Browsing by Author "Evrenos, MK"
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Item Giant eccrine porocarcinoma in an unusual locationErmertcan, AT; Evrenos, MK; Öztürk, F; Temiz, PItem Dermoscopy of scalp cutaneous metastasis of sarcomatoid renal cell carcinomaÇetinarslan, T; Ermertcan, AT; Temiz, P; Evrenos, MK; Müezzinoglu, TItem Clinicopathological characteristics and mutation profile of BRAF and NRAS mutation in cutaneous melanomas in the Western Turkish populationEvrenos, MK; Temiz, P; Çam, FS; Yaman, M; Yoleri, L; Ermertcan, ATBackground/aim: Malignant melanoma is the most common cause of death due to skin cancers. The most common mutations in RAF-RAS pathway from tumor oncogenes are BRAF and NRAS. In this study, we analyzed the frequency of BRAF and NRAS gene mutations and investigated their association with clinicopathological features of melanomas in the Turkish population. Materials and methods: 65 primary cutaneous melanoma were included in the study. The mutations were evaluated with real-time PCR-based PCR-array through allele-specific amplification, and the results were correlated with various clinicopathological characteristics. Results: 52.3% of the patients were female and 47.7% were male. The mean age of the patients with a mutation was lower than those without mutation. 16 patients had BRAF mutation. 12 patients had NRAS mutation. NRAS mutation was statistically more common in men (P = 0.036). The number of mitoses increased with the increase of the tumor thickness (P = 0.003). There was more mitosis in the presence of ulceration (P = 0.05). A total of 41.7% of NRAS mutations had adjuvant chemotherapy. Conclusion: We found lower mutation rate when compared to regional studies. NRAS mutation was common in men. This is the first study from our region evaluating the prognostic value of clinical stage and necessity of adjuvant treatment with the presence of BRAF and NRAS mutations.Item Evaluation of the effect of surgical treatment on quality of life with the Dermatology Life Quality Index in patients with facial nonmelanoma skin cancerÇetinarslan, T; Evrenos, MK; Bilaç, C; Özyurt, B; Ermertcan, ATSkin cancers are the most common type of cancer. Nonmelanoma skin cancers (NMSCs) are more common than melanoma. Although the mortality rate is low, cancer word can be frightening for patients. Surgery is the main treatment. As skin cancers are most commonly located on the face, undesirable cosmetic results can occur as a result of treatments or due to primary disease. Therefore, the quality of life of patients could be affected. To determine the effect of surgical treatment on quality of life of the patients with facial NMSC using the Dermatology Life Quality Index (DLQI) at baseline and 3 months after surgery. We aimed to see if there was any improvement in quality of life scores after surgery, and to identify factors affecting quality of life. A total of 255 patients; 174 basal cell carcinoma (BCC) (68.2%) and 81 squamous cell carcinoma (SCC) (31.8%) were included in our study. All participants completed DLQI at baseline and 3 months after surgery. The mean total DLQI scores were 6.37 +/- 6.28 in patients with BCC, and 6.35 +/- 6.16 in patients with SCC. The mean total DLQI scores were 3.96 +/- 5.14 in patients with BCC (P < .001), and 4.49 +/- 5.24 in patients with SCC (P < .001) 3 months after surgery. In patients with primary skin cancer, all subscale scores and total DLQI scores were worse than the recurrent skin cancer group in both BCC and SCC at baseline. According to the treatment modalities, total DLQI scores and all subscales were worse in the graft group in BCC and SCC patients at baseline. Interestingly, the sex and the type of skin cancer did not affect quality of life, but tumor localization ([auricula OR: 6.45 [95% CI: 1.28-37.47] and eyelid OR:0.20 [95% CI: 0.04-0.96]) treatment procedure ([flap procedure OR: 7.90 [95% CI: 2.64-23.62] and graft procedure OR: 5.47 [95% CI: 1.60-18.71]) and, primary tumor OR:3.86 (95% CI: 1.01-14.78) were significant. The quality of life of skin cancer patients was affected by tumor localization, treatment procedure, primary, or recurrent tumor. The quality of life showed a significant improvement in patients with facial NMSC after surgical treatment. However, the type of NMSC seems to have no effect on the quality of life.Item An effective technique for managing vascular diameter discrepancies in microsurgery: tapering with a hemoclipBali, ZU; Evrenos, MK; Karatan, B; Kececi, Y; Yoleri, LMicrovascular anastomosis is mandatory for free flap surgery, but free flap transfer can be challenging because of vascular diameter discrepancies during microsurgery. Different methods have been described for preventing vascular discrepancies. The