Publications by authors named "Hakan Uzun"

49 Publications

Comparative assessment of fingertip replantation in paediatric and adult patients within a single institution.

J Hand Surg Eur Vol 2021 Mar 24:17531934211002476. Epub 2021 Mar 24.

Department of Plastic, Aesthetic and Reconstructive Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey.

The purpose of this retrospective study was to compare the outcomes of paediatric and adult fingertip replantation within a single institution. Our retrospective study found no significant difference in the survival rate between the paediatric (10/12) and adult (22/26) groups. At 6 months follow-up, there was no significant difference in sensory recovery between both groups, as measured with Semmes-Weinstein testing, but a significant difference in mean static two-point discrimination testing values between the paediatric (4.0 mm) and adult (6.2 mm) groups. Moreover, the mean time for regaining sensation was faster in paediatric patients (1.3 months) as compared with adult patients (4.1 months). Five children and four adults received erythrocyte transfusion. Paediatric fingertip replantation has similar survival rates, faster and better sensory nerve recovery as compared with adults despite a higher erythrocyte transfusion rate. Although technically demanding, paediatric fingertip replantation is recommended, whenever possible, because of the good outcomes achievable. IV.
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http://dx.doi.org/10.1177/17531934211002476DOI Listing
March 2021

A family with novel homozygous deletion mutation (c.1255delT; p.Phe419Serfs*12) in the glucokinase gene, which is a rare cause of permanent neonatal diabetes mellitus.

Turk Pediatri Ars 2020 16;55(4):434-437. Epub 2020 Dec 16.

Department of Pediatrics, Düzce University Faculty of Medicine, Düzce, Turkey.

Heterozygous inactivating mutations in the glucokinase gene cause the mildest form of maturity-onset diabetes of the adolescents. However, homozygous or compound heterozygous mutations in the glucokinase gene are a rare cause of permanent neonatal diabetes mellitus. Herein, we present the case of a male child with permanent neonatal diabetes mellitus whose mutational analysis revealed a novel homozygous deletion mutation in the glucokinase gene. The male proband of Turkish ancestry from consanguineous parents was born at 37 weeks gestation with a birth weight of 1870 g (<3 percentile). Hyperglycemia developed during the first postnatal day and diabetes-related autoantibodies were negative. He was put on insulin on the first day of life. Insulin has never been discontinued since then. The mother was aged 35 years and had gestational diabetes. The father and the two brothers had impaired fasting glucose. Both parents and brothers were heterozygous for this mutation.
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http://dx.doi.org/10.14744/TurkPediatriArs.2019.05882DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7750344PMC
December 2020

A hesitated approach: primary radiotherapy for keloids-a case series.

Strahlenther Onkol 2021 Jan 4. Epub 2021 Jan 4.

Department of Radiation Oncology, Hacettepe University Medical School, 06100, Ankara, Turkey.

Purpose: To assess the efficacy and toxicity of hypofractionated radiotherapy (RT) alone in treatment-resistant symptomatic keloids.

Methods: Six patients with a total of 13 inoperable large keloid lesions and no response to previous treatments were admitted to our department between 2017 and 2019. All patients were examined for detailed wound localization, size, contour, and color assessment, and for objective and subjective symptoms. Response to treatment was graded as "complete remission" in case of full symptomatic relief and >75% decrease in lesion size, as "partial remission" in case of partial symptomatic relief and 25-75% decrease in lesion size, and as "stable disease" in case of no symptomatic relief or <25% decrease in lesion size. Patients were followed up monthly for the first 3 months and every 3 months thereafter by physical examination.

Results: A total dose of 37.5 Gy external RT in five fractions was prescribed by 6‑MeV electrons in 4 patients and 6‑MV photons in 2 patients. Complete response was obtained in all patients at the 6‑month control. All patients were satisfied with cosmetic results at their last control. Grade 2 dermatitis developed in all patients during the second week of RT but resolved completely in all after 6 months following the end of RT.

Conclusion: In keloids that are unresponsive to standard treatment, hypofractionated RT using a total dose of 37.5 Gy in five fractions is feasible.
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http://dx.doi.org/10.1007/s00066-020-01736-3DOI Listing
January 2021

Robotic-assisted microsurgical penile replantation.

Int J Impot Res 2020 Oct 6. Epub 2020 Oct 6.

Department of Plastic Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey.

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http://dx.doi.org/10.1038/s41443-020-00359-7DOI Listing
October 2020

A New Experimental Lymphedema Model: Reevaluating the Efficacy of Rat Models and Their Clinical Translation for Chronic Lymphedema Studies.

Ann Plast Surg 2020 Jul 21. Epub 2020 Jul 21.

From the aDepartment of Plastic Reconstructive and Aesthetic Surgery, China Medical University Hospital, Taichung, Taiwan bDepartment of Plastic Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine cPrivate Practice, Plastic Reconstructive and Aesthetic Surgery, Sıhhiye dDepartment of Pathology, Hacettepe University Faculty of Medicine eHacettepe University Faculty of Medicine, Ankara, Turkey.

Background: Our aim was to create a new rodent hind limb lymphedema model lacking the fibrosis effect induced by radiotherapy and subjected to the inhibition of lymphangiogenesis via sirolimus (rapamycin) to maintain a chronic lymphedema model and investigate its reliability for human treatment modalities.

Methods: Forty-two Sprague-Dawley rats were randomly assigned to 7 groups: (1) surgery control, (2) vehicle-surgery control, (3) vehicle control, (4) rapamycin control, (5) surgery with 1 mg/kg per day rapamycin, (6) surgery with 1.5 mg/kg per day rapamycin, and (7) surgery with 2 mg/kg per day rapamycin. All surgeries were performed on the right hind limbs, with the left hind limbs also considered as a control. The drug and its solvent were administered daily into the relevant groups intraperiteonally. The presence of lymphedema was investigated by weekly limb circumference measurements, microcomputed tomography, fluorescence lymphography using indocyanine green dye, and microscopic evaluation at the end of the sixth week to determine any histological changes in the hind limbs.

Results: In group 1, lymphedema was observed for 2 weeks (P = 0.032), whereas in groups 5, 6, and 7, lymphedema lasted for 3 weeks (P < 0.05.) Fluorescence using indocyanine green revealed that the edema was totally resolved after 6 weeks of surgery by a well-developed superficial lymphatic organization instead of the normal distinct vessel structure. Histologically, groups 1, 5, 5, and 7 demonstrated a significant increase in both the number of macrophages (P < 0.001) and newly formed lymphatic vessels in the right side surgically treated hind limb (P < 0.05).

