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Measurement of epidermis, dermis, and total skin thicknesses from six different body regions with a new ethical histometric technique
Pembe Oltulu, Bilsev Ince, Naile Kokbudak, Sidika Findik, Fahriye Kilinc
April-June 2018, 26(2):56-61
Introduction: Although it is important to know the normal values of dermis, epidermis, or total skin thicknesses (ST) for some drugs and vaccine research, skin-related clinical investigations, and skin transfer operations used in plastic surgery, it would not be ethical to take new biopsies from healthy volunteers to measure their ST. This study aims to describe a new ethical histometric technique for the measurement of skin layers and to determine the mean ST of some major body regions in the people living in our region. Materials and Methods: A total of 180 skin samples from six major body regions of 90 males and 90 females were enrolled in the study. The measurements were performed histometrically from appropriate skin samples obtained from the pathology archive. The samples were classified according to the six different parts of the body (scalp, abdomen, back, dorsum of foot, dorsum of hand, and the breast). Results: The mean epidermal thickness ranged from 76.9 ± 26.2 to 267.4 ± 120.6 μm. The thickest epidermis was found in the dorsum of foot in women (267.4 ± 120.6 μm) while the thinnest was found in the breast in women (76.9 ± 26.2 μm). The mean dermal thickness ranged from 2115 ± 946.4 to 5888 ± 2422.3 μm. The thickest dermis was found in the breast in men (5888 ± 2422.3 μm), while the thinnest dermis was found in the dorsum of hand in women (2115 ± 946.4 μm). Conclusions: Human ST varies according to ethnic origin. It was determined that the dermis and epidermis of Anatolian people are thicker than that of the previously reported other ethnic groups. The skin pathology archive can be used to create maps of the body's skin structure.
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The effects of breast reduction on sexual activity
Meltem Ayhan Oral, Cem Aslan, Murat Tuzuner, Ersin Aksam, Fatma Buse Kilin Capkinoglu, Demet Gulpek
April-June 2018, 26(2):62-66
Background: Patients with macromastia sometimes claim that their sexual life is negatively affected from the hypertrophic breasts. The intention of this prospective study is to evaluate the effects of breast reduction surgery on sexual satisfaction, marital adjustment, and the psychological condition of patients. Materials and Methods: The experimental group (n = 25) consisted of patients who had undergone surgery for macromastia, while the control group (n = 23) consisted of matched patients with similar demographic features. Using questionnaires, the respondents from the experimental group were evaluated for their body image perception, self-esteem, anxiety and depression status, sexual satisfaction, and marital adjustment both before surgery and 12 months after surgery. The same questionnaires were administered to the patients in the control group. Results: A comparison of the pre- and postoperative scores from the questionnaires revealed that the women in the experimental group observed an improvement in their body image perception and self-esteem and a decrease in their levels of anxiety and depression. There was no significant change between the pre- and post-operative scores of the experimental group in the sexual satisfaction index. Between the experimental group and the control group, a statistically significant difference was seen only for preoperative anxiety levels. Conclusion: Reduction mammoplasty had a favorable effect on the self-esteem, body image perception, depression, and anxiety but had no impact on sexual satisfaction of the patients. Level of evidence: Level II, Evidence obtained from well-designed controlled trials without randomization.
  2,209 137 -
Cleft lip and palate assessment form: Medical history, oral-peripheral characteristics, speech problems
Ozlem Unal-Logacev, Deniz Kazanoglu, Eren Balo, Ayse Nemutlu
October-December 2018, 26(4):156-168
Objective: The objective of the study is to identify the medical histories, oral-peripheral characteristics and speech problems of children with cleft lip and palate (CLP) or craniofacial anomalies, and eventually create an assessment form that highlights the factors that should be taken into consideration in the examination of those children. Materials and Methods: An assessment form was developed and used to assess with a descriptive method the medical history, oral peripheral, speech, and resonance characteristics of children with CLP. The study included 56 (21 females and 35 males) children with CLP. The results are presented as frequency or percentage. Results: About 20% of the CLP patients were offspring of consanguineous marriage and about 30% had positive family history of CLP. The major difficulty families experienced was feeding. Hearing impairment at various degrees was reported in 23% of the participants. The presence of cardiovascular, renal, neurological and endocrinological problems, and symptoms addressed in peripheral examination were identified as critical in discriminating syndromic cases. Assessment of the speech skills showed backing to be the most prevalent error among the participants. Conclusion: The form that was developed in scope of this study was observed to successfully define the medical history, oral-peripheral characteristics and speech problems of individuals with CLP. The form, however, needs further testing in larger populations and comparison to non-CLP populations.