aim of this study was to test a simple technique using a hemostatic clip to taper the vessels. In 12 patients who had free tissue transfer with diameter discrepancies between donor and recipient vessels, tapering with a hemostatic clip technique was used. After key sutures were placed on the vessels, a hemostatic clip was placed in an oblique fashion on the vessel with a larger diameter. After the vessel was tapered and the same diameters in the donor and recipient vessels were achieved, anastomosis was completed. This technique was used in head and neck reconstruction and lower extremity reconstruction. The luminal diameters of arteries, and veins of the flap and recipient differed by 1.6- to 3.0-fold and 1.5- to 2.6-fold, respectively. All the flaps survived without complications. Tapering with a hemoclip technique is a rapid procedure that can be considered for managing vascular diameter discrepancies in free tissue transfers.Item An Update on Quality of Life in Malignant Melanoma and Nonmelanoma Skin CancersCetinarslan, T; Evrenos, MK; Ermertcan, ATSkin cancer is the most common type of cancer. Nonmelanoma skin cancers (NMSCs) are more common than malignant melanoma. It is expected that the incidence of skin cancer will increase in the future. Although the mortality rate is low, cancer wording can be frightening for patients. Because skin cancers are most commonly located in the head and neck, unwanted cosmetic consequences can occur as a result of treatments. Therefore, the quality of life (QOL) of patients could be affected negatively. Today, there are various scales that assess the QOL of patients. These can be grouped as general, disease-specific, and cancer-specific questionnaires. Studies have been carried out and are still in progress to develop scales of QOL specific to skin cancers. In this paper, the questionnaires used in malignant melanoma and/or NMSCs and studies on this subject are reviewed.Item Modified Temporalis Muscle Flap for Eyelid ReanimationEvrenos, MK; Bali, ZU; Yaman, M; Yoleri, LThe reanimation of both upper and lower paralytic eyelids requires dynamic procedures for longevity of correction. Temporalis muscle ensures the criteria for reanimation and is used widely as a result. Many modifications were described to improve the success of the classical technique. One of these modifications was reported by the senior author in 1999. Twice as much muscle mass (in thickness) to the upper eyelid than the lower was taken and passed submuscularly 5 to 6 mm away from the limbus and a thinner split was passed subcutaneously beneath the lower cilia. The aim of this study was to present the outcomes of the technique after 38 operations with 37 patients and to describe deep temporalis musculofascial-fatty flap to recover depression of temporalis muscle split donor area. Seventeen lower eyelids were evaluated as mild, 12 were as moderate, and 9 were as severe ectropion. One upper eyelid was evaluated as mild, 14 were as moderate, and 23 were as severe lagophthalmos preoperatively. Mean follow-up time was 28.8 months. Five patients had mild ectropion and 2 patients had mild lagophthalmos postoperatively at last follow-up. Two patients needed medial canthal tendon reinsertion secondary to relaxation of fixation suture at medial canthus. All patients tolerated the procedure and all complaints were resolved without creating a notable cosmetic deformity.Item Factors determining poor prognostic outcomes following diabetic hand infectionsInce, B; Dadaci, M; Arslan, A; Altuntas, Z; Evrenos, MK; Karsli, MFBackground and Objective: Hand ulcers are seen in a small percentage of patients with diabetes. The predisposing factors of diabetic hand varies between different countries. However, the effects of predisposing factors on prognosis are not clear in diabetic hand infections. In this study, our aim was to determine the effects of predisposing factors on poor prognostic outcomes in patients with diabetes mellitus. Methods: Thirty-four patients with diabetes mellitus who were treated and followed up for a hand infection in between 2008 and 2014 were investigated retrospectively. Patients were evaluated according to predisposing factors defined in the literature that included disease period, age, gender, admission time, presence of neuropathy, smoking habits, HbA1c levels at admission time, peripheral vascular disease, end-stage renal disease (ESRD), and trauma. Death and minor/major amputation cases during treatment were defined as poor prognosis. Results: Patients who had ESRD, peripheral neuropathy, or an HbA1c level greater than 10% had significantly higher amputation rates. Conclusions: Peripheral neuropathy, ESRD, and HbA1c levels greater than 10% at the time of admission were determined as poor prognosis criteria for diabetic hand treatment.