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Öğe Aesthetic reconstruction of large scalp defects by sequential tissue expansion without interval(Springer, 2004) Gürlek, A; Alaybeyoglu, N; Demir, CY; Aydogan, H; Bilen, BT; Öztürk, ATissue expansion is indicated in the reconstruction of various scalp defects when there is inadequate adjacent tissue to allow either primary closure of the defect or repair with a local flap. It is the most important armamentarium for aesthetic hair-bearing scalp reconstruction in cases of congenital or required defects. This technique was used sequentially without interval to achieve scalp reconstruction for 12 patients with a defect ranging from 30% to 75% of the scalp (average, 55%). For 12 patients, 32 expansion treatments were undertaken between September 1997 and January 2002. The 12 patients included 3 women, 4 men, and 5 children with a mean age of 20 years (range, 45 days to 36 years). All patients had more than one period of treatment. The most common conditions treated were burns (n = 7). trauma (n = 1), congenital naevi (n = 2), and male pattern baldness (n = 2). Reconstruction of 12 large scalp defects has been performed with a 3.1% rate of major complications. Results show that tissue expansion is a safe and efficient but time-consuming technique for aesthetic scalp reconstruction, especially in the case of sideburn scenario or large defects. There was no significant alteration in ratio of complications although tissue expansions were made sequentially.Öğe The continuing scourge of congenital syphilis in 21st century: A case report(Elsevier Ireland Ltd, 2005) Gurlek, A; Alaybeyoglu, NY; Demir, CY; Aydogan, H; Coban, K; Fariz, A; Arslan, AAlthough the rate of congenital syphilis is declining in developed countries, a significant increase has been observed in the underdeveloped countries. Unfortunately, little concern is raised about the increasing numbers of babies born with congenital syphilis. The procedure to prevent congenital syphilis through antenatal screening and treatment is well established. But implementation of effective programs has proved very difficult especially in resource - poor settings. Congenital syphilis, if not treated promptly and adequately, may result in significant physical and emotional squeal in children. A case of complicated late congenital syphilis is reported in order to emphasize that syphilis is still present nowadays, and re-emerging many countries even some of the industrialized ones. Most of the cases can not be prevented by routine antenatal screening. Thus it is essential to develop strategies to prevent sexually transmitted disease from being a hidden and neglected problem. (c) 2005 Elsevier Ireland Ltd. All rights reserved.Öğe Correction of the crooked nose using custom-made high-density porous polyethylene extended spreader grafts(Springer, 2006) Gürlek, A; Ersoz-Ozturk, A; Celik, M; Firat, C; Aslan, S; Aydogan, HCorrection of the crooked or deviated nose, a complex cosmetic and functional problem, is a big challenge for the rhinoplasty surgeon. Although corrections using a wide range of surgical techniques to straighten the nose and maximize nasal function have been proposed, recurrence is very common because of cartilage memory and scar contracture. Therefore, to prevent recurrence and to maintain the correction of the septum, a permanent support that is stable and strong, with the ability to maintain its given shape after placement on one or both sides of the septum, is needed. For this purpose, the authors planned to use a pair of custom-made high-density porous polyethylene (HDPP) extended spreader grafts. In this study, the concept and technique of HDPP, composed of a nonresorbable alloplastic material for correction of the crooked nose, and the authors' experience using it, are presented. Currently, HDPP is readily available on the market as a thin plain sheet (0.85 x 38 x 50 mm) that can be cut to an appropriate size for spreader grafts. Ingrowths of fibrous tissue inside and around HDPP stabilize the upper lateral cartilages and septum in their new corrected position and maintain the corrected/straightened position. This material was used in 20 patients with crooked noses (9 with C-type and 11 with S-type noses). During a mean follow-up period of 18 months (range, 8-30 months), there were no complications, recurrences, or extrusions. Functional evaluation was performed using a visual analog scale before surgery and 6 months after surgery. Patients were asked to score their nasal breathing on a scale ranging from 0 to 100. The mean preoperative value was 32.50% +/- 11.18%, and the postoperative value was 88.75% +/- 8.71%. In conclusion, the use of custom-made HDPP extended spreader grafts is a safe, effective, reliable, and permanent method for correction of the crooked nose. In the long term, the authors believe that custom-made HDPP extended spreader grafts provide functional recovery and increased strength against further trauma or forces of scar contracture, and have the ability to prevent recurrence attributable to cartilage memory.