Browsing by Author "Ergen, Duygu"

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Fournier Gangreni'nde Rekonstrüktif Aklaşımlarımız: 27 Hastada Retrospektif Bir Çalışma
(2007) Tan, Önder; Ergen, Duygu; Atik, Bekir
Fournier gangreni olarak bilinen perine ve genital bölgenin nekrotizan fasiiti nadir fakat yaşamı tehdit eden bir olgudur. Hastalığın tedavisi cerrahi debritman, parenteral antibiyoterapi ve oluşan defektin rekonstrüksiyonunu içerir. Günümüzde mortalite oranı halen % 15-50 arasındadır. Bu çalışmada Fournier Gangreni nedeni ile tedavi edilmiş yaşları 18 ile 81 yıl arasında değişen 26'sı erkek toplam 27 hasta retrospektif olarak değerlendirildi. Debritman ve antibiyoterapi sonrası oluşan doku defektleri 17 hastada kısmi kalınlıkta deri greftleri (tek başına, primer onarım ya da fleplerle birlikte), 8 hastada uyluk flepleri ile, 4 hastada ise kasık flebi ile kapatıldı. 5 hastada tek başına yada diğer yöntemlerle birlikte primer onarım yapıldı. Erkek hastaların hiçbirine orşiektomi uygulanmadı. Ortalama izlem süresi 7.7 aydı.Ameliyat sonrası 3 hasta (% 11.1) kaybedildi. Hiçbir hastada rekürrensle karşılaşılmadı. Uyluk flebi yapılan 1 hastada kısmi nekroz, 1 hastada sütür hattında kısmi ayrılma, greft uygulanan 1 hastada ise kısmi greft kaybı gelişti, tümü konservatif yöntemlerle sekonder olarak iyileşti. Tüm hastalar normal günlük aktivitelerine ve cinsel işlevlerine döndüler. Fournier gangreninde, erken ve agresif multidisipliner yaklaşımlarla mortalite oranları azaltılabilmekte; uygun rekonstrüktif girişimlerle kabul edilebilir estetik ve fonksiyonel sonuçlar elde edilebilmekte; ve hastaların yaşam standartları yükseltilebilmektedir. İyi bir rekonstrüksiyon tedavinin başarısını direkt etkilediği için günümüzde plastik cerrahi belirleyici bir rol oynamaktadır.
Kısmi Kalınlıkta Çilt Grefti Verici Sahalarının Bakımında Açık-kuru ve Kapalı-nemli Pansuman Tekniklerinin Karşılaştırılması
(2007) Tan, Önder; Atik, Bekir; Ergen, Duygu; Acemoğlu, Hamit
Amaç: Kısmi greftlerin alındığı verici sahaların tedavisinde bugüne kadar birçok pansuman yöntemi kullanılmış olmasına rağmen henüz standart bir yöntem bulunmamaktadır ve bu tip kısmi kalınlıktaki yaraların tedavisi hâlâ tartışmalıdır. Biz, bu çalışmada antibiyotik emdirilmiş gazlı bez kullanarak, yaranın açık ve kuru ortamda bırakılması ile kapalı ve nemli ortamda bırakılmasının greft verici saha iyileşmesi üzerine olan etkileri, iyileşme süresi, hasta memnuniyeti ve komplikasyonlar açısından karşılaştırmayı amaçladık. Yöntem: Çalışmaya 40 hasta dahil edildi ve rastgele 2 eşit gruba ayrıldı. Her iki grupta da aynı dermatom makinasıyla, kalınlıkları 0.30 mm-0.45 mm arasında değişen orta kısmi kalınlıkta deri greftleri aynı vücut bölgesinden (uyluk anterolaterali) alındı. Birinci grupta greft verici sahaları açıkta bırakılıp bir ışık kaynağıyla kurutulurken, ikinci grupta kapalı ve nemli tutuldu. Hastalar epitelizasyonun tamamlanma süresi, komplikasyonlar ve hasta memnuniyeti yönünden değerlendirildi. Bulgular: Hastalarda ameliyat sonrası verici alanda ağrı ve kaşıntı yakınmaları açık-kuru grupta, kapalı-nemli gruba göre daha belirgindi. Ameliyat sonrası ilk grupta verici sahalarda herhangi bir komplikasyonla karşılaşılmazken, kapalı-nemli grupta 2 hastada yüzeysel yara enfeksiyonu gelişti. İyileşme süreleri açık-kuru grupta 7-18 gün (ortalama 12.05±3.07 gün), kapalı-nemli grupta ise 5-15 gün (ortalama 8.45±2.39 gün) arasında değişmekteydi (p< 0.05) Sonuç: Kapalı-nemli yöntemin daha yüksek enfeksiyon riskine sahip olmasına rağmen biz, kısmi kalınlıkta deri grefti verici sahalarının tedavisinde kapalı-nemli yöntemin açık-kuru yöntemden daha hızlı bir yara iyileşmesi oluşturduğunu düşünmekteyiz.
