Browsing by Author "Tan, Onder"

Now showing 1 - 20 of 25

Amputations in Eastern Turkey (Van): a Multicenter Epidemiological Study
(Turkish Assoc Orthopaedics Traumatology, 2008) Dogan, Ali; Sungur, Ibrahim; Bilgic, Serkan; Uslu, Mustafa; Atik, Bekir; Tan, Onder; Akpinar, Fuat
Objectives: The indications for amputations vary among countries and different regions depending on many factors. This study was designed to evaluate amputations performed in the province of Van and to determine specific causes of amputations associated with geographical and. cultural characteristics of the region. Methods: A total of 475 amputations were performed in 440 patients (345 males, 95 females; mean age 28.5 years; range 3 months to 85 years) in medical institutions of Van between 1995 and 2005. The patients were evaluated with respect to age and sex, etiology, side and level of amputations, and surgical interventions performed. Results: Amputations were the most common in the 21 to 30-year age group with 109 patients. Pediatric patients below the age of 10 years accounted for 13.4%. Of all the amputations, 218 (45.9%) involved the upper extremity, and 257 (54.1%) involved the lower extremity. Amputations were right-sided in 223, left-sided in 188 patients, and 29 patients underwent multiple amputations. Trauma was the most common cause of amputations (n=177, 40.2%), with leading etiologies as gunshot injuries (n=45), land mine (n=3.3) and hand grenade (n=7) blasts. Other frequent indications apart from traumatic causes were diabetes mellitus (n=86), congenital diseases (n=33), and peripheral vascular disease (n=30). Causes more specific to regional characteristics were tandoor burns (n=7), mistreatment by traditional bonesetters (n=3), and frostbites (n=3). Replantation was performed in 24 patients, of which 15 (62.5%) were successful. Conclusion: Our region features gunshot injuries and land mine blasts as the most common traumatic causes of amputations.
Calculation of Flap or Defect Size - Response
(Lippincott Williams & Wilkins, 2007) Atik, Bekir; Tan, Onder
Comparison of Techniques for Long-Term Storage of Fat Grafts: an Experimental Study
(Lippincott Williams & Wilkins, 2006) Atik, Bekir; Ozturk, Gurkan; Erdogan, Ender; Tan, Onder
Background: Absorption of autologous fat graft in the recipient area necessitates recurrent fat transplantation. Harvesting extra tissue during the first operation and storing it for future use is considered a solution to this problem. Methods: Fat tissue was removed from the inguinal region of 40 Swiss albino mice, which were arranged into four equal groups, and treated as follows: immediately transplanted to the donor animal; dry frozen; immersed in glycerol; or frozen in liquid nitrogen. The grafts that were frozen or immersed in glycerol were stored at -35 degrees C for 6 months and then transplanted to their original donors. Transplantations were performed by injecting the fat under the scalp. Viability of the fat tissue was evaluated with the MTT reduction test before transplantation, and histology of the transplanted tissue was examined at the end of the study. Results: The viability and histology of grafts frozen in liquid nitrogen were similar to those of fresh tissue, whereas with other methods the grafts had a considerable loss of viability during storage that was reflected in the low number of adipocytes and high proportion of vacuolar and fibrotic areas. Conclusion: Freezing fat grafts in liquid nitrogen and storing them at -35 degrees C is an effective way of preserving tissue for future use, with clear superiority over other methods.
Evaluation of Dynamic Magnetic Resonance Imaging in Assessing Velopharyngeal Insufficiency During Phonation
(Lippincott Williams & Wilkins, 2008) Atik, Bekir; Bekerecioglu, Mehmet; Tan, Onder; Eflik, Omer; Davran, Ramazan; Arslan, Halil
Background: Velopharyngeal insufficiency (VPI) expresses the structural and neuromuscular disorder of soft palate and pharyngeal walls inhibiting the normal functions of velopharyngeal (VP) sphincter mechanism. In this study, efficacy of dynamic magnetic resonance imaging in the diagnosis of VPI is investigated. Materials and Methods: A total of 32 cases, 16 controls and 16 cleft palates, were included in this study. T1 fast spin echo-weighted imaging during rest, dynamic investigations with True-fast imaging with steady-state precession sequence during /sss/ and /mmm/ phonations were performed. Results: During /sss/ phonation, complete closure was observed in the control group, whereas mean VP opening was 4.11 cm(2) preoperatively and 0.21 cm(2) postoperatively in the cleft palate group. In the postoperative period, only 3 patients did not have complete closure. In the second operations, performed 6 months later, only muscle repair was done. All 3 had complete closure. Conclusions: In cleft palate cases with delayed diagnosis, appropriate application of muscle repair will be sufficient for anatomic repair of VPI without any extra procedures. In addition, dynamic magnetic resonance imaging is an objective, noninvasive, reliable, and effective modality that may be used in the diagnosis and treatment of VPI without any extra investigations.
