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    Complex Scalp and Calvarium Defects After Giant Basal Cell Carcinoma Excision: Management, Challanges, Outcomes
    (Lippincott Williams & Wilkins, 2018) Ozcan, Utku; Akyurek, Mustafa; Arslan, Emrah
    Giant basal cell carcinoma (GBCC) is defined as a tumor >= 5 cm in diameter. GBCC of scalp usually requires extended resection of soft tissues, calvarium, and dura. In this study, we present 5 patients with GBCC of head, who underwent a single-stage combined scalp, calvarium, and dural reconstruction. Herein, we aim to discuss reconstruction methods, cerebrospinal fluid (CSF) leakage, duration of hospital stay, and tumor recurrency. Peroperative and postoperative follow-ups, defect areas, and performed calvarium reconstruction methods of 5 patients, who underwent complex scalp and calvarium reconstruction after GBCC between year 2010 and 2017, were retrospectively maintained. We studied reconstruction methods, CSF leakage, duration of hospital stay, and tumor recurrency. All patients undergone single-stage reconstruction. Avarge duration of hospital stay was 15 days. Titanium mesh was used in 3 patients and methyl methacrylate was used in 2 patients for calvarium reconstruction. CSF leakage was seen in patients who underwent calvarium reconstruction with titanium mesh. Tumor recurrence occured next to calvarium in 1 patient who undergone calvarium reconstruction with methyl methacrylate. CSF leakage and duration of hospital stay may induce morbidity of this oncoplastic procedure. The fact of longer hospital stay of patients reconstructed with titanium mesh might be a new data presented in this study. These parameters can be related with the method of calvarium reconstruction.
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    Curcumin Protects Against Ischemia/Reperfusion Injury in Rat Skeletal Muscle
    (Academic Press Inc Elsevier Science, 2012) Avci, Gulden; Kadioglu, Huseyin; Sehirli, Ahmet O.; Bozkurt, Suleyman; Guclu, Oguz; Arslan, Emrah; Muratli, Sedit K.
    Background. Curcumin has been shown to decrease ischemia-reperfusion (I/R) injury in kidney or brain tissues. In this study, the effects of curcumin were evaluated in skeletal muscle during I/R injury. Materials and Methods. Hind limb ischemia was induced by clamping the common femoral artery and vein. After 4 h ischemia, the clamp of the femoral vessels of animals was taken off and the animal underwent 2 h reperfusion. We measured plasma concentrations of interleukin-1 beta (IL-1 beta) and tumor necrosis factor-alpha (TNF-alpha) using enzyme-linked immunosorbent assay (ELISA). The right gastrocnemius muscle was harvested and immediately stored at -30 degrees C for the assessment of superoxide dismutase (SOD), catalase (CAT) activities, and measurement of glutathione (GSH), malondialdehyde (MDA), and protein oxidation (PO) levels. Curcumin (100 mg/kg), alpha-tocopherol, and normal saline (10 mL /kg1) were administered intraperitoneally 1 h prior reperfusion. Results. Plasma TNF-alpha or IL-1 beta levels increased significantly in I/R group. The plasma levels of these proinflammatory cytokines were reduced in curcumin group. Muscle tissues of I/R groups revealed significantly higher antioxidant enzyme (superoxide dismutase, glutathione peroxidase, catalase) activities, and increased levels of malondialdehyde, nitric oxide, and protein carbonyl content compared with the SHAM group. Levels of these parameters in muscle revealed significant reductions in the I/R D curcumin group compared witho the I/R group. Curcumin has more potent antioxidant activity than vitamin E in the skeletal muscle I/R. Conclusion. In this study, protective effects of curcumin against skeletal muscle ischemia-reperfusion injury have been revealed. We underscore the necessity of human studies with curcumin that would be hypothetically beneficial preventing skeletal muscle I/R injury. Crown Copyright (C) 2012 Published by Elsevier Inc. All rights reserved.
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    Effect of systemic carnitine therapy on serum fibronectin level in diabetic rats
    (Academic Press Inc Elsevier Science, 2014) Komurcu, Erkam; Ozkan, Omer Faruk; Kemik, Ahu Sarbay; Nusran, Gurdal; Asik, Mehmet; Arslan, Emrah
    Background: L-carnitine has been shown to enhance wound healing. There has, however, not been sufficient research on the effect carnitine has on diabetic wound healing. We investigated the relationship between the viability of full thickness skin grafts (FTSGs) and fibronectin (FN) serum levels in diabetic rats that were administered carnitine. Materials and methods: A total of 40 rats were divided into four groups of 10 rats each and operated on. The FTSG model was 10 x 3 cm, with the dorsal flap extending from the tip of the scapula to the hip joint. After surgery, group 1 (nondiabetic control, n = 10) and group 2 (diabetic control, n = 10) were given a sterile saline solution at 0.9% with a dose of 100 mg/kg/d intraperitoneally for 7 d after the surgery. Group 3 (diabetic sham, n = 10) contained diabetic rats and did not receive any agent after the surgery. The diabetic rats in group 4 ( carnitine study diabetic, n 10) were given carnitine with a dose of 100 mg/kg/d intraperitoneally for 7 d after the surgery. Results: The percentages of viable areas in groups 1-4 were 70.38 +/- 6.10%, 62.66 +/- 1.55%, 62.59 +/- 2.94%, and 73.48 +/- 4.43%, respectively. The mean levels of FN, measured in milligram per deciliter, in groupse4 were 23.57 +/- 3.27 mg/dL, 21.58 +/- 2.35 mg/dL, 22.04 +/- 2.71 mg/dL, and 27.11 +/- 2.79 mg/dL, respectively. Furthermore, we found that there was a strong positive correlation (R = 0.509; P = 0.001) between FN and the viability of the FTSG. Conclusions: We demonstrated that administering carnitine leads to an increase in diabetic wound healing. Further increasing the levels of the FNserum might have a role in this process. Crown Copyright (c) 2014 Published by Elsevier Inc. All rights reserved.
