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Gelbal C, Tatar BE, Yilmaz B, Uyanikgil Y, Tomruk C, Bozkurt M. Histopathological Evaluation of Bipolar and Microneedle Radiofrequency Energy on the Skin and Fat of the Abdominal Region of the Rat. Plast Reconstr Surg 2024:00006534-990000000-02318. [PMID: 38652818 DOI: 10.1097/prs.0000000000011490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Radiofrequency (RF)-based devices are frequently used in plastic surgeries. In the current literature, no comparative experimental study has demonstrated the histological and immunological effects of these devices that are frequently used in the facial area. In this study, we investigated the histological and immunological effects of Bipolar RF (BodyTite) and Microneedle RF (Morpheus 8) devices in the rat abdominal region. METHODS 24 rats were used in this study. The rats were divided into four groups: group I: Control. In group II, BodyTite was applied to the abdominal region. Group III: Morpheus 8 was applied to the abdominal region. Group IV: Both Morpheus 8 and BodyTite were applied to the abdominal region. The histological and immunological features of the tissues in the groups were examined using light microscopy, and collagen formation and desmosome structures were examined using light microscopy. RESULTS Collagens in Group II were thinner than those in the other groups. In addition, there were fewer vessels in Group III. The collagen scores were as follows: Group II:1.5; Group III:2; and Group IV:3. The VEGF scores were II:2.5, group III:2, and IV:3, respectively. The collagen score in group II and VEGF score in group III were significantly lower than those in the other groups. In addition, the bonds between desmosomes in group III were found to be looser using electron microscopy. Collagen morphology in groups III and IV was found to be similar to that in group I. CONCLUSIONS The conclusion of comparison RF-based devices increased tissue regeneration and healing. CLINICAL RELEVANCE STATEMENT The use of radiofrequency devices has increased in plastic surgery practice over the past two decades, particularly emerging as a unique alternative for non-surgical candidates. There is a lack of experimental studies concerning these commonly used devices in clinical practice.
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Affiliation(s)
- Caner Gelbal
- ORCID: 0000-0002-8372-7509, University of Health Sciences, Bagcilar Training and Research Hospital, Department of Plastic Surgery, Istanbul, Turkey,
| | - Burak Ergün Tatar
- ORCID:0000-0002-5446-1940 Erzurum Regional Training and Research Hospital, Department of Plastic Surgery, Erzurum, Turkey
| | - Bengi Yilmaz
- ORCID:0000-0001-7642-4684 , University of Health Sciences,Department of Biomaterials and Department of Experimental Medicine Research and Application Center, Istanbul, Turkey,
| | - Yiğit Uyanikgil
- ORCID, Ege University Faculty of Medicine, Department of Histology and Embryology, Izmir, Turkey,
| | - Canberk Tomruk
- ORCID: 0000-0002-3810-3705 , Histology and Embryology, Samsun University, Samsun Education and Research Hospital, Samsun, Turkey,
| | - Mehmet Bozkurt
- ORCID: 0000-0002-4480-513X, University of Health Sciences, Bagcilar Training and Research Hospital, Istanbul, Turkey,
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Özkan B, Tatar BE, Savran S, Albayati A, Uysal CA. Reconstruction of finger contracture with an expanded first dorsal metacarpal artery perforator flap: A case report. Microsurgery 2024; 44:e31057. [PMID: 37199482 DOI: 10.1002/micr.31057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 03/15/2023] [Accepted: 05/05/2023] [Indexed: 05/19/2023]
Abstract
Volar finger contractures can be challenging for plastic surgeons. The dorsal metacarpal artery perforator (DMCAP) flap is frequently used to cover bones, tendons, and neurovascular structures in the dorsum of the hand after trauma and burns as an alternative to grafts and free flaps. We aimed to report volar finger defect reconstruction with expanded DMCAP flap. A 9-year-old male patient applied to our clinic with the complaint of inability to open the second finger of the left hand after an electrical burn that caused proximal and distal interphalangeal joints flexion contractures. Reconstruction was planned for the patient with a two-session expanded first DMCAP flap. A 16 mL 5 × 3 cm tissue expander was placed in the prepared area from the vertical incision in the first session. The tissue expander was inflated with 4 mL of isotonic solution. The DMCA area was enlarged 6 weeks later by giving 22 mL of isotonic solution. After the pedicle dissection, the 9 × 3 cm DMCAP flap was elevated by dissection over the paratenon. With 180° of rotation, the left-hand second finger was adapted to the 6 × 2 cm defect area on the volar face. The flap donor site was closed primarily. The operation was terminated by placing the hand on a protective splint. There were no complications in the flap in the postoperative 6 months. The patient was referred to the physical therapy and rehabilitation department. As a result, an expanded DMCAP flap may cover volar tissue defects up to the distal phalanx. This report may present the first case in which volar finger contracture reconstruction was performed with an expanded first DMCAP flap after an electrical burn in a pediatric patient.