Extensive Skin Calcifications in an Infant With Chronic Renal Failure: Metastatic Calcinosis Cutis
(Wiley, 2006) Tan, Onder; Atik, Bekir; Kizilkaya, Ali; Ozer, Erdener; Kavukcu, Salih
Calcinosis cutis, one of the rare manifestations of systemic calcinosis, is characterized by the deposition of calcium and phosphate salts in the skin. Metastatic calcinosis, usually a late complication of chronic renal failure, arises from increased calcium or phosphate levels in the serum or both. Both sexes and all ages may be affected; however, cutaneous involvement is uncommon, particularly in children. We present the youngest patient, to our knowledge, with end-stage renal disease and cutaneous metastatic calcification resulting from secondary hyperparathyroidism. A 2-month-old infant presented to the pediatric service with anuria and uremia. A renal biopsy specimen showed chronic tubulo-interstitial nephritis. Indurated, firm, tender reddish papules were localized to both lower limbs, and extensive irregular nodules and plaques with ulceration and white stony contents were localized to the right upper limb. Topical antibiotic ointment was applied to the skin lesions to prevent secondary infection. However, acute peritonitis developed during peritoneal dialysis, and death occurred as a result of sepsis.
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.
Middle Phalangectomy: a Functional and Aesthetic Cure for Macrodactyly
(informa Healthcare, 2006) Tan, Onder; Atik, Bekir; Dogan, Ali; Alpaslan, Suleyman; Uslu, Mustafa
Macrodactyly is a rare congenital anomaly of the extremities. Some treatments such as debulking, epiphysiodesis, stripping or resection of the digital nerve, shortening of the fingers, amputation, and angulation osteotomy have been tried. We describe a patient with a giant digit in the hand, and present middle phalangectomy as a suitable treatment.
Minimal Invasive Excision of Intraorbital Dermoid Cyst
(Modestum Ltd, 2007) Atik, Bekir; Tan, Onder; Kaya, Zulkuf; Kiroglu, A. Faruk
Orbital dermoid cyst is a rare tumor for which the pathogenesis remains unclear. It is usually located in the lateral side of the orbita, and may also rarely be observed in the intraorbital region. In this cases, aggressive treatment is necessary for the success because recurrence rate is high. But it should work delicately because of the risk of the eye damage. We report three cases with intraorbital dermoid cysts who were successfuly treated by using a minimally invasive surgery. Eye movements and visual functions were normal in all patients. No recurrences or complications appeared postoperatively. We think that it is possible to excise dermoid cysts totally using a classical surgical technique, including an anterior approach, by careful dissection under loupe magnification.
A New Method in Tendon Repair - Angular Technique of Interlocking (Atik)
(Lippincott Williams & Wilkins, 2008) Atik, Bekir; Tan, Onder; Dogan, Ali; Kalender, Murat; Tekes, Lufti; Korkmaz, Mahmut; Uslu, Mustafa
Background: The risk of adhesion following flexor tendon repair, despite provision of rehabilitation by mobilization of the tendon with passive exercises without the risk of rupture, is not negligible. Active mobilization of tendons has recently been more frequently recommended to prevent adhesions of tendons. The tendon repair zone, which should withstand active traction forces, should maintain its strength until complete recovery of the tendon. For this purpose, a new treatment method named angular technique of interlocking (ATIK) has been developed. This method was compared with the Modified Kessler method, in vivo and in vitro. Materials and Methods: In four groups, each consisting of 10 chickens, severed flexor tendons repaired with the Modified Kessler and ATIK techniques were compared for biomechanical properties. Results: Although there were no differences between these techniques in vitro, this new technique's superiority was statistically significant in in vivo studies. Conclusions: The second and third postoperative weeks are periods during which the number of fibroblasts and the amount of collagen, are the highest. In these periods, edema resolves and sutures begin to loosen. In this situation, the force withstanding the active movements is the support of the suture materials and the degree of recovery of the tendon. Following this recommended suture technique and active movements, the healing potential of the tendon increases and the risk of tendon rupture owing to decrease in the force exerted per unit area decreases.
