Browsing by Author "Yoleri, L"

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    Lateral thoracic artery perforator-based flap: a new experimental model
    Bali, U; Gungor, M; Yoleri, L
    Background: 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.
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    Different venous end-to-side microanastomotic techniques
    Yoleri, L; Songür, E
    End-to-side venous anastomosis is sometimes necessary when there is the lack of a suitable vein, when there is a size discrepancy in the veins to be repaired, or when the anastomosis of multiple veins is required. The effects of elliptical vs. slit venotomy on vessel patency have not been investigated in a flap model. A new, simple, reliable, and reproducible model is described in which the femoral vein of the groin flap is anastomosed to the side of the deep dorsal penile vein. Elliptical hole and slit venotomies were tested in 26 Sprague-Dawley rats, and the anastomoses were 100% patent. The type of venotomy was not found to affect patency. Either technique is equally valid in end-to-side venous anastomosis, and the model itself is convenient for training.
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    The use of free helical rim flaps for the reconstruction of the ala nasi and lower eyelid
    Bali, ZU; Aksoy, A; Yoleri, L
    Aims and Objectives: The aim of this study was to present our experience using free flaps harvested from the helix in the reconstruction of the nose and lower eyelid. Materials and Methods: Between 2016 and 2019, 5 male and 2 female patients treated surgically with free helical flaps were included in the study. All defects had occurred due to tumor excision. Results: A total of two lower eyelid defects and five ala nasi defects were reconstructed using free helical rim flaps. Seven helical flaps based on the superficial temporal vessels were obtained and used for reconstruction. No recurrence was detected in any of the patients within the followup period. The only remarkable complication reported was dehiscence development, which was attributed to partial venous congestion in one patient. Free helical rim flaps are similar to the ala nasi and lower eyelids in terms of concave shape, tissue, and color. Conclusion: The results have shown that free helical rim flaps are a suitable option for use in the repair of appropriately sized fullthickness defects of the ala nasi and lower eyelid.
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    Late diagnosis of a lateral abdominal wall hematoma presenting with nonspecific findings
    Ilkgül, Ö; Özden, S; Özsoy, Y; Yoleri, L; Erhan, Y; Aydede, H
    We report a case with a late diagnosis of posttraumatic lateral abdominal wall hematoma. The patient was admitted with a giant hematoma presenting with pleural effusion, anemia and weight loss on postoperative 30th day after a blunt trauma. Computerized tomography analysis revealed a hematoma extending from axilla to the gluteus. Fine-needle aspiration revealed an exudative fluid and five liters of fluid collection was drained. Misdiagnosed lateral abdominal wall hematomas can be diagnosed with nonspecific findings as in this case.
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    RECONSTRUCTION OF LABIUM MINUS HYPERTROPHY TAKING INTO ACCOUNT ANATOMICAL DIFFERENCES
    Güngör, M; Sir, E; Çelik, D; Seyhan, A; Yoleri, L
    Introduction: In labioplasty, wedge resection is a preferential method because of easy application and good results. In the identified wedge resection models certain zones and usually certain angles have been recommended. However, it's obvious that each enlarged labium minus shows different properties from another. The most protuberant portion, the excess volume and skin laxity are different for each case. Therefore, the zone of the triangle that will be resected and the apical angle should be planned specially for each case. Thus, we determined wedge resection zone and apical angle taking into account patient's anatomy. Material and Methods: We evaluated retrospectively 14 patients underwent labioplasty with this method. 11 (78.5 percent) patients underwent central, 2 (14.2 percent) patients underwent inferior and 1 (7.1 percent) patient underwent two different zones (central and inferior) wedge resections. We also excised redundant preputium clitoris in 2 (14.2 percent) patients. In wedge resection, apical angle varied between 60120 degrees. Results: In all patients, the labia minoras were covered by the labia majoras. None of the patients showed introitus narrowing and scar contraction. All of the patients reported that preoperative complaints disappeared or diminished. 9 (64.2 percent) patients evaluated postoperative satisfaction degree as very good and 5 (35.7 percent) patients as good. Complications were observed in 2 (% 14.2) patients. In 1 patient dehiscence of the suture line and in 1 patient asymmetry occurred. Conclusions: The results of this study demonstrate that we can get successful results when taking into account each labium minus anatomical differences.