Conclusions: Despite the extreme surgical destruction and lymphangiogenesis inhibition in the rat model, the sustained lymphedema did not last >3 weeks. Because of the rapid neolymphangiogenesis in murines and a different wound healing mechanism, they should not be considered as an appropriate model for research on human lymphedema in first place.
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http://dx.doi.org/10.1097/SAP.0000000000002479DOI Listing
July 2020

Monozygotic twins with familial hypercholesterolemia and high lipoprotein(a) levels leading to identical cardiovascular outcomes: Case report and review of the literature.

Turk Kardiyol Dern Ars 2020 07;48(5):531-538

Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Homozygous familial hypercholesterolemia (HoFH) is a rare, autosomal dominant disease that leads to premature cardiovascular disease (CVD). Since monozygotic twins share the intrauterine environment and have the same age and gene profile, they could represent a very special resource for the investigation of the causes and the natural course of FH. This report is a description of 36-year-old monozygotic twin brothers with almost identical early coronary artery involvement due to FH concomitant with high lipoprotein(a) (Lpa) levels and a review of the literature. Sequence analysis revealed that the twins were homozygous for the LDLR c.1060+10G>A (rs12710260) mutation and heterozygous for the LDLR c.542C>T (rs557344672) mutations. Both were also homozygous for the c.1060+7T>C (rs2738442) and c.1586+53A>G (rs1569372) mutations in the LDLR gene as well as c.4265A>T (rs568413) mutations in the APOB gene. In the literature, there are 7 twin cases with reported FH, but none with high Lpa levels. The HoFH twins in this case report had lower low-density lipoprotein (LDL) cholesterol levels than expected (before treatment 204 and 223 mg/dL), with almost identical coronary involvement. Both had an extremely high Lpa level (308 and 272 nmol/L) with a very low coronary calcium score (16 AU) and a good response to statins (>60%). There was a history of the first CVD event occurring at nearly the same age (32-34 years) in the family. This could be an important aspect of FH families as a result of the similar timing of cumulative LDL exposure exceeding the threshold of CVD events. In conclusion, this first report of monozygotic HoFH twins with elevated Lpa levels and almost identical early coronary artery involvement at the same age provides evidence to substantiate the hypothesis of lifetime cholesterol burden/exposure.
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http://dx.doi.org/10.5543/tkda.2020.62185DOI Listing
July 2020

Serum 25-hydroxyvitamin D is associated with insulin resistance independently of obesity in children ages 5-17.

Prim Care Diabetes 2020 12 29;14(6):741-746. Epub 2020 Jun 29.

Department of Pediatrics, Düzce University School of Medicine, Düzce, Turkey. Electronic address:

Aim: To determine the association of vitamin D with insulin resistance and obesity in children.

Methods: A total of 92 obese and 58 non-obese children aged 5-17 years were evaluated. Data were collected related to anthropometric (weight, height), and biochemical parameters (fasting plasma glucose, serum insulin, serum 25-hydroxyvitamin D, lipid profile, vitamin B12, parathormone) and physical examination (blood pressure, acanthosis nigricans, stria, lipomastia). Insulin resistance (IR) was calculated using the homeostasis model assessment (HOMA). HOMA-IR = fasting insulin level (μU/ml) × fasting glucose (mg/dL)/405. A HOMA-IR value >2.5 was defined as insulin resistance.

Results: According to the US Endocrine Society classification, vitamin D deficiency (0-20 ng/ml) was determined at significantly higher rates in the obese group than in the control group (p < 0.001). The rate of subjects with a vitamin D level of 20-30 ng/ml was significantly lower in the obese group than in the control group (p < 0.001) Within the obese group a statistically significant difference was determined between the insulin resistant and non-insulin resistant groups in respect of serum 25-hydroxyvitamin D levels (p = 0.001) and vitamin B12 levels (p = 0.001). A significant negative correlation was determined between serum 25-hydroxyvitamin D and HOMA-IR (r=-0.256, p = 0.016) and insulin (r = -0.258, p = 0.015). The systolic blood pressure (p = 0.001) and diastolic blood pressure (p = 0.003) values were significantly different in the control and obese groups. A statistically significant difference was determined between the control and obese groups in terms of the levels of insulin, HOMA-IR, HbA1c, cortisol, LDL, total cholesterol, HDL, triglyceride, hemoglobin, MCV, MPV, and calcium.

Conclusion: The prevalence of vitamin D deficiency was higher in obese children compared to normal-weight and overweight children. Serum 25(OH)D levels showed a negative correlation with insulin and HOMA-IR. Serum 25(OH)D is associated with insulin resistance independently of obesity.
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http://dx.doi.org/10.1016/j.pcd.2020.06.006DOI Listing
December 2020

Oberg-Manske-Tonkin Classification of Congenital Upper Extremity Anomalies: The First Report From Turkey.

Ann Plast Surg 2020 09;85(3):245-250

Department of Plastic Reconstructive and Aesthetic Surgery, Department of Hand Surgery, Hacettepe University Faculty of Medicine, Sihhiye, Ankara, Turkey.

Purpose: Although the Oberg-Manske-Tonkin (OMT) classification has been recommended by the International Federation of Societies for Surgery of the Hand owing to some insufficiencies of the Swanson classification system, it has not achieved a universal adoption by hand surgeons. In this study, we hypothesize that the OMT classification can be used easily to classify congenital upper extremity anomalies. We also aim to make epidemiological analysis of congenital upper extremity anomalies with the OMT classification and to compare the applicability of the OMT and the Swanson classifications.

Methods: We retrospectively analyzed 711 patients and 833 extremities operated on between 2012 and 2017. Photographs, plain x-rays, and brief medical histories of the patients were evaluated by 4 plastic surgeons. Two independent evaluations were made by each surgeon in 1-month interval using these classification systems.

Results: Total number of upper extremity anomalies recorded was 1050. Of the 711 patients operated on, 122 had bilateral anomalies. The anomalies were identified in 833 extremities because many extremities had more than a single diagnosis. We were able to classify all of the anomalies within the OMT classification. The OMT classification gives better reliability results compared with the Swanson classification according to intrarater and interrater reliabilities.

