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    An Autoprosthesis Technique for Better Breast Projection in Free Nipple Graft Reduction Mammaplasty
    (Springer, 2012) Firat, Cemal; Gurlek, Ali; Erbatur, Serkan; Aytekin, Ahmet Hamdi
    Reduction mammaplasty for macromastia provides relief from uncomfortable symptoms and improves self-confidence and the ability to participate in sports activities. Reduction mammaplasty using the free nipple graft technique may result in bottoming-out deformity and a lack of upper-pole projection. We describe a modified breast reduction technique that combines the Graf and Thorek methods. We operated on 26 patients with gigantomastia using this novel technique. Preoperative markings were planned according to the classic Thorek amputation technique using a Wise pattern. A 10-cm x 14-cm pyramidal inferior-based dermoglandular flap was prepared, passed under a transverse pectoral muscle loop, and then back-folded over the pectoral loop, thereby establishing an autoprosthesis to increase upper-pole fullness and prevent bottoming-out deformity. The average weight of the removed breast tissue was 1,634 g (range = 1,120-2,140 g) for the right breast and 1,630 g (range = 1,110-2,120 g) for the left breast. The average follow-up period was 22 months (range = 11-37 months). All samples were pathologically assessed. Minor complications included wound breakdown at the T-junction, fat necrosis, hypertrophic scarring, and partial necrosis of the nipple-areola complex (NAC). Loss of nipple projection and partial hypopigmentation of the NAC occurred in most patients. Mild glandular ptosis was observed in two patients, with no flattening or deflation, but no severe bottoming-out deformity was observed during long-term follow-up. All patients were happy with their new bra size, breast projection, and breast weight. Our combined autoprosthesis technique resulted in satisfactory long-term breast projection and upper-pole fullness. 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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    Beneficial Effects of Aminoguanidine on Skin Flap Survival in Diabetic Rats
    (Hindawi Publishing Corporation, 2012) Ozturk, Ayse; Firat, Cemal; Parlakpinar, Hakan; Bay-Karabulut, Aysun; Kirimlioglu, Hale; Gurlek, Ali
    Random flaps in DM patients have poor reliability for wound coverage, and flap loss remains a complex challenge. The protective effects of aminoguanidine (AG) administration on the survival of dorsal random flaps and oxidative stress were studied in diabetic rats. Two months after the onset of DM, dorsal McFarlane flaps were raised. Forty rats were divided into four groups: (1) control, (2) AG, (3) DM, and (4) DM + AG groups. Flap viability, determined with the planimetricmethod, and free-radical measurements were investigated. In addition, HbA1c and blood glucose levels, body weight measurements, and histopathological examinations were evaluated. The mean flap necrotic areas (%) in Groups I to IV were 50.9 +/- 13.0, 32.9 +/- 12.5, 65.2 +/- 11.5, and 43.5 +/- 14.7, respectively. The malondialdehyde (MDA) and nitric oxide (NO) levels were higher in the DM group than in the nondiabetic group, while the reduced glutathione (GSH) levels and superoxide dismutase (SOD) activity were reduced as a result of flap injury. In the diabetic and nondiabetic groups, AG administration significantly reduced the MDA and NO levels and significantly increased GSH content and SOD enzyme activity. We concluded that AG plays an important role in preventing random pattern flap necrosis.
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    Combined cervical and vaginal reconstruction with prefabricated pudendal thigh flap in a case with cervical and vaginal agenesis (MURCS syndrome)
    (Lippincott Williams & Wilkins, 2008) Gurlek, Ali; Aslan, Serkan S.; Firat, Cemal; Otturk-Ersoz, Ayse; Burak, Feza
    In the presence of functional endometrium, in addition to the construction of anatomically, functionally normal and sensitive neovagina and cervix, the preservation of the uterus for future possible pregnancies must also be considered as the main goal in this process. So far.. hysterectomy was the general treatment modality in such cases. For maintaining cervical patency, there were no reports in the literature related to cervical prefabrication using flaps. In this report we present a case with cervical and vaginal agenesis (MURCS syndrome). In this case combined cervical and vaginal reconstructions were successfully performed by using bilateral pudendal thigh flaps; a real-like cervix and cervical canal had been previously prefabricated on the distal part of one of the pudendal thigh flaps. Sensitivity and function were both preserved and maintained at the end of this operation.
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    Computer-Assisted Analysis of Images for Evaluation of Long-Term Reduction Mammaplasty Results
    (Springer, 2013) Firat, Cemal; Gurlek, Ali
    [Abstract Not Available]
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    Medial epicanthoplasty using the skin redraping method - Reply
    (Lippincott Williams & Wilkins, 2007) Gurlek, Ali; Firat, Cemal; Tenekeci, Goektekin; Eren, Ahmet T.
    [Abstract Not Available]
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    Pneumocephalus as a Fatal but Very Rare Complication of Septorhinoplasty
    (Lippincott Williams & Wilkins, 2008) Gurlek, Ali; Firat, Cemal; Ozturk-Ersoz, Ayse; Tenekeci, Goektekin; Bilen, Bilge T.
    [Abstract Not Available]
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    Viability of Cartilage Grafts in Various Forms
    (Lippincott Williams & Wilkins, 2011) Firat, Cemal; Gurlek, Ali; Aydin, Nasuhi Engin
    The viability of cartilage grafts, in many forms, has been researched since the using of cartilage grafts in surgical procedures. Cryopreservation period and viability of cartilage grafts have remained unclear. This study was performed to investigate the durability, viability, and behavior of fresh or cryopreserved cartilage grafts when used as autografts or allografts in various forms. Six cartilage grafts (1 of each preparation type; 3 blocks and 3 diced) were prepared by wrapping with Surgicel or autogenous fascia, or they were left bare. After the graft preparation stage, the cartilage grafts were inserted into pockets prepared on the dorsum of each rabbit. Groups 1, 2, 3, and 4 (6 rabbits in each group) received autogenous fresh grafts, allogenous fresh grafts, autogenous cryopreserved grafts, and allogenous cryopreserved grafts, respectively. All cartilage grafts were implanted for 2 months. At the end of the second month, specimens were harvested and analyzed. The bare grafts provided the most viable specimens. There was no significant difference between the frozen or fresh and allograft or autograft groups with respect to viability and resorption ratios. The bare block graft, in all groups, survived significantly more than the other graft types. Allografts (homografts), similar autografts, did not create major problems, and they had excellent host tolerance and low antigenicity, especially when the perichondrium was removed. Viability and durability of the bare grafts (diced and block) were better than fascia or Surgicel-wrapped cartilage graft forms.