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Öğe A Method for Flap Monitoring Based on Bioelectrical-Resistance Analysis(Lippincott Williams & Wilkins, 2011) Misirlioglu, Aykut; Karaca, Mustafa; Avci, Gulden; Akoz, TayfunAxial pattern flaps are characterized by a single vascular pedicle that supplies the whole flap and carry the danger of flap loss. For this reason, monitoring and early identification of vascular perfusion is important for flap prognosis. The most commonly used method for flap monitoring is clinical assessment, but it has certain limitations. The bioelectrical properties of tissues can be affected by ischemic conditions, and a preliminary study showed that the bioelectrical resistance of blood was decreased under thrombotic conditions. In this controlled study, the resistance values of the axial flaps were calculated during thrombosis. A total of 28 rats were randomly divided into a control group (n = 14) and an experimental group (n = 14). Axial flaps were elevated based on the inferior epigastric pedicle. For the ischemic group, microvascular clamps were placed in the ischemic group to produce artificial thrombosis from day 1 of the experiment. Bioelectrical resistance was measured every 30 minutes for the first 6 hours and then daily after that. The resistance values from the ischemic group decreased progressively, and 150 minutes after the clamping, the difference became statistically significant (P < 0.05). The results showed that the assessment of flap resistance is a valuable tool and may allow early recognition of a compromise in the vascular system before clinical signs become obvious.Öğe A new practice of trichloroaceticacid peeling: reduction of second primary skin cancer(Aves, 2009) Avci, Gulden; Akoz, Tayfun; Gul, Aylin EgePurpose: Exposure to solar radiation is a major cause of non-melanoma skin cancer. Topical application of chemical peeling agents to reverse actinic damage of skin is a well-established, accepted clinical practice. Subclinic malignant lesions are generally seen with skin cancers simultaneously. In this paper, we evaluated effectiveness of the tricholoroacetic acid peeling to treatment of subclinic lesions. Material and Methods: Between 1999 and 2004, 102 patients with skin cancer were treated surgically. In addition to the surgical treatment of malignant lesions, full-face chemical peeling with 35-40% trichloroacetic acid was applied during the same operative session to 48 patients whose faces had extensively sun-damaged skin. The ages of patients were varied between 51 and 93. They were followed-up 1-5 years. The effectiveness of the TCA treatment was evaluated with pathologic examinations. Result: Second primary skin cancer was observed in only 3 patients who were applied TCA peeling. TCA peeling causes histologic changes such as correction of epidermal atrophy and atypia as well as deposition of new subepidermal collagen. Conclusion: Trichloroaceticacid peeling provides a prophylactic effect against the development of skin malignancies.Öğe A PEDICLED MUSCLE FLAP BASED SOLELY ON A NEURAL PEDICLE(Wiley-Liss, 2009) Avci, Gulden; Akan, Mithat; Akoz, Tayfun; Kuzon, William; Gul, Aylin EgeWe 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.Öğe CALF AUGMENTATION WITH SILICON IMPLANT(Medknow Publications & Media Pvt Ltd, 2010) Avci, Gulden; Akoz, Tayfun; Aydogdu, EserCalf augmentation is indicated for cosmetic reasons or to reconstruct a shrunken lower leg that is the result of injury, illness, or congenital disability. During the years 2005 through 2010, six patients (five women and one man) underwent calf augmentation. Indication for operation was aesthetic in five patients. Another one underwent unilateral crural restoration due to the deformity caused by poliomyelitis. All patients obtained good aesthetic improvement and were satisfied with the outcome. No serious complications were encountered in our patients. Calf augmentation or reconstruction with silicone implants is a safe, efficient, and satisfying aesthetic procedure.Öğe Colloidal drug carries from (sub)micron hyaluronic acid hydrogel particles with tunable properties for biomedical applications(Elsevier Sci Ltd, 2010) Ilgin, Pinar; Avci, Gulden; Sılan, Coşkun; Ekici, Sema; Aktas, Nahit; Ayyala, Ramesh S.; John, Vijay T.Hyaluronic acid (HA) hydrogel particles were synthesized in a single step employing water-in-oil microemulsion system. The HA particles were formed in the micro-environments of aqueous HA solution in oil by chemical crosslinking with divinyl sulfone (DVS). To produce magnetic field responsive HA-composite particles, iron magnetic nanoparticles were introduced into microemulsion system during synthesis to obtain HA-magnetic composites. For this purpose, iron nanoparticles were separately synthesized and mixed with linear HA followed by chemical crosslinking of linear HA with DVS in the micro-environments to envelope magnetic metal nanoparticles in the emulsion system. Scanning electron microscopy (SEM), dynamic light scattering (DLS) studies, and zeta potentials measurement were performed for particle size, charge and morphological characterization. Additionally. HA particles were chemically modified to induce desired functional groups on the particle surface and utilized for potential drug delivery vehicles. Trimethoprim (TMP) a bacteriostatic antibiotic drug were used as a model drug for the release studies in phosphate buffer solution (PBS) at pH 7.4 from bare HA, magnetic HA-composite and modified HA hydrogel particles. (C) 2010 Elsevier Ltd. All rights reserved.