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Affiliation(s)
- Burak Özkan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Baskent University, Ankara, Turkey
| | - Burak Ergün Tatar
- Department of Plastic, Reconstructive and Aesthetic Surgery, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Süleyman Savran
- Department of Plastic, Reconstructive and Aesthetic Surgery, Baskent University, Ankara, Turkey
| | - Abbas Albayati
- Department of Plastic, Reconstructive and Aesthetic Surgery, Baskent University, Ankara, Turkey
| | - Cagri Ahmet Uysal
- Department of Plastic, Reconstructive and Aesthetic Surgery, Baskent University, Ankara, Turkey
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Özkan B, Tatar BE, Albayati A, Uysal CA. Utilization of Perifascial Loose Areolar Tissue Grafting as an Autologous Dermal Substitute in Extremity Burns. J INVEST SURG 2023; 36:2192786. [PMID: 37004999 DOI: 10.1080/08941939.2023.2192786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
BACKGROUND Perifascial areolar tissue (PAT) is an areolar layer over the muscle fascia. PAT has been shown to be resistant to ischemia and prone to survival even in ischemic conditions. PAT grafts provide a vascular tissue layer on necrotic bone and tendons where skin grafting is not possible. The effect of PAT grafting on burn reconstruction has not yet been reported. Thus, in this study, we aimed to present our experience and discuss the role of PAT grafting in extremity burn reconstruction. METHODS Between January 2019 and December 2020, 16 PAT grafting procedures were performed in 11 patients. All patients had second- or third-degree burns in the upper and lower extremities, with exposed bone or tendon. PAT grafts were harvested from the abdominal region and were used for the upper extremity in 7 patients and the lower extremity in 4 patients. Immediate skin grafting was performed during the same session. RESULTS The patients' mean age was 50.7 years; defect size, 3.3 × 3 cm2; and follow-up time, 11.8 months. The survival rates of the PAT and skin grafts were 93.8% and 68.6%, respectively. Partial skin graft losses were encountered in 4 patients, and total skin graft loss was seen in 1 patient. CONCLUSION PAT grafting is an alternative method to the use of dermal substitutes and flap surgery in small-to-medium-sized defects with exposed bone and tendon in burn patients.