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    Total nasal reconstruction with pre-laminated, super-thin anterolateral thigh flap: A case report
    Bali, ZU; Karatan, B; Parspanci, A; Tuluy, Y; Kececi, Y; Yoleri, L
    Many techniques for nasal reconstruction have been described to achieve aesthetically and functionally favorable results. Local tissues, specifically the forehead flap, provide the best tissue match with the nose. However, when local tissue donor sites are limited, alternative options such as free tissue transfers should be considered. Herein, we describe a case of a 72-year-old male patient who had a total nasal and left malar defect reconstructed with a two-staged, pre-laminated, super-thin anterolateral thigh (ALT) flap. The patient's nasectomy was performed 15 years ago. The adjacent left malar defect was due to recent squamous cell carcinoma excision. Local tissues were unavailable for reconstruction due to previous tumor excisions. For the 8.5 x 5 cm defect, a 12.5 x 8 cm ALT flap was planned, with 7.5 x 8 cm for nasal reconstruction and 5 x 4 cm for malar reconstruction. During the first stage, a super-thin fascial ALT flap was raised without dissecting the perforators, and the nasal skeleton was laminated between these two flaps. Costal cartilages were harvested for the nasal skeleton and positioned between the suprafascial and the fascial ALT flaps. During the second stage, two perforators were dissected to the pedicle on the pre-laminated flap, and the flap was divided from the donor site. The nasal skeleton was fixed and anastomosis with the facial vessels was established. After both stages, no complications were observed. After one month, a revision surgery was performed to enhance the transition between the reconstructed nose and the cheek, and improve the nasal projection. Postoperatively, after one year, the patient had a stable nasal reconstruction with good breathing. Prelaminated, super-thin ALT flaps provide the advantages of a wide and versatile donor site and an acceptable donor site scar. They may be an option for patients who are not amenable to traditional reconstruction methods.
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    Clinicopathological characteristics and mutation profile of BRAF and NRAS mutation in cutaneous melanomas in the Western Turkish population
    Evrenos, MK; Temiz, P; Çam, FS; Yaman, M; Yoleri, L; Ermertcan, AT
    Background/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.
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    An effective technique for managing vascular diameter discrepancies in microsurgery: tapering with a hemoclip
    Bali, ZU; Evrenos, MK; Karatan, B; Kececi, Y; Yoleri, L
    Microvascular 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.
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    The significance of venous dominance in color Doppler ultrasound for the diagnosis of primary nodular skin lesions
    Özkol, M; Yoleri, L; Demir, MA; Dernireli, P; Pabusçu, Y
    The aim of this study was to investigate the significance of color Doppler ultrasound (CDUS) findings in the differential diagnosis of suspicious nodular skin lesions and to compare the results according to the Giovagnorio 1999 classification and the modified classification. Forty nodular skin lesions were evaluated with CDUS and US. The number of arteries and veins was recorded in hypervascular lesions. Findings were compared with histopathological results. The specificity and predictivity of the modified classification were higher than those of the Giovagnorio 1999 classification. (c) 2006 Elsevier Inc. All rights reserved.
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    Modified Temporalis Muscle Flap for Eyelid Reanimation
    Evrenos, MK; Bali, ZU; Yaman, M; Yoleri, L
    The 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.
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    Cross-facial nerve grafting as an adjunct to hypoglossal-facial nerve crossover in reanimation of early facial paralysis
    Yoleri, L; Songür, E; Mavioglu, H; Yoleri, Ö
    Reanimation of a spontaneous and synchronous smile, and sufficient depressor mechanism of the lower lip presents a surgical challenge in facial paralysis. Hypoglossal-facial nerve crossover and cross-facial nerve grafting are the best options if the mimetic muscles around the mouth are still viable in patients in whom the facial nerve was sacrificed at the brainstem, Although good muscle tone and facial motion have been obtained by hypoglossal-facial nerve crossover, smile is dependent on conscious tongue movement, Cross-facial nerve grafting provides a voluntary and emotion-driven smile, but requires two coaptation sites, which leads to substantial axonal loss and a long regeneration time. This method was not successful in activating the depressor mechanism. The first stage is the classic baby-sitting procedure, in which the bulk of the mimetic muscles was maintained by the rapid reinnervation of the hypoglossal-facial nerve crossover during the regeneration period of the cross-facial nerve graft, and temporalis muscle transfer to the eyelids is performed. During the second stage, the cross-facial nerve graft that used the thickest zygomaticobuccal branch on the healthy side was coapted with the corresponding branches on the paralyzed side. The hypoglossal-facial nerve crossover continued to innervate the depressor muscles. Good spontaneous smile and sufficient depressor mechanism were achieved by cross-facial nerve grafting and hypoglossal-facial nerve crossover respectively, and these techniques are demonstrated by the authors clinically and electrophysiologically.
