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Öner Ç, Irmak F, Eken G, Öner BB, Karsıdağ SH. The effect of stromal vascular fraction in an experimental frostbite injury model. Burns 2023; 49:149-161. [PMID: 35241296 DOI: 10.1016/j.burns.2022.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/29/2022] [Accepted: 02/14/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Despite current treatment modalities, frostbite remains an injury with a poor prognosis which may cause functional morbidities. Several experimental and clinical studies have demonstrated that stromal vascular fraction is an autologous mixture, which can improve wound healing and vasculogenesis. The aim of this study was to show the beneficial effects of stromal vascular fraction on experimental frostbite healing. MATERIAL AND METHODS Stromal vascular fraction (SVF) was harvested from 5 rats after excision of the inguinal fat pads. Another 20 rats were separated into 2 groups of 10 as the SVF group and the control group. A frostbite injury was created on each rat using a cryoprobe frozen with liquid nitrogen (-196 °C). SVF was applied to the SVF group and phosphate-buffered saline to the control group. All injections were performed subcutaneously within the frostbite injury area. Biopsies were performed on days 5 and 14 for histopathological and immunochemical evaluations. The tissue perfusion rates of both groups were assessed on day 14 using indocyanine green angiography (SPY system). RESULTS The increase in mean tissue perfusion was 373.3% ( ± 32.1) in the SVF group and 123.8% ( ± 16.3) in the control group (p < 0.001). The macroscopic wound reduction rates of the SVF and control groups were 25.5% ( ± 19.1) and 18.0% ( ± 5.9), respectively on day 5%, and 78.2% ( ± 9.2) and 57.3% ( ± 16.7) on day 14 (p = 0.007; p = 0.003). Acute inflammation and the fibrosis gradient were significantly decreased in the SVF group compared to the control group (p = 0.004, p = 0.054 respectively on day 14). Granulation tissue amount, re-epithelialization score and neovascularization were significantly increased in the SVF group (p = 0.006, p = 0.010 and p = 0.021, respectively on day 14). CONCLUSIONS The study results demonstrated that SVF increases frostbite wound healing by increasing tissue perfusion rate, neovascularization and re-epithelialization, and modulating acute inflammation and fibrosis.
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Affiliation(s)
- Çağatay Öner
- Department of Plastic, Reconstructive and Aesthetic Surgery, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey; Department of Plastic, Reconstructive and Aesthetic Surgery, Sirnak State Hospital, Sirnak, Turkey.
| | - Fatih Irmak
- Department of Plastic, Reconstructive and Aesthetic Surgery, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
| | - Gülçin Eken
- Department of Clinical Pathology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
| | - Burcu Bitir Öner
- Department of Anesthesiology and Reanimation, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
| | - Semra Hacıkerim Karsıdağ
- Department of Plastic, Reconstructive and Aesthetic Surgery, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
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Kwon H, Lee S, Kim J, Song SH. Efficacy and safety of stromal vascular fraction on scar revision surgery: a prospective study. J DERMATOL TREAT 2023; 34:2171260. [PMID: 36661928 DOI: 10.1080/09546634.2023.2171260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Cell-based therapies are popular in the field of reconstructive surgery. The stromal vascular fraction (SVF), comprised of mature adipocytes or blood, reportedly has a regenerative effect; however the mechanism remains unclear. This study aimed to prove the viability and effectiveness of using SVF in scar treatment. METHODS This prospective double-blind study involved 20 patients who visited an outpatient clinic for 2 years, from July 2016 to July 2018, and underwent scar revision for traumatic or surgical scars. After scar revision surgery performed by a single surgeon, patient scars were divided into experimental and control sides. The subcutaneous layer of the experimental and control sides were injected with 0.1 mL/cm of SVF and normal saline, respectively. Each side was evaluated using the Patient and Observer Scar Assessment Scale (POSAS) before and six months after the surgery. RESULTS Of the 20 patients who underwent scar revision surgery and SVF treatment, 4 dropped out for personal reasons. In 11 of 12 POSAS items, the experimental side showed significant improvements compared to the control side. CONCLUSIONS Although more research is needed, autologous SVF is a valuable source of regenerative medicine that can be swiftly and inexpensively prepared from human fat tissue.
