Browsing by Author "Bali, U"
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Item Lateral thoracic artery perforator-based flap: a new experimental modelBali, U; Gungor, M; Yoleri, LBackground: The aim of this study was to describe a new experimental perforator-based flap in rats, supplied by lateral thoracic artery perforator. Methods: Through out the study, two control and two experimental groups were created consisting of six rats in each group. In the first control group (group 1), mid-axillary line and the fourth intercostal space intersection were used as the center of the flap. A 3 x 2 cm flap was designed and elevated above the cutaneous maximus muscle by transecting all connections with the muscle. In the second control group (group 2), the flap was extended caudally, and 3 x 6 cm flap was designed. Then, the flap was elevated in the same manner as it was described for group 1. In the first experimental group (group 3) 3 x 2 cm flap and in the second experimental group (group 4) 3 x 6 cm flap were designed like control groups. The flaps were islanded on a single musculocutan perforator arising from lateral thoracic artery. The surviving skin paddle areas were calculated on postoperative day 7. Results: The flap viability was calculated 0% for control groups (groups 1 and 2), 100% for the first experimental group (group 3), between 33.3% and 37.7% for the second experimental group (group 4; mean +/- standard deviation, 34.76% +/- 1.92%). Conclusions: This new lateral thoracic artery perforator-based flap has a constant anatomy and reliable survival pattern. Also, easy harvesting and the possibility of designing two flaps per animal make this new flap an appealing model for pathophysiological or pharmacologic researches. (C) 2016 Elsevier Inc. All rights reserved.Item Clinical outcomes of salvage revision surgery following finger replantation with vascular insufficiency: A retrospective studyGüntürk, ÖB; Kayalar, M; Bali, U; Özaksar, K; Toros, T; Gürbüz, YObjective: The aim of this study was to analyze the outcomes of revision surgery following replantation of single digital amputations. Methods: In this study, first, a total of 403 patients (339 male, 64 female; mean age=28 years; age range=1-76) in whom a single finger replantation was performed were retrospectively reviewed, and then 60 patients with arterial or venous insufficiency in whom revision surgery was performed were reanalyzed. The second finger was observed to be the most injured one (32.8%). Injury type was classified as clean cut (25.3%), local crush (38.7), extensive crush (7.9%), and avulsion (28.1%). When taking the levels of injuries of the artery-only finger replantations into account, one finger (0.8%) was nail distal third, 70 fingers (56%) were nail distal third to lunula, 43 fingers (34.4%) were lunula to distal phalanx basis, 10 fingers (8%) were distal interphalangeal (DIP) joint, and one finger (0.8%) was middle phalanx. Operative revision was performed on 60 (14.9%) fingers. The need for operative revision was arterial insufficiency in 37 fingers (61.7%) and venous insufficiency in 23 fingers (38.3%). The average revision time was 43 (range=6-144) hours. While the average elapsed time for artery procedures was 35.3 (range=8-110) hours, the average elapsed time for vein procedures was 47.1 (range=6-144) hours. Finger survival rates were examined. Injury mechanism, amputation level, the number of artery/vein repairs and methods were examined in all patients and revision patients separately. Results: After the replantations, according to survival analysis, while 342 (84.9%) fingers were operated upon successfully, 61 (15.1%) fingers developed necrosis. In the patients with revision surgery, the survival rate was 78.3%. The need for revision was arterial insufficiency in 37 fingers (61.7%) and venous insufficiency in 23 fingers (38.3%). The revision rate was significantly lower than other injury types in clean-cut cases. In terms of levels of injury, no revisions were required from distal to lunula level, and the highest revision rate was observed at the proximal interphalangeal (PIP) joint level. Conclusion: The results of the present study have shown that early re-exploration can provide a 78.3% success rate and can increase the survival rate from 67.6% to 84.2% following replantation of single digital amputations. Surgical re-exploration seems to be a reasonable salvage for replanted fingers with vascular insufficiency.Item The Double Scalpel Flap: A New Technique for the Closure of Circular Skin DefectsKerem, H; Bali, U; Manavbasi, YI; Karaaltin, MVReconstruction needs to be designed attentively to obtain a functional and a good aesthetic consequence for closing skin defects. Numerous local flaps have been defined to conceal skin defects. However, new techniques are still required, especially for circular type of skin defects. This study describes a new technique that has been well defined to repair the circular type of skin defects. The technique basically uses extra skin relaxation provided with 2 opposing flaps' rotation maneuver in favor of the defect closure. The objective of this technique is for the flaps to start from one border of the defect and extend just to the other border, not invading beyond the defect borders. This enables us to apply the procedure on defects that are close to important anatomical structures because it is sufficient to use only the opposing 2 sides of the defect for its closure. With this method, 2 opposing flaps that resemble the tip of a scalpel were rotated to the existing circular defect; and by suturing these 2 flaps at the midline, the defect was closed. This technique was applied to 17 