  1,344 182 -
A general evaluation of stem cell studies and human cloning from the ethical, faith, and legal perspective
Cemal Alper Kemaloglu, Fatih Birtek
January-March 2019, 27(1):3-8
Stem cell and cloning studies bear promising potential in the field of regenerative medicine with their exciting and innovative features. The wide range of applications of these cellular treatments and their permanent repairing qualities foretell that a completely different scientific paradigm is emerging for the future. However, satisfactory insight has not yet been developed with respect to the moral status and legal aspects of these studies. Furthermore, their potentially untoward side effects are not understood well enough to compare with the benefits they provide for human life. In general, attempts are made to place the subject in a pattern composed of the sanctity of life, the unique characteristics of being an individual, the boundaries drawn by beliefs, and the basic principles of law. This article will discuss the benefits of stem cell and cloning studies as well as their undeveloped medical, ethical, religious, and legal aspects.
  1,198 209 -
Tessier number 30 facial cleft: A rare maxillofacial anomaly
Elif Sari
January-March 2018, 26(1):12-19
Introduction: In number 30 facial cleft patients, the deformities vary in their presentation, ranging from minor clefting of the lower lip (2) to complete clefts of the mandible with absence of the hyoid bone, thyroid cartilage, and manibrium. Materials and Methods: A case of Tessier number 30 facial cleft with only lower lip deformity is reported in this paper. Results: The pathognomonic features of the facial clefts were reviewed in terms of the related literature. Conclusion: We aimed to remind the pathology and review the literature in this report.
  1,147 131 -
Malignant proliferating trichilemmal tumor: Clinical presentations, treatment, and outcomes
Mustafa Kürşat Evrenos, Zülfikar Ulaş Bali, Peyker Temiz, Aylin Türel Ermertcan, Levent Yoleri
January-March 2018, 26(1):24-28
Background: Malignant proliferating trichilemmal tumor (MPTT) is very rare malignant tumors of hair follicles derived from outer root sheath. This tumor is mostly located on the head and neck of elderly women. Regional or distant metastasis is possible. In this study, we present clinical features and treatment outcomes of cases diagnosed as MPTT. Furthermore, we aimed to emphasize a different clinical form of the tumor that can be misdiagnosed clinically. Patients and Methods: A retrospective evaluation of five cases operated between September 2009 and February 2017 Celal Bayar University Faculty of Medicine, Plastic Reconstructive and Aesthetic Surgery Department at were included in the study. Clinicopathological features of patients, type of surgery, and follow-up information were evaluated. Results: Four patients were female. Average age was 72.2. All of the lesions were located on the head and neck. All patients had a history of rapid growth of lesions. Patients were scanned with computed tomography. There was no metastasis at the time of diagnosis. None of the patients needed adjuvant therapy. Mean follow-up time was 11.8 months. None of the patients developed recurrence or metastasis. Conclusions: These tumors resemble basal cell or squamous cell carcinoma. Rapid progress of benign form of the tumor should address malignant transformation. There is no consensus about adjuvant therapy. Screening for metastasis and close follow-up are mandatory.
  1,011 104 -
Nasolabial flaps for nasal reconstruction: Pros and cons
Ersin Aksam, Berrak Aksam, Onder Karaaslan, Mustafa Durgun
October-December 2018, 26(4):151-155
Background: Nasolabial flaps are one of the most preferred methods for nasal reconstruction. Lots of modifications of nasolabial flaps were defined. V-Y or hatchet type advancement, transposition, subcutaneous pedicled, two-stage interpolation, and propeller types are commonly used. Objective: The objective of the study is to evaluate the nasal reconstructions with nasolabial flaps according to subunits and defining the advantages and disadvantages for each subunit. Patients and Methods: Patients whose nasal defects were reconstructed with nasolabial flaps in the last 5 years were evaluated in this study. Results: Ninety-one patients whose nasal defects were reconstructed with nasolabial flaps were included in this study. V-Y advancement, hatchet type advancement, transposition, subcutaneous pedicled, two-stage interpolation, and propeller type nasolabial flaps were used for reconstruction of defects. The most common complication was trap-door deformity that was followed by alar distortion and venous congestion. Conclusion: V-Y or hatchet type advancement flaps and subcutaneous pedicled type should be preferred for sidewalls and dorsum defects, respectively. Two-stage interpolation type gives the best results for tip region defects. Propeller and transposition type flaps should be the choice of treatment in alar region defects.