Conclusions: Compared with the Swanson classification system based on phenotypic evaluation of the extremity, the OMT classification system is easier to apply and the association of the anomaly with the embryologic origin during evaluation is possible. We believe that multiple studies from different centers will boost the international acceptance of the OMT classification.
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http://dx.doi.org/10.1097/SAP.0000000000002397DOI Listing
September 2020

Endoscopic retrieval of retracted flexor tendons: An atraumatic technique.

J Plast Reconstr Aesthet Surg 2019 Apr 14;72(4):622-627. Epub 2019 Jan 14.

Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Hacettepe University, Sihhiye, 06080 Ankara, Turkey.

Background: The repair of retracted flexor tendons is a challenging problem for hand surgeons. The tendon stump should be handled in an atraumatic manner because any microtrauma to the sheath and tendon can lead to poor functional outcomes.

Methods: Twenty-three patients with flexor zone 2 injuries and intraoperative finding of retracted tendons were randomly divided into two groups: endoscopic retrieval group and proximal incision group. A flexible endoscope and a flexible grasping forceps were used for endoscopic retrieval of the retracted flexor tendons. The groups were compared in terms of infection rate, neurovascular complications, regional pain, total range of active motion (TAM) and functional outcomes.

Results: Age, gender, average preoperative pain and general pain perception scores were similar between the two groups. We found a significantly shorter duration of operation and better pain scores at 1-2 weeks in the endoscopic group than in the other group (p = 0.002 and p = 0.020, respectively). A significant difference in TAM was demonstrated between the groups at 3 to 5 weeks (p = 0.003).

Conclusion: The surgical procedure presented here has the advantages of direct visibility of the proximal tendon end and retrieval in an atraumatic manner, with better results and decreased morbidity. It is a promising approach and can be used as a routine procedure in retracted tendon cases.
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http://dx.doi.org/10.1016/j.bjps.2019.01.007DOI Listing
April 2019

Effects of Systemic and Local Caffeine on Vessel Diameter, Anastomosis Patency, and Intimal Hyperplasia in the Rat.

J Reconstr Microsurg 2019 May 19;35(4):244-253. Epub 2018 Sep 19.

Department of Plastic, Reconstructive, and Aesthetic Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Background:  The use of caffeine is not recommended prior to elective microsurgery due to its demonstrated negative effects on vessel anastomosis by the presumed sympathomimetic induction of vasoconstriction. In this study, we aimed to elucidate the systemic and local effects of caffeine on vessel diameter, anastomosis patency, and degree of intimal hyperplasia during the healing process.

Methods:  Twenty-five rats were randomly assigned to five groups: (1) negative control, (2) preoperative systemic caffeine, (3) postoperative systemic caffeine, (4) perioperative systemic caffeine, and (5) a local caffeine group. Both the right and left femoral arteries were used. Ten anastomoses were performed per group. The arterial diameter was measured by micrometer, anastomosis patency was assessed surgically and histologically, and the histological examination was conducted 3 weeks postoperatively to determine intimal hyperplasia.

Results:  The overall patency rate was 96%. Mild vasoconstriction was observed in the systemic caffeine groups (statistically insignificant); however, there were no negative effects on anastomosis patency. Local caffeine irrigation resulted in significant vasodilatation in the local caffeine group ( = 0.001); a similar effect was not observed in the other groups. There was a significant decrease in the intima/media ratio in the local caffeine group (< 0.01), when compared with the control and systemic caffeine groups. No other intima/media ratio differences were observed among other comparison groups.

Conclusion:  The systemic administration of caffeine, although statistically insignificant, has an observable effect on vasoconstriction. However, it does not appear to have negative effects on anastomosis patency regardless of its application period (pre-, post-, or perioperatively). The local application of caffeine resulted in considerable vasodilatation as opposed to the vasoconstriction effect in the systemic caffeine groups. Decreased intimal hyperplasia at the anastomosis edge, and antifibrotic properties in the surgical field were also observed in this group. Histologically, the local caffeine group demonstrated an additional beneficial effect on anastomosis remodeling.
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http://dx.doi.org/10.1055/s-0038-1672130DOI Listing
May 2019

Comparison of Musculocutaneous and Fasciocutaneous Free Flaps for the Reconstruction of the Extensive Composite Scalp and Cranium Defects.

J Craniofac Surg 2018 Oct;29(7):1947-1951

Department of Plastic, Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine, Sihhiye.

Composite scalp and cranium defects, which require microsurgical reconstruction, result from tumor resection, radiation, trauma, severe burn injuries, and rarely vasculitic disorders. In the current study, the authors aim to compare the outcomes of the fasciocutaneous flaps and musculocutaneous free flaps used for the reconstruction of extensive composite scalp and cranium defects. From 2010 to 2017, 21 patients who underwent composite scalp and cranium defect reconstruction with a free flap were retrospectively identified. Eighteen patients had squamous cell carcinoma, 2 patients had meningioma, and 1 patient had Ewing sarcoma. Thirteen musculocutaneous free flaps including latissimus dorsi and vertical rectus abdominis flaps and 9 free fasciocutaneous flaps including radial forearm and anterolateral thigh flaps were used. Only 1 flap loss was encountered. No neurologic impairment in postoperative period was reported. The mean length of stay in the hospital, the duration of surgery, and total volume of blood transfusion for the fasciocutaneous flap group were significantly shorter than those for musculocutaneous flap group. No flap atrophy was reported in fasciocutaneous flap group. Reconstruction of the composite scalp and cranium defects with fasciocutaneous free flaps allows shorter hospitalization, less blood transfusion and less flap atrophy than those of musculocutaneous flaps. To this respect, their usage should be prioritized in such challenging patients.
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http://dx.doi.org/10.1097/SCS.0000000000005052DOI Listing
October 2018

Varenicline increases random flap survival in rats submitted to nicotine.

J Plast Surg Hand Surg 2018 Oct 24;52(5):312-318. Epub 2018 Jul 24.

a Department of Plastic, Reconstructive and Aesthetic Surgery , Hacettepe University Faculty of Medicine , Sihhiye , Ankara 06100 , Turkey.

