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Öğe A RARE MULTILOCULAR CYSTIC DISEASE OF MANDIBLE: CHERUBISM(Medknow Publications & Media Pvt Ltd, 2014) Gumus, Nazim; Yilmaz, SarperCherubism is a rare skeletal dysplasia located to the maxilla and mandible which is characterized by bilateral, symmetric, fibro-osseous and multilocular cystic lesions. In most of the cases, dominant mutations are detected in the SH3BP2 gene on chromosome 4p. While affected children seem to be clinically normal at birth, whose jaws start swelling and enlargement between 2 and 7 years of age. Full round cheek and upward tilting of the eyes consist of typical appearance of children. Apart from various cystic lesions of mandible, cherubism is a tumor which regresses spontaneously, ossifies over time and has a likelihood for leaving unrecognizable remnants after years, although radiologically, extensive bone involvement appears. Presented here was a patient who suffered from this rare disease and his clinical findings.Öğe DOES THE NEGATIVE PRESSURE DRESSING REMOVE THE NECROTIC PARTS OF THE WOUNDS? A HISTOPATHOLOGICAL EVALUATION OF WOUND FLUID(Medknow Publications & Media Pvt Ltd, 2014) Gumus, Nazim; Yilmaz, Sarper; Cennet, AhmetIntroduction: Wound fluid collected in the container of the negative pressure dressing system was examined histopatologically to reveal detailed information about cellular and liquid components of it. Materials and Methods: This study included six wounds of six patients who had injured with electrical burn, traffic accident and scald burn. All of the wounds were debrided surgically to viable-appearing tissue and then a negative pressure dressing was applied to the wounds. Then, the wound fluid collected in the container of the dressing system and its components were examined histopatologically under light microscope. Results: Evaluation of all specimens revealed that the content of the samples was including exudate, fibrin, nonviable epithelial cells and fibrocytes, cell remnants such as nucleus or cell membrane, but no viable tissue or cell. Conclusions: Negative pressure dressing may be considered as a tool for the debridement of wounds which involve bacterial colonization, exudate, particles or insignificant tissue necrosis.Öğe An Easy, Rapid, and Reproducible Way to Create a Split-Thickness Wound for Experimental Purposes(LIPPINCOTT WILLIAMS & WILKINS, 2014) Gumus, Nazim; Ozkaya, Nese Kurt; Bulut, Huseyin Eray; Yilmaz, SarperPartial-thickness wound models of rat skin have some difficulties in creating the wounds in equal size and depth. Moreover, making a split-thickness wound on the rat skin seems not to be simple and rapid. A new alternative method was presented here to overcome these obstacles, by using a waterjet device to create a split-thickness wound on rat skin. Twenty-four male Wistar rats were randomly divided into 3 groups. An area of 4 x 4 cm in diameter was marked on the center of the dorsal skin. Waterjet hydrosurgery system was used to create a wound on the dorsal rat skin, by removing the outer layers of the skin. In group 1, rat skin was wounded with setting 1 to create a superficial skin wound. In group 2, it was injured with setting 5 to make a deeper wound, and in group 3, skin wound was performed with setting 10 making the deepest wound in the experiment. After the wounds were created on the rat skin, a full-thickness skin biopsy was taken from the middle of the cranial margin of the wound, including both the wound surface and the healthy skin in a specimen. Healing time of the wounds of animals was recorded in the experiment groups. Then, the results were compared statistically between the groups. In the histologic assessment, both the thickness of the remnant of the epidermis in the wound surface and the thickness of the healthy epidermis were measured under light microscope. Thickness of the epidermis remaining after wounding was statistically compared among the groups and with the healthy epidermis. The mean thickness of the remaining epidermis was determined for each group. It was higher in the superficial wounds than in the deep wounds, because of the removal of the skin from its outer surface through the deep layers of the skin with waterjet device. The most superficial wound in the experiment was observed in group 1, which was statistically different from the wounds of group 3, whereas there was no difference between the wounds of groups 1 and 2. Compared with the wounds of groups 1 and 2, the wounds in group 3 were significantly deeper than the wounds of other groups, which was statistically significant. In all groups, mean thickness of epidermis in the wound surface showed statistically significant difference from that in the healthy skin. When compared with the healing times of the wounds in the groups, a statistically significant difference was found between them. Creation of a split-skin wound, by using the waterjet system, provides a wound in reproducible size and depth, also in a standardized and rapid manner. Moreover, it makes precise and controlled wound creation in the rat skin.Öğe The Effect of Topical Minoxidil Pretreatment on Nonsurgical Delay of Rat Cutaneous Flaps: Further Studies(SPRINGER, 2013) Gumus, Nazim; Odemis, Yusuf; Tuncer, Ersin; Yilmaz, SarperThe purpose of this study was to determine the effectiveness of topically applied minoxidil in the pharmacological delay phenomenon and to demonstrate the comparable microscopic and macroscopic changes between minoxidil-pretreated flaps and surgically delayed flaps. A modified version of the McFarlane flap was used. Group 1 rats, in which a caudally based dorsal skin flap was raised and sutured back, were the control group. In group II, minoxidil solution was spread over the marked skin flap area for 7 days. On the 7th day, a caudally based dorsal skin flap was elevated and then sutured back. Group III rats underwent a surgical delay procedure alone. On the 7th day after flap elevation, evaluation was done by histologic examination and calculation of the flap survival areas in all groups. The lowest flap survival rate appeared in group I and was statistically different from groups II and III. The mean surviving skin flap area in the minoxidil-pretreated group was significantly larger than that in the control group. After histologic evaluation, moderate angiogenesis was also detected in group II. We also found that surgical delay significantly reduced flap necrosis when compared to the minoxidil pretreatment group. According to our study, minoxidil may be considered an effective vasoactive agent for the stimulation of angiogenesis in rat cutaneous flaps and capable of achieving pharmacological delay and increasing flap survival. This journal requires that authors assign a level of evidence to each article. 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.Öğe Effect of Topically Applied Minoxidil on the Survival of Rat Dorsal Skin Flap(SPRINGER, 2012) Gumus, Nazim; Odemis, Yusuf; Yilmaz, Sarper; Tuncer, ErsinFlap necrosis still is a challenging problem in reconstructive surgery that results in irreversible tissue loss. This study evaluated the effect of topically applied minoxidil on angiogenesis and survival of a caudally based dorsal rat skin flap. For this study, 24 male Wistar rats were randomly divided into three groups of eight each. A caudally based dorsal skin flap with the dimensions of 9 x 3 cm was raised. After elevation of the flaps, they were sutured back into their initial positions. In group 1 (control group), 1 ml of isotonic saline was applied topically to the flaps of all the animals for 14 days. In group 2, minoxidil solution was spread uniformly over the flap surface for 7 days