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Reconstruction of finger composite defects with perforator free flap from the superficial palmar branch of radial artery
Alper Aksoy, Emin Sir, Daghan Dagdelen, Meliha Kasapoglu Aksoy
April-June 2018, 26(2):44-49
Background: Relatively rare scarce number of flaps are used to repair composite defects occurring as a consequence of finger injuries. The main objective in this study is reconstruction of the composite defects of the fingers to share in our study; we aimed to transfer our the experience with the use of the free perforator flap of the radial artery superficial palmar branch (SUPBRA). Materials and Methods: A total of 10 (three women and seven men; age between range, 18 and 47 years) patients who had undergone free composite SUBPRA flap reconstruction, operations between 2010 and 2013 were included in the study. Defect sizes ranged between from 2 cm × 3 cm to 3 cm × 5 cm. The patients were followed up postoperatively for a median an average period of 11.5 (six-18 months) months. All patients were assessed with static and dynamic two-point discrimination tests, Semmes-Weinstein monofilament test, cold intolerance test, time of returning to work, the active total range of motion of the injured fingers, cosmetic appearance of the donor/recipient sites and were also assessed for neuroma the development of neuroma on the donor site. Results: All composite free flaps survived completely, and the follow-up duration was 11.5 months. The average median operative time was 194 min (180–260 min) and the patients returned to their work their normal life after an average of 13 weeks (11–21). Any complication concerning with donor sites and wrist movements when primary closures were performed was observed. Conclusion: Free SUBPRA flap can be elevated from ipsilateral extremity under regional anesthesia which can be easily used for the reconstruction of composite defects with an advantage of providing a relatively hairless and thinner coverage. Therefore, it can be a perfect alternative for the repair of composite tissue defects encountered in the practice of hand surgery.
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Medial thigh flap: An eminent method of reconstruction of scrotal defect following fournier's gangrene
Imran Ahmad, Rajesh Kumar Maurya, Ali Adil Mahmud, Brajesh Pathak, Sudheer Kumar Maurya, Agrawal Lalit Harswarup
July-September 2018, 26(3):116-121
Background and Objectives: Fournier's gangrene is a rare, rapidly progressive, fulminant form of necrotizing fasciitis of the genital, perianal, and perineal regions. It is characterized by progressive spread of necrosis in the skin and subcutaneous tissue which results in defects of various sizes in perineal region. Various techniques have been described for the reconstruction of these defects such as split thickness skin grafts, muscle flaps (e.g., Gracilis flap), and fasciocutaneous flaps (e.g., pudendal flap), perineal flap, anterolateral thigh flap, deep inferior epigastric perforator flap, and anteromedial thigh flap. We intend to study the results of medial thigh flap procedure in patients with scrotal defect following Fournier's gangrene. Materials and Methods: Medial thigh flap was performed in eight patients with Fournier's gangrene. The patients were selected consecutively from December 2016 to December 2017. All patients were followed for 3-6 months postoperatively. Results: All flaps survived well. However, in two cases, there was partial distal necrosis. Both cases were managed conservatively. In all cases, donor site healed well except for one case in which infection of the donor site suture line occurred. It was managed by frequent dressing. Interpretation and Conclusions: The medial thigh flap is a reliable fasciocutaneous flap which can be done in reasonably short operative time to cover difficult defects with excellent results.
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A systematic review of penile replantations: May it guide us in penile allotransplantation?