Smoking is a leading cause of flap failure. Varenicline-assisted smoking cessation has shown beneficial effects on vascular endothelial function. The aim of this study was to determine whether varenicline conveys beneficial effects for skin flap survival. Twenty-four rats were randomly divided into four groups of six. The rats in the control group received normal saline subcutaneous injections, and those in the nicotine group received subcutaneous nicotine injections. The rats in the varenicline group received varenicline intraperitoneally, and those in the nicotine-varenicline group received both nicotine and varenicline. At the end of week 3, the dorsal skin flaps were raised in all rats. On postoperative day 7, the flaps were evaluated by direct observation, microangiography, and light microscopy. The mean necrotic area of the flaps was significantly greater in the nicotine group than in the control group (49.2 ± 4.71 vs. 22.03 ± 0.93%, respectively,  < .01) and significantly higher in the nicotine-varenicline group than in the varenicline group (22.4 ± 1.23 vs. 9.2 ± 0.59%, respectively,  < .01). However, no significant difference was observed between the control and nicotine-varenicline groups ( = .934). Microangiographically, vascularity was lowest in the nicotine group and highest in the varenicline group. Histologically, larger areas of necrosis, more severe inflammation and less vessel formation were observed in the nicotine group. Healing, exhibited by a greater number of vessels, was evident in the varenicline-applied groups. Varenicline appears to increase the microcirculation of random flaps, as shown by decreased flap necrosis and increased vascularity.
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http://dx.doi.org/10.1080/2000656X.2018.1493387DOI Listing
October 2018

The Composite Spreader Flap.

Aesthet Surg J 2019 01;39(2):137-147

Department of Plastic, Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Background: The effect of a spreader flap on the keystone area and the upper bony vault depends on the structural strength and cephalic extent of upper lateral cartilages, both of which can be significantly variable among individuals.

Objectives: The authors present a novel cephalically extended osseocartilaginous composite spreader flap technique that was designed to overcome the limitations of a conventional spreader flap on the keystone area upper bony vault, in patients with cephalically short and structurally weak upper lateral cartilages and thin nasal bones.

Methods: This study was a retrospective review of the recorded perioperative information to investigate the frequency of the use of the composite spreader flap technique and perioperative parameters that relate to postoperative dorsal deformities. One-hundred-seventy-six consecutive primary open approach rhinoplasty cases performed by the first author (O.B.) between November 2015 and February 2017 were included in the study. Patient data were obtained from rhinoplasty data sheets, standardized photographs, and postoperative physical examinations.

Results: Of the 176 cases who underwent primary open approach rhinoplasty whose data were reviewed for the purpose of this study, 38 (32 females, 6 males) had dorsal reconstruction with the use of a composite spreader flap. Seventeen patients had a deviated nose with an asymmetric bony pyramid. In 8 patients, the composite spreader flap was used unilaterally. No patients in the composite spreader flap group had a postoperative dorsal deformity or required surgical revision.

Conclusions: Composite flap preparation extends the reliability and the reach of the spreader flap technique beyond its previous borders.

Level Of Evidence 4:
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http://dx.doi.org/10.1093/asj/sjy122DOI Listing
January 2019

Scroll Reconstruction: Fine Tuning of the Interface Between Middle and Lower Thirds in Rhinoplasty.

Aesthet Surg J 2019 04;39(5):481-494

Department of Plastic Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Background: The junction between upper and lower lateral cartilages, known as "the scroll area," is an important determinant of the spatial relationship between the middle and lower nasal thirds.

Objectives: We offer a graduated and reproducible surgical technique of scroll area management that takes into consideration anatomic, functional, and aesthetic relationships.

Methods: This study was a retrospective review of the recorded intraoperative information to investigate the frequency of the use of scroll reconstruction techniques and perioperative parameters that relate to unintended component alterations in the scroll area. A total of 364 consecutive primary open approach rhinoplasty cases performed by the first author (O.B.) between July 2011 and September 2015 were included in the study.

Results: Of the 364 cases who underwent primary open approach rhinoplasty, 329 received some form of scroll reconstruction. Scroll reconstruction was performed in all deviated cases, and 88% of straight noses. The most common technique for scroll reconstruction was overlapping repair (88.3%). As expected, both alar rim and alar crease asymmetries were very frequent in the deviated nose group, 89.4% and 75% respectively. Alar rim and alar crease asymmetries were frequent enough in the straight nose group to deserve special attention, 14.2% and 10.4% respectively.

Conclusions: With careful attention to anatomic details of the scroll area, nasal tip refinements can be performed with predictable safety and accuracy. Our approach is a graduated, reproducible, and individualized way of scroll area management that aims to create the ideal cartilage configuration while preventing unintended component alterations.

Level Of Evidence: 4:
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http://dx.doi.org/10.1093/asj/sjx264DOI Listing
April 2019

Let us save the brain with cerebral oximeter: Two case reports.

Afr J Paediatr Surg 2017 Oct-Dec;14(4):74-78

Department of Anesthesiology and Reanimation, Faculty of Medicine, Duzce University, Duzce, Turkey.

In the neonates, tracheal atresia and tracheoesophageal fistula (TEF) surgery may result in hemodynamic instabilization, leading to cerebral perfusion insufficiency due to the retraction of the pulmonary vessels and truncus brachiocephalicus. We represented one male and one female neonates which were performed thoracoscopic primary repair of TEF through right thoracotomy at the 3 and 4 postpartum day. Anesthesia was induced using sodium thiopental (5 mg/kg), fentanyl 4 mcg, and rocuronium (0.5 mg/kg) given through intravenous route. Sevoflurane 2% and 50% Oin air were used for the maintenance therapy. During the right lung compression to expose posterior esophagus, no value was observed on the pulse oximeter (PO) probe placed on the right hand, and radial artery was not palpated. At the same time, oxygen saturation was observed as 96%-97% on the left foot probe. As the right cerebral oximeter values (rSO) were rapidly decreased to 31%, the lung compression was ceased. Right pulse oximeter and right rSOmeasurements return to the baseline levels. For the second case - different from the first case -both left and right rSOwas rapidly decreased to 40% levels and return to the baseline levels after was removed the retractors. Right PO and right and left cerebral rSOvalues returned to baseline immediately when the retractor compression was ended During the operations involving the great vessels in neonates, cerebral perfusion could be preserved using cerebral oximeter. Cerebral oximeter is more efficient than pulse oximeter for detecting cerebral tissue oxygenation and could be helpful to minimize neuronal damage in the neonates.
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http://dx.doi.org/10.4103/ajps.AJPS_117_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6369595PMC
May 2019

Groin and thigh reconstructions with pedicled rectus abdominis myocutaneous flaps.

Turk J Med Sci 2017 Jun 12;47(3):883-890. Epub 2017 Jun 12.