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    Free gracilis muscle flap: Variations of obturator nerve
    Tuluy, Y; Bali, ZU; Unsal, MO; Parspanci, A; Yoleri, L; Kececi, Y
    Background: Gracilis muscle has been used in reconstructive surgery for free muscle flap transfer. It was reported to be a reliable flap with lower rates of donor-site morbidity. In this study, we aimed to emphasize the anatomical variations of the obturator nerve. Materials and Methods: Clinical results of 14 patients who underwent lower lip reconstruction and facial reanimation with free gracilis muscle transfer between March 2017 and May 2021 were examined. Results: We identified eight male and six female patients, with a mean age of 55.6 years (range: 37-73 years). Of 14 patients, nine (64.3%) were operated on for lower lip reconstruction, and the remaining five cases underwent facial reanimation. Despite adequate dissection, we could not find the branch of the obturator nerve for gracilis muscle in two cases (14.3%), while vascular pedicles are detected in all cases. The first case was a lower lip reconstruction and the second case was a facial reanimation. Conclusion: While gracilis muscle is a good option for functional muscle transfer, it may be difficult to find the branch of the obturator nerve. Our study may suggest the need for consideration of anatomical variations of the obturator nerve before surgical planning for improved shared decision-making.
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    A Mother and Child with Moebius Syndrome
    Bali, ZU; Usluer, A; Yoleri, L
    In this case report, we present the case of a 25-year-old male with familial Moebius syndrome having facial nerve paralysis; his mother had both facial nerve paralysis and sixth cranial nerve paralysis. He was admitted to our outpatient clinic with complaints of an unclosed left eye and a sagging left corner of the mouth. During preoperative procedures for the operation for the correction of facial paralysis, we noticed that his mother also had peripheral facial nerve and ipsilateral sixth cranial nerve paralysis simultaneously. Either patient underwent examinations and research considering the familial Moebius syndrome and its clinical findings. The male patient was operated with a modified temporal muscle transposition technique for lagophthalmos and tendon graft hanging and cross facial nerve graft (CFNG) with the sural nerve for the sagging mouth corner.
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    Modified temporalis muscle transfer for paralytic eyelids
    Yoleri, L; Songür, E
    The major problems in paralytic eyelids are the inability to close the eye, lower lid sagging, and epiphora. The upper eyelid is responsible for most of the opening and closing of the eye, whereas a lower eyelid positioned properly against the globe is necessary for collection and Row of the tear fluid. Modification of temporalis muscle transfer, a classic technique, was planned to restore these functions selectively in paralytic eyelids. Twelve unilateral and one bilateral irreversible facial paralysis patients with different degrees of lagophthalmos and ectropion were included. 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 for stronger motion of the upper eyelid, and a thinner muscle mass was passed subcutaneously beneath the lower cilia for longevity of the correction of ectropion and epiphora. Fixation of these strips was performed to the medial canthal ligament and 3 to 4 mm above it. The average duration of follow-up was 35.5 months. Excellent eyelid closure and correction of ectropion and epiphora were achieved with one procedure in all patients without creating a cosmetic deformity.
