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    Comparison of Nerve, Vessel, and Cartilage Grafts in Promoting Peripheral Nerve Regeneration
    (Lippincott Williams & Wilkins, 2014) Firat, Cemal; Geyik, Yilmaz; Aytekin, Ahmet Hamdi; Gul, Mehmet; Kamisli, Suat; Yigitcan, Birgul; Ozcan, Cemal
    Peripheral nerve injury primarily occurs due to trauma as well as factors such as tumors, inflammatory diseases, congenital deformities, infections, and surgical interventions. The surgical procedure to be performed as treatment depends on the etiology, type of injury, and the anatomic region. The goal of treatment is to minimize loss of function due to motor and sensory nerve loss at the distal part of the injury. Regardless of the cause of the injury, the abnormal nerve regeneration due to incomplete nerve regeneration, optimal treatment of peripheral nerve injuries should provide adequate coaptation of proximal and distal sides without tension, preserving the neurotrophic factors within the repair line. The gold standard for the treatment of nerve defects is the autograft; however, due to denervation of the donor site, scarring, and neuroma formation, many studies have aimed to develop simpler methods, better functional results, and less morbidity. In this study, a defect 1 cm in length was created on the sciatic nerve of rats. The rats were treated with the following procedures: group 1, autograft; group 2, allogeneic aorta graft; group 3, diced cartilage graft in allogeneic aorta graft; and group 4, tubularized cartilage graft in allogeneic aorta graft. Group 5 was the control group. The effects of cartilage tissue in nerve regeneration were evaluated by functional and histomorphological methods. Group 1, for which the repair was performed with an autograft, was evaluated to be the most similar to the control group. There was not a statistically significant difference in myelination and Schwann cell rates between group 2, in which an allogeneic aorta graft was used, and group 3, in which diced cartilage in an allogeneic aorta graft was used. In group 4, myelination and Schwann cell formation were observed; however, they were scattered and irregular, likely due to increased fibrosis. In all of the groups, nerve regeneration at various rates was observed both functionally and histomorphologically. This study demonstrates that cartilage tissue has promoting effects in nerve regeneration.
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    Comparison of the effects of PRP and hyaluronic acid in promoting peripheral nerve regeneration An experimental study with vascular conduit model in rats'
    (Edizioni Luigi Pozzi, 2016) Firat, Cemal; Aytekin, Ahmet Hamdi; Durak, Mehmet Akif; Geyik, Yilmaz; Erbatur, Serkan; Dogan, Metin; Elmas, Omer
    AIM: Peripheral nerve defects generally occur due to mechanical, chemical, thermal and pathologic causes and the reconstruction is still a challenging problem. In the present study, we aimed to compare the effects of platelet rich plasma (PRP) that has high levels of growth factors and hyaluronic acid (HA) that is known to have positive effects on nerve regeneration by decreasing scar formation in a rat model where they were injected through allogeneic aorta graft in peripheral nerve defects using histopathologic and functional methods. MATERIAL AND METHODS: The study involved 20 Wistar Albino male rats that weighed 200 to 250 grams and aged about 1 year old. Of the rats, two were used as donor for PRP and aorta graft harvest. Three random groups of 6 rats were composed. In all of the groups, the left sciatic nerves were used and 1 cm of defects were created. The right sciatic nerves were used as control groups. Group I was the group repaired with autograft, Group 2 was the group repaired with HA injected through aorta graft and Group 3 was the group repaired with PRP injected through aorta graft. The findings were evaluated in terms of functional (electromyography and walk test analysis) and histopathologic parameters at 12 weeks. RESULTS: In all of the groups varying degrees of axonal regeneration was observed. Group I was the closest group to the control group showing highest rate of nerve regeneration followed by Group 3 where PRP was injected through aorta graft and group 2 where ha was used respectively. CONCLUSION: The study demonstrates that PRP enhances peripheral nerve regeneration more than HA when used in a vascular conduit model.
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    Correction of True Hanging Columella Using Medial Crural Tuck-Up Technique
    (Springer, 2013) Bilen, Bilge Turk; Aytekin, Ahmet Hamdi; Erbatur, Serkan; Geyik, Yilmaz
    The nasal tip and columella are the two main key components that affect the results of a successful and aesthetically satisfactory rhinoplasty. A true hanging columella is a deformity in which the caudal border of the columella has a downward bowing appearance due to disproportion between the ala nasi and the columella, which is usually congenital. In the management of this challenging deformity, a thorough understanding and consideration of tip dynamics and the anatomical causes address the proper technique to be used. In this study we present our clinical experience with the medial crural tuck-up technique used on 53 consecutive patients with a true hanging columella. A total of 1,421 patients underwent rhinoplasty between January 2005 and September 2011; 53 of those patients (age range = 20-37 years; mean = 27.3 years), who underwent this technique, were involved in the study. Thirty-eight patients were followed up for more than 1 year. The results were evaluated by comparing postoperative photos with preoperative photographic documentation. The appearance of the nasal tip and columella remained fine and stable over the 1 year of follow-up. Despite its limitation of applicability in secondary cases, the advantages of this technique are that it does not require conchal or costal cartilage and the desired tip rotation and projection can be done with ease.
