Browsing by Author "Ozalp T."
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Item An alternative approach in the treatment of Dupuytren's contracture skin defects: First dorsal metacarpal artery island flap(2004) Ozdemir O.; Coskunol E.; Ozalp T.Skin defects are often present following surgery for Dupuytren's contracture. The first dorsal metacarpal artery island flap (FDMA) has been used by others for soft tissue reconstruction about the radial and dorsal aspect of the hand, thumb and fingers. We have used it successfully to fill the skin defects often seen following palmar fasciectomy for Dupuytren's contracture. The thin nature of the flap makes it suitable for this application. The FDMA arises from the radial artery just before the radial artery enters the first dorsal interosseous muscle and divides into three branches: 1 to the thumb, 1 to the index finger (radiodorsal branch) and a muscular branch. It is the radiodorsal branch that supplies the skin over the index finger. The island flap based on this artery includes the dorsal terminal branches of the radial nerve and venae comitantes. The flap is formed to include the fascia of the first dorsal interosseous muscle to avoid injury to a possible deep artery and to yield sufficient fat to promote venous drainage. The flap is passed subcutaneously through the first web space and sutured in place to cover the skin defect in the palm. A full thickness skin graft is used to cover the defect over the proximal phalanx of the index finger. © 2004 Lippincott Williams & Wilkins, Philadelphia.Item Giant-cell tumors of the tendon sheath involving the hand or the wrist: an analysis of 141 patients; [El ve el bileginde tendon kilifinin dev hücreli tümörü: 141 hastanin degerlendirilmesi.](2004) Ozalp T.; Yercan H.; Kurt C.; Ozdemir O.; Coşkunol E.OBJECTIVES: Giant-cell tumors of the tendon sheath localized in the hand or wrist were retrospectively reviewed with respect to diagnosis, surgical treatment, and postoperative complications. METHODS: During a 21-year period, a total of 141 patients (83 females, 58 males; mean age 37.5 years; range 6 to 77 years) underwent surgery for 146 lesions that developed in the hand (n=134) or the wrist (n=12). Involvement was on the right side in 77 patients, and on the left side in 64 patients. The mean follow-up period was 3.5 years (range 6 months to 11 years). RESULTS: On presentation, the most common symptom was the presence of a painless soft tissue mass. The most frequent localization was the volar part (76%) of the second (27%) and the third (24) fingers, or the proximal phalanx (57%). Forty per cent of tumors were encountered at ages between 30 and 50 years. The duration of symptoms ranged from one month to five years and the highest number of presentations fell within the first six months. In eighteen patients, radiologic studies showed osseous involvement, being cortical sclerosis in 12 patients, and erosion in eight patients. Postoperative complications included digital nerve injuries in four patients, superficial infection in three patients, and joint stiffness in 12 patients. Twenty-three patients (16%) developed recurrences within a mean of 3.7 years (range 2 months to 7 years). CONCLUSION: Taking high rates of recurrences into consideration, surgery for giant-cell tumors of the tendon sheath requires wide surgical exposure, attentive skills, and the use of magnification.Item Long-term results of autograft and allograft applications in hand enchondromas; [El yerleşimli enkondromlarin tedavisinde otogreft veya allogreft uygulamalarinin geç dönem sonuçlari.](2004) Yercan H.; Ozalp T.; Coşkunol E.; Ozdemir O.OBJECTIVES: We evaluated the long-term results of treatment with curettage followed by an autograft or allograft application in patients with enchondroma of the hand. METHODS: Within a 15-year period, 76 patients (41 males, 35 females; mean age 32 years; range 14 to 47 years) were operated on for enchondroma of the hand. Following curettage of the lesion, reconstruction of the defect was made either by an autograft obtained from the iliac crest (n=76) or by a dehydrated cancellous allograft (n=15). The diagnosis was histologically confirmed in all the cases. Functional and radiographic results were assessed according to the Enneking scoring system and the Tordai classification system, respectively. The mean follow-up periods were 13.5 years (10-22 years) and 7.4 years (6-11 years) in autograft