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Affiliation(s)
- Burak Özkan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Burak Ergün Tatar
- Department of Plastic Surgery, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Abbas Albayati
- Department of Plastic, Reconstructive and Aesthetic Surgery, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Cagri Ahmet Uysal
- Department of Plastic, Reconstructive and Aesthetic Surgery, Baskent University Faculty of Medicine, Ankara, Turkey
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Tatar BE, Erçin BS. Comparison of Dorsoulnar Artery Perforator, Superficial Palmar Branch of the Radial Artery, and Superficial Circumflex Iliac Artery Perforator Flaps in Volar Finger Defects. Ann Plast Surg 2023; 91:348-354. [PMID: 37566816 DOI: 10.1097/sap.0000000000003660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
BACKGROUND Volar finger defects can sometimes be challenging for plastic surgeons. There are many reconstruction options from local flaps to free flaps. Therefore, the aim of this study was to present a functional and cosmetic comparison of the results of using dorsoulnar artery perforator (DUAP), superficial palmar branch of the radial artery (SPBRA), and superficial circumflex iliac artery perforator (SCIP) flaps for repairing volar finger defects. METHODS Thirty-two patients were included in the study. The age and sex of the patients, cause of injury, defect location, defect size, and presence or absence of nerve damage were noted. The patients' defects were reconstructed with DUAP, SCIP, or SPBRA flaps. The flap size, flap elevation time, vessels, and early postoperative complications were noted. During the postoperative follow-up period, the Michigan Hand Outcomes Questionnaire scale was used to evaluate hand function, and the modified Vancouver Scar Scale was used to assess aesthetic appearance. Two-point discrimination tests and cold intolerance tests were performed to measure sensory outcomes. Donor site improvements were also noted. RESULTS There was no significant difference between the groups in terms of age, defect size, flap size, follow-up time, and 2-point discrimination. It was observed that the elevation time was significantly shorter in the SCIP flap group, and the Michigan Hand Outcomes Questionnaire score was significantly lower in the DUAP flap group compared with the other 2 groups (P < 0.01). In addition, the modified Vancouver Scar Scale score was significantly higher in the DUAP flap group (P < 0.01). CONCLUSION The findings of this study show that the use of SPBRA flaps has more advantages than the use of DUAP and SCIP flaps in many respects.
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Affiliation(s)
- Burak Ergün Tatar
- From the Department of Plastic Surgery, Erzurum Regional Training and Research Hospital, Erzurum
| | - Burak Sercan Erçin
- Department of Plastic Surgery, VM Medical Park Pendik Hospital, Bahçeşehir University, Istanbul, Turkey
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Tatar BE, Gelbal C, Uslu C, Yılmaz B, Tomruk C, Uyanıkgil Y, Akkoç T, Bozkurt M. Histological and Immunological Evaluation of the Osteogenic Effects of Compact Bone-Delivered Stem Cell on Spongiosis Bone in the Rat Zygomatic Arch Defect Model. Ann Plast Surg 2023; 91:385-394. [PMID: 37566821 DOI: 10.1097/sap.0000000000003638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
BACKGROUND In stem cell applications, apart from bone marrow and adipose tissue, compact bone is also used as an alternative. However, studies on this subject are limited. In our study, we investigated the effect of stem cell derived from compact bone on rat zygomatic arch defect. METHODS Fifteen rats were included in the study. Five rats were killed to obtain stem cells before the experiment. The rats were divided into 2 groups with 5 rats each. In group 1, compact bone-derived stem cell was applied. In group 2, adipose tissue-derived stem cell was applied. Right zygomatic arch defect was created in rats in both groups. Zygomatic bones were decellularized by cryosurgery. Stem cells were transferred to zygomatic bones. The number of stem cells, stem cell differentiation, and superficial markers obtained from the groups were examined. Histologically, cell structure, osteocyte count and osteopontin scores, elemental composition of the groups, percentages of resemblance to intact bone, osteocytes numbers, and cells were examined by electron microscopy of the bones in the groups after killing. RESULTS The number of stem cells administered to the groups was 5 × 107 and 3.2 × 107 for group 1 and group 2, respectively (P > 0.05). Histologically, the morphology of the cells in group 1 was found to be healthier than group 2. The number of osteocytes was 97.56 ± 15.4 and 132.93 ± 10.8 in group 1 and group 2, respectively (P < 0.05). The osteopontin score was 3.47 ± 0.73 and 65 ± 0.64 in group 1 and group 2, respectively (P < 0.05). In the electron microscope examination, the morphologies of the cells in group 1 were seen more normal. The Ca/P ratio of the groups was 1.51 and 1.59 in group 1 and group 2, respectively (P > 0.05). Osteocyte counts were 10.7 ± 2.8 and 6.1 ± 1.2 in group 1 and group 2, respectively (P < 0.05). Morphological similarity percentages to normal bone were 88.4% and 79.6% in group 1 and group 2, respectively (P > 0.05). CONCLUSION Stem cells obtained from compact bone gave positive results in zygomatic arch defect. This method can also be used as an alternative in stem cell applications.