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    MANAGEMENT OF FLAP DEHISCENCE AFTER LIMBERG PROCEDURE FOR RECURRENT PILONIDAL DISEASE BY NEGATIVE PRESSURE WOUND THERAPY (NPWT)
    (Colegio Brasileiro Cirurgia Digestiva-Cbcd, 2017) Tas, Sukru; Ozkan, Omer Faruk; Ocakli, Muzaffer Muazzez; Arslan, Emrah; Kiraz, Asli; Karaayvaz, Muammer
    [Anstract Not Available]
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    No Osteotomy Rhinoplasty: Indications and Surgical Details
    (Springer, 2014) Arslan, Emrah
    Lateral osteotomy is a particular step in rhinoplasty that aims to close an open roof deformity after hump reduction, narrow the lateral walls of the nose, and symmetrically align the nasal bony framework in cases with asymmetry. When the only reason for performing lateral osteotomy is to close an open roof, this can be avoided by using auto spreader flaps. In component hump reduction, the entire length of the upper lateral cartilage is preserved, including the portion under the nasal bone bilaterally. The basic principles involve suturing the flaps in the midline with a modified technique and supporting the lateral nasal walls with onlay cartilage grafts. This method was used for 34 patients. The lack of lateral wall support was obvious in one of the patients. With precise indications and a well-designed surgery, can be achieved. Further studies with more patients and a longer follow-up period are needed to determine the accuracy of this philosophy. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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    Reverse Nasal SMAS-Perichondrium Flap to Avoid Supratip Deformity in Rhinoplasty
    (Springer, 2012) Arslan, Emrah; Gencel, Eyuphan; Pekedis, Oznur
    Supratip deformity is an iatrogenic convexity that occurs cephalically to the nasal tip. This is also known as parrot beak deformity and causes an unnatural appearance of the nose. In the literature there are several explanations of the mechanism of the deformity and methods to correct it. One of the most accepted theories about the cause of supratip deformity is overresection of the caudal dorsum. Healing soft tissues fill in the gap created between the septum and the tip of the lower lateral cartilages, leading to fullness in the supratip area. The lower third and basically distal third of the middle third of the nose include several muscle groups, ligamentous structures, and perichondrium as the subcutaneous soft tissues. With the idea of elevating a reverse-based flap basically from the lower third and the lower third of the middle third of the nose, including the perichondrium and SMAS tissue, we aimed to reduce this gap, which has the potential to accumulate soft tissues that cause supratip fullness. Between December 2008 and July 2010, the reverse nasal SMAS-perichondrium flap was used in 42 primary rhinoplasty patients. This flap was used in 42 patients. Follow-up ranged from 3 to 18 months. No early or late complications were noted, such as infection, excessive bleeding, or extended edema. Minor revisions were performed in only two patients with the aim of achieving a smoother nasal dorsum. The reverse nasal SMAS-perichondrium flap is a new flap. The results presented here are not long term; however, the preliminary results are promising. The flap should be avoided in cases of thin skin, or at least be used with caution, whereas in thick skin cases it is very safe. Further studies in larger groups are required to better define the advantages and disadvantages of this flap.
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    Vacuum-assisted closure therapy leads to an increase in plasma fibronectin level
    (Wiley, 2011) Arslan, Emrah; Ozturk, Ozlem Goruroglu; Aksoy, Alper; Polat, Gurbuz
    An extensive research has been performed to investigate the mechanisms of action by which the application of subatmospheric pressure to wounds increases the rate of healing. Increased blood flow with vacuum-assisted closure (VAC) use is the most popular aspect. Fibronectin, which is an adhesion molecule, has several functional domains mediating chemotaxis, adhesion and migration. This is thereby involved in differentiation, proliferation, inflammation and thus in wound healing. In this study, plasma fibronectin levels were measured before and after VAC in patients with wounds. The results showed that there was an increase in pre- and post-VAC levels of plasma fibronectin. This statistically significant increase could be another explanation of how VAC therapy promotes wound healing.