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Öğe Comment on 'reconstruction of orbital floor and maxilla with divided vascularised calvarial bone flap in one session'(Elsevier Sci Ltd, 2008) Bilen, Bilge Turk; Kilinc, Hidir; Aslan, Serkan; Tenekeci, Goektekin[Abstract Not Available]Öğe Double-Skin Paddled Superficial Temporofascial Flap for the Reconstruction of Full-Thickness Cheek Defect(Lippincott Williams & Wilkins, 2013) Kilinc, Hidir; Geyik, Yilmaz; Aytekin, Ahmet HamdiThe 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.Öğe Effectiveness of early fasciotomy in the management of snakebites(Turkish Assoc Trauma Emergency Surgery, 2012) Firat, Cemal; Erbatur, Serkan; Aytekin, Ahmet Hamdi; Kilinc, HidirBACKGROUND The purpose of this study was to emphasize that early fasciotomy performed in the treatment of snakebites in the absence of the classic compartment syndrome criteria accelerates the clinical recovery and reduces the progressive tissue damage. METHODS Fourteen patients with snakebite were examined retrospectively. Five of them healed with routine treatments. Six patients who did not respond to the treatment underwent early fasciotomy procedure in 48 hours. All of the patients had edema, pain, ecchymosis, bulla formation, and progressive skin necrosis over the extremity. Fasciotomy was performed in three patients who were referred in the late period with compartment syndrome. Fasciotomy incisions were closed after 4-6 days. RESULTS After the early fasciotomy, edema diminished rapidly, the skin became more viable and local necrosis did not progress. Further, the toxic symptoms like local temperature increase and fever also diminished. The healing process in the three patients who underwent late fasciotomy was much slower compared with the early fasciotomy group. In particular, necrosis on the muscle and skin had deteriorated. CONCLUSION Fasciotomy has a special place in snakebites. In cases of compartment syndrome, all necessary treatments including early fasciotomy should be performed before the full clinical symptoms develop or the compartment pressure reaches the threshold value.Öğe Effects of Verapamil, Nifedipine, and Daflon on the Viability of Reverse-Flow Island Flaps in Rats(Lippincott Williams & Wilkins, 2013) Kilinc, Hidir; Aslan, Suleyman Serkan; Bilen, Bilge Turk; Eren, Ahmet Tuna; Karadag, Nese; Karabulut, Aysun BayReverse-flow flaps are preferable in reconstructive surgery due to their several advantages. However, they may have venous insufficiency and poor blood flow. In this study, effects of various pharmacological agents on the viability of reverse-flow flaps were investigated. Forty Sprague-Dawley rats were used. Superficial epigastric artery- and superficial epigastric vein-based reverse-flow island flaps were preferred. The rats were divided into 4 groups. Group 1 was considered as the control group. Group 2 was given verapamil 0.3 mg/kg per day, group 3 nifedipine 0.5 mg/kg per day, and group 4 Daflon 80 mg/kg per day for 7 days. On day 7, viable flap areas were measured, angiography was performed, serum nitric oxide levels were evaluated, and histopathological examination was done. The mean flap viability rate was 67.59%(+/- 13.12259) in group 1, 77.38% (+/- 4.12506) in group 2, 74.57% (+/- 3.44780) in group 3, and 85.39% (+/- 4.36125) in group 4 (P = 0.001). The mean nitric oxide level was 31.66 mu mol/dL (+/- 2.42212) in group 1, 51.00 mu mol/dL (+/- 2.96648) in group 2, 34.00 mu mol/dL (+/- 2.96648) in group 3, and 47.66 mu mol/dL (+/- 2.80476) in group 4 (P=0.001). On angiography, there were vessel dilations and convolutions in group 2; capillaries became noticeable, and anastomotic vessels extended toward the more distal part of the flaps in group 4. Histological examinations showed severe inflammation in group 3 and minimal inflammation and venous vasodilatation in group 2. Verapamil and Daflon in therapeutic doses significantly increased the viability of reverse-flow island flaps. However, nifedipine did not make a significant contribution to the flap viability. The results of this study will contribute to the literature about the hemodynamics of reverse-flow island flaps and guide further studies on the issue.