Department of Plastic, Reconstructive, and Aesthetic Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Background/aim: Resection of tumors from the groin and thigh regions with safe margins often results in significant soft tissue defects, which preclude primary closure. This study presents a series of rectus abdominis myocutaneous flaps for irradiated thigh and groin wounds with the purpose of evaluating the efficacy and outcomes of these flaps in this population.

Materials And Methods: From 2008 to 2015, all patients who underwent resection of thigh or groin region tumors and reconstruction with an inferiorly based rectus abdominis myocutaneous flap were retrospectively identified. Medical records of the patients were reviewed.

Results: A total of 27 patients, aged 20-67 years, were operated on for defects in the groin and upper thigh region. Nine patients underwent immediate reconstruction. The remaining 18 patients underwent late reconstruction. There was neither total flap loss nor partial flap loss. We chose to utilize 15 ipsilateral and 12 contralateral pedicles. The mean length of stay in hospital was 13.7 days.

Conclusion: A rectus abdominis myocutaneous flap can be successfully used in patients with groin and upper thigh defects due to its predictable and robust vascular supply, bulky muscle content, wide arc of rotation, and large skin island.
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http://dx.doi.org/10.3906/sag-1604-46DOI Listing
June 2017

Microvascular Tissue Transfers for Midfacial and Anterior Cranial Base Reconstruction.

J Craniofac Surg 2017 May;28(3):659-663

Department of Plastic, Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Reconstruction of a midfacial defect can represent a difficult challenge for the plastic surgeon. Although many midfacial deformities have traumatic or congenital origins, the vast majority of head and neck defects occur after resection of malignant head and neck neoplasms. Autogenous reconstruction is now routinely performed for larger, complex defects resulting from surgical resection or trauma. In this study, the authors present 27 patients with midfacial defects reconstructed with free flaps. Twenty-two of the defects were created by surgical ablation of cancer (maxillectomy) and the others were traumatic. The maxillectomy defects were classified into 4 according to the classification proposed by Cordeiro. Eighteen of the patients were male and 9 were female. Twenty-nine free flaps were performed. Six different types of flaps including radial forearm flap, vertical rectus abdominis (VRAM) flap, anterolateral thigh (ALT) flap, tensor fasciae latae (TFL) flap, fibula osteocutaneous flap, and iliac osteocutaneous flap were accomplished. Types I and II defects were reconstructed with radial forearm flap. Type III defects were reconstructed with VRAM and ALT. Type IV defects were reconstructed with VRAM and TFL. Two patients underwent a second flap reconstruction due to recurrent disease (9.1%). Average patient age was 53.1 years. Free-flap survival was 100%. Free tissue transfer is the method of choice in midfacial reconstruction. Following a reconstructive algorithm is useful in the decision-making process for patient evaluation and treatment. Every reconstructive microsurgeon might have different experiences with different flaps. Therefore, the algorithm for flap choices is not universal among surgeons.
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http://dx.doi.org/10.1097/SCS.0000000000003448DOI Listing
May 2017

The systematic review and meta-analysis of free flap safety in the elderly patients.

Microsurgery 2017 Jul 20;37(5):442-450. Epub 2017 Mar 20.

Department of Plastic Surgery, Hacettepe University Hospitals, Ankara, Turkey.

Background: Prolonged mean life expectancy gives rise to a more populated and older patient group. With increasing number of cases during the past decades, older patients are regarded as candidates for microsurgical interventions. Whether advanced patient age is an independent risk factor for microsurgical reconstruction is still an ongoing matter of debate.

Methods: The Cochrane Central Register of Controlled Trials, PubMed, MEDLINE, CINAHL and EMBASE databases were screened for combination of the key words "elderly", "geriatric", "advanced age", "free flap", "microsurgery", free tissue transfer" by using time limits between 1989 and 2015.

Results: According to results of the meta-analysis, there was no significant difference in the flap success rates(P =.39, CI = 0.848 to 2.329) and surgical complication rates (P = .83, CI = 0.792 to 1.163) between the young and elderly patient groups. However, the systemic complication rates(P = .02, CI = 1.468 to 3.572), preoperative ASA scores(P < .0001, CI = 0.342 to 1.078), and mortality rates (P = .03, CI = 2.636 to 9.055) were found to be significantly higher in the elderly patients.

Conclusions: Although an increased rate of systemic complications and mortality has been associated with advanced age, our study results showed no significant difference between the flap success rates and surgical complications. A successful reduction in systemic complications would bring the risk level of reconstructive microsurgical interventions of the elderly patient group to the level of the young patient group. © 2017 Wiley Periodicals, Inc. Microsurgery 37:442-450, 2017.
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http://dx.doi.org/10.1002/micr.30156DOI Listing
July 2017

Intramuscular myxoma: clinical and surgical observation notes on eleven cases.

Int Orthop 2017 Apr 14;41(4):837-843. Epub 2017 Jan 14.

Department of Plastic Reconstructive and Aesthetic Surgery, Ankara Oncology Training and Research Hospital, Ankara, Turkey.

Purpose: Intramuscular myxoma (IM) is a benign, soft tissue neoplasm of mesenchymal origin. We report our experience with this tumour.

Method: This clinical study comprised 11 cases of IM that were operated on between March 2008 and June 2016. Tumour location and size, results of pre-operative radiological studies, preop-erative biopsies, pathology examinations, applied surgical method and post-operative complications were reported for all patients.

Results: In total, nine patients with 11 IMs with a mean age of 60.0 years were assessed. Mean follow-up was 39.2 months. Tumours were located in the right thigh (5 patients, 7 IM), left gluteal area (2 patients, 2 IM), right gluteal area (1 IM) and left thigh (1 IM) ranging from 2 × 1 cm to 10 × 17 cm Pre-operative radiological diagnoses were cystic lesion, abscess, bursitis, fibrosarcoma, fibroma, lipoma, malign mesenchymal tumour and IM. Pre-operative biopsy was performed for five cases. All tumours were removed via simple excision and were pathologically consistent with IM. No complication or recurrence was observed during the follow-up period.

Conclusion: IM is a relatively rare benign tumour, the pre-operative diagnosis of which using radiological and clinical methods is quite difficult, creating pre-operative diagnostic confusion. It is generally diagnosed by microscopic examination. Simple excision with a small margin of surrounding tissue is considered to be sufficient for its treatment.
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http://dx.doi.org/10.1007/s00264-016-3396-8DOI Listing
April 2017

Platelet-rich plasma versus corticosteroid injections for carpal tunnel syndrome.

