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Öğe Bone flap prefabrication -: An experimental study in rabbits(Lippincott Williams & Wilkins, 2005) Top, H; Aygit, C; Sarikaya, A; Çakir, B; Çakir, B; Unlu, EThe usual method to prefabricate a bone flap is to harvest a nonvascularized bone graft and to implant the artery and vein bundle between segments of bone graft. The basic problem of this method is sacrificing an artery for prefabrication. Another method for creating flap donor sites without using an artery is venous flap prefabrication. There are a few articles describing bone flap prefabrication, and these include implantation of both artery and vein as a vascular bundle. Also, there is no experimental study in the literature using a vein or an arterialized vein pedicle for bone flap prefabrication. As an experimental model for bone flap prefabrication, the rabbit car vascular model was chosen. For the experiments 3 groups were formed. Each group contained 5 rabbits. In the first experimental group a vein was implanted between the halves of bone graft. In the second experimental group an arterialized vein was implanted between the halves of bone graft. To compare the viability of the bone graft of the 2 prefabrication groups, a bone graft was implanted into the subcutaneous pocket of the posterior auricular area in the third group. The authors examined 5 rabbits in each group by microangiography at the end of 6 weeks except for group 3. On microangiographic analysis, groups 1 and 2 showed patency of the vascular pedicle. There was no difference between these 2 groups from the point of view of vascular patency and bone appearance. Bone scintigraphy was performed for 5 rabbits in each group. On bone scintigraphic scans, the bone component of the flaps was visualized in groups 1 and 2, but not in group 3. A quantitative analysis of images was performed by drawing symmetric spherical regions of interest (ROIs) over both the implanted area and cranial bone. The uptake ratios were computed by dividing the mean counts in the implanted ROI by mean counts in the cranial bone ROI. The mean value was 0.86 +/- 0.02 in group 1 and 0.86 +/- 0.04 in group 2. A statistically significant uptake difference was not seen between venous and arterialized venous groups (P < 0.01). Histologic examination was performed all rabbits in each group, and demonstrated that the bony component was viable, showing osteocytes containing lacunae, osteoblasts along bony trabeculae, and vascular channels in groups 1 and 2. In group 3, the bony architecture of the graft was still apparent, but all bone within it was dead. There were no significant microangiographic, histologic, and scintigraphic differences between the 2 experimental methods.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 Evaluation of maxillary sinus after treatment of midfacial fractures(W B Saunders Co-Elsevier Inc, 2004) Top, H; Aygit, C; Sarikaya, A; Karaman, D; Firat, MTPurpose: Maxillary sinuses are the most frequently injured anatomic region of the facial skeleton in midfacial fractures. The purpose of this study was to evaluate the patients with maxillary sinus wall fractures using clinical examinations, maxillofacial computed tomography (GT), and cranial bone single-photon emission tomography (SPECT) and to interpret the results of these examinations to evaluate the indications of surgical intervention or drainage for maxillary sinus after maxillary sinus wall fractures. Materials and Methods: The results of examinations of 15 patients with maxillary sinus fractures who were treated for midfacial fractures were evaluated. Follow-up examinations were performed in the range of 3 to 47 months after surgery (average, 19.8 months). The patients ranged in age from 10 to 45 years, with an average age of 31.6 years. There were 11 male and 4 female patients. Seven patients had Le Fort 11 fractures, 6 patients had tripod zygomatic fractures, 1 patient had infraorbital fracture, and 1 patient had zygomatic arch fracture. Operative procedure was performed in all cases. To evaluate maxillary sinus after surgery, maxillofacial computed tomography (CT), cranial bone SPECT, and maxillary sinusitis evaluation form were used in all patients. Results: Maxillofacial CT scans were related to sinusitis in 9 patients who had positive complaints for sinusitis. The cranial bone SPECT showed positive uptake at the fractured sites in 8 patients, minimal uptake in 2 patients, and normal uptake in 5 patients. Conclusions: Clinical examination, maxillofacial CT, and cranial bone SPECT are the most reliable methods available today for the diagnosis and follow-up of complications of maxillary sinus fractures. (C) 2004 American Association of Oral and Maxillofacial Surgeons.Öğe Evaluation of maxillary sinus after treatment of midfacial fractures [Meeting Abstract](Springer, 2004) Top, H; Aygit, AC; Sarikaya, A; Karaman, D; Firat, MF[Abstract Not Available]Öğe The fate of intramuscularly injected fat autografts: An experimental study in rabbits(Springer, 2004) Aygit, AC; Sarikaya, A; Doganay, L; Top, H; Cakir, B; Firat, MFAn experimental study was designed to assess the viability and revascularization of intramuscularly injected fat autografts. For the study, 18 rabbits were divided into two groups. In the first group, fat was injected intramuscularly (12 rabbits). Autologous fat was obtained from the inguinal area and subsequently injected into the thigh muscle. In the second group, physiologic saline was injected intramuscularly to determine the effects of cannulation and pressure on muscle tissue (6 rabbits). Fat autografts were performed on the right side of the animal, and the left side was used as the control. Scintigraphic imaging and histopathologic examination of the limbs were performed