Öğe Lower Face Reconstruction Using the Visor Flap(Lippincott Williams & Wilkins, 2019) Kilinc, Hidir; Dinc, Orhan GaziWe present an alternative method instead of classical methods for lower face reconstruction in this study involving clinical experiences. We aimed to achieve more esthetic and functional results using visor flap. This flap has been used for the reconstruction of lower lip and submental region in two patients. Satisfactory functional and cosmetic outcomes were obtained in patients. Flaps and donor sides healed with no complications. The hair follicles on the flap continued to grow in new locations. The visor flap is a useful alternative method for lower face reconstruction. This technique offers perfect color and texture matching and hair growth.Öğe Nasal Tip Contouring Using Lower Lateral Cartilages(Lippincott Williams & Wilkins, 2011) Bilen, Bilgetuerk; Kilinc, Hidir; Tenekeci, GoktekinNasal tip management is the most important and challenging part of rhinoplasty surgery. For nasal tip management, optimal nasal tip projection and rotation must be maintained. For this reason, several methods have been developed to obtain optimal results. In this article, we share with the rhinoplasty surgeons how we use cartilage grafts for nasal tip projection, nasal tip shaping, and maintaining natural and symmetric appearance and avoid visible cartilage problem by using a simple and easily applicable method. After performing standard open rhinoplasty techniques, we used the cephalic portion of the lower lateral cartilages to overgraft the already placed numerous layers of shield or onlay grafts. All the cartilage grafts are sutured in their place to prevent malpositions or undesired angularities. We operated on 1480 patients between September of 2002 and September of 2009 for rhinoplasty. Ages of the patients range from 18 to 58 years with nasal tip ptosis. We performed 1235 primary rhinoplasties and 245 secondary rhinoplasties. Of 365 patients, who were followed up regularly, 330 (approximately 90%) were operated on according to this technique and were included in the study. By using such an overgrafting technique for nasal tip, we obtained satisfactory results both by the patients and by the surgeons. Satisfactory results and being a facilitating method for shaping of nasal tip are the advantages of this technique.Öğe A Novel Flap for the Reconstruction of Midcheek Defects: Rabbit Ear Flap(Lippincott Williams & Wilkins, 2013) Kilinc, Hidir; Erbatur, Serkan; Aytekin, Ahmet HamdiCheek defects generally occur because of reasons such as trauma, burn, and tumor excisions. In the reconstruction of cheek defects, it is essential to cover the defects using the tissues with compatible color and similar texture. Although many techniques have been described for this purpose, local flaps are more likely to be used. In this study, we describe a new technique named rabbit ear flap, which we used for the reconstruction of a 4.5 x 7-cm cheek defect due to basal cell carcinoma excision in a 71-year-old male patient. Two separate flaps on the extension of right facial artery with an inferior pedicle on the nasolabial region (hairless skin) and a superior pedicle flap that extended from right oral commissure to the submandibular region (hairy skin) were used. The hairy skin part of the defect was closed via the hairy skin flap, whereas the hairless region was closed with the hairless skin flap. The donor sites were closed primarily. No complication was encountered in the early or long-term follow-ups. In the 28-month follow-up of the patient, it was observed that the color and texture compatibility was fine, the natural beard integrity was obtained, the donor site scarring was minimal, and the scarring was camouflaged well in the anatomical lines. This technique is supposed to be an alternative method for reconstruction of medium-sized cheek defects because it is a simple, reliable, and single-session procedure, and because of its similar color and texture, it offers satisfactory aesthetic and functional outcomes due to natural beard restoration.