and allograft applications, respectively. RESULTS: Consolidation of the autografts took a mean of 38 days and maximum grasp force was obtained in a mean of 46 days. These periods were 51 and 55 days, respectively, for the allografts. Functional results were excellent/very good in 64%, good in 23%, and poor in 13.1% with autografts; radiographically, 78.7% of the patients were in group I, 18% were in group II, and 3.3% were in group III. Of the allograft group, the results were excellent/very good in 66.7%, good in 26.7%, and poor in 6.7%. Radiographically, 80%, 13.3%, and 6.7% of the patients were classified in group I, II, and III, respectively. There were two recurrences in the autograft group, while one patient, in the allograft group, who had multiple enchondromatosis required a ray amputation because of malignant transformation. CONCLUSION: Autograft and allograft applications seem to yield similar success rates in the treatment of enchondroma of the hand.Item Giant cell tumor at the wrist: a review of 23 cases; [El bileginde dev hücreli tümör: yirmi üç olgunun incelenmesi.](2006) Ozalp T.; Yercan H.; Okçu G.; Ozdemir O.; Coşkunol E.OBJECTIVES: We evaluated patients who underwent surgical treatment for giant cell tumor of the wrist with regard to recurrence rates, factors influencing tumor recurrence, complications, and postoperative functional and emotional status of the patients. METHODS: The study included 23 patients (6 males, 17 females; mean age 31.6 years; range 12 to 74 years) who were treated surgically for giant cell tumor of the wrist. Grading, assessment of surgical margins, and functional evaluation were performed according to the Enneking's criteria. The effects of tumor volume, soft tissue extension, and selected surgical therapy on recurrence were investigated. Joint movements and stability, postoperative pain, presence of deformity, muscle strength, limitations in functional activities, and patient satisfaction were evaluated. The mean follow-up period was 6.7 years. RESULTS: Of all the patients, 69% had stage 2 and 23% had stage 3 tumors. There was no significant correlation between tumor volume and recurrence (p=0.22). Recurrences were observed in three (33%) of nine patients with soft tissue extension and in four (28.6%) of 14 patients without soft tissue extension. Recurrence rates were 33.3% in those who were treated by curettage alone (n=3), 50% with curettage and grafting (n=6), 50% with curettage and bone cement (n=2), and 16% in those who underwent wide excision (n=12). CONCLUSION: The most important factor influencing recurrence rate in giant cell tumors is the extent of surgical resection. At least marginal resection must be considered in patients with stage 2 and 3 lesions especially in cases with soft tissue extension. Adjunctive therapy should be added if curettage is considered.Item Septocutaneous perforators of the peroneal artery relative to the fibula: Anatomical basis of the use of pedicled fasciocutaneous flap(2006) Ozalp T.; Masquelet A.C.; Begue T.C.There are many studies describing the perforating branches of the peroneal artery but none of them identifies their locations relative to fibula. The aim of this study was to demonstrate the locations of the perforators relative to the fibula and to present a case, treated with an adipofascial flap, based on one of these small arteries. In this study, nine fresh male cadavers' legs injected with colored latex were dissected for demonstration of the longitudinal axis of these perforators. A large incision was made on the lateral part of the leg from the head of the fibula to the ankle. The peroneal perforating vessels were displayed. The posterior margin of the fibula was marked with needles from proximal to distal just above every perforator. The distance between the needle and the perforator was recorded. Their diameters were measured at the level of fascial emergence. There were four to seven perforating vessels; the larger vessels were near the proximal end of the fibula with an average of 1.1 mm and a minimum of 0.8 mm. We found that these branches were not parallel to fibula, but aligned in an oblique projection from posterior to anterior and from distal to proximal because of the course of the intermuscular septum between the soleus and peroneus longus muscles. The lowermost vessel was 1.7 cm away from the posterior margin of the fibula while the uppermost vessel was 0.25 cm away from the posterior