Yigit Ozer Tiftikcioglu, Cagil Meric Erenoglu, William C Lineaweaver
July-September 2018, 26(3):97-102
Introduction: Penis replantation cases may serve as a model for identifying important elements in developing clinical penile allotransplantation. Material and Methods: We reviewed 82 published cases of penis replantation. Results: Besides the basic repair of urethra and corpora, we found that dorsal artery and dorsal nerve repair was associated with significantly better sensory return. Deep dorsal vein repair was associated with decreased sensation and increased complication rates. Conclusion: Penile allotransplantation may need to incorporate these findings.
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Surgically treating hidradenitis suppurativa that does not respond to medical treatment
Musa Kemal Keles, Ugur Horoz, Ergin Seven, Sebat Karamursel, Ali Teoman Tellioglu
April-June 2018, 26(2):67-70
Objective: Hidradenitis suppurativa is a chronic inflammatory disease of the skin involving the infundibular terminal follicles in the areas of the body containing apocrine glands. The pathology leads to purulent drainage and pain, abscesses, hypertrophic scars, and sinus formation in the affected areas. Treatment options for the disease include retinoid, antibiotics, antiandrogens, immunosuppressive agents, laser therapy/phototherapy, and surgery. This study aimed to assess the results of surgical treatment in patients who could not be treated medically. Materials and Methods: This study reviewed twenty patients who did not heal with medical treatment in the last 5 years. Results: Defect reconstructions were performed using grafts on eight patients, flaps on five patients, and primary closure on seven patients. One patient had a long-term recurrence. Conclusion: In the researchers' experience with different reconstruction methods and the wide excision of the disease, clinically satisfactory results can be achieved in cases that do not heal with medical treatment.
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A new technique in fingertip defects including nail lost: Reverse dorsal fascial flap with skin graft
Bulent Ozcelik, Bilsev Ince
October-December 2018, 26(4):140-143
Background/Aim: Many different flaps described in the reconstruction of fingertip amputations may not provide optimal esthetic appearance due to hyponychial tissue loss and the lack of volar support of the nail bed. Except for free nail transfer and composite graft, the number of techniques described for nail reconstruction of the finger is limited. We aimed to investigate the utility of the reverse dorsal facial flap and to determine satisfaction rate of the esthetic and functional results obtained. Patients and Methods: Sixteen patients who were referred due to fingertip amputation including loss of nail bed between 2014 and 2017 and who could not be replanted were prospectively included. Flap planning was made from the proximal part of the nail bed toward the middle phalanx depending on the defect size. The skin was harvested superficially to the lateral side and kept on the fascial layer at the bottom. A fascial flap was harvested by preserving the paratenon. The flap was transposed, and the reconstructed area of the nail bed or defect of the nail bed was closed. A full-thickness skin graft was applied over the fascia. Results: There was no total flap loss or partial necrosis in any patient. None of the patients had complications that would require a second flap surgery. The mean Visual Analog Scale score of the patients control was 1.06. The calculated Disabilities of Arm, Shoulder, Hand score was 3.08. The mean Likert score of the patients was 17. Conclusion: The dorsal fascial flap can be applied as an alternative surgical method in patients with fingertip defects including nail loss or damage in order to provide esthetically favorable nail appearance.
  808 164 -
An assessment of the effects of serum vitamin d levels on snoring in patients who have undergone septorhinoplasty
Bilsev Ince, Mehmet Emin Sakarya, Mehmet Dadaci
April-June 2018, 26(2):50-55
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.
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Treatment of crush degloving injury of the hand with totally avulsed thumb
Altug Altinkaya, Anil Demiröz, Hakan Arslan, Müge Anil Küçüksucu
January-March 2018, 26(1):29-31
Avulsion injuries of the upper extremities are challenging injuries for microsurgeons, and almost always crush and degloving components are present. Due to the severe damage to the neurovascular structures, microsurgical treatment options are quite difficult, but technical advances in microsurgery have resulted in increases in the possibilities of success in crush-avulsion type replantation. Good functional outcomes can be obtained with successful replantation in these cases. In this case report, we present a successful replantation of the totally degloved thumb, the result of a crush-avulsion injury caused by silicone molding machine.