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 effect of human recombinant epidermal growth factor on capsule contraction in an irradiated rat modelTuluy, Y; Evrenos, MK; Yoleri, L; Temiz, P; Ölmezoglu, ABackground Breast implants are commonly used in plastic surgery for aesthetic and reconstructive purposes. One of the most important complications of this surgery is capsule contraction. Methods In this study, it is aimed to evaluate the effect of recombinant human epidermal growth factor (rh-EGF) on capsule contraction in the model of capsule contraction provided by radiation therapy after silicone block placement in rats. The results were evaluated by histopathologic examination. Twenty-four rats were divided into 4 groups. In the group A, rats were followed for 63 days without radiation therapy and rh-EGF. In the groups B, C, and D, a total of 19.56 Gy radiation therapy was administrated in two fractions with an interval of 1 week. Forty-two days after the last radiation therapy, 3 doses of rh-EGF were given to the group C and 6 doses of rh-EGF to the group D with an interval of 1 day. Rats were sacrificed on the 63rd day of the study. Results In the study, no statistically significant difference was observed between the groups in chronic inflammation, eosinophil, and inflammatory cell amount. Neutrophil levels, collagen amount, vascular proliferation, and capsule thicknesses were examined, and it was observed that they were significantly increased in the experimental groups compared to the control group. However, there was no significant difference between the experimental groups. Conclusions Different rh-EGF doses were used in the study, and no significant effect was observed on capsule contraction. Different doses and durations may be considered to evaluate the effectiveness.Item Fractional CO2 Laser Treatment for Cutaneous Leiomyomas in a Patient with Reed's SyndromeÇetinarslan, T; Ermertcan, AT; Evrenos, MK; Temiz, PItem Dermoscopic features of trichilemmal carcinomaArslan, Z; Bali, ZU; Evrenos, MK; Temiz, P; Ermertcan, ATItem Cutaneous Mucormycosis in Immunocompromised Patients Due to Corticosteroid UseEvrenos, MK; Ünsal, MÖ; Keçeci, YItem Idiopathic Scrotal ElephantiasisEvrenos, MK; Özkaya, M; Yaman, M; Yoleri, LItem Malignant tumor of outer root sheath epithelium, trichilemmal carcinoma: Clinical presentations, treatments and outcomesEvrenos, MK; Kerem, H; Temiz, P; Ermertcan, AT; Yoleri, LObjectives: To emphasize different clinical features of tumor that can be misdiagnosed clinically. Methods: A total of 8 cases operated between September 2009 and 2016 at the Celal Bayar University, Faculty of Medicine were included in the study. Patients' clinicopathological features, type of surgery and follow up information were evaluated. Results: Six patients were male. The average age was 75.50. The lesions were located on the head and neck, and chest wall. Six patients had a history of the rapid growth of lesion. There was no metastasis at the time of diagnosis. None of the patients needed adjuvant therapy. Mean follow up time was 19.37 months. None of the patients developed recurrence or metastasis. Conclusion: This tumor resembles basal or squamous cell carcinoma. The histopathological evaluation may lead to misdiagnosis. Regional or distant metastasis is very rare. There is no consensus about adjuvant therapy. Screening for metastasis and close follow up are mandatory.Item Malignant Proliferating Trichilemmal Tumor: Clinical Presentations, Treatment, and OutcomesEvrenos, MK; Bali, ZU; Temiz, P; Ermertcan, AT; Yoleri, LBackground: Malignant proliferating trichilemmal tumor (MPTT) is very rare malignant tumors of hair follicles derived from outer root sheath. This tumor is mostly located on the head and neck of elderly women. Regional or distant metastasis is possible. In this study, we present clinical features and treatment outcomes of cases diagnosed as MPTT. Furthermore, we aimed to emphasize a different clinical form of the tumor that can be misdiagnosed clinically. Patients and Methods: A retrospective evaluation of five cases operated between September 2009 and February 2017 Celal Bayar University Faculty of Medicine, Plastic Reconstructive and Aesthetic Surgery Department at were included in the study. Clinicopathological features of patients, type of surgery, and follow-up information were evaluated. Results: Four patients were female. Average age was 72.2. All of the lesions were located on the head and neck. All patients had a history of rapid growth of lesions. Patients were scanned with computed tomography. There was no metastasis at the time of diagnosis. None of the patients needed adjuvant therapy. Mean follow-up