patients between the ages of 48 and 83 years. Defect sizes were between 2.5 x 2.5 and 5 x 5 cm. With the use of opposing flaps designed narrower than half-width of the defect, a tension-free closure could be achieved on both the donor and the recipient site. No flap necrosis was detected on any patients. After a mean follow-up of 11 months (3-26 months), it was realized that a good aesthetic appearance could be achieved in all the patients about 2 to 3 months postoperatively.Item Cranially-based nasolabial flaps for the reconstruction of nasal surgical defectsKerem, H; Bali, U; Sönmez, E; Evrenos, MKBackground Cranially-based nasolabial flaps are a good alternative for the reconstruction of nasal defects. Methods A cranially-based nasolabial flap was used in 18 patients to reconstruct defects of the nose from 2010 to 2016, and the long-term results are presented in this report. Results Fifteen of the flaps completely survived. All the patients had a bulky appearance, but they did not want to undergo a second operation for cosmesis. The dissection of the flap took approximately 20 minutes, and the total operation lasted for 1 hour. The patients were hospitalized for 1-7 days, and the postoperative follow-up period was 1-28 months (mean, 17 months). Conclusions The cranially-based nasolabial flap possesses all the advantages of the traditional forehead flap, and can safely be used in selected cases.Item The cranially based contralateral nasolabial flap for reconstruction of paranasal and periorbital surgical defectsKerem, H; Bali, U; Sönmez, E; Manavbasi, YI; Yoleri, LThe importance of the paranasal and periorbital regions on the aesthetics of the face presents a variety of reconstructive challenges for surgical and traumatic defects of those regions. We used the cranially based nasolabial flap in patients with full-thickness soft-tissue defects of the paranasal and periorbital regions harvested from the contralateral side of the present defect. We present our experience in 25 patients of geriatric population (13 females and 12 males with a mean age of 76) with complex soft-tissue defects in the paranasal and periorbital regions whose defects were reconstructed with contralateral nasolabial skin flaps. Sizes of the defects changed between 2 x 3 cm and 6 x 7 cm. The flap sizes varied from a width of 2 to 5 cm (average 3 cm) and a length of 7 to 11 cm (average 8 cm). Primary closure of the donor sites of the flaps was possible in 24 of the patients in this series. Twenty-one flaps of this series (84%) healed without any necrosis and completely survived. The contralateral nasolabial flap is a very convenient, safe and reliable flap that can be used in medium to large paranasal and periorbital defects. Optimal aesthetic results for a variety of central facial defects could be obtained with this flap, especially when the ipsilateral nasolabial flap cannot be used due to various reasons. (C) 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.Item ECCRIN POROCARCINOMA: OUR CLINICAL EXPERIENCES IN TREATMENT AND FOLLOW-UP OF THIS RARE LESION WITH A HIGH INCIDENCE OF LOCAL AND REGIONAL RECURRENCESKerem, H; Yaman, M; Bali, U; Öksüz, M; Yoleri, LIntroduction: Eccrin porocarcinoma is a rare tumor originating from intraepithelial parts of eccrin sweat glands. It has a bad prognosis and very different biological behaviors with a high recurrence rate and metastasis to both local skin and lymphatics. Five cases with different clinical and histopathological properties treated in our clinic were presented to add some contribution to the literature. Material and Methods: Five cases of eccrin porocarcinoma patients treated in our clinic between 2009 and 2013 were analyzed according to age, sexuality, tumor localization and histopathological records. Results: All patients were women and their mean age was 77. Localization of tumors was as follows: medial of thigh, upper lip, deltoid region, gluteal region and left cheek. Sizes of the tumors were between 3 and 16 cm. Two patients had concurrent regional lymph node metastasis and they had lymphatic dissection procedures. One patient with local recurrence was lost after a two-year follow-up period. Conclusions: Eccrin porocarcinoma is a rare tumor and there are insufficient numbers of reports about its diagnosis, treatment, results and follow-up protocols in the literature. The patients have to be in a close follow-up about the local and regional recurrences.Item Effects of oxidative stress and apoptosis on vascularity and viability of perforator flapsBali, U; Aydemir, I; Keçeci, Y; Yoleri, L; Tuglu, MIWe investigated lateral thoracic and posterior thigh perforator flaps for viability, vascularization, perfusion and apoptosis in a rat model. Wistar albino rats were divided into six groups: lateral thoracic artery perforator flap (LTPF) sham, 3 x 2 cm(2) LTPF, 3 x 6 cm(2) LTPF, posterior thigh perforator flap (PTPF) sham, 3 x 2 cm(2) PTPF, and 3 x 6 cm(2) PTPF. Flap viability was determined on postoperative days 1 and 7. On day 7, flaps were photographed and their viability was measured using two-dimensional planimeter paper. Tissue samples were harvested for examination by histology and immunohistochemistry. Viability differences were statistically significant. Epithelial thickness, vascularity and number of fibroblasts were reduced in the 3 x 6 cm(2) groups. Neovascularization and apoptosis based on molecular tests were not significantly different among groups. Flap size and location are important factors for closure of surgical or traumatic defects. We suggest that for clinical application, wound complications will occur less frequently with perforators that nourish large areas of flaps.