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Affiliation(s)
- Hyeokjae Kwon
- Department of Plastic and Reconstructive Surgery, Chungnam National University Hospital, Daejeon, South Korea.,Department of Plastic and Reconstructive Surgery, College of Medicine, Chungnam National University, Daejeon, South Korea
| | - Seokui Lee
- Department of Plastic and Reconstructive Surgery, Chungnam National University Hospital, Daejeon, South Korea
| | - Jiyoung Kim
- Healthcare Data Science Center, Konyang University Hospital, Daejeon, Korea
| | - Seung Han Song
- Department of Plastic and Reconstructive Surgery, Chungnam National University Hospital, Daejeon, South Korea.,Department of Plastic and Reconstructive Surgery, College of Medicine, Chungnam National University, Daejeon, South Korea
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Özkan B, Eyüboğlu AA, Terzi A, Özturan Özer E, Tatar BE, Uysal CA. The Effect of Adipose Derived Stromal Vascular Fraction on Flap Viability in Experimental Diabetes Mellitus and Chronic Renal Disease. J INVEST SURG 2022; 35:1492-1501. [PMID: 35450516 DOI: 10.1080/08941939.2022.2066741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The presence of chronic renal disease(CRD) concurrently with diabetes mellitus(DM) increases the flap failure. Adipose derived stromal vascular fraction (SVF) is known to enhance skin flap viability in both healthy and diabetic individuals. The aim of this experimental study was to investigate the effect of SVF on skin flap viability in rats with DM and CRD. METHODS 48 Sprague-Dawley rats were separated into four groups as follows: group I (control), group II (diabetes mellitus), group III (chronic renal disease), and group IV (diabetes with chronic renal disease).Two dorsal flaps were elevated. Flaps on left side of all groups received 0.5 cc of SVF, while same amount of plasma-buffered saline (PBS) was injected into right side. On postoperative day 7, flaps were harvested for macroscopic, histopathologic and biochemical assessments. Areas of flap survival were measured macroscopically. Blood level of vascular endothelial growth factor (VEGF) was measured after injection of SVF. RESULTS Macroscopically, SVF has significantly improved flap viability (p < 0.05). Flap viability percentage was lower in DM and CRD groups when compared with healthy control group. In respect of new capillary formation, there was a statistically significant difference between SVF injected flaps and PBS injected sides (p < 0.05). Similarly, VEGF levels were higher in all study groups and there was a significant difference in comparison to control group (p < 0.05). CONCLUSIONS The study showed that injection of SVF increased flap viability via endothelial differentiation and neovascularization. In vivo function of stem cells might be impaired due to uremia and diabetes-related microenviromental changes.
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Affiliation(s)
- Burak Özkan
- Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Baskent University, Ankara, Turkey
| | | | - Aysen Terzi
- Faculty of Medicine, Department of Pathology, Baskent University, Ankara, Turkey
| | - Eda Özturan Özer
- Faculty of Medicine, Deparment of Biochemistry, Baskent University, Ankara, Turkey
| | - Burak Ergün Tatar
- Department of Plastic Surgery, University of Health Sciences, Bagcılar Training and Research Hospital, Istanbul, Turkey
| | - Cagri A Uysal
- Department of Plastic, Reconstructive and Aesthetic Surgery, Baskent University, Ankara, Turkey
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Chen J, Wang Y, Hu H, Xiong Y, Wang S, Yang J. Adipose-derived cellular therapies prolong graft survival in an allogenic hind limb transplantation model. Stem Cell Res Ther 2021; 12:94. [PMID: 33514430 PMCID: PMC7847016 DOI: 10.1186/s13287-021-02162-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/12/2021] [Indexed: 12/05/2022] Open
Abstract
Background The long-term survival after vascularized composite allotransplantation (VCA) is often limited by systemic rejection as well as the adverse effects of immunosuppressants. The stromal vascular fraction (SVF) can be expanded to produce adipose-derived stem cells (ADSC) which represents a combination of endothelial cells, preadipocytes, immune cells, and ADSC. It has been demonstrated that ADSC possess consistently reliable clinical results. However, literature is scarce regarding SVF in VCA. This study seeks to determine the impact of ex vivo allograft pretreatment in combination with SVF cells in the ability to promote composite tissue allotransplantation immunotolerance. Methods A rat hind limb allotransplant model was used to investigate the influence of ex vivo pretreatment of SVF and ADSC on VCA survival. Intravascular cell-free saline, ADSC, or SVF was infused into the models with immunosuppressants. The histopathological examination and duration that the allografts went without displaying symptoms of rejection was documented. Peripheral T lymphocytes and Tregs were quantified with flow cytometry while allotissue expressions of CD31 were quantified with immunohistochemical staining (IHC). ELISA was used to detect vascular endothelial growth factor (VEGF)-A as well as anti- and pro-inflammatory cytokines. Results We demonstrated that ex vivo treatment of allografts with SVF or ADSC prolonged allograft survival in contrast to medium control cohorts. There were also enhanced levels of immunomodulatory cytokines and increased VEGF-A and CD31 expression as well as reduced infiltration and proliferation of T lymphocytes along with raised Treg expressions. Conclusion These studies demonstrated that adipose-derived cellular therapies prolong graft survival in an allogenic hind limb transplantation model and have the potential to establish immunotolerance. Supplementary Information The online version contains supplementary material available at 10.1186/s13287-021-02162-7.