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    Double-Skin Paddled Superficial Temporofascial Flap for the Reconstruction of Full-Thickness Cheek Defect
    (Lippincott Williams & Wilkins, 2013) Kilinc, Hidir; Geyik, Yilmaz; Aytekin, Ahmet Hamdi
    The most common causes of cheek defects include trauma, burn, and tumor resections. In the reconstruction of the defects in this region, it is essential to use similar or adjacent tissue considering the aesthetic and functional properties. For this purpose, numerous local, regional, or distant free flaps were described. The local flaps harvested from the head and neck region are the most frequent methods because of the similar skin color, texture, and compatibility with cheek. In this study, the reconstruction in a 29-year-old male patient who had a full-thickness cheek defect due to tumor resection on the left side was performed, wherein a hairless skin island was carried through the frontal branch of superficial temporal artery for oral mucosa, and a hairy skin island through the parietal branch of the same pedicle was carried for the bearded skin defect. No complication occurred postoperatively and both aesthetic and functional satisfactory results were obtained, providing the oral mucosal and natural beard integrity. Donor-site scarring and temporal alopecia were recorded as the disadvantages of this method. This technique is a useful method for the reconstruction of full-thickness cheek defects because of its advantages including compatibility of color and texture, reliable blood supply, requiring single-session procedure, and being able to carry 2 different skin islands on the same pedicle.
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    An Ideal Composite Graft Donor Site for Postburn Alar Rim Deficiencies: Root of Helix
    (Lippincott Williams & Wilkins, 2010) Coban, Yusuf Kenan; Geyik, Yilmaz
    One of the challenging postburn face deformities is alar rim defects or deformities. Small through-and-through defects of the nasal ala may be managed with a composite graft of auricular tissue, obtained from the earlobe, the helical rim, and the root of the helix. We use usually the root of the helix for postburn alar defect correction as a composite graft donor site. The advantage of these composite grafts is that the procedure is a single-stage operation with excellent contour correction and a well toleration of donor site morbidity by the patient.
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    Supratrochlear island flap for reconstruction of the periorbital and nasal defects
    (Springer, 2014) Kilinc, Hidir; Geyik, Yilmaz; Aytekin, Ahmet Hamdi
    Background The reconstruction of nasal and periorbital defects has been a challenging task for plastic surgeons in terms of obtaining aesthetic and functional results. So far, many surgical methods have been described for the closure of these defects; however, the lack of sensation and inadequate cosmetic appearance were the main disadvantages of these procedures. Methods This study involved all patients who underwent reconstruction of nasal and periorbital defects due to tumor resection by means of a supratrochlear artery island flap, between 2007 and 2011. Doppler USG on the frontal region was routinely performed on all of the patients. Results This technique was used in six male patients with a mean age of 59.6 years (ranged, 44-68 years). The flap sizes ranged from 3x2.2 to 5x4.5 cm (mean 3.83x3.13 cm). The mean follow-up period was 23.6 months. All of the flaps survived without any problem, and no total or partial loss of flap was observed. The defects were closed with sensate and durable skin. Temporary loss of sensation on frontal regions was observed on all of the patients, but it decreased within 812 months in the follow-ups. Conclusions The supratrochlear artery island flap is a good alternative for the reconstruction of small-and medium-sized periorbital and nasal defects that offers a single-stage procedure, good perfusion and drainage, reliability, technical easiness, and sensorial superiority.
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    Surgical Modalities in Gunshot Wounds of the Face
    (Lippincott Williams & Wilkins, 2013) Firat, Cemal; Geyik, Yilmaz
    Maxillofacial traumas caused by gunshot wounds may cause quite varied defects. The objective of this study was to evaluate the reconstruction methods in 12 patients with gunshot wound-related mandibular and maxillofacial bony and soft tissue defects. Twelve patients who were operated on for maxillofacial gunshot wounds at our clinic between 2002 and 2012 were included in the study. Seven patients were wounded in a suicide attempt, and 5 were wounded as a result of an accident or in assaults. Two patients underwent reconstruction using free fibula osteocutaneous flap, 4 patients received the free radial forearm osteocutaneous flap, 2 patients received costal bone graft, and 3 patients received iliac bone grafts. Satisfactory functional and aesthetic outcomes were achieved in cases where staged secondary reconstruction, balloon treatment, and consecutive fat and steroid injections into the depressed scar areas were applied. In conclusion, the basic goal in maxillofacial reconstruction is the functional and aesthetic reconstruction of the contours. Because it is not easy to get perfect results with only 1 clinical approach or 1 method, the proper timing and reconstruction method should be selected.