time was 11.8 months. None of the patients developed recurrence or metastasis. Conclusions: These tumors resemble basal cell or squamous cell carcinoma. Rapid progress of benign form of the tumor should address malignant transformation. There is no consensus about adjuvant therapy. Screening for metastasis and close follow-up are mandatory.Item A painless, solitary, yellow-pink colored, vascularized, firm nodule on the foreheadArslan, Z; Çetinarslan, T; Bali, ZU; Evrenos, MK; Temiz, P; Ermertcan, ATItem Case Report: Gorham-Stoute Syndrome with Involvement of Majority of Mandible, and Partial Maxillary, Temporal and Zygomatic BonesEvrenos, MK; Özkaya, M; Yaman, M; Proff, LYThe Gorham-Stout syndrome is a rare condition in which spontaneous, progressive resorption of bone occurs. The diagnosis is based on clinical, radiological and histopathological findings after excluding other etiologies and as a result it is often delayed. We present the case of a 21-year-old male diagnosed with Gorham-Stout syndrome with involvement of the majority of the mandible, partial involvement of right maxillary, temporal and zygomatic bones and discuss its diagnostic and therapeutic features.Item Clinical Outcomes of Large Meningomyelocele Defect Repair by Bilateral Fasciocutaneous Rotation and Advancement Flaps with PerforatorsEvrenos, MK; Kamburoglu, HO; Seçer, M; Çinar, K; Dadaci, M; Ince, BObjective: Neural tube defects occur in approximately one in 1000 live births in the US. Myelomeningocele (MMC) is the most common and severe form of spina bifida aperta. In this study, we present a surgical modification of the bilateral fasciocutaneous rotation and advancement flap technique in MMC patients. Material and Methods: Twenty-four patients (12 male, 12 female) with MMC who were operated on between August 2011 and June 2013 were retrospectively evaluated. Presence of hydrocephalus, the neurological status, and the level and size of the MMC were recorded. We used bilateral perforator-based fasciocutaneous rotation and advancement flaps for defects larger than 3 cm in width, or in the presence of prominent kyphosis together with any defect size. Results: The follow-up period ranged from eight days to two years. One patient died on the eighth day after surgery because of sepsis secondary to aspiration pneumonia. One patient had cerebrospinal fluid accumulation under the repair zone. In another patient, cerebrospinal fluid leakage through the repaired incision was observed on the ninth day after surgery. Three patients had minimal wound dehiscence at the distal end of the suture line. Conclusion: In this study, 24 patients were treated with the described perforator-based technique by preserving at least one perforator vessel on each side. Reconstruction of MMC defects with paraspinal fasciocutaneous rotation and advancement flaps is still one of the best choices for closing moderate-to-large defects without using skin graft, and the safety of the flaps increases by preserving the perforators.Item Negative pressure wound therapy in the early period after hand and forearm replantation: is it safe?Dadaci, M; Isci, ET; Ince, B; Altuntas, Z; Evrenos, MK; Uzun, H; Sönmez, E; Bitik, OObjective: In this study, effectiveness and reliability of negative pressure wound therapy (NPWT) in the early period after replantation will be examined retrospectively in a series of patients. Method: Patients who underwent replantation between 2007 and 2014, and had tissue defect or partial necrosis in the absence of a major circulation problem were included in this retrospective study. Following debridement of necrotic tissues on the postoperative 7-10 days, NPWT was applied to all patients one day later and adjusted as intermittent 75 mmHg pressure. Intermittent phase adjustment was arranged as 5 minutes suction and 2 minutes resting, and resting pressure was adjusted as 35 mmHg. NPWT was applied for six days and dressings were changed in every three days in the first six day period. Open wounds was debrided again and grafted with split-thickness skin graft and NPWT was continued over the graft for 4 days more. Results: There were 11 patients included of which nine amputations were complete and two were nearly total amputations of forearm. Granulation tissue was observed following 6 days of NPWT application in all patients. Graft survival was observed to be almost complete. Wound infection did not occur and tissue cultures obtained in the course of debridement were all negative. Partial oxygen saturations were between 96-99% during the NPWT. Conclusion: NPWT (75 mmHg) can be used in the intermittent mode in order to improve wound healing and shorten the period to start physical therapy in the early period after replantation and revascularisation.