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Reconstruction of fingertip with hypothenar free perforator flaps
Daghan Dagdelen, Alper Aksoy
July-September 2018, 26(3):89-96
Introduction: In fingertip injuries where replantation is not possible, options for reconstructing the fingertip with similar type of tissue are limited. Palmar and plantar regions are the donor sites that offer similar characteristics. In this study, we aim to evaluate the clinical outcomes of the hypothenar perforator free flap from the palmar region, compare this flap with the reports available in the literature, and share our experience regarding the practicality of the flap. Patients and Methods: The two-center retrospective clinical study included 15 patients who were operated on between 1 June 2015 and 31 December 2017. All patients were analyzed according to their demographic characteristics, mode and level of injury. Perforator flaps used in fingertip reconstruction were analyzed for skin island size, number of anastomosed arteries and veins, and number of reconstructed nerves. Static and dynamic two-point discrimination tests were applied, and grip strength and pulp-to-pulp pinch measurements were performed in the 13th-month visit of each patient. Surgical results were assessed with the Michigan Hand Outcomes Questionnaire (MHQ). Results: Mean age of the 15 patients was 39.1 years (range: 27-61). While majority of the injuries were of crush type, 8 cases were classified as Ishikawa subzone 2 and 3 cases as Ishikawa subzone 1. One perforator artery and 2 veins were anastomosed in 13 cases. Neural reconstruction was performed in all of the cases. Mean dynamic two-point discrimination value was 3.0 mm (range: 2.8-3.2). Mean grip strength was 42.5 kg (range: 17.7-74.8) and mean pulp-to-pulp pinch strength was 10.7 kg (range: 5-19). MHQ results were 90% in subgroup 1, 95.3% in subgroup 2, 79.5% in subgroup 3, 92.9% in subgroup 5, and 93% in subgroup 6. Conclusion: In cases of fingertip injuries where replantation is not possible, hypothenar free perforator flaps come forth as a sophisticated reconstruction option with favorable outcomes suitable to the similar tissue principle.
  770 166 -
How to calculate journal impact factor?
Cenk Demirdover
April-June 2018, 26(2):43-43
  768 152 -
Epidemiologic analysis and evaluation of complications in 1266 cases with maxillofacial trauma
Cenk Demirdover, Alper Geyik, Hasip Samil Yazgan, Fatih Alp Ozturk, Suleyman Cakmak, Haluk Vayvada, Adnan Menderes, Mustafa Yilmaz
January-March 2018, 26(1):6-11
Introduction: Patients with maxillofacial trauma represent a major group of patients in plastic surgery practice. These traumas are often caused by in-car and noncar road accidents and can result in permanent damages. This study aims at providing an epidemiologic analysis of such cases together with their diagnostic procedures, treatment methods, and postoperative complications. Materials and Methods: A total of 1266 maxillofacial trauma cases that were operated on between 2003 and 2017 were studied, and analyzed for fractured bones, etiology, diagnosis and treatment principles, and complications. Results: The major etiologic factor causing maxillofacial trauma in our study is noncar road accidents (25.5%). Mandible fractures were seen to be the most common type of bone fracture (52.2%). Together with physical examination, computerized tomography and orthopantomography are the diagnostic procedures we effectively use in our clinic. Rigid and semi-rigid fixation with plate and screws are the most frequently used treatment methods, and complication rates are seen to be lower (by 6.6%) than those reported in the literature. Conclusion: Careful and meticulous processes, as well as effective follow-up of the patient are required to achieve optimal esthetic and functional results in maxillofacial trauma cases. Such approach can help to reduce the possibility of complications and allow for their early identification, hence early intervention.