ridge of the fibula. Adipofascial or fasciocutaneous flaps, which have important advantages in covering small to medium sized defects, can be based on the perforators of the peroneal artery. But for the centralization of the flap pedicle, the locations of the perforators, which are aligned from the lateral malleolus to the fibular head in oblique direction and from the posterior to the anterior must be taken into consideration. This knowledge is crucial for the flap design and the centralization of the vessels. © Springer-Verlag 2005.Item Reconstruction of diabetic foot ulcers by lateral supramalleolar flap(2007) Yercan H.S.; Ozalp T.; Okcu G.Objectives: To report a series of 8 diabetic patients in whom the reconstruction of large-sized defect of the foot was performed using lateral supramalleolar flap. Methods: Coverage of the soft tissue defect was carried out by a lateral supramalleolar flap in 8 patients who had large-sized, non-healing ulcers at the Celal Bayar University, Department of Orthopedics and Traumatology, Manisa, Turkey, between 1998-2003. The mean age was 54 years. Preoperatively Doppler flowmeter evaluation was performed, and the ischemic index was calculated in all patients. Results: The flaps survived except for one patient who had a large defect on the heel with low ischemic index. The average healing time of the ulcer region and recovery of regular walking status was 34 days. The average healing period of the donor site was 35 days. After the average follow-up period of 40 months, neither infection nor a recurrence of the ulcer was encountered. The major problem of the donor area was skin graft breakdown and its non-aesthetic appearance due to hypertrophic granulation tissue. Conclusions: The lateral supramalleolar flap is a reliable option for the reconstruction of large-sized diabetic ulcers involving the dorsal aspect of the foot. This can also be used in conjunction with local muscle flaps, such as abductor hallucis for covering deep and large heel defects when the sural neurocutaneous flap is contraindicated.Item The modifed Eden-Lange procedure for paralysis of the trapezius muscle; [Trapezius felcinde modifiye Eden-Lange prosedürü: Olgu sunumu.](2007) Ozalp T.; Yercan H.; Okçu G.; Erkan S.Trapezius muscle paralysis results from injury to the spinal accessory nerve. Impairment in the trapezius muscle function may destabilize the muscle resulting in winged scapula. A 25-year-old university student who was active in sports had complaints of shoulder drop and pain on abduction. He had a three-year history of fall resulting in a scapular fracture for which he received conservative treatment. Physical examination showed asymmetry and drop of the right shoulder. Lateral scapular winging was apparent particularly above 90 degrees of abduction. Electromyography revealed isolated paralysis of the trapezius muscle. The patient underwent reconstruction with the modified Eden-Lange procedure. After a two-year follow-up, asymmetry in the shoulder decreased, there was no pain on active abduction, and the patient returned to active sports and was fully satisfied with the outcome.Item Giant-cell tumor of the hand: Midterm results in five patients; [Tumeur à cellules géantes de la main: Résultats du traitement: 5 Cas au recul moyen de 7,8 ans](Elsevier Masson SAS, 2007) Ozalp T.; Yercan H.; Okçu G.; Ozdemir O.; Coskunol E.; Bégué T.; Calli I.Purpose of the study: Giant-cell bone tumors are benign but have great potential for recurrence. Frequently observed in epiphyseal areas of tubular bones, these tumors are rarely found in hand localizations. We examined the characteristic features of giant-cell tumors of the hand and analyzed the pertinence of surgical treatment. We noted complications, consequences of recurrence and later operations on the same tumor site in five cases. Case reports: Five patients treated between 1973 and 2000 for giant-cell tumors involving the hand bones were reviewed retrospectively. Mean age was 41.6 years and mean follow-up was 7.8 years. The surgical procedure was curettage for two, curettage with bone graft for two and amputation for one. The Enneking score was noted. Results: Pain was the main symptom, with local swelling in several cases. At 7.8 years follow-up recurrence was noted for four of the five tumors. Two patients were treated for a second recurrence. Amputation of the forearm was required for one recurrence affecting soft tissue. Mean time