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Affiliation(s)
- Burak Ergün Tatar
- From the Department of Plastic Surgery, Erzurum Regional Training and Research Hospital, Erzurum
| | - Caner Gelbal
- Department of Plastic Surgery, Bagcılar Training and Research Hospital
| | - Can Uslu
- Department of Plastic Surgery, Bagcılar Training and Research Hospital
| | - Bengi Yılmaz
- Department of Biomaterials and Department of Experimental Medicine Research and Application Center, University of Health Sciences, Istanbul
| | - Canberk Tomruk
- Histology and Embryology, Samsun University Samsun Education and Research Hospital, Samsun, Turkey
| | - Yiğit Uyanıkgil
- Department of Histology and Embryology, Ege University Faculty of Medicine, Izmir
| | - Tunç Akkoç
- Department of Immunology, Marmara University Pendik Training and Research Hospital, Istanbul
| | - Mehmet Bozkurt
- Bagcılar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Özkan B, Albayati A, Tatar BE, Uysal CA. The use of mathematically standardized bilobed design perforator flaps for coverage of sacral pressure ulcers. Microsurgery 2023; 43:229-237. [PMID: 36205233 DOI: 10.1002/micr.30973] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/25/2022] [Accepted: 09/28/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Sacral pressure ulcer reconstruction is frequently applied in plastic surgery practice. Although perforator flaps are frequently used, recurrence is not uncommon in patients. For this reason, using the as little area as possible during the reconstruction is vital. Therefore, we aimed to describe a mathematically standardized bilobed perforator flap design for sacral pressure ulcer reconstruction with a certain proportion and angle relation between limbs. METHODS A total of 17 patients (5 female/12 male)were included in this report. The mean age of the patients was 50.4 years (Ranging from 32 to 79 years). The patients with grade 3-4 sacral pressure ulcers were included in the report. The patients have grade 1-2 sacral ulcers or the other areas of pressure ulcer excluded. The size of the defects ranged from 8 × 14 cm to 5 x 16 cm. For ulcers in the sacral region, we used bilobed flaps that we mathematically standardized. The length of the first limb of the flap was planned 90° vertically oriented according to the distance between the perforator zone to the distal lateral border of the defect. The width of the first limb was kept equal to the length of the defect. The orientation of the second limb of the flap was designed 90 degrees horizontally according to the first limb. Therefore, the lengths of second limbs were calculated as half of the first limb's width, and the widths of second limbs were calculated as ¾ width of the first limb's width. RESULTS A total of 10 flaps were elevated based on superior gluteal artery perforators, and seven flaps were nourished by inferior gluteal artery perforators. The mean size of the first limb of the flaps was 14.7 × 7.2 cm (Ranging from 8 to 20 × 6 to 13 cm). The mean size of the second limb of the flaps was 6.7 × 5.3 cm (Ranging from 5 to 12 × 4 to 8 cm). The mean size of defects was 10.5 × 7.3 cm (Ranging from 8 to 14 × 5 to 16). The mean rotation angle was 91.7° (ranging from 90 to 100). In the early postoperative period, the hematoma was detected in three patients and evacuated in one patient, resulting in wound separation. Tip necrosis was seen in a patient that was healed by wound care. No total flap loss was encountered. No late-term recurrence was seen during the follow-up. The mean follow-up time was 13.1 months (Ranging from 4 to 24 months). CONCLUSION Unilateral standardized bilobed perforator can reliably be preferred in medium to large size sacral pressure ulcer defects.