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.
Postoperative Dynamic Extension Splinting Compared With Fixation With Kirschner Wires and Static Splinting in Contractures of Burned Hands: a Comparative Study of 57 Cases in 9 Years
(informa Healthcare, 2007) Tan, Onder; Atik, Bekir; Dogan, Ali; Uslu, Mustafa; Alpaslan, Suleyman
Skin grafting is widely used for the treatment of postburn contractures. Their main disadvantage, a tendency to contract again, can be reduced and better outcomes achieved by postoperative splinting. In this study we compared the outcomes of dynamic and static splinting postoperatively. Of the 57 patients managed by split grafts, 36 (44 hands) had Kirschner (K) wires applied with static splints, whereas 21 (26 hands) had dynamic splinting. The mean age was 11 (range 2-37) and 15 (range 2-50) years in the two groups. Before and after the operation, basic hand functions were evaluated clinically, and the results analysed statistically. The mean follow-up times were 18 and 14 months respectively, and recurrence rates were 22% and 14%. We think that the postoperative dynamic splinting is superior to fixation with K-wires with or without static splints.
Primary Repair of the Alveolar Cleft
(Lippincott Williams & Wilkins, 2011) Isik, Daghan; Atik, Bekir; Tan, Onder; Aktar, Safak; Dogan, Murat; Goktas, Ugur
Nasoalveolar fistula and oropharyngeal fistula of the anterior palatal region are very commonly seen in cases when there are concomitant clefts of the lip and the palate. Absence of adequate tissue in that region complicates the treatment and necessitates new tissue transfers from near or distant tissues. Today, the techniques used for correcting cleft lip cannot successfully solve these 2 problems. In this study, we describe a technique that depends on the principle of using the lip mucosal tissues that remains during the Tennison cleft lip correction technique, with a flap designation, to correct the tissue defect of the cleft between the foramen incisivum and lip and the alveolar region. Twenty-two patients (13 boys and 9 girls), with ages ranging from 3 to 53 months (mean, 24 mo), with unilateral cleft lip and palate underwent surgery with this new technique. In all these patients, clefts in the anterior palatal and alveolar regions were successfully corrected. Fistula was observed in none of these patients in these regions. Through this method, clefts in the anterior palatal and alveolar regions can be corrected during repair of cleft lips.
Reconstruction of Lower Eyelid Defects Using a Cross Upper Eyelid Flap Composited With Ear Cartilage
(Blackwell Publishing, 2007) Atik, Bekir; Tan, Onder; Bekerecioglu, Mehmet; Cinal, Adnan; Tekes, Lutfi
Backgrounds Basal cell carcinomas (BCC) most frequently involve the lower eyelid and are treated with total excision. Various techniques have been proposed for reconstruction of the excised eyelid. Objective Because most flaps used in such techniques are bulky, thinner, and aesthetically more favorable, flaps have been sought recently. Methods Defects of the lower lid have been closed with a combination of cross-flaps and choncal cartilage prepared from the upper eyelid. Results Eleven lower lids from 10 patients operated for BCC were reconstructed. All flaps survived. The duration of follow-up was 10 months, and no complications such as relapse, ectropion, or lagophthalmus occurred. Conclusions The upper eyelid flap was found to be an appropriate cover for both the skin and the conjunctiva due to its hairless and smooth structure. The outcome in patients followed up for a mean of 10 months was successful, cosmetically and functionally.
Reconstruction of the Columella Using the Prefabricated Reverse Flow Submental Flap: a Case Report
(Wiley, 2006) Tan, Onder; Kiroglu, Ahmet Faruk; Atik, Bekir; Yuca, Koksal
Background. The reconstruction of columellar defects is still a challenging procedure because of limited local and regional flap options and the characteristics of the anatomy of this site. Although a number of methods are available to repair nasal columella defects, no treatment of choice ensuring an excellent texture and color-matched tissue in one stage has been determined to date. Method. In this case, we used a reverse-flow submental island flap prefabricated with the costal cartilage for the reconstruction of a complex columellar defect. Result. The flap survived completely with reversible venous congestion, The cosmetic result and nasal respiratory function were acceptable during the follow-up time of 6 months. Conclusion. We propose that the prefabricated reverse submental flap may be an alternative among the surgical options for columellar defects, This flap may also be considered in the reconstructive repertoire of other composite defects of the head and neck region, (c) 2006 Wiley Periodicals, Inc.