Öğe 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.Öğe Cutaneous Cholesterol Embolization(Specjalisci Dermatolodzy, 2009) Avci, Gulden; Akoz, Tayfun; Gul, Aylin EgeBackground: Cutaneous cholesterol embolization syndrome occurs as a result of cholesterol embolization from atherosclerotic plaques lining the walls of arteries and arterioles. It can occur sporadically but is more commonly associated with iatrogenic manipulation via invasive vascular procedures or therapies (anticoagulation or thrombolytics) The three most common organ systems afflicted by cholesterol emboli include the kidneys, gastrointestinal system, and skin. Main Observations: We present two patients with cutaneous cholesterol embolization. A 74-year-old with no prior disease or trauma was referred to the hospital with the acute chest pain. After 24-48 he developed livedo reticularis, followed by necrotic areas like bilaterally on hips and in the lumbar region. The second patient, 69-year-old man with a history of hyperglycemia, hyperlipidaemia, and hypertension was referred with weight loss, bilateral livedo reticularis, severe pain of lower extremities and impaired renal function. The toes first became cyanotic and than skin necrosis developed. Skin biopsy revealed presence of cholesterol clefts in the lumina of small arteries and arterioles. In both patients the necrotic skin and subcutaneous tissue had been debrided. Daily dressing was applied and tissue defects underwent secondary healing. Conclusion: The diagnosis of cholesterol embolization relies on clinical and histologic examination. Both, diagnosis and treatment needs a multidisciplinary approach, especially in cases of multi-organ involvement.Öğe 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, TayfunNecrotizing 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.Öğe Neural fibrolipoma of a digital nerve of the index finger without macrodactyly(Taylor & Francis Ltd, 2010) Avci, Gulden; Akan, Mithat; Taylan, Gaye; Akoz, TayfunWe 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.Öğe RETROSPECTIVE ANALYSIS OF SKIN CANCERS(Medknow Publications & Media Pvt Ltd, 2009) Avci, GuldenBetween October 1 2005 and November 15 2007, patients with skin cancers were analyzed epidemiologic, pathologic and therapeutic at Balikesir Statement Hospital, Plastic and Reconstructive Surgery Department. 173 patients were operated in hospital enrolled in this study. Epicrisis, inpatient files, pathologic reports were assessed. Ages and sexes of patients, localization of lesions, tumour thickness, horizontal size were confirmed, operations of patients, postoperative follow-up were recorded. Ninety three women, eighty men were enrolled this study. 45 patients with squamous cell carcinoma, 126 patients with basal cell carcinoma, 2 patients with malignant melanoma were diagnosed. About 73% of cases were diagnosed as basal cell carcinoma, 26% of cases were diagnosed as squamous cell carcinoma, 1% of cases were malignant melanoma. Mean age of the patients was 66.64, more women were affected than men. Localizations of lesions were head-neck region in 18 patients, upper extremity in 7 patients, lower extremity in 5 patients, and thorax in 2 patients. Most of the squamous cell carcinoma occurred on the cheek and the lower lip, most of the basal cell carcinoma occurred on the cheek and nose. The defects after the skin cancer excision were reconstructed with skin greft in 87 patients, with local flaps in 49 patients. The defects of other patients were sutured primarily. The 2 patients were diagnosed malignant melanoma were forwarded to the university hospital. All patients with squamous cell carcinoma were assessed by oncologists. Mean follow up is 13 months. Obviously, skin cancer is very important problem.Öğe Surgical Treatment of Trigonocephaly(Journal Neurological Sciences, 2011) Akan, Mithat; Avci, Gulden; Silav, Gokalp; Akoz, Tayfun; Elmaci, IlhanMetopic 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.Öğe The Surgical Treatment of Plagiocephaly(Turkish Neurosurgical Soc, 2011) Silav, Gokalp; Avci, Gulden; Akan, Mithat; Taylan, Gaye; Elmaci, Ilhan; Akoz, TayfunAIM: 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.