J Plast Surg Hand Surg 2017 Oct 6;51(5):301-305. Epub 2016 Dec 6.

d Orthopaedics and Traumatology , Ankara Oncology Research and Training Hospital , Yenimahalle , Ankara , Turkey.

Background: Platelet-rich plasma therapy has the potential to promote peripheral nerve regeneration through the autologous supply of growth factors. Therefore, this study aimed to compare the effects of platelet-rich plasma injections with the effects of corticosteroid injections in the treatment of carpal tunnel syndrome.

Methods: In total, 40 patients with mild carpal tunnel syndrome were equally divided into two groups. Nerve conduction studies were carried out, and the Boston Carpal Tunnel Questionnaire was administered to both groups before treatment. One group of patients received platelet-rich plasma injections, and the patients in the other group received corticosteroid injections into the carpal tunnel. The patients were followed for 6 months. After 3 and 6 months, the nerve conduction studies and the Boston Carpal Tunnel Questionnaire were repeated.

Results: Although distal motor latencies did not change in either of the groups during the follow-up period, improvements in sensory nerve conduction were recorded after 3 months in both groups. However, there was no significant difference between the groups in the nerve conduction studies. In the Boston Carpal Tunnel Questionnaire, both the symptom severity score and the functional capacity score of the platelet-rich plasma group were significantly better than those of the corticosteroid group after 3 months, although there were no significant differences after 6 months.

Conclusions: Platelet-rich plasma injections may be considered for the temporary symptomatic relief of mild carpal tunnel syndrome.
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http://dx.doi.org/10.1080/2000656X.2016.1260025DOI Listing
October 2017

The reduction of extraneural scarring with buccal mucosa graft wrapping around the sciatic nerve: an experimental study in a rat model.

J Plast Surg Hand Surg 2017 Aug 14;51(4):259-263. Epub 2016 Oct 14.

c Department of Plastic and Reconstructive Surgery , Uludag University School of Medicine , Bursa , Turkey.

Background: The postoperative development of epineural and extraneural scar tissue adversely affects peripheral nerve surgery outcomes. Although several surgical methods, pharmacological agents, and chemical materials have been used to prevent epineural scar formation in both clinical and experimental models, the results are still unsatisfactory. The purpose of this study was to investigate the efficacy of buccal mucosa graft (BMG) wrapping on epineural scarring in an adult rat model.

Methods: Bilateral sciatic nerves were carefully exposed in 24 adult Sprague-Dawley rats, and a circumferential segment of epineurium (0.5 cm) was excised from both nerves. The epineurectomised left nerve segment was wrapped with a BMG (experimental side), while the right nerve segment did not receive any surgical procedure other than the epineurectomy, and served as the control side. To perform gross and histopathological examinations, 12 randomly selected rats were euthanised at 4 weeks postoperatively, and the remaining rats were euthanised at 8 weeks.

Results: The left sciatic nerve that was wrapped with a BMG following epineurectomy showed significantly less nerve adhesion at 8 weeks (p = .018), and less epineural scar tissue at both 4 (p = .014) and 8 weeks (p = .025). Inflammation of the BMG-wrapped nerves was increased at 4 weeks (p = .029), but not at 8 weeks.

Conclusion: BMG wrapping decreases postoperative adhesion and scar tissue formation of epineurectomised healthy nerves, despite the presence of increased inflammation in the early postoperative period.
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http://dx.doi.org/10.1080/2000656X.2016.1241790DOI Listing
August 2017

Assessment of survival rates compared according to the Tamai and Yamano classifications in fingertip replantations.

Indian J Orthop 2016 Jul-Aug;50(4):384-9

Department of Plastic, Reconstructive and Aesthetic Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey.

Background: The fingertip is the most frequently injured and amputated segment of the hand. There are controversies about defining clear indications for microsurgical replantation. Many classification systems have been proposed to solve this problem. No previous study has simultaneously correlated different classification systems with replant survival rate. The aim of the study is to compare the outcomes of fingertip replantations according to Tamai and Yamano classifications.

Materials And Methods: 34 consecutive patients who underwent fingertip replantation between 2007 and 2014 were retrospectively reviewed with respect to the Tamai and Yamano classifications. The medical charts from record room were reviewed. The mean age of the patients was 36.2 years. There were 30 men and 4 women. All the injuries were complete amputations. Of the 34 fingertip amputations, 19 were in Tamai zone 2 and 15 were in Tamai zone 1. When all the amputations were grouped in reference to the Yamano classification, 6 were type 1 guillotine, 8 were type 2 crush and 20 were type 3 crush avulsions.

Results: Of the 34 fingertips, 26 (76.4%) survived. Ten (66.6%) of 15 digits replanted in Tamai zone 1 and 16 (84.2%) of 19 digits replanted in Tamai zone 2 survived. There were no replantation failures in Yamano type 1 injuries (100%) and only two failed in Yamano type 2 (75%). Replantation was successful in 14 of 20 Yamano type 3 injuries, but six failed (70%). The percentage of success rates was the least in the hybridized groups of Tamai zone 1-Yamano type 2 and Tamai zone 1-Yamano type 3. Although clinically distinct, the survival rates between the groups were not statistically significantly different.

Conclusions: The level and mechanism of injury play a decisive role in the success of fingertip replantation. Success rate increases in proximal fingertip amputations without crush injury.
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http://dx.doi.org/10.4103/0019-5413.185602DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4964771PMC
August 2016

Analysis of Lower Breast Pole Length and Nipple-Areola Complex Position Following Superior Pedicle, Short Horizontal Scar Breast Reduction.

Aesthetic Plast Surg 2016 Oct 29;40(5):690-8. Epub 2016 Jun 29.

Department of Plastic Surgery, Hacettepe University Faculty of Medicine, Sihhiye, 06100, Ankara, Turkey.

Background: Postoperative changes following superior pedicle breast reduction are closely related to the pattern of skin resection. We have observed that the superior pedicle, short horizontal scar breast reduction technique provides a stable breast shape in the long term. We test the validity of our clinical observations through objective analysis of postoperative dimensional changes following superior pedicle, short horizontal scar breast reduction.

Methods: Of 42 patients who underwent superior pedicle, short horizontal scar breast reductions between January 2011 and June 2012, 38 (75 breasts) were available for long-term follow-up. The midclavicular point-to-superior areolar border distance (A), the inferior areolar border-to-inframammary fold (IMF) distance (B), and the areolar diameter (C) were measured and recorded at the time of (1) preoperative markings, (2) first postoperative visit, and (3) 2-year postoperative follow-up visit. The specifications of the preoperative markings were recorded to analyze their correlation with actual breast dimensions.