Öğe Our Clinical Algorithmic Approach for Meningomyelocele Defects Reconstruction with Fasciocutaneous Flaps(Turkish Neurosurgical Soc, 2021) Algan, Mehmet Fatih; Firat, Cemal; Bekircan, Kagan; Kilinc, Hidir; Onal, Selami CagatayAIM: To evaluate fasciocutaneous flaps used for reconstruction of meningomyelocele defects in our clinic and to suggest an algorithm for flap selection. MATERIAL and METHODS: A retrospective analysis of 45 patients with meningomyelocele, who underwent repair with fasciocutaneous flaps, was carried out. Preoperative and postoperative photos were analyzed. The defect areas were measured by Adobe Photoshop CC. Limberg flap, bilateral Limberg flaps, bilateral bipedicled advancement flaps, bilobed flap and reading man flap were performed. RESULTS: Wound dehiscence and partial necrosis occurred in 8 patients. All wounds were managed conservatively and healed successfully. No other complications were observed. The mean defect size for all patients was 36 cm(2). The mean defect size was 45.3 cm(2) in bilateral bipedicled flaps cases; 33.5 cm(2) in bilateral Limberg flaps cases; and 19.6 cm(2) in the unilateral Limberg flap cases. According to the algorithm, a unilateral Limberg flap or bilobed flap or reading man flap can be used for the defects smaller than 25 cm(2); bilateral Limberg flaps can be used for the defects between 25 and 35 cm(2); and bilateral bipedicled advancement flaps can be used for the defects larger than 35 cm(2). CONCLUSION: Fasciocutaneous flaps can be preferred in meningomyelocele defect reconstruction due to the easy planning of flaps, easy and fast flap elevation, and low complication rates due to their reliable circulation. The measurement of the defect area allows this algorithm selecting a flap in a more practical way.Öğe Prelaminated Calvarial Osteofascial Flap for Palatal Reconstruction(Lippincott Williams & Wilkins, 2014) Kilinc, Hidir; Aytekin, Ahmet HamdiReconstruction of the hard palate defects is among the most challenging problems for plastic surgeons. Prosthetic obturations and local flaps for small defects have been used, whereas numerous regional and free flaps have been described for larger defects. The search for the ideal method offering a natural palatal structure is still ongoing. Five male patients with a mean age of 30.4 years experiencing hard palate defects due to congenital cleft palate or tumor excisions were repaired by prelaminated calvarial osteofascial flap. The mean defect size was 3.14 +/- 2.48 cm. Both of the surfaces of the calvarial bone elevated with superficial temporal fascia were wrapped with fascia and covered with split-thickness skin graft. The interval between the 2 sessions ranged from 3 to 6 weeks. In the second session, triple layered reconstruction involving the bony layer as well as the oral and nasal mucosa was performed. In 1 case, partial skin loss on the oral surface of the flap was seen in the second session but epithelialized spontaneously. The mean follow-up period was 21.8 months, and no complication such as wound detachment, infection, flap loss, as well as fistula or nasal regurgitation was encountered. A hard palatal reconstruction was performed, offering a natural anatomy in terms of structure and shape. This reliable technique, which is convenient for the three-dimensional reconstruction of the hard palate defects offering a near-normal anatomy owing to its triple layered structure, thickness, and the compatible shape of the calvarial bone to the palate, can be a good alternative against other regional and free flaps.Öğe Radiological and Histopathological Evaluation in Reduction Mammoplasty(İnönü Üniversitesi, Tıp Fakültesi, Plastik Rekonstrüktif ve Estetik Cerrahi Anabilim Dalı, Malatya, Türkiye, 2013) Kilinc, Hidir; Elmas, Omer; Bilen, Bilge TurkRadiological and Histopathological Evaluation in Reduction Mammoplasty Öz: Amaç: Mammografi ve Ultrasonografi (USG), redüksiyon mammoplasti öncesinde asemptomatik lezyonların tespit edilmesinde yardımcı tanı yöntemleridir. Ancak preoperatif radyolojik değerlendirme her zaman kesin sonuçlar vermemektedir. Bu nedenle premalign lezyonların veya sessiz kanser odaklarının tanısı amacıyla, preoperatif radyolojik inceleme ve postoperatif histopatolojik değerlendirme birlikte kullanıldı. Gereç ve Yöntemler: Kliniğimizde, 2007-2011 yılları arasında 135 hastada radüksiyon mammoplasti ameliyatı yapıldı. Hastaların yaşları 18 ile 67 arasında değişmekteydi (ortalama 44,6 yıl). Operasyondan önce tüm hastalarda USG ve 40 