significantly higher (P<0.005). Conclusions: Although sufficient depth of anesthesia and standard protocol of analgesia were applied, pain response was found to be significantly higher at some procedures during septorhinoplasty. The authors think that increasing the depth of anesthesia during these procedures will increase the comfort of this operation by inhibiting pain response. Level of Evidence: 4Öğe The Impact of Wearing a Face Mask during the COVID-19 Pandemic on Temporomandibular Joint: A Radiological and Questionnaire Assessment(Thieme Medical Publ Inc, 2022) Zuhour, Moath; Ismayilzade, Majid; Dadaci, Mehmet; Ince, BilsevAim Several health problems have been reported to be triggered or facilitated by prolonged mask usage during the coronavirus disease 2019 (COVID-19) pandemic. While wearing a face mask, people tend to push their jaws forward and downward in a repetitive manner to hold their masks in the right position; these jaw motions may induce temporomandibular joint disorder (TMD). In this study, we aimed to investigate these repetitive jaw movements while wearing face masks and their effects on TMD. Patients and Methods Patients who applied with TMD signs between June 2020 and May 2021 were evaluated prospectively. A survey using a questionnaire was conducted to define patients with TMD that caused only by mask-related repetitive jaw movements. Demographic data (age and gender), mean duration of daily mask usage, mask type, and magnetic resonance imaging results were recorded. Results Prolonged daily mask usage (>= 8 hours/day) was significantly higher in patients with mask-related habits (group a) with a rate of 40.4% ( p approximate to 0.001). Also, in this group, the disc displacement with reduction rate (54.6%) was higher compared with other groups ( p approximate to 0.010). On the contrary, patients with no underlying risk factor (group c) showed an unexpected high osteoarthritis rate ( p approximate to 0.029). Conclusions In this study, we demonstrate that correcting the position of a face mask by repetitive jaw movements can increase the occurrence of TMD. Informing individuals wearing face masks about the risk of TMD and the importance of choosing the appropriate mask size according to the face shape are important issues to be addressed in the near future.