Öğe An easy way of finding a vein in microsurgery(Lippincott Williams & Wilkins, 2003) Gürlek, A; Askar, I; Bilen, BT; Çelik, M; Fariz, A; Aydogan, H; Arslan, A[Abstract Not Available]Öğe Effects of different corticosteroids on edema and ecchymosis in open rhinoplasty(Springer, 2006) Gurlek, A; Fariz, A; Aydogan, H; Ersoz-Ozturk, A; Eren, ATA double-blind, randomized trial with placebo control was planned to evaluate the effects of corticosteroids (betamethasone, dexamethasone, methylprednisolone) in approximately equivalent doses (8 mg dexamethasone/day), and to compare their effects with that of tenoxicam, an antiinflammatory drug, on both the edema and ecchymosis in open rhinoplasty with osteotomies. For this study, 40 patients were divided randomly into five groups of 8 patients each, which received, respectively, betamethasone (group 1), dexamethasone (group 2), methylprednisolone (group 3), tenoxicam (group 4), and placebo (group 5). Open rhinoplasty with osteotomies was performed by the same surgeon with the patient under general anesthesia. Drugs were administered just before the induction of anesthesia and continued for 3 days. Only acetaminophen was used to control postoperative analgesia. Digital photographs of each patient were taken on postoperative days 1, 3, and 7. Scoring was performed separately for eyelid swelling and ecchymosis by three observers independently using a graded scale from 0 to 4. No statistically significant differences existed among the five groups in terms of age, sex, duration of surgery, amount of bleeding, and intravenous fluid administration during the surgery. On postoperative days 1, 3, and 7, no differences in the levels of ecchymosis or edema among the steroid groups, the tenoxicam group, and the control groups were observed. In conclusion, the authors observed no significant differences among the different kinds of steroids administered in equivalent doses (8 mg dexamethasone/day). Steroids used in these doses were not effective in preventing or reducing edema and ecchymosis after open rhinoplasty with osteotomies. Tenoxicam also was not effective. No complications caused by the use of steroids were observed during the 6-month follow-up period.Öğe Grafting the nasal dorsum with tandem ear cartilage(Lippincott Williams & Wilkins, 2004) Gürlek, A; Aydogan, H; Askar, I[Abstract Not Available]Öğe Lengthening of the amputation stumps in hand by distraction osteogenesis(Medimond S R L, 2002) Gürlek, A; Inan, M; Bilen, BT; Aydogan, H; Ersöz, A; Çelik, M; Fariz, ADigital amputations have been seen commonly at the emergency services. Mutilation, functional, cosmetic and psychological problems occur when they can not be transplanted or failed after transplantation. Bone lengthening was carried out on 18 digital amputation stumps of 10 patients by distraction osteogenesis (Ilizarov's method) during the period of January 2000 to January 2002. Mean age was 14.2+/-8.1, ranging between 4 and 27 years. The average lengthening achieved 28.4 +/- 83 (15 - 50 mm). Distraction durations varied between 20 -70 (mean 35.2 +/- 8.3) and consolidation between 45 -120 days (mean 74.2 +/- 17.1). Two pin-tract infections, one bone fracture because of trauma, one early fusion of osteotomy and severe pain in two patients due to distraction were observed as complication. Distraction osteogenesis is very effective, simple, no necessity to donor area in the treatment of amputation stumps to get function; in spite of requiring long duration, patience and a good cooperation of both family and patient.Öğe The protective effect of melatonin on ischemia-reperfusion injury in the groin (inferior epigastric) flap model in rats(Blackwell Publishing, 2006) Gurlek, A; Celik, M; Parlakpinar, H; Aydogan, H; Bay-Karabulut, AInadequate blood perfusion and ischemia-reperfusion (I/R) injury in the surgical skin flap are believed to be the major factors that cause harmful changes within the tissue and vasculature, resulting in flap necrosis. Reactive oxygen radical species (ROS), in part, are believed to play an important role in this injury. Melatonin, in many physiological conditions, has been shown to have direct and indirect antioxidative effects and free-radical-scavenging properties. Therefore, it may have a beneficial effect on I/R-induced flap injury. In this study, the possible protective effects of melatonin were investigated in I/R injury of rat epigastric (axial pattern) flaps. Ischemia was achieved for 12 h by occlusion of inferior epigastric artery. Melatonin or vehicle was administered 1 h before flap elevation and was continued for 6 days after ischemia. I/R injury elevated malondialdehyde (MDA), an end product of lipid peroxidation, and nitric oxide (NO) levels while the glutathione (GSH) content was reduced. Myeloperoxidase (MPO) activity, which is known to be related to tissue neutrophil accumulation, was found to be statistically higher in the I/R group when compared with the sham group. Administration of melatonin significantly decreased MDA, NO and MPO levels and elevated the GSH content. Moreover, melatonin reduced the flap necrosis area, which was determined using a planimetric method. In conclusion, melatonin, a potent scavenger of free radicals, plays a major role in preventing the inferior epigastric arterial I/R-induced flap necrosis, based on planimetric flap survival and biochemical results. The beneficial effects of melatonin in I/R injury implies the involvement of free radicals in flap damage.