Management of a Composite Foot Defect Due To Mine Explosion Using the Free Fibula Osteocutaneous Flap
(Thieme Medical Publ inc, 2008) Tan, Onder; Atik, Bekir; Ergen, Duygu
Free flaps have recently become the first preference for complex foot defects, with many advantages including ability to present suitable and adequate tissue, to enhance blood flow of the extremity, and to decrease risk of osteomyelitis. A 25-year-old male patient was referred to us with a complex injury of the left foot due to mine explosion. We successfully restored the defect with the ipsilateral free vascularized fibula osteocutaneous flap. The flap survived completely. After 8 weeks postoperatively, the patient began to walk. An adequate foot contour was achieved, and both the transverse and longitudinal arches were reestablished. Recovery of the donor site was also good. The free fibula osteocutaneous flap was able to present a composite tissue required in a defective foot, by leaving single donor site morbidity in one session. We believe that this flap may be a preferred option in complex foot defects.
A New Method in the Treatment of Postburn Scar Contractures: Double Opposing V-Y Plasty
(Elsevier Sci Ltd, 2006) Tan, Onder; Atik, Bekir; Ergen, Duygu
Purpose: Postburn scar contractures are fairly often seen in many parts of the body, and are still a considerable problem for reconstructive surgeons. Although the mild to moderate contractures can easily be managed by numerous surgical methods, serious contractures usually require more comprehensive surgical solutions including multiple Z plastics and rhomboid flaps, each of which have disadvantages. We used a new method called "double opposing V-Y-Z plasty" in this study. This technique is a combination of V-Y plasty with Z plasty in double opposing fashion, both ensuring primary donor site closure. Materials and methods: The technique was applied to 21 postburn scar contractures in 14 patients (9 males and 5 females). The localization most often seen was in the hand. Results: The mean follow-up time was 7.6 months. All flaps healed uneventfully. An adequate lengthening and functional recovery were achieved in all cases. The donor site scars were acceptable in all cases. None of the patients developed contracture recurrence in our series. Conclusions: Double opposing V-Y-Z plasty, as a good alternative to multiple Z plastics and multiple rhomboid flaps, is a very useful technique to insure more lengthening and to prevent recurrence in the treatment of serious postburn scar contractures. (c) 2005 Elsevier Ltd and ISBI. All rights reserved.
Our Reconstructive Approaches To the Fournier's Gangrene: a Retrospective Study on 27 Patients
(Medknow Publications & Media Pvt Ltd, 2007) Tan, Onder; Atik, Bekir; Ergen, Duygu
The necrotizing fasciitis of the perineum and genitalia, known as Fournier's gangrene, is a rare but life-threatening entity. Treatment includes surgical debridement, parenteral antibiotherapy and reconstruction of the resultant defects. The mortality rate is recently still between 15 to 50 percent. In this study, 27 patients managed for Fournier's gangrene were evaluated retrospectively. The ages were ranged from 18 to 81 years old, and all patients but one were male. The resultant defects following the debridement and antibiotherapy were covered using split thickness skin grafts which were utilized with/without primary closure or flaps in 17 patients, thigh flaps in 8, and groin flaps in 4. Primary closure was applied in 5 patients. No male patient underwent orchiectomy. The mean follow up time was 7.7 months. 3 patients (11.1 %) was died postoperatively. No recurrence was occurred. Partial flap necrosis and wound dehiscence were encountered in one each patient who had been reconstructed with thigh flaps, while partial graft failure was ocurred in one. All three complications were secondary healed by means of the conservative methods. All patients were gained normal daily activities and sexual functions postoperatively. It is possible to decrease the mortality rates via early and agressive multidisciplinary approaches; to obtain acceptable aesthetic and functional outcomes by appropriate reconstructive procedures; and to enhance the life standards of the patients in Fournier's gangrene. Recently plastic surgery has gained an important role, because a good reconstruction directly affects the success rate of the treatment.
Repair of a Large Pharyngocutaneous Fistula With the Free Dorsalis Pedis Flap
(Modestum Ltd, 2007) Tan, Onder; Atik, Bekir; Ergen, Duygu
Postoperative pharyngocutaneous fistulas are the relatively frequent complications of total laryngo-oesophagectomy. Despite various treatment strategies have been mentioned in the literature, ideal method for closure of the large pharyngocutaneous fistulas is still controversial. In this report we have succesfully closed a large pharyngocutaneous fistula with free dorsalis pedis flap after ablation of oesophageal cancer.