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Affiliation(s)
- Jingting Chen
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yinmin Wang
- Department of Plastic and Reconstructive Surgery, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Haoyue Hu
- Basic Medical School , Jining Medical University , Jining, 272000, China
| | - Yao Xiong
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Shoubao Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Jun Yang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Castiglione F, Hedlund P, Weyne E, Hakim L, Montorsi F, Salonia A, Bivalacqua TJ, De Ridder D, Milenkovic U, Ralph D, Garaffa G, Muneer A, Joniau S, Albersen M. Intratunical injection of stromal vascular fraction prevents fibrosis in a rat model of Peyronie's disease. BJU Int 2019; 124:342-348. [DOI: 10.1111/bju.14570] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Fabio Castiglione
- Laboratory for Experimental Urology; Organ Systems; Department of Development and Regeneration; University of Leuven; Leuven Belgium
- Institute of Urology; University College of London Hospital; London UK
- Division of Oncology/Unit of Urology; Urological Research Institute; IRCCS Ospedale San Raffaele; Milan Italy
| | - Petter Hedlund
- Department of Clinical and Experimental Pharmacology; Lund University; Lund Sweden
- Division of Drug Research; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - Emmanuel Weyne
- Laboratory for Experimental Urology; Organ Systems; Department of Development and Regeneration; University of Leuven; Leuven Belgium
| | - Lukman Hakim
- Laboratory for Experimental Urology; Organ Systems; Department of Development and Regeneration; University of Leuven; Leuven Belgium
- Department of Urology; Airlangga University / Dr Soetomo General Hospital; Surabaya Indonesia
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology; Urological Research Institute; IRCCS Ospedale San Raffaele; Milan Italy
| | - Andrea Salonia
- Division of Oncology/Unit of Urology; Urological Research Institute; IRCCS Ospedale San Raffaele; Milan Italy
| | - Trinity J. Bivalacqua
- James Buchanan Brady Urological Institute; Department of Urology; Johns Hopkins Medical Institutions; Baltimore MD USA
| | - Dirk De Ridder
- Laboratory for Experimental Urology; Organ Systems; Department of Development and Regeneration; University of Leuven; Leuven Belgium
| | - Uros Milenkovic
- Laboratory for Experimental Urology; Organ Systems; Department of Development and Regeneration; University of Leuven; Leuven Belgium
| | - David Ralph
- Institute of Urology; University College of London Hospital; London UK
| | - Giulio Garaffa
- Institute of Urology; University College of London Hospital; London UK
| | - Asif Muneer
- Institute of Urology; University College of London Hospital; London UK
- Division of Surgery and Interventional Science; NIHR Biomedical Research Centre; University College London Hospital; London UK
| | - Steven Joniau
- Laboratory for Experimental Urology; Organ Systems; Department of Development and Regeneration; University of Leuven; Leuven Belgium
| | - Maarten Albersen
- Laboratory for Experimental Urology; Organ Systems; Department of Development and Regeneration; University of Leuven; Leuven Belgium
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Effects of açaí and cilostazol on skin microcirculation and viability of TRAM flaps in hamsters. J Surg Res 2018; 228:253-262. [PMID: 29907219 DOI: 10.1016/j.jss.2018.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 12/08/2017] [Accepted: 03/13/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Tissue necrosis caused by insufficient perfusion is a major complication in flap transfer. This study evaluated whether treatment with cilostazol or hydroalcoholic extract of seeds of Euterpe oleracea Mart. (açaí) protects the transverse rectus abdominis myocutaneous (TRAM) flap against ischemic damage in hamsters. MATERIALS AND METHODS Fifty-four hamsters were divided into three oral treatment groups: placebo, açaí, or cilostazol. Caudally based, unipedicled TRAM flaps were raised, sutured back, classified into four vascular zones (I-IV), and evaluated for tissue viability, capillary blood flow (CBF), perfused vessel density (PVD), and microvascular flow index (MFI) by orthogonal polarization spectral imaging at three time points: immediately postoperatively (IPO), 24 h postoperatively (24hPO), and 7 d postoperatively (7POD). RESULTS Comparing to placebo, açaí increased PVD at IPO and açaí and cilostazol increased CBF and PVD at 24hPO in zone I; cilostazol increased CBF, PVD, and MFI at IPO, and CBF at 24hPO in zone II; açaí and cilostazol increased CBF at all time points and PVD and MFI at IPO and 24hPO in zone III; cilostazol increased CBF at IPO and 7POD, açaí increased CBF at 7POD, and both increased PVD and MFI at all time points in zone IV; and açaí and cilostazol increased the percentage of viable area in zones III and IV. CONCLUSIONS Açaí and cilostazol treatments had a protective effect against ischemic damage to TRAM flaps in hamsters, improving microvascular blood flow and increasing the survival of flap zones contralateral to the vascular pedicle (zones III and IV).
