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    A PEDICLED MUSCLE FLAP BASED SOLELY ON A NEURAL PEDICLE
    (Wiley-Liss, 2009) Avci, Gulden; Akan, Mithat; Akoz, Tayfun; Kuzon, William; Gul, Aylin Ege
    We tested the hypothesis that the intrinsic vascular plexus of the motor nerve could support viability in a rat hindlimb muscle flap. In a preliminary study, we examined the course and vascularity of the sciatic nerve, the peroneal nerve, and the peroneous longus muscle in the rat hindlimb via anatomic dissection, microangiography, and histologic study (n = 10 animals). On the basis of this examination, the peroneous longus muscle was chosen as our experimental model in this study. In 12 animals, the peroneus longus was acutely elevated, which severed all tendinous and vascular structures, this left the muscle pedicled on the motor nerve only (Group 1). Animals in Group 11 underwent a staged elevation of the flap with division of the vascular pedicle, the tendon of insertion, and the tendon of origin during separate procedures that were 5 days apart (n = 12). Muscle viability was evaluated by gross inspection, measurement of muscle weight and length, nitroblue tetrazlium (NBT) staining, microangiography, and histology. NBT staining demonstrated that immediate elevation of the peroneus longus muscle flaps led to an average necrotic area of 80.6% +/- 9.8% (Group 1). A significant improvement in viability was observed for muscle flaps of animals in Group II, with peroneus longus muscle necrosis averaging 25.6% +/- 9.3%. Microangiography demonstrated that the intrinsic vascularity of nerve was increased dramatically in Group II. These data support the hypothesis that the intrinsic vascular plexus of the motor nerve of a skeletal muscle can support at least partial viability of a muscle flap. However, this vascular axis is inadequate to support complete viability of a muscle flap if the flap is elevated immediately. If a staged elevation affects a surgical delay, the viability of a muscle flap elevated on a neural pedicle can be increased significantly. With adjustments in the delay procedure, this strategy may allow transfer of muscle flaps when maintenance or reconstitution of the primary vascular axis is not possible. (C) 2009 Wiley-Liss, Inc. Microsurgery 29:218-225, 2009.
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    Necrotizing Fasciitis as a Cause of Tissue Defect in of the Breast: Case Report
    (Ortadogu Ad Pres & Publ Co, 2010) Avci, Gulden; Akan, Mithat; Akoz, Tayfun
    Necrotizing fasciitis is a rapidly developing, fatal bacterial infection that can ocur in any part of the body. It can occur after trauma, around foreign bodies in surgical wounds, or can be idiopathic. The disease is more common in old patients who have diabetes mellitus, peripheral vascular disease, chronic renal failure, iv drug abuse, alcoholism, or obesity, as well as in immuno-suppressed patients. Necrotizing fasciitis is a polymicrobial infection of the skin, subcutaneous tissue and fascia with a fulminant course and a high morbidity and mortality. We describe a case of necrotizing fasciitis involving the posterior thorax wall, bilateral walls of thorax and right breast. It rarely affects the breast. Mortality due to this condition can be dramatically reduced by early diagnosis, aggressive resuscitation, and ruthless debridement.
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    Neural fibrolipoma of a digital nerve of the index finger without macrodactyly
    (Taylor & Francis Ltd, 2010) Avci, Gulden; Akan, Mithat; Taylan, Gaye; Akoz, Tayfun
    We present a case of neural fibrolipoma arising from the digital nerve in the index finger of the right hand. A 31-year-old man was referred with a soft tissue mass in the ulnar aspect of the index finger of his right hand, which had gradually enlarged during the past seven years. Histological examination of an excisional biopsy specimen identified a neural fibrolipoma, which is a differential diagnosis of a lipomatous lesion of the digits.
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    Surgical Treatment of Trigonocephaly
    (Journal Neurological Sciences, 2011) Akan, Mithat; Avci, Gulden; Silav, Gokalp; Akoz, Tayfun; Elmaci, Ilhan
    Metopic synostosis is a relatively rare form of nonsyndromic synostosis. Premature closure of the metopic suture results in deformation of the anterior calvarium, in the phenotypic features of trigonocephaly Trigonocephalic deformities are recognized because of a pathognomic 'keel-shaped' deformity of the forehead with a prominent midline ridge, bilateral frontotemporal constriction with compensatory biparietal expansion, supraorbital and lateral orbital retrusion and hypotelorism. 1 This article presents a surgical technique used over 5 years to treat trigonocephalic children. Retrospective analyses were performed on 9 patients with metopic synostosis treated during 2005-2010. The study included reviews of preoperative and postoperative computed tomography scans, operative techniques, clinical outcomes and complications. Operative techniques included fronto-orbital bandeau tilting after expansion with a midline interpositional -bone graft, detriangulation of foreheads with an inward bending at lateral orbital wall, multiple zigzag osteotomy of frontal bone, barrel-stave osteotomy of parietal bone. The average age of the patients at time of surgery was 11 months. Interorbital distances widened from 18.8 mm to 20.9 mm, biocular distance widened from 67.56 mm to 74.39mm, interorbital distance widened from 13.44mm to 15.65mm, intertemporal distance widened from 58.22mm to 64.16mm. Mean follow-up was 34 months, and no neurological sequelae or other significant complications were encountered. Trigonocephaly requires surgical correction involving anterior two-thirds calvarial remodeling with fronto-orbital advancement and frontal-bone remodeling. The described operative approach minimizes bone defects by adopting multiple zigzag osteotomy of the frontal bone. This modality results in significant improvements in skull form and high patient/parent satisfaction.
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    The Surgical Treatment of Plagiocephaly
    (Turkish Neurosurgical Soc, 2011) Silav, Gokalp; Avci, Gulden; Akan, Mithat; Taylan, Gaye; Elmaci, Ilhan; Akoz, Tayfun
    AIM: Anterior plagiocephaly usually occurs with premature synostosis of the ipsilateral half of the coronal suture. The forehead is flattened on the affected side, with a backward and upward displacement of the affected orbit. The bulging of the calvaria may occur in the contralateral parietal area. MATERIAL and METHODS: This article presents the surgical techniques used over 7 years to treat plagiocephalic children. Eleven patients with unilateral coronal synostosis treated during 2003-2010 were analyzed retrospectively. The study included reviews of pre and postoperative computed tomography scans, operative techniques, clinical outcomes and complications. Unilateral orbital advancement with tongue in groove was performed in 5, and bilateral orbital advancement in 6 cases. Pre and postoperative anthropometric measurements were used to document the amount of advancement of the elevated and recessed orbita, and the amount of withdrawal of the contralateral side. RESULTS: The mean age of the patients at time of surgery was 11 months. The preoperative values of the orbital height and retrusion were 0.68 cm and 1.87 cm, respectively. They were recorded as -0.1cm and 0,63 cm, postoperatively. Mean follow-up was 36 months, neither neurological sequelae nor other significant complications were encountered. CONCLUSION: The surgical corrections have resulted in significant improvements in skull shape and high patient/parent satisfaction.