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Affiliation(s)
- Burak Özkan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Baskent University, Ankara, Turkey
| | - Abbas Albayati
- Department of Plastic, Reconstructive and Aesthetic Surgery, Baskent University, Ankara, Turkey
| | - Burak Ergün Tatar
- Department of Plastic Surgery, Bagcılar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Cagri Ahmet Uysal
- Department of Plastic, Reconstructive and Aesthetic Surgery, Baskent University, Ankara, Turkey
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Tatar BE, Erçin BS. Using Merocel Marked with Skin Marker as a Background in Microsurgical Anastomosis: Our Clinical Practice. Indian J Plast Surg 2022; 55:311-312. [DOI: 10.1055/s-0042-1750374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- Burak Ergün Tatar
- Department of Plastic Surgery, University of Health Sciences, Bagcılar Training and Research Hospital, Istanbul, Turkey
| | - Burak Sercan Erçin
- Department of Plastic Surgery, Bahçeşehir University, VM Medicalpark Pendik Hospital, Istanbul, Turkey
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Erçin BS, Kabakaş F, Tatar BE, Keleş MK, Özçelik IB, Mensa B, Cavadas PC. Salvage of Devascularized and Amputated Upper Extremity Digits with Temporary Ectopic Replantation: Our Clinical Series. J INVEST SURG 2022; 35:1451-1461. [PMID: 35414330 DOI: 10.1080/08941939.2022.2062497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND One of the reasons for unsuccessful replantation is recipient site problems. In cases where proximal stump status cannot be predicted exactly, reamputation may be required depending on the result of infection and tissue necrosis. The ectopic banking method has been defined for this type of injury. In this study, we presented the amputated or devascularized upper extremity digit ectopic banking application results in our clinical practice. METHODS Nineteen digits (17 patients) banking ectopically were included in the study. All digits ectopically banked in the forearm volar of the non-injured upper limb. Transfers were made after waiting for the appropriate time. Ectopic banking periods, postoperative complications, and other descriptive data were recorded. In the postoperative 6th month, the range of motion (ROM) values of the digits were measured and compared with the ROM values of the same digit on the non-injured extremity.Also, in the postoperative 6th month, a questionnaire with a score of 1-5 was conducted for cosmetic results. RESULTS The mean follow-up time was 13.6 months. The mean patient age was 39.5 years. The ectopic banking success rate is 94.1% (16/17). The orthotopic/heterotopic transfer success rate is 100% (17/17). Ectopic banking time is, on average, 19.2 days (min 5-max 55). Average cosmetic scale is 3.54. CONCLUSIONS We think that the results of our study will shed light on surgeons who make ectopic banking applications.
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Affiliation(s)
- Burak Sercan Erçin
- Department of Plastic Surgery, Bahçeşehir University, VM Medicalpark Pendik Hospital, Istanbul, Turkey
| | - Fatih Kabakaş
- Department of Plastic and Hand Surgery, Medicalpark Gebze Hospital, Kocaeli, Turkey
| | - Burak Ergün Tatar
- Department of Plastic Surgery, University of Health Sciences, Bagcılar Training and Research Hospital, Istanbul, Turkey
| | - Musa Kemal Keleş
- Department of Plastic and Hand Surgery, Medicalpark Gebze Hospital, Kocaeli, Turkey
| | - Ismail Bülent Özçelik
- IST-EL Hand Surgery, Microsurgery and Rehabilitation Group, GOP Hospital, Istanbul, Turkey
| | - Berkan Mensa
- IST-EL Hand Surgery, Microsurgery and Rehabilitation Group, GOP Hospital, Istanbul, Turkey
| | - Pedro C Cavadas
- Department of Reconstructive Surgery, Clinica Cavadas, Valencia, Spain
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Erçin BS, Tatar BE, Keleş MK, Kabakaş F. The Roles of Injury Type, Injury Level and Amputation Type in the Need for Revision Surgery after Replantation: Retrospective Clinical Outcome with 296 Finger Replantation. J INVEST SURG 2021; 35:1178-1183. [PMID: 34620039 DOI: 10.1080/08941939.2021.1988772] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND With the development of microsurgical techniques, the replantation survival rate has increased, but in some cases, revision surgery is required. Although there are many studies on replantation survival rate, studies on revision surgery are limited. In this study, we evaluated replantation patients requiring revision surgery in terms of amputation level, injury type, and amputation type (single-multiple). METHODS This is a retrospective study.Two hundred fifty-six patients (296 fingers) who were operated on for total finger amputation in our hospital between 2013 and 2018 were included in the study. In the postoperative period, revision surgery was required for 24 fingers due to vascular insufficiency. Patients were evaluated in terms of amputation level, injury type, and amputation type. RESULTS Two hundred sixty-four fingers were saved after primary surgery. Eight fingers failed before they could undergo revision surgery. Revision surgery was performed for 24 fingers. After revision surgery, 19 fingers were saved, and five fingers were failed. There was no significant effect of gender and age in terms of revision (p > 0.05).There was no statistically significant difference in injury level and injury type, but there was a statistically significant difference in terms of amputation type (p < 0.05). CONCLUSION Despite advanced microsurgery and experience, vascular insufficiency can be observed after replantation. Surgical re-exploration is necessary for salvage.