  777 140 -
The determination of the effect of curcumin on autologous fat graft survival in rats: Experimental study
Mahmut Ozgul, Yakup Karabagli, Atacan Emre Kocman, Ayse Aydan Kose, Cengiz Cetin, Dilek Burukoglu Donmez
October-December 2018, 26(4):144-150
Introduction: Curcumin, extracted from the roots of plant Curcuma longa, had been widely used in eastern medicine for centuries for the treatment of infections and pain management. It is vastly studied in modern medicine in the last two decades. In oncology, it is studied for its anticarcinogenic properties also to reduce the toxicity of chemotherapeutics, in diabetes to treat microvascular complications and wound healing management, and in ophthalmology for inflammatory diseases, and its therapeutic efficiency has been shown. Material and Method: In this study, 80 Wistar Albino rats' (female) inguinal fat pads excised, weight, and volume measures recorded and put under the scalp flap as en bloc fat grafts. Rats grouped in four such as control (Group 1), oral curcumin (Group 2), topical curcumin (Group 3), and oral + topical curcumin (Group 4), and at the days 1st, 4th, 7th, and 14th, two rats from each group were sacrificed, grafts extracted, and stained with perilipin for immunohistochemical and hematoxylin-eosin for histological examination. At the day 98th, all groups were sacrificed, fat grafts extracted, weight and volume differences recorded, and same histologic and immunohistochemical stains applied. Results: Topical curcumin applied groups' (Group 3 and Group 4) weight and volume “percent change” was statistically significant lower than groups which curcumin not topically applied (Group 1 and Group 2) (P < 0.05, P = 0.062). Early biopsies' histological and immunohistochemical examinations show that topically curcumin applied groups have more adipocytes that maintain their normal shape and better neovascularization of graft, however, less tissue cellular infiltration, hemorrhagic, and cyst and vacuole formation. Conclusion: Topically applied curcumin on fat grafts increased fat graft survival rate.
  736 125 -
H-Index and the other metrics in analyzing Authors' impact
Cenk Demirdover
July-September 2018, 26(3):87-88
  689 162 -
A new method for elbow arthrodesis for soft-tissue coverage: The use of biceps brachii muscle flap
Soysal Bas, Sercin Bas, Utku Uyan, Mustafa Durgun
April-June 2018, 26(2):77-80
Elbow arthrodesis is a rarely applied and difficult procedure that is performed to reduce extremity pain and prevent amputation in various clinical states. Infection, nonunion, plate-screw exposition, and skin loss are the major complications of this procedure. In this report, a new reconstruction technique with biceps brachii muscle flap was presented in a case of elbow arthrodesis performed with three operations.
  758 85 -
Our clinical experiences in lower eyelid reconstruction
Zeynep Altuntas, Ilker Uyar, Sidika Findik
January-March 2018, 26(1):2-5
Objective: Different treatment principles have been applied in the reconstruction of partial or full layer defects of the lower eyelid. The use of the most similar tissue for eyelid reconstruction is important for both functional and esthetic results. This study aims to investigate the reconstruction methods performed in lower eyelid defects and to evaluate their esthetic and functional results. Patients and Methods: In this study, patients who underwent reconstructive surgery from 2012 to 2016 in our clinic were investigated. Cases of primary repairs after skin tumors located in the lower eyelids were excluded from the study. The sociodemographic characteristics of patients, the type and location of the tumor, defect size after surgery, anterior and posterior lamellar defects, and reconstruction methods used were retrospectively reviewed. Results: Thirty-seven patients were included in the study. Fifteen were male and 22 were female. There was only anterior lamellar defect in 29 patients and full-thickness lower eyelid defect in 8 patients. Anterior flaps used in lamellar defects were identified as glabellar flap, Limberg flap, advancement, transposition flap, nasolabial flap, forehead flap, and cheek flap. Chondromucosal graft, palatal mucosal graft, and buccal mucosal graft were used for repairing posterior lamellar defects. Conclusion: Separate reconstruction of the posterior and anterior lamellae is important to provide good functional and esthetic results in lower eyelid reconstruction. Depending on the size of the defect, using a single local flap or a combined flap with posterior lamella repair provides highly acceptable results.
  714 128 -
Applicability of medial sural artery perforator flap in patients with diabetes with peripheral arterial disease for complex lower extremity defects
Heval Selman Ozkan, Saime Irkoren, Osman Enver Aydin
July-September 2018, 26(3):110-115
Background : The objective of this study was to determine the applicability and reliability of the medial sural artery perforator (MSAP) flap in patients with diabetes with peripheral arterial disease (PAD) for lower extremity defects and to assess the effects of sacrificing the MSA on distal circulation. Patients and Methods: A radiologic and clinical study has been utilized to assess safety and applicability of MSA perforator flap in diabetics. Five diabetic patients operated for complex lower extremity defects were analyzed and radiological findings from 43 lower limbs of patients with diabetes previously subjected to angiography for PAD were analyzed. Age, duration of diabetes, concomitant complications and occluded vessel type, the diameter of MSA at the popliteal junction, the branching pattern, and the number of sizeable perforators were documented. Results: One total flap loss occurred, one donor side dehiscence occurred. All other flaps survived, and defects were successfully closed. Radiologically MSA was present in unoccluded form in all 43 diabetic patients. At least one sizeable perforator was observed in all patients. There was a statistically significant, but negative, correlation between the size of MSA and the occlusion of the popliteal artery. Conclusions: Diabetes solely is not a contraindication of MSAP flap usage, as MSA is not affected by PAD. However, perigenicular collateral hypertrophy through arteriogenesis can be an issue in patients with severe occlusion at the level of the popliteal artery, since MSA enlarges. Cases of MSA hypertrophy in the presence of PAD constitute a high risk; therefore, selection of another flap is recommended.
