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Öğe Distally based sural flap in treatment of chronic venous ulcers(Lippincott Williams & Wilkins, 2005) Top, H; Benlier, E; Aygit, AC; Kiyak, MThe treatment of venous ulcers of the leg often fails to heal because venous ulcers are mostly associated with severe lipo-dermatosclerosis. These complicated ulcers may require correction of local hemodynamics, excision of ulcer with surrounding lipodermatosclerotic skin, and replacement of the defect with healthy tissue. We present our experience with the use of the distally based sural flaps for the reconstruction of soft-tissue defects of the distal region of the lower limb in patients with chronic venous ulcer. Between 2001 and 2003, 12 patients with venous ulceration were treated with distally based sural flaps. At operation, the ulcer and its surrounding lipodermatosclerotic skin were excised. The defects after excision ranged from 3 X 3 to I I X 17 cm. The distally based sural artery flap was inset within the defect. In all patients, the flap survived completely, and in only I patient, distal venous congestion was seen and was treated successfully with leeches. There was donor site skin graft loss in 2 patients. Two flaps had minor local complications that healed with local wound care. No recur-rent ulcers were identified after average 19.7 months. In conclusion, the distally based sural flaps can be used reliably for treatment of venous ulcers. Our approach in treatment of chronic venous ulcers improves venous hemodynamics and provides local flap alternative that should be considered prior to a free-flap transfer for closure of the defect.Öğe Management of the long nose: Review of techniques for nasal tip supporting structures(Springer, 2006) Benlier, E; Top, H; Aygit, ACThe long nose with a plunging tip is a deformity that involves an inferiorly rotated nasal tip, leading to an increase in the length of the nose. The anatomic basis of the long nose with a plunging tip may be divided into two types. Type 1 presents a normal alar-cartilage complex inferiorly displaced by a long nasal septum and long upper lateral cartilages. Type 2 is caused by a dislocation of the alar cartilages downward from the aponeurotic attachments to the septal angle. During the study period, the authors identified 60 patients with long noses and plunging tips. For 22 patients with type 1 long noses, the high septal incision technique was used in 12 cases and the step technique in 10 cases. The invagination procedure alone was used for 22 of 38 patients with type 2 plunging noses. Also, an extension graft with the invagination procedure was used for 6 patients, and a columellar strut graft was used for 10 patients. A high septal incision increased tip rotation without significantly changing the amount of tip projection. However, the step procedure, the invagination technique alone, septal extension graft with the invagination technique, and columellar strut grafts increased nasal tip rotation and projection. During the study period, 38 patients were identified as having a smiling deformity, which was improved using the authors' modification procedure. On the basis of the results, the authors recommend that the appropriate treatment for each patient with a long nose and a plunging tip must be determined by preoperative and intraoperative examination findings with the patient at rest and while smiling.Öğe A new approach to smiling deformity: Cutting of the superior part of the orbicularis oris(Springer, 2005) Benlier, E; Top, H; Aygit, ACA diagnosis of an aesthetic smiling deformity, which is functional rather than anatomic, is essential for provision of the best treatment in rhinoplasty. Smiling deformity consists of three elements: (a) the nasal tip tending to retrodisplace and rotate inferiorly; (b) the lower part of the upper lip moving superiorly; and (c) a horizontal groove occurring in the midphiltral area. An active depressor septi and orbicularis muscle can accentuate a drooping nasal tip and shorten the upper lip during smiling. Downward movement of the nasal tip and a sharper nasolabial angle usually are aesthetically unpleasant. During the study period (January 2000 to January 2004), the authors identified 38 patients with smiling deformities, 16 of whom underwent dissection and transposition of the paired depressor septi during rhinoplasty. The remaining 22 patients experienced hyperactivity of both the depressor septi and orbicularis muscles, as diagnosed by a descending nasal tip and a shortened upper lip at animation. These patients underwent a modification of the depressor septi and orbicularis muscles. No relapse was evident up to 2 years postoperatively. Repositioning of the depressor septi nasi muscle improved only mild cases. However, modification of the orbicularis and depressor septi muscles was a valuable adjunct to rhinoplasty for moderate and severe forms of smiling deformity. The new approach for smiling deformity provided an aesthetically pleasant appearance for the patient both at rest and when smiling.Öğe Review of monitoring free muscle flap transfers in reconstructive surgery(Lippincott Williams & Wilkins, 2006) Top, H; Sarikaya, A; Aygit, AC; Benlier, E; Kiyak, MBackground Free tissue transfer is a method of moving any tissue from a donor area of the body to a recipient site and re-attaching the arteries and veins to the blood vessels at the recipient site by microvascular surgery. Improved microsurgical techniques have resulted in a high percentage of successful free tissue transfers. Post-operative monitoring of tissue viability can detect early problems in free tissue transfer which may allow early intervention and salvage. Although many flap monitoring methods have been described, there is still no consensus on which of these techniques will become the standard accepted method for monitoring free muscle flaps. Objective In present study, we investigated the use of Tc-99m sestamibi scintigraphy in determining free muscle flap viability and complications, and also in directing treatment. Methods Thirteen patients were examined prospectively during the post-operative period after free tissue transfer for foot defects. The cause of the defect was diabetic foot ulcer in 10 patients, dermatofibrosarcoma in one patient, squamous cell carcinoma in one patient and gunshot wound in one patient. Foot defect covering was carried out with a free latissimus dorsi muscle flap and skin graft (n=12) and a free gracilis muscle flap (n=1). All patients were examined with a monitoring system that consisted of visual inspection, hand-held Doppler ultrasonography and scintigraphic examinations. Scintigraphic imaging of all cases was performed routinely within the first 48 h post-operatively, and also on days 10 and 91 in two patients. Results There were four flap failures during the study. One of these patients had viable findings upon visual inspection and no evidence of vascular compromise on Doppler at the first examination. In the other patient, visual inspection of the flap showed that it was ischaemic in one region, but there was no vascular compromise on Doppler examination. Scintigraphic images of each of these patients showed a partial hypoperfused area in the flap region. Later, these two flaps showed positive clinical indications of hypoperfusion (colour of muscle and appearance of skin graft) and Doppler abnormalities. The remaining two patients had non-viable scintigraphic images as well as positive clinical indicators of hypoperfusion and evidence of vascular compromise on Doppler. Nine patients each had a viable flap. In these patients, all three examination tools demonstrated that the flaps were totally viable and there were no vascular complications. Conclusion According to the results of this study, Tc-99m sestamibi scintigraphy appears to be a feasible and promising method in the evaluation of free muscle flap viability and complications. On the other hand, to demonstrate any impact on management or patient outcome, further evaluation of 99mTc sestamibi imaging, including comparative studies with different established methods in a larger patient population, is highly recommended.