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Affiliation(s)
- Burak Sercan Erçin
- Department of Plastic Surgery, Bahçeşehir University, VM Medicalpark Pendik Hospital, Istanbul, Turkey
| | - Burak Ergün Tatar
- Department of Plastic Surgery, University of Health Sciences, Bagcılar Training and Research Hospital, Istanbul, Turkey
| | - Musa Kemal Keleş
- Department of Plastic and Hand Surgery, Medicalpark Gebze Hospital, Kocaeli, Turkey
| | - Fatih Kabakaş
- Department of Plastic and HandSurgery, Medicalpark Gebze Hospital, Kocaeli, Turkey
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Bozkurt M, Tatar BE, Karakol P, Sezgiç M, Uslu C, Solak HT, Gelbal C. Matriderm and platelet-rich plasma combination in the treatment of recurrent carpal tunnel syndrome: a new approach. Eur J Plast Surg 2021. [DOI: 10.1007/s00238-021-01863-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Seyid M, Tiftikcioglu Y, Erdem M, Akdemir O, Tatar BE, Uyanıkgil Y, Ercan G. The Effect of Ceruloplasmin Against Ischemia-Reperfusion Injury in Epigastric Island Flap in Rats. J Surg Res 2021; 267:627-635. [PMID: 34273792 DOI: 10.1016/j.jss.2021.05.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 04/20/2021] [Accepted: 05/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Flap surgery is frequently used in plastic surgery to close tissue defects. Ischemia-reperfusion (I/R) injury is a significant problem resulting in partial or total flap necrosis. This study aimed to investigate the effect of ceruloplasmin on I/R injury in epigastric island flaps in rats. MATERIAL AND METHOD A total of 32 male Sprague-Dawley rats were divided into four groups with eight rats in each group: The flap was not elevated in Group I; the flap was elevated without ischemia or any application in Group II, after the intraperitoneal saline and ceruloplasmin application the flaps were elevated and ischemia was created in group III-IV, respectively. Bilateral epigastric artery flap was elevated in all groups except Group I. After 6 h of ischemia, the flap was reperfused and inset. Samples were taken from the right and left side of the flap area in other groups at the postoperative 24th h for biochemical analysis (catalase and malondialdehyde-MDA) and the seventh postoperative day for histopathological analysis (Modified Verhofstad score and epidermal thicknesses), respectively. Image analysis for necrosis areas was performed on photos taken on the 7th d. RESULTS Catalase level was significantly higher in Group IV.(0.15 ± 0.04 U/mg protein) (P < 0.05) Necrosis area percentage(14.4% ± 3.3%),MDA(3.6 ± 0.9 nmol/mg protein), edema(3), necrosis(2.75), and polymorphonuclear leukocyte infiltration(2.87) scores were significantly higher in group III.(P < 0.05). Fibroblast proliferation, collagen density (0.25), vascular density (0.25) scores and epidermal thickness (15.68 µm,) was significantly lower in group III. (P < 0.05) CONCLUSIONS: Our study demonstrated that ceruloplasmin application before ischemia reduced I/R injury in epigastric island flaps in rats.