Reconstruction of Wide Scrotal Defect Using Superthin Groin Flap
(Elsevier Science inc, 2006) Atik, Bekir; Tan, Onder; Ceylan, Kadir; Etlik, Omer; Demir, Cengiz
Introduction. Grafts and flaps have been widely used to reconstruct scrotal defects due to Fournier's gangrene. Controversy still exists concerning the use of grafts and flaps because of the low protection provided by the grafts and the high volume of the flaps. We describe the use of an expanded groin flap for scrotum reconstruction. Technical Considerations. Three patients were treated for total scrotal tissue loss using this method. An expander was installed through an incision from the inferolateral aspect of the groin, and superthin flaps obtained after 3 weeks were dissected starting from the medial side. Care was taken during dissection, because the skin was thin on the lateral side, and dissection was performed in a subfascial fashion. Finally, the defect was covered with the lateral part of the expanded flap and the donor site was primarily closed. Conclusions. To cover the testes, both the aesthetic and functional state should be taken into consideration. Therefore, a thin and durable cover is required for scrotal reconstruction. The expanded superthin groin flap possesses these features and is a good option.
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.
Skin Perforators of Back Region - Anatomical Study and Clinical Applications
(Lippincott Williams & Wilkins, 2008) Atik, Bekir; Tan, Onder; Mutaf, Mehmet; Senel, Berna; Yilmaz, Nebi; Kiymaz, Nejmi
Background: Despite widespread studies that have been commonly performed recently on skin perforators and perforator flaps of various regions of the body, investigations on the back region of the body are still insufficient. This study investigates the anatomical characteristics and clinical applications of perforating vessels in the back region. Materials and Methods: The skin on the back region between the right and left, 7th to 11th thoracic vertebrae of 10 fresh cadavers were raised as flaps. Perforating vessels perfusing the skin with pedicle diameters of over 1 mm were included in the study. The anatomical localization, diameter, pedicle size, and the supplying vessels of these pedicles were determined. Utilizing this information, the defects of 8 patients with large meningomyeloceles included in the study were closed with prepared intercostal artery perforating flap. Results: Perforators of the back region were seen to originate from the posterior intercostal vessels. There were a higher number of perforators on the right side of the body. The most commonly observed perforators were the 7th and 9th posterior intercostal perforators, and their diameters were larger. All flaps were viable following perforator flap closure for defects in 8 patients with large meningomyelocele included in the clinical study. No problems were encountered in the postoperative 3-month follow-up of cases. Conclusion: Owing to the low donor area morbidity and wide motion capabilities, the perforator flap is a new choice of flap for the back region. Perforator pedicle flaps supplied by the posterior intercostal vessels may be safely used in congenital tissue defects, such as meningomyelocele, tumors, and traumatic defects.
Soft-Tissue Augmentation of the Middle and Lower Face Using the Deepithelialized Submental Flap
(Lippincott Williams & Wilkins, 2007) Tan, Onder; Atik, Bekir; Parmaksizoglu, Duygu
Background: Facial contour augmentation is an entity often encountered by reconstructive surgeons. To date, very different autologous tissues such as fat, dermofat, dermal fascia, muscle, cartilage, and bone in the manner of grafts or flaps according to the requirements of the defect have been used for facial augmentation. Although many free flap procedures have become popular in facial contouring, these microsurgical methods have some limitations and risks, especially in patients who are not suitable for microsurgery. Moreover, the patient may wish to be treated by means of a more conservative procedure. Methods: The authors used the submental flap in deepithelialized fashion successfully for augmentation of the face in three patients who presented with hemifacial microsomia (n = 2) and longstanding facial paralysis (n = 1). Results: Adequate augmentation was achieved in all cases, without any complications. All donor sites were closed primarily and healed well. Patient satisfaction was perfect in all cases. A second debulking procedure was performed in case 3 only. The average follow-up was 1 year. Conclusions: The authors believe that the deepithelialized submental flap can be used safely for all facial contour restorations of the lower and, midface necessitated by various causes, including hemifacial microsomia and facial paralysis as a main or adjunct procedure. In these cases, this flap may be a good alternative, especially for patients who are not suitable for microsurgery.