The Retroangular Flap Revisited
(Blackwell Publishing, 2007) Tan, Onder; Atik, Bekir; Ergen, Duygu
Background: To date, the retroangular flap has been used only for reconstruction of defects of the nose and the glabella. Objective: The objective was to expand the indications of the retroangular flap in facial reconstruction. Materials and methods: We repaired the facial defects of 11 patients using 12 retroangular flaps. These defects were located on the nose in 4 patients, the lower eyelid in 4 patients, the upper eyelid in 2 patients, and the cheek in 1 patient. Results: The mean follow-up time was 13.2 months. All of the flaps survived, and no revisional procedures were required. Cosmetic and functional outcomes were satisfactory in all patients. Conclusions: The retroangular flap is a valuable alternative for the management of small- to moderate-sized defects of the midface. We strongly suggest extending the use of this flap to include reconstruction of nasal, eyelid, and cheek defects.
Temporal Flap Variations for Craniofacial Reconstruction
(Lippincott Williams & Wilkins, 2007) Tan, Onder; Atik, Bekir; Ergen, Duygu
Learning Objectives: After studying this article, the participant should be able to: 1. Describe the anatomy of the temporal region. 2. Identify the types and possible indications of the temple group flaps to be selected depending on the defects, and then raise the flap safely for reconstruction. 3. Predict and manage successfully the potential complications of surgery. Background: Good harmony of color and texture with surrounding tissues, thinness and adequate pliability, good alignment, obliteration of the cavities, and minimal donor-site morbidity are the main features of an ideal flap to be used in the reconstruction of craniofacial defects. Despite the numerous local, regional, and free flaps that have been described, to date, there has not yet been an ideal flap. The authors discuss the reconstruction alternatives presented by the temporal site and its outcomes. Methods: The temporal group flaps can be raised using one or more tissues based on the superficial temporal artery and its branches, depending on the defect site and nature. They can be designed as axial skin flaps consisting of transposition or V-Y island flaps, composite flaps including more than one tissue, and chimeric flaps involving both the temple skin and temporal fascia based on the two distal branches of the superficial temporal artery. Results: The temporal region is a good donor site for closure of craniofacial defects, by means of its rich vascular network and almost all types of tissue, including skin, fascia, muscle, galea, calvarial bone, and periosteum. The charm of this region has gradually increased as clinical experiences have advanced and its anatomy has been better understood. Conclusions: The authors discuss the history, anatomy, surgical dissection techniques, and potential complications and their management of temporal flaps. (Plast. Reconstr. Surg. 119: 152e, 2007.)
The, Effect of Perforator Location on Epigastric Perforator Flap Survival: an Experimental and Stereological Study in Guinea Pigs
(Thieme Medical Publ inc, 2008) Tan, Onder; Ergen, Duygu; Atik, Bekir; Gundogdu, Cemal; Calik, Ilknur; Can, Ismail
One challenge most often seen in perforator-based flaps is the topographic relationship between the flap and its perforator, which determines flap design and pedicle length. Thirty female guinea pigs were used in this study. They were divided into four different groups including three experimental groups (n=8), which were designed as central, lateral, and distal groups according to the perforator location, and one control group (n = 6). Flap survival and vessel density rates were assessed. There was no statistically significant difference (p > 0.05) among either the surviving skin areas or the vascular density rates of the experimental groups, although all flaps were necrosed in the control group. We concluded that perforator flaps can safely be raised on the perforators located very distal or lateral to the flaps, as well as central classical location. Moreover, perforator flaps larger than suggested can safely be harvested in the same donor sites.
Versatile Use of the Pedicled Latissimus Dorsi Flap as a Salvage Procedure in Reconstruction of Complex Injuries of the Upper Extremity
(Lippincott Williams & Wilkins, 2007) Tan, Onder; Atik, Bekir; Ergen, Duygu
Complex injuries of the upper limb are usually associated with massive soft tissue necrosis, infection, and exposure of the vital structures. Management is fairly problematic, requiring multiple operations and prolonged hospitalization. We herein present a versatile use of the pedicled latissimus dorsi flap as a salvage procedure, and its advantages. In 6 patients with such injuries, all known variations of the flap have been successfully used as a musculocutaneous, pure muscle, and pure skin (thoracodorsal artery perforator) flap. The mean follow-up time was 11.8 months. All flaps survived completely. The donor sites were closed primarily, with acceptable linear scars in all cases. Variants of the pedicled latissimus dorsi flap may be suitable to address complex defects of the upper extremity, including forearm and hand, which have little chance for free flap. Content of the flap to be used should be determined depending on requirements in the recipient site.