after injection of adipose tissue on days 15, 30, 45, 60, 90. and 120. On the technetium-99m (Tc-99m) hexamethylpropylene amine oxime scintigraphy, whereas similar activity distribution was observed between the left and right thigh on days 15, 30, and 45, there was increased uptake at the right thigh on days 60, 90, and 120. This increased uptake indicates that there is viable fat tissue in this region. Histopathologic evaluation showed that microcysts resulting from degeneration of some adipocytes and inflammatory changes on day 15 additionally increased vascularity and fibrosis in some animals on day 30, as well as fibrosis, microcysties, and focal calcification areas in adipose tissue on day 45 and later. It was observed that adipose tissue survived in more than 50% of the graft area in all the animals. These findings show that fat autografts can survive in muscle tissue with less than 50% fibrotic change.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 Osteocutaneous flap prefabrication in rats(Lippincott Williams & Wilkins, 2004) Top, H; Mavi, A; Barutcu, A; Yilmaz, OComposite tissue defects may involve skin, mucosa, muscle, and bone together or in combinations of two or three of these tissues. Defects involving bone and skin are frequently encountered. Osteocutaneous flaps may be used to reconstruct these composite tissue defects. Sometimes, it is not possible to obtain a vascular osteocutaneous flap. Another way of producing an osteocutaneous flap that has the desired feature is prefabrication. Prefabrication of osteocutaneous flaps can be performed in two ways: (1) a vascularized osseous flap may be grafted with skin and (2) an osteocutaneous flap can be prefabricated by implanting an osseous graft into air axial island flap. There are many articles describing osteocutaneous flap prefabrication, but there is no comparison of both methods in the literature. As an experimental model for osteocutaneous flap prefabrication, rat tail bone was chosen. For the experiments, five groups were formed. Each group contained 10 rats. In the first experimental group, a vascularized osseous segment was skin grafted and an osteocutaneous flap was prefabricated. In the second experimental group, an osseous graft was implanted into an axial skin flap. To compare viability of skin and bone components of the two prefabrication groups, vascularized tail bone was elevated with overlying skin in the third group, a bone flap was elevated in the fourth group, and a skin flap that had been prefabricated by using vascular implantation was elevated in the fifth group. The authors examined five rats in each group by microangiography at the end of 4 weeks. On microangiographic analysis, all groups showed patency of vascular pedicles. There was no difference among the groups from the point of view of vascular patency and bone appearance. Bone scintigraphy was performed on the live rats in each group. On bone scintigraphic scans, the bone component of flaps was visualized in all groups except for group 5. The mean radioactivity value on the flap side was 10,362 +/- 541.1 in group 1, 10,241 1173 in group 2,10,696 +/- 647.1 in group 3, and 10,696 647.1 in group 4. When the radioactivity values on the flap side were compared, no statistically significant difference among groups was seen, except for grout) 5 (p < 0.05). To evaluate bone metabolic activity, the bone component of flap and remaining last tail bone was bar-vested and the radioactivity of each specimen was measured with a well-type gamma counter. The parameter of percentage radioactivity in counts per minute per unit per gram of tissue was calculated. The value of the bone component of the flap side and the value of normal bone were estimated and results were compared. The mean result was 0.86 +/- 0.08 in group 1, 0.88 +/- 0.07 in group 2, 0.87 +/- 0.07 in group 3, and 0.81 +/- 0.04 in group 4. The difference among all groups was not statistically significant. Histologic examination was performed on all rats in each group and demonstrated that the bony component was viable, showing a cellular bone marrow, osteoblasts along bony trabeculae, and vascular channels in bone-containing groups. There were no significant microangiographic, histologic, or scintigraphic differences between the two experimental methods.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.Öğe Salivary duct carcinoma of the parotid gland metastasizing to the skin - A case report and review of the literature(Lippincott Williams & Wilkins, 2005) Aygit, AC; Top, H; Cakir, B; Yalcin, OSalivary duct carcinomas of parotid gland are rare, as are the skin metastases from them. Four cases are reported with metastases to the skin. We present an additional case, with Subcutaneous metastases of the back and leg. To our knowledge, this is the first case reported in the literature in which the nodule on an extremity was the metastasis of a salivary duct carcinoma of parotid gland.Öğe Spitzoid melanoma in childhood(John Libbey Eurotext Ltd, 2006) Top, H; Aygit, AC; Bas, S; Yalcin, OSpitzoid melanoma is a rare variant of melanoma. It has morphological features similar to those of Spitz's nevus. In this study, the histologic and immunohistochemical features of both Spitzoid melanoma and Spitz's nevus are emphasized. We report two cases of melanoma with spitzoid features occurring in the extremities of 9 and 8-year-old girls. Histologically both lesions had typical features of Spitzoid melanoma. We conclude that the differential diagnosis of Spitzoid melanoma and Spitz's nevus is at times problematic in childhood, in that distant metastasis may be the only diagnostic criteria for some cases to be distinguished from Spitz's nevus if strict criteria are followed. Spitzoid melanoma must be treated as other types of melanoma.