yaş üstündeki hastalarda ek olarak mammografi yapıldı. Çıkarılan tüm doku örnekleri histopatolojik olarak incelendi. Bulgular: Preoperatif olarak yapılan radyolojik incelemede; 96 hastada (%71,1) USG sonuçları normal olarak değerlendirildi. %8,1 Fibrokistik değişiklik, %0,7 lipoma, %4,4 fibroadenoma, %2,9 benign lenf nodu olduğu tespit edildi. Histopatolojik olarak yapılan incelemede; %7 hafif-orta epitelyal hiperplazi, %4,8 ağır epitelyal hiperplazi, %25,9 fibrokistik değişiklik, %16,2 fibrozis, %9,6 yağdan zengin meme dokusu, %7,7 apokrin metaplazi, %4,4 duktal ektazi, %3,7 fokal adenozis, %4,4 hafif-orta dereceli duktal hiperplazi, %3,7 fibroadenoma ve %12,2 normal meme dokusu olarak değerlendirildi. Sonuç: Bu çalışmada, meme dokusu örneklerinde %87,6 oranında non-proliferatif benign değişiklikler olduğu görüldü. Premalign veya malign lezyona rastlanmadı. Bu sonuçlar, preoperatif radyolojik değerlendirme ve postoperatif histopatolojik incelemenin, memenin benign, premalign veya sessiz malign lezyonlarının tanısındaki önemini göstermesi açısından anlamlı bulundu.Öğe Radiological and Histopathological Evaluation in Reduction Mammoplasty(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2013) Kilinc, Hidir; Elmas, Omer; Bilen, Bilge TurkAim: Mammography and ultrasonography are helpful diagnostic methods for the detection of asymptomatic lesions prior to reduction mammoplasty operations. Preoperative radiological evaluation does not give accurate results all time. Consequently, preoperative radilological and postoperative histopathologic evaluation were used together in order to diagnose the premalignant and silent cancer foci. Material and Methods: In our clinic, 135 patients underwent reduction mammoplasty operation between 2007 and 2011. The age of the patients ranged from 18 to 67 (mean 44.6). Ultrasonography was performed for all the patients and mammography was performed additionally for the ones older than 40 years of age. The excised tissue samples were sent for histopathologic evaluation. Results: Preoperative radiologic evaluation, USG results were assessed as normal in 96 patients (71,1%) and, of the patients, % 8,1 had fibrocystic changes, 0,7% had lipoma, 4.4% had fibroadenoma and 2,9% had benign lymph node. In the histopathologic evaluation, 7% had mild epithelial hyperplasia, 4,8% had severe epithelial hyperplasia, 25,9% had fibrocystic changes, 16.2% had fibrosis, 9,6% had fatty breast tissue, 7,7% had apocrine metaplasia, 4,4% had ductal ectasia, 3,7% had focal adenosis, 4,4% had mild ductal hyperplasia, 3,7% had fibroadenoma and 12,2% had normal breast tissue. Conclusion: In this study, non-proliferative benign changes were seen in the 87,6% of the breast tissue samples. No premalignant or malignant lesions were detected. These results revealed that preoperative radiologic evaluation and postoperative histopathologic analysis were significant in terms of diagnosis of benign, premalignant or silent malignant lesions of the breast.Öğe Reconstruction of Hair-Bearing Areas(Lippincott Williams & Wilkins, 2020) Kilinc, Hidir; Algan, Mehmet FatihHair-bearing areas reconstruction is a difficult field because of limited donor area. Various techniques have been described for hair-bearing areas reconstruction, but the choice of the flap is variable depending on surgeons and patients. In this study, the authors present 7 patients who underwent soft tissue reconstruction with the pedicled superficial temporal artery-based flaps in the hair-bearing areas. No postoperative complications like bleeding, flap congestion, wound dehiscence, and flap necrosis were observed. This flap can be an alternative to the other methods because it is compatible with the face by the flap color and thickness, it can be easily harvested, it has a reliable circulation and minimum donor site scar.Öğe Reconstruction of orbital floor and maxilla with divided vascularised calvarial bone flap in one session(Elsevier Sci Ltd, 2008) Bilen, Bilge Turk; Kilinc, Hidir; Aslan, Serkan; Tenekeci, Goektekin[Abstract Not Available]Öğe Supratrochlear island flap for reconstruction of the periorbital and nasal defects(Springer, 2014) Kilinc, Hidir; Geyik, Yilmaz; Aytekin, Ahmet HamdiBackground 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.