  705 123 -
Management of the hand tumors
Fatih Irmak, Selami Serhat Sirvan, Isil Akgun Demir, Kamuran Zeynep Sevim, Memet Yazar, Aysin Karasoy Yesilada
July-September 2018, 26(3):103-109
Background: Tumors of the hand are usually benign in nature, and therefore, treatment is usually nonessential. Indications for the surgical treatment are cosmetic concern and potential for malignancy. Since malignant hand tumors are seen very rarely, suspicious findings should be assessed thoroughly, and the diagnosis should be established as well. The purpose of this article is to evaluate those lesions that commonly arise in the hand region including lipomas, ganglion cysts, and glomus tumors as well as malignant tumors such as soft-tissue sarcomas and squamous cell carcinomas. Material and Methods: A retrospective review of all 528 surgically removed primary skin and soft-tissue tumors of the hand at our department between 1996 and 2016 was performed. Results: A total of 528 patients were evaluated in this study. The most common benign tumor of the hand was pyogenic granuloma (24%), and the most common malign tumor of the hand was squamous cell carcinoma (65.2%). Malignant tumors incidence was higher in males, whereas benign tumors incidence was higher in females. Conclusions: A careful history and physical examination performed by a specialist can narrow down the possibilities regarding the type of tumor. The vast majority of hand tumors tend to be benign. In contrast to skin cancers in general, those occurring on the hand frequently have a worse prognosis, with a greater propensity for recurrence, metastatic spread, and functional deficit.
  700 113 -
Pediatric upper extremity fence-penetrating traumas
Musa Kemal Keles, Ugur Horoz, Bugçe Ballioglu, Hatice Gözde Muratoglu, Ergin Seven, Ali Teoman Tellioglu
January-March 2018, 26(1):20-23
Purpose: Penetrating hand injuries related to sharp metal or wooden fences are rarely reported in pediatric population. Most of these traumas occur after accidentally falling on the fence. The aim of this study is to evaluate the characteristics of the patients suffering from fence injuries and to present our management. Materials and Methods: In this study, 14 patients admitted to our emergency department with fence postpenetrating traumas between March 2013 and April 2016 were retrospectively examined. Eleven pediatric patients with fence postpenetrating trauma to upper extremity were included. Patient demographics, zone of injury, injury type, surgical intervention, and follow-up results were documented. Statistical analysis was performed using Chi-square test. Results: In the past 4 years, 11 patients aged 4 to 15 years with fence-related upper extremity traumas were treated in our clinic. Preteen age group was the most affected group. The most commonly penetrated region was below the elbow (7 patients). All wounds were surgically explored for accompanying injuries and repaired if any neurovascular or muscle injuries were present. Conclusion: To be able to prevent and appropriately treat these types of injuries in children, it is necessary to surgically explore and understand the mechanism.
  662 105 -
Clear cell acanthoma in an unexpected location
Atilla Adnan Eyuboglu, Arzu Karatas Togral, Eda Yilmaz Akçay, Nilgün Markal Ertas
January-March 2018, 26(1):40-42
Clear cell acanthoma (CCA) is an uncommon, benign, and slow progressing lesion originating from epidermal keratinocytes. Lesions are not gender specific and usually diagnosed at 50–60 years of age. It is generally represented in the lower extremities. CCA was first described by Degos et al. as “Degos acanthoma” for a lesion presented in the lower extremity. Clinically, it is hard to distinguish whether the lesion is benign or malignant. Final diagnosis can be made histopathologically. Biopsy material is periodic acid–Schiff positive. While CAA commonly presents itself in the lower extremities, our patient had a CAA in his abdominal region.
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