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Affiliation(s)
- Mircafer Seyid
- Baku Medical Plaza, Department of Plastic Surgery, Baku, Azerbaijan.
| | - Yigit Tiftikcioglu
- Ege University Faculty of Medicine, Department of Plastic Surgery, Izmir, Turkey
| | - Mehmet Erdem
- University of Health Sciences, Bagcılar Training and Research Hospital, Department of Plastic Surgery, Istanbul, Turkey
| | - Ovunc Akdemir
- Esenyurt University, Department of Plastic Surgery, Istanbul, Turkey
| | - Burak Ergün Tatar
- University of Health Sciences, Bagcılar Training and Research Hospital, Department of Plastic Surgery
| | - Yigit Uyanıkgil
- Ege University Faculty of Medicine, Department of Histology and Embryology, Izmir, Turkey
| | - Gülinnaz Ercan
- Ege University Faculty of Medicine, Department of Biochemistry, Izmir Turkey
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13
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Tatar BE, Uslu C, Erdem M, Sabancıogullarından F, Gelbal C, Bozkurt M. Observation of the Absence of Ulnar Artery in a Patient Planned to Free Dorsoulnar Artery Perforator Flap for Finger Defect: Is Preoperative Doppler evaluation of Perforator Alone Sufficient? Journal of Reconstructive Microsurgery Open 2021. [DOI: 10.1055/s-0041-1726303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Abstract
Background Volar finger defects where critical structures exposed are always challenging for plastic surgeons. In these types of defects, local flaps, cross finger flaps, abdominal flaps, and free flaps are used. Free dorsoulnar artery perforator (DUAP) flaps and superficial palmar branch of radial artery (SPBRA) flaps are also used. In this case, we present a patient who was scheduled to receive a DUAP flap to address defect on the second finger of right hand; however, we repaired the defect with a SPBRA flap because intraoperative absence of the ulnar artery was observed.
Materials and Methods A 34-year-old male patient was admitted with a wound that exposed the tendon and neurovascular bundle on the volar side of the second finger of the right hand. A free DUAP flap was planned for the patient. A perforator was detected during the preoperative Doppler ultrasound examination. While dissecting the perforator, we noted the absence of an ulnar artery proximal to the perforator vessel. The elevated SPBRA flap from same extremity and the defect were closed.
Results Postoperative computer tomography showed an absence of the ulnar artery distal to the right antecubital region. No complications were seen in the donor and recipient areas. Long-term motor movements were natural, and the patient's quality of life was good.
Conclusion Determining the perforator site using Doppler alone may not be sufficient in preoperative evaluation of patients scheduled to receive DUAP flaps. Performing an Allen test and using advanced imaging methods can prevent surgeons from encountering a bad surprise.