between two consecutive recurrences was three months. In all six episodes of recurrent tumor were treated. These five patients had a total of ten operations. There were no cases of metastasis nor multicentric foci. Discussion: Treatment of giant-cell tumors involving the hand bones is designed to eradicate the tumor and also protect hand function while keeping in mind the aggressive nature of these benign tumors. Surgical alternatives for radical treatment can include wide resection, resection of the ray and amputation. © 2007. Elsevier Masson SAS.Item Extensor indicis proprius transfers for extensor pollicis longus ruptures secondary to rheumatoid arthritis; [Romatoid artritte ekstansör pollisis longus kopmalari için ekstansör indisis proprius transferi.](2007) Ozalp T.; Ozdemir O.; Coşkunol E.; Erkan S.; Calli I.H.OBJECTIVES: We evaluated the results of extensor indicis proprius (EIP) to extensor pollicis longus (EPL) transfers for EPL ruptures secondary to rheumatoid arthritis. METHODS: Twenty-four patients (7 males, 17 females; mean age 41 years; range 22 to 72 years) with rheumatoid arthritis underwent EIP to EPL transfer for 25 ruptures. The mean duration from rupture to surgery was 4.3 months (range 1.5 to 11 months). Functional assessment of the fingers was made using a specific EIP-EPL evaluation method developed by Lemmen et al. Pinch and grip strengths were measured. Range of motion of the metacarpophalangeal and interphalangeal joints of the thumb was compared with the normal side. Patient satisfaction was evaluated by a visual analog scale. The mean follow-up period was 6.2 years (range 4.7 to 7.9 years). RESULTS: Functional results were perfect in 14 fingers (56%), good in six fingers (24%), moderate in four fingers (16%), and poor in one finger (4%). The pinch and grip strengths were 86% and 92% of the uninvolved hand, respectively. The mean visual analog scale score was 74 (range 24 to 99). Compared to the uninvolved side, the range of motion of the thumb and index finger decreased by 23 degrees and 7 degrees , respectively, with a 9% loss of interphalangeal motion and a 17% loss of metacarpophalangeal motion in thumb extension. Independent extension of the index finger was possible in 21 hands. CONCLUSION: The results of EIP to EPL transfers are successful in ruptures secondary to rheumatoid arthritis.Item Bilateral fracture of the pisiform bone; [Fracture bilatérale de l'os pisiforme](Elsevier Masson SAS, 2007) Ozalp T.; Kurt C.; Coskunol E.; Ozdemir O.; Bégué T.Fracture of the pisiform bone is exceptional compared with the other carpal bones. Such lesions may be missed in the emergency room because of the complex anatomy of the carpal region. The usual circumstances leading to fracture of the pisiform bone include fall with reception on the hyperextended wrist, traffic accidents, and blunt trauma. The purpose of this work was to present a case of bilateral fracture of the pisiform bones. A 34-year-old woman presented with pain along the ulnar borders of both wrists after a fall. The mechanism of fracture was direct trauma on both hands after reception in radial inclination. The diagnosis was established late and conservative treatment was applied. After simple immobilization, the clinical and functional outcome was excellent. The anatomic position of the pisiform bone exposes it to direct trauma. Late diagnosis can favor osteoarthritic sequelae involving the pisotriquetral joint. © 2007. Elsevier Masson SAS.Item The role of creating a biological membrane in expediting nerve regeneration(Turkish Association of Orthopaedics and Traumatology, 2008) Ozalp T.; Masquelet A.-C.Objectives: Nerve guidance channels are natural or synthetic tubular conduits used to bridge the gap between the nerve stumps. Creation of a biological membrane may be a simple and cheaper way to obtain a nerve guidance channel. The goal of this study was to examine the role of a biological membrane in expediting nerve regeneration. Methods: Twenty adult male Wistar albino rats weighing 200 to 250 g were divided into two groups equal in number. All the animals underwent median nerve dissection to create a 5-mm gap. In the first group, the defect was repaired with a graft obtained from the contralateral median nerve, while in the second group, a silicon implant was sutured and anastomosed between the stumps. After five weeks, the silicon implant was removed and a nerve graft taken from the contralateral