Öğe Protective effect of melatonin on random pattern skin flap necrosis in pinealectomized rat(Blackwell Munksgaard, 2004) Gurlek, A; Aydogan, H; Parlakpinar, H; Bay-Karabulut, A; Celik, M; Sezgin, N; Acet, ARandom pattern skin flaps are still widely used in plastic surgery. However, necrosis in the distal portion resulting from ischemia is a serious problem, increasing the cost of treatment and hospitalization. Free oxygen radicals and increased neutrophil accumulation play an important role in tissue injury and may lead to partial or complete flap necrosis. To enhance skin flap viability, a variety of pharmacological agents have been intensively investigated. The aim of this study is to test the effects of melatonin, the chief secretory product of the pineal gland and a highly effective antioxidant, on random pattern skin flap survival in rats. Herein, to investigate the physiological and pharmacological role of melatonin on dorsal skin flap survival. Pharmacological (0.4, 4 and 40 mg/kg) levels of melatonin were given intraperitoneally (i.p.). For this, pinealectomized (Px) and sham operated (non-Px) rats were used. The effects of melatonin on levels of malondialdehyde (MDA), nitric oxide (NO), glutathione (GSH) and the activities of glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) were measured in the skin flap. The ratio of skin flap necrosis was compared among the experimental groups by using planimetry. MDA and NO levels were found to be higher in Px than non-Px rats; while GSH levels and GSH-Px, and SOD activities were reduced. Melatonin administration to Px rats reduced MDA and NO levels and increased GSH, GSH-Px, SOD levels. Melatonin also reduced the ratio of flap necrosis determined by using planimetry and supported through the photography. In conclusion, these results show that both physiological and pharmacological concentrations of melatonin improve skin flap viability.Öğe A total lower lip reconstruction with a composite radial forearm-palmaris longus tendon flap(Lippincott Williams & Wilkins, 2005) Gürlek, A; Aslan, A; Celik, M; Aydogan, H; Alaybeyoglu, N[Abstract Not Available]Öğe A transverse rectus abdominis myocutaneous (TRAM) flap for reconstruction of a large deformity in the buttock(Taylor & Francis As, 2005) Gürlek, A; Demir, CY; Askar, I; Aydogan, H; Alaybeyoglu, N; Coban, KA rectus abdominis myocutaneous flap has been used to repair the abdominal wall, chest wall, sternum, breast, and groin. We describe a patient in whom a large deformity in the buttock caused by a road crash was repaired with a transverse rectus abdominis myocutaneous (TRAM) flap. Distally-based TRAM flaps provide a good and reliable way of reconstructing the buttock. Its advantages are a long arc of rotation and well-vascularised bulky tissue that serve as a partition and promote quick healing of the defect. However, the flap is not the first choice for traumatic and infected wounds where fatty tissue is not desired.Öğe The use of lower turbinate bone grafts in the treatment of saddle nose deformities(Springer-Verlag, 2002) Gurlek, A; Askar, I; Bilen, BT; Aydogan, H; Fariz, A; Alaybeyoglu, NSaddle nose reconstruction is based on the use of support grafts to manage aesthetic and functional problems. Bone (calvarial, iliac crest, costal, nasal hump, ulnar, and heterogenous origin), cartilage (septal, costal, heterogenous), and synthetic materials (silicon, silastic, polyethylene) were used as support grafts. Three patients have been included in this study to define the surgical management and long-term aesthetic and functional results of patients undergoing rhinoplasty with support grafts for a saddle nose deformity. Open rhinoplasty was employed. Both the lower turbinates were excised and the bone dissected from the soft tissues in two cases and in one case, only mucosa was removed. The amount of support needed was measured by using bone wax. The bone was used shaped in layers, according to the defect, and sutured to each other by vycril suture, and wrapped around by surgicell. The graft was then inserted in its place and fixed with external prolene sutures. Results were satisfactory in both function and aesthetics. Ten to 16-month followups had no complications. Saddle nose surgery basically requires the use of a support graft to repair the nasal dorsum. A lower turbinate bone graft procedure has some advantages: it is cheap and safe, it is ready to use and not time-consuming, there is no donor area and no additional donor site morbidity, and it enlarges the airway and the passage to prevent nasal airway obstruction.Öğe The use of suture cover as an internal nasal splint(Lippincott Williams & Wilkins, 2004) Gürlek, A; Çoban, K; Aydogan, H; Çelik, M; Aslan, A[Abstract Not Available]