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Affiliation(s)
- Burak Ergün Tatar
- Department of Plastic Surgery, University of Health Sciences, Bagcılar Training and Research Hospital, Istanbul, Turkey
| | - Can Uslu
- Department of Plastic Surgery, University of Health Sciences, Bagcılar Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Erdem
- Department of Plastic Surgery, University of Health Sciences, Bagcılar Training and Research Hospital, Istanbul, Turkey
| | - Fahri Sabancıogullarından
- Department of Plastic Surgery, University of Health Sciences, Bagcılar Training and Research Hospital, Istanbul, Turkey
| | - Caner Gelbal
- Department of Plastic Surgery, University of Health Sciences, Bagcılar Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Bozkurt
- Department of Plastic Surgery, University of Health Sciences, Bagcılar Training and Research Hospital, Istanbul, Turkey
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Erdem M, Tiftikcioglu Y, Tatar BE, Kılıc KD, Uyanıkgil Y, Gürler T. The Effect of Botulinum Toxin on Flap Viability of the Posterior Thigh Perforator Flap in Rats. J Surg Res 2021; 261:85-94. [PMID: 33422903 DOI: 10.1016/j.jss.2020.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 10/19/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The use of perforator propeller flaps in lower limb reconstruction has increased recently. Many pharmacological agents are used to increase flap viability. Botulinum toxin has been used in various types of flaps in the literature. However, there is no study regarding the use of botulinum toxin in the lower limb propeller flaps. This study investigates the effect of botulinum toxin administration on flap survival for lower limb propeller flap in rats. MATERIALS AND METHODS The study included 20 male Wistar albino rats, divided into two groups with a flap rotation of 90° in group 1 and 180° in group 2. In both groups, botulinum toxin was administered to the right thigh and a physiological saline solution was applied to the left thigh. Five days later, flaps were elevated over the posterior aspect of the right and left thighs and inset after 90° and 180° rotation was performed. Histopathological, immunohistochemical, and necrosis area analyses were performed. RESULTS Necrosis area, edema, polymorphonuclear leukocyte infiltration, and necrosis were found to be higher on the left side of the groups, whereas epidermal thickness, collagen density, vascularization, and hair root density were found to be higher on the right side of the groups. No significant difference was found between the right posterior thighs in either group on any parameter other than vascularization. Histopathologically and immunochemically statistically significant differences were found between the two groups. CONCLUSIONS The present study found that botulinum toxin increases flap viability in lower limb perforator-based propeller flaps.
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Affiliation(s)
- Mehmet Erdem
- Department of Plastic Surgery, University of Health Sciences, Bagcılar Training and Research Hospital, Istanbul, Turkey.
| | - Yigit Tiftikcioglu
- Department of Plastic Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Burak Ergün Tatar
- Department of Plastic Surgery, University of Health Sciences, Bagcılar Training and Research Hospital, Istanbul, Turkey
| | - Kubilay Dogan Kılıc
- Department of Histology and Embryology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Yigit Uyanıkgil
- Department of Histology and Embryology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Tahir Gürler
- Department of Plastic Surgery, Ege University Faculty of Medicine, Izmir, Turkey
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Karakol P, Sezgiç M, Tatar BE, Gelbal C, Uslu C. The use of dorsoradial forearm flap for the treatment of dorsal hand defect. J Surg Case Rep 2020; 2020:rjaa153. [PMID: 32699598 PMCID: PMC7365035 DOI: 10.1093/jscr/rjaa153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/27/2020] [Indexed: 11/14/2022] Open
Abstract
Generally dorsal hand defects are often closed with a flap. Dorsoradial forearm artery flap has generally been used in thumb defects; however, it can also be used in the reconstruction of dorsal hand defects thanks to its wide rotation arc and appropriate pedicle length. In this case report, we presented the outcome of a case where the dorsoradial forearm flap was applied to treat the dorsal hand defect. A 27-year-old patient was admitted to emergency room with trauma on hand. Fixation of metacarpal bone fractures was performed. The dorsoradial forearm flap was elevated and inserted in order to close an opening exposing bones and tendons in the dorsum of hand. There was no complication with flap viability in the postoperative period. Patient's joint range of motion and vital functions were acceptable. Dorsoradial forearm flap, which is generally used in thumb reconstruction, can also be used in dorsal hand defects.
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Affiliation(s)
- Perçin Karakol
- Department of Plastic Surgery, Bagcılar Research and Education Hospital, Istanbul 34100, Turkey
| | - Melihcan Sezgiç
- Department of Plastic Surgery, Bagcılar Research and Education Hospital, Istanbul 34100, Turkey
| | - Burak Ergün Tatar
- Department of Plastic Surgery, Bagcılar Research and Education Hospital, Istanbul 34100, Turkey
| | - Caner Gelbal
- Department of Plastic Surgery, Bagcılar Research and Education Hospital, Istanbul 34100, Turkey
| | - Can Uslu
- Department of Plastic Surgery, Bagcılar Research and Education Hospital, Istanbul 34100, Turkey
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