median nerve was anastomosed inside the neoformed biological membrane. Recovery of muscular function indicating nerve regeneration was assessed by the prehension test proposed by Bertelli and Mira. In both groups, measurements were started after five weeks of grafting and continued for 12 weeks. Results: Rats in the second group exhibited an accelerated recovery and nerve regeneration compared to the first group. Nerve regeneration was completed at 10 weeks in the second group, whereas the recovery rate was 90.2% at 12 weeks in the first group (p<0.05). Conclusion: The use of autogenous grafts is still the gold standard in nerve repair. This biological membrane not only expedites nerve regeneration, but also facilitates surgery and reduces operating time because it requires small incisions at the two ends. Considering these advantages, it may prove to be a good alternative to other techniques. ©2008 Turkish Association of Orthopaedics and Traumatology.Item A novel nerve transfer: The first palmar interosseous motor branch of the ulnar nerve to the recurrent motor branch of the median nerve(Elsevier Ltd, 2020) Ozcelik I.B.; Yildiran G.; Mersa B.; Sutcu M.; Celik Z.E.; Ozalp T.Introduction: The recovery of recurrent motor branch of the median nerve might be delayed in high level median nerve injuries due to the long reinnervation distance. The aim of this study is to define a novel nerve transfer to restore the opposition and pinch. Methods: Two fresh frozen hand cadavers were used for the study. The motor branch of the first palmar interosseous muscle of the ulnar nerve was identified and dissected. Thenar branch of the median nerve was dissected from its insertion site. The motor branch of the first palmar interosseous muscle of the ulnar nerve was transferred to the thenar motor branch of the median nerve. Axon counts were examined histopathologically. Clinically this nerve transfer was performed for two female patients with a high-level median nerve injury. Mehta opposition scores were 21 and 20, respectively and the results were satisfactory six months after the surgery. Discussion: Although exploration and repair are recommended as the first treatment for median nerve injuries, the waiting time until the motor branch is reinnervated is critical in high level lesions. Nerve transfers become very important for fast recovery. Conclusions: This new nerve transfer proposal may be an important step in nerve transfer surgery. © 2020Item Comparison of clinical outcomes and repair integrity after arthroscopic versus mini-open rotator cuff repair: An observational study(Lippincott Williams and Wilkins, 2024) Tosyali H.K.; Kaya H.; Hancioglu S.; Tamsel I.; Orguc S.; Tekustun F.; Kayikci K.; Kucuk L.; Ozalp T.This study aimed to evaluate the differences between mini-open (MO) and arthroscopic (ART) repair procedures for rotator cuff tendon tears in terms of clinical and radiological outcomes. This retrospective study included 59 patients, and data were collected prospectively. Patients with full-thickness rotator cuff tears were randomized to undergo MO or ART repair at 2 centers by 2 surgeons between January 2012 and December 2017. Data were collected 3 weeks before surgery and 6 and 12 months after surgery. Physical function was assessed using the American Shoulder and Elbow Surgeons index, VAS, and Constant scoring system. Radiological outcomes were assessed using the Sugaya classification, adapted for ultrasound. Changes between baseline and follow-up were compared between the 2 groups. Fifty-nine patients who underwent ART or MO rotator cuff repair were included in this study. The 2 groups had similar demographic characteristics and preoperative baseline parameters. Both the MO and ART groups showed statistically significant improvement in outcome parameters (P ≤.0001); however, cuff repair integrity was significantly better in the ART group (P = .023). All other improvements in the patient-derived parameters were equivalent. None of the patients in either group required revision surgery. According to the results of our retrospective study, MO and ART rotator cuff repair are effective and viable options for surgeons to repair rotator cuff tears. There were no differences in objective and subjective outcomes between the full ART and MO techniques for rotator cuff tears. Surgeons should choose a technique with which they are more familiar. © 2024 Lippincott Williams and Wilkins. All rights reserved.