Results: The superior border of the nipple-areola complex (NAC) was located, on average, 1.2 cm higher at the first postoperative visit when compared with the markings (P < 0.001). The nipple-areola position did not change significantly in the long term (P = 0.224). The average postoperative increase in the IMF-to-inferior areolar border distance between the first postoperative visit and the long-term follow-up visit was 0.3 cm (P < 0.001). Although statistically significant, this extent of change (4.5 %) in the lower pole vertical length was clinically unidentifiable, and pseudoptosis did not occur after superior pedicle, short horizontal scar mammaplasty.

Conclusion: Long-term stability of the NAC position and lower breast pole length makes superior pedicle, short horizontal scar breast reduction a predictable and dependable option for primary breast reduction/mastopexy and for a matching procedure.

Level Of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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http://dx.doi.org/10.1007/s00266-016-0663-4DOI Listing
October 2016

Central artery perforator propeller flap for nasal and medial canthal defects.

J Plast Reconstr Aesthet Surg 2016 Aug 5;69(8):e180-5. Epub 2016 May 5.

Bursa State Hospital, Dept. of Plastic Reconstructive and Aesthetic Surgery, Bursa, Turkey. Electronic address:

Introduction: Non-melanoma skin cancer is the most common type of skin cancer of the nasal dorsum and the medial canthal region, which is caused by chronic sun exposure. Limited adjacent tissue and the need for aesthetically pleasing result make the reconstruction of these regions very challenging. To overcome this challenge, we designed a perforator propeller flap based on the central artery.

Methods: Between January 2014 and November 2015, we covered the nasal or medial canthal defects of 22 patients with central artery perforator propeller flaps.

Results: The mean age of the patients was 60.4 years (range: 47-81 years). The median follow-up period was 7.5 months (range: 2-23 months). The pathological diagnoses were basal cell carcinoma for 14 patients and squamous cell carcinoma for the remaining eight patients. The size of the defects ranged from 2 × 2 to 3.5 × 4 cm, and that of the flaps ranged from 2 × 3.5 to 3.2 × 6 cm. We did not observe any major complications requiring surgery, such as total flap loss, hematoma, or dog-ear deformity. However, venous congestion was seen in five patients and partial flap necrosis (that healed without intervention) in two patients.

Conclusion: The central artery perforator propeller flap is a reliable and versatile flap for the reconstruction of the nasal dorsum and medial canthal region. Reconstruction with this flap is a single-stage procedure that can cover large defects without causing dog-ear deformity or eyebrow asymmetry compared with other local flap options.
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http://dx.doi.org/10.1016/j.bjps.2016.04.017DOI Listing
August 2016

The Effects of Reduction Mammaplasty on Serum Leptin Levels and Insulin Resistance.

Int J Endocrinol 2015 13;2015:719824. Epub 2015 Oct 13.

Department of Genetics, Ankara Oncology Research and Training Hospital, Yenimahalle, 06200 Ankara, Turkey.

Background. The reduction mammaplasty has been a well-executed and known procedure in which considerable amount of fatty tissue is removed from the body. The authors aimed to show the effects of the reduction mammaplasty on serum leptin levels and insulin resistance. Methods. 42 obese female patients who had gigantomastia were operated on. We recorded patients' demographic and preoperative data, including age, weight, height, and body mass index. Fasting serum leptin, glucose, and insulin levels were noted. Homeostasis model assessment scores were calculated. At the postoperative 8th week, patients were reevaluated in terms of above parameters assessing the presence of any difference. Results. Serum leptin levels were decreased postoperatively and the decrease was statistically significant. We were able to show a decrease in homeostasis model assessment score, which indicated an increase in insulin sensitivity, and this change was statistically significant. A significant correlation between body mass index and leptin change was found postoperatively. Conclusion. Reduction mammaplasty is not solely an aesthetic procedure but it decreases serum leptin levels and increases insulin sensitivity, which may help obese women to reduce their cardiovascular risk.
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http://dx.doi.org/10.1155/2015/719824DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4621362PMC
November 2015

Assessment of Patients Who Underwent Nasal Reconstruction After Non-Melanoma Skin Cancer Excision.

J Craniofac Surg 2015 Jun;26(4):1299-303

*Ankara Oncology Research and Training Hospital, Plastic and Reconstructive Surgery Yenimahalle, Ankara †Hacettepe University Faculty of Medicine, Plastic and Reconstructive Surgery Sihhiye, Ankara ‡Necmettin Erbakan University, Meram Faculty of Medicine, Konya §Ankara Research and Training Hospital, Plastic and Reconstructive Surgery Altindağ, Ankara ||Düzce Atatürk State Hospital, Plastic and Reconstructive Surgery Sihhiye, Ankara, Turkey.

Background: Basal and squamous cell carcinomas are the most common malignant cutaneous lesions affecting the nose. With the rising incidence of skin cancers, plastic surgeons increasingly face nasal reconstruction challenges. Although multiple options exist, optimal results are obtained when "like is used to repair like". We aimed to introduce a simple algorithm for the reconstruction of nasal defects with local flaps, realizing that there is always more than one option for reconstruction.

Patients And Methods: We retrospectively reviewed 163 patients who underwent nasal reconstruction after excision of non-melanoma skin cancer between March 2011 and April 2014. We analyzed the location of the defects and correlated them with the techniques used to reconstruct them.

Results: There were 66 males and 97 females (age, 21-98 years). Basal cell carcinoma was diagnosed in 121 patients and squamous cell carcinoma in 42. After tumor excision, all the defects were immediately closed by either primary closure or local flap options such as Limberg, Miter, glabellar, bilobed, nasolabial, V-Y advancement, and forehead flaps.

Conclusions: Obtaining tumor-free borders and a pleasing aesthetic result are major concerns in nasal reconstruction. Defect reconstruction and cosmesis are as important as rapid recovery and quick return to normal daily activities, and these should be considered before performing any procedure, particularly in elderly patients.
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http://dx.doi.org/10.1097/SCS.0000000000001563DOI Listing
June 2015

A novel technique for distal fingertip replantation: Polypropylene suture guided interpositional vein graft.