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Miana VV, González EAP. Adipose tissue stem cells in regenerative medicine. Ecancermedicalscience 2018; 12:822. [PMID: 29662535 PMCID: PMC5880231 DOI: 10.3332/ecancer.2018.822] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Indexed: 12/26/2022] Open
Abstract
Adipose tissue-derived stem cells (ADSCs) are mesenchymal cells with the capacity for self-renewal and multipotential differentiation. This multipotentiality allows them to become adipocytes, chondrocytes, myocytes, osteoblasts and neurocytes among other cell lineages. Stem cells and, in particular, adipose tissue-derived cells, play a key role in reconstructive or tissue engineering medicine as they have already proven effective in developing new treatments. The purpose of this work is to review the applications of ADSCs in various areas of regenerative medicine, as well as some of the risks associated with treatment with ADSCs in neoplastic disease.
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Affiliation(s)
- Vanesa Verónica Miana
- Centre for Advanced Studies in Humanities and Health Sciences, Interamerican Open University, Buenos Aires, Argentina
| | - Elio A Prieto González
- Centre for Advanced Studies in Humanities and Health Sciences, Interamerican Open University, Buenos Aires, Argentina
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Eyuboglu AA, Uysal CA, Ozgun G, Coskun E, Markal Ertas N, Haberal M. The effect of adipose derived stromal vascular fraction on stasis zone in an experimental burn model. Burns 2018; 44:386-396. [DOI: 10.1016/j.burns.2017.08.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/18/2017] [Accepted: 08/22/2017] [Indexed: 01/02/2023]
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Adipose-derived cellular therapies in solid organ and vascularized-composite allotransplantation. Curr Opin Organ Transplant 2018; 22:490-498. [PMID: 28873074 DOI: 10.1097/mot.0000000000000452] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Controlling acute allograft rejection following vascularized composite allotransplantation requires strict adherence to courses of systemic immunosuppression. Discovering new methods to modulate the alloreactive immune response is essential for widespread application of vascularized composite allotransplantation. Here, we discuss how adipose-derived cellular therapies represent novel treatment options for immune modulation and tolerance induction in vascularized composite allotransplantation. RECENT FINDINGS Adipose-derived mesenchymal stromal cells are cultured from autologous or allogeneic adipose tissue and possess immunomodulatory qualities capable of prolonging allograft survival in animal models of vascularized composite allotransplantation. Similar immunosuppressive and immunomodulatory effects have been observed with noncultured adipose stromal-vascular-fraction-derived therapies, albeit publication of in-vivo stromal vascular fraction cell modulation in transplantation models is lacking. However, both stromal vascular fraction and adipose derived mesenchymal stem cell therapies have the potential to effectively modulate acute allograft rejection via recruitment and induction of regulatory immune cells. SUMMARY To date, most reports focus on adipose derived mesenchymal stem cells for immune modulation in transplantation despite their phenotypic plasticity and reliance upon culture expansion. Along with the capacity for immune modulation, the supplemental wound healing and vasculogenic properties of stromal vascular fraction, which are not shared by adipose derived mesenchymal stem cells, hint at the profound therapeutic impact stromal vascular fraction-derived treatments could have on controlling acute allograft rejection and tolerance induction in vascularized composite allotransplantation. Ongoing projects in the next few years will help design the best applications of these well tolerated and effective treatments that should reduce the risk/benefit ratio and allow more patients access to vascularized composite allotransplantation therapy.
