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    A new practice of trichloroaceticacid peeling: reduction of second primary skin cancer
    (Aves, 2009) Avci, Gulden; Akoz, Tayfun; Gul, Aylin Ege
    Purpose: 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.
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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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    Cutaneous Cholesterol Embolization
    (Specjalisci Dermatolodzy, 2009) Avci, Gulden; Akoz, Tayfun; Gul, Aylin Ege
    Background: 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.