J Plast Surg Hand Surg 2015 Oct 4;49(5):280-283. Epub 2015 May 4.

c 3 Clinic of Plastic, Reconstructive and Aesthetic Surgery, Elbistan State Hospital , Kahramanmaras, Turkey.

Background: Despite current advances in microsurgery, fingertip replantation is still controversial, mainly due to its difficulty and cost. The purpose of this study is to describe a new technique of interposition vein graft guided by polypropylene suture in distal fingertip replantation.

Methods: A total of eight consecutive Tamai zone 1 fingertip replantations performed by the same author were included. All replantations were performed using interposition vein graft guided by polypropylene suture. This technique involved a vein graft of ∼ 2 cm, with appropriate calibration, obtained from the volar part of the forearm and a 2-0 polyprolene suture passed through the interposition vein graft. Then, a polypropylene suture guide carrying the vein graft was inserted into the artery. The anastomosis was easily performed with the aid of 10-0 or 11-0 nylon in a bloodless medium and without encountering the posterior wall problem.

Results: Average surgery time was 2.5 hours (range = 2-3 hours). Among eight Tamai zone 1 replantations, six were successful (75%). There were two replantations lost because of arterial failure.

Conclusion: This technique may ease fingertip replantations and increase the success rate for Tamai zone 1 injuries.
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http://dx.doi.org/10.3109/2000656X.2015.1041968DOI Listing
October 2015

Revisiting the role of columellar strut graft in primary open approach rhinoplasty.

Plast Reconstr Surg 2015 Apr;135(4):987-997

Ankara, Turkey; and Cleveland, Ohio From the Department of Plastic Surgery, Hacettepe University Faculty of Medicine; and the Section of Cosmetic Surgery, Cleveland Clinic Foundation.

Background: The effect of a columellar strut graft on final nasal tip position has been a subject of ongoing debate. The purpose of this study was to retrospectively analyze a series of 100 consecutive primary rhinoplasty cases performed without the use of columellar strut grafts, with a specific focus directed toward comparing preoperative, morphed, and actual postoperative changes in nasal tip position.

Methods: Data were collected from patient charts and digital images of 100 consecutive primary open rhinoplasty patients. Preoperative, morphed, and actual postoperative digital images were quantitatively analyzed using image-processing software to compare various anatomical features, including nasal tip projection, nasolabial angle, and Goode ratio. Patient satisfaction regarding long-term postoperative results was also surveyed.

Results: Primary rhinoplasty did not demonstrate a universal trend toward either an increase or a decrease in nasal tip projection. The planned changes in nasal tip projection, nasal tip rotation, and nasal profile proportions were obtained with statistically significant accuracy without the use of columellar strut grafts. The overall incidence of columellar contour irregularities was 3 percent.

Conclusion: In primary open approach rhinoplasty, if native anatomical support structures of the nasal tip are preserved or reconstructed, preoperative goals regarding nasal tip projection, nasal profile proportions, and columellar integrity can be consistently achieved without using columellar strut grafts.
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http://dx.doi.org/10.1097/PRS.0000000000001263DOI Listing
April 2015

[A rare case of Hymenolepis diminuta infection in a small child].

Mikrobiyol Bul 2015 Jan;49(1):135-8

Duzce University Faculty of Medicine, Department of Medical Microbiology, Duzce, Turkey.

Unlike Hymenolepis nana that transmits directly from person to person, the transmission of Hymenolepis diminuta to human is via accidentally ingesting of arthropods carrying cysticercoid larvae as intermediate host. In places with poor hygienic conditions, this cestod may cause seldom infections especially in children. Studies carried out on various populations have reported the prevalence rate of H.diminuta between 0.001% and 5.5%. Although the reported cases are mostly children, the disease can be seen in every age group. In this report, a pediatric case of H.diminuta infection is presented. A twenty one-month-old male patient with the symptoms of vomiting 3-4 times a day along with mud-like diarrhea continuing for a week was admitted to the pediatric outpatient clinic. According to the history, it was learned that the house where he lived was above a barn and there was a history of insect swallowing. Laboratory findings revealed iron-deficiency anemia. The macroscopic appearance of the stool was in a pale clay-like form, and by direct microscopic examination with lugol solution, 70-75 μm in diameter, thick-shelled and six central hookleted eggs that are characteristic for H.diminuta were identified. A six-day course of oral niclosamide was administered to the patient beginning with 500 mg on the first day and 250 mg on the following five days, together with the treatment for the iron deficiency anemia. After fifteen days, the oral niclosamide treatment was repeated. No H.diminuta eggs were detected in the parasitological examination performed one month after completion of the second round of treatment. This case has been presented to call attention to the importance of patient anamnesis and microscopic examination in the diagnosis of H.diminuta infection which is a rarely seen parasitosis.
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http://dx.doi.org/10.5578/mb.8695DOI Listing
January 2015

Meningitis caused by Neisseria Meningitidis, Hemophilus Influenzae Type B and Streptococcus Pneumoniae during 2005-2012 in Turkey. A multicenter prospective surveillance study.

Hum Vaccin Immunother 2014 17;10(9):2706-12. Epub 2014 Nov 17.

a Department of Pediatric Infectious Diseases ; Hacettepe University Faculty of Medicine ; Ankara , Turkey.

Successful vaccination policies for protection from bacterial meningitis are dependent on determination of the etiology of bacterial meningitis. Cerebrospinal fluid (CSF) samples were obtained prospectively from children from 1 month to ≤18 years of age hospitalized with suspected meningitis, in order to determine the etiology of meningitis in Turkey. DNA evidence of Neisseria meningitidis (N. meningitidis), Streptococcus pneumoniae (S. pneumoniae), and Hemophilus influenzae type b (Hib) was detected using multiplex polymerase chain reaction (PCR). In total, 1452 CSF samples were evaluated and bacterial etiology was determined in 645 (44.4%) cases between 2005 and 2012; N. meningitidis was detected in 333 (51.6%), S. pneumoniae in 195 (30.2%), and Hib in 117 (18.1%) of the PCR positive samples. Of the 333 N. meningitidis positive samples 127 (38.1%) were identified as serogroup W-135, 87 (26.1%) serogroup B, 28 (8.4%) serogroup A and 3 (0.9%) serogroup Y; 88 (26.4%) were non-groupable. As vaccines against the most frequent bacterial isolates in this study are available and licensed, these results highlight the need for broad based protection against meningococcal disease in Turkey.
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http://dx.doi.org/10.4161/hv.29678DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4977434PMC
May 2016