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Abbas OL, Terzi YK, Özatik O, Özatik FY, Turna G, Nar R, Musmul A. Enhancement of vascular endothelial growth factor's angiogenic capacity by the therapeutic modulation of notch signalling improves tram flap survival in rats submitted to nicotine. J Plast Surg Hand Surg 2017; 51:405-413. [PMID: 28277073 DOI: 10.1080/2000656x.2017.1285784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Smoke of cigarettes, and specifically nicotine, has been shown to diminish pedicled transverse rectus abdominis musculocutaneous (TRAM) flap survival. Considering that Notch signalling through its ligand Delta-like 4 (Dll4) functions as anti-angiogenic factor by inhibiting the pro-angiogenic effects of vascular endothelial growth factor (VEGF), it is hypothesised that inhibition of the Notch would promote angiogenesis and increase TRAM flap survival in rats submitted to nicotine. METHODS Twenty rats were treated with nicotine for 28 days preoperatively. Thereafter, a pedicled TRAM flap was created in all animals. The Notch inhibitor N-[N-(3,5-difluorophenacetyl)-1-alanyl]-S-phenylglycine-t-butyl-ester was administered in animals of the treatment group. Animals in the control group were given the same amount of solvent. Five days after the surgery, viable flap areas were determined. Skin samples were evaluated for VEGF and Dll4 mRNA levels. Immunohistochemical analysis was used for the assessment of endothelial Dll4 expression. Vascular density was determined histologically. Plasma levels of VEGF and Dll4 were measured. RESULTS A significant improvement in TRAM flap surviving area was observed in the treatment group (53.50 ± 14.25%) compared with the controls (32.20 ± 9.15%). Immunohistochemical analysis revealed a significant increase in the number of Dll4 stained vessels in animals of the treatment group (9.2 ± 1.6) in comparison with the controls (5.7 ± 1.9). VEGF mRNA levels (0.22 ± 0.08) in the treatment group were significantly lower than those in the control group (0.36 ± 0.09). CONCLUSION Notch inhibition significantly improved TRAM flap survival in animals exposed to nicotine by promoting VEGF-induced angiogenesis.
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Affiliation(s)
- Ozan Luay Abbas
- a Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery , Ahi Evran University , Kırşehir , Turkey
| | - Yunus Kasım Terzi
- b Faculty of Medicine, Department of Medical Genetics , Başkent University , Ankara , Turkey
| | - Orhan Özatik
- c Faculty of Medicine, Department of Histology and Embryology , Ahi Evran University , Kırşehir , Turkey
| | - Fikriye Yasemin Özatik
- d Faculty of Medicine, Department of Pharmacology , Ahi Evran University , Kırşehir , Turkey
| | - Gamze Turna
- e Faculty of Medicine, Department of Biochemistry , Ahi Evran University , Kırşehir , Turkey
| | - Rukiye Nar
- e Faculty of Medicine, Department of Biochemistry , Ahi Evran University , Kırşehir , Turkey
| | - Ahmet Musmul
- f Faculty of Medicine, Department of Biostatistics , Osmangazi University , Eskişehir , Turkey
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