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    Reconstruction of burn contractures with free anterolateral thigh flap in various anatomic sites
    Bali, ZU; Özkan, B; Keçeci, Y; Ertas, N; Yoleri, L
    BACKGROUND: Burn contractures that cause a restriction in extremity movements have to be reconstructed. Free microvascular flaps are generally needed in cases of severe contractures. The ideal free flap for severe contracture defects has to have a large skin island without bulk and a long pedicle for preventing recurrence and tension-free adaptation. Anterolateral thigh flap (ALT flap) that meets these features has widely been used for several indications in reconstructive surgery. Usage of ALT flap in burn contracture was described for burn and axillary contractures in literature. In this study, the usage of free ALT flaps in various anatomic contracture sites was reported. METHODS: Fifteen free ALT flaps were performed in 14 (12 male, two female) patients with a mean age of 36.6. Burn contracture defects in neck, axilla, popliteal, cubital region, plantar foot and hand were reconstructed with ALT flap. RESULTS: No total flap loss was encountered. Distal flap necrosis was seen in one case. All patients had significant improvement in a range of motions. Recurrence in contracture was seen in one patient with hand flexor contracture due to lack of physical treatment. CONCLUSION: ALT flap can safely be used in various anatomic contracture sites. Suprafascial elevation of the flap can be preferred for better adaptation in the neck, hand and foot and prevention of bulky appearance.
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    Asymmetry, Handedness and Auricle Morphometry
    Tatlisumak, E; Yavuz, MS; Kutlu, N; Asirdizer, M; Yoleri, L; Aslan, A
    The aims of this study were to determine various morphometric measurements of auricle, to investigate asymmetry and its relation with handedness in both sexes. Main morphometric measurements of both auricles and hand preferences were determined on 200 male and 200 female healthy university students. All measurements of the auricles were larger in males than the corresponding ones in females and all the differences except earlobe widths were statistically significant. All measurements of left and right auricles were statistically significantly different in both sexes except earlobe length in males, and distance from the highest point of the auricle to the bottom of the intertragic notch and earlobe length in females. Auricle length and distance from the highest point of the auricle to the bottom of the intertragic notch had higher values at the left side and all other measurements were larger at the right side. There was no significant difference between the measurements of the corresponding auricles of the righthanded and lefthanded subjects. All measurements were larger at the right side except auricle length and distance from the highest point of the auricle to the bottom of the intertragic notch in righthanded and lefthanded subjects and all differences except earlobe length were significantly different in righthanded subjects as in the total population but in lefthanded subjects the difference of the auricle width was not significant, either. There was an apparent asymmetry of right and left auricles of normal people in the current study which should be taken in to consideration in plastic surgeries of the external ear, designing the ear devices and forensic applications of earprints.
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    The cranially based contralateral nasolabial flap for reconstruction of paranasal and periorbital surgical defects
    Kerem, H; Bali, U; Sönmez, E; Manavbasi, YI; Yoleri, L
    The 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.
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    Investigation of the Effect of Mobile and Immobile Regions on Fat Graft Viability: An Experimental Study in a New Model
    Bozkurt, GC; Yoleri, L; Temiz, P
    BackgroundFat grafts are widely used in plastic, aesthetic and reconstructive surgery. Their unpredictable resorption is their main disadvantage. A review of the literature shows that there is a lack of research on the effect of mobile and immobile regions on fat graft survival in fat graft applications.ObjectiveOur aim was to investigate the relationship of fat graft survival with mobile and immobile region in a new experimental model.MethodsTwenty-four male Wistar albino rats were randomly divided into two groups (n=12). Fat grafts were harvested from the right inguinal region of the rat. In Group 1, the fat graft was placed in the subcutaneous pouch formed in the scalp region of the rat. In Group 2, fat grafts were placed in the pouch formed in the posterior cervical region of the rat. At the end of 6 weeks, the weights and histopathology of the fat grafts were evaluated. Histopathological examinations were performed in a blinded fashion.ResultsThe weights of the fat grafts were found to be higher in Group 1. At the same time, histopathological examinations showed that vascular density was higher in Group 1. There was no statistically significant difference in other histopathological examinations.ConclusionThe mobile and immobile areas may have different effects on the survival of transplanted fat grafts. Sliding movement between muscle and skin in the mobile zone puts stress on the fat graft. In our study, the mobile site was shown to have a negative effect on the vascularity of the fat graft. It was observed that the vascular density was higher in the fat graft placed in the immobilised area. Further studies on the increase in vascularity can be carried out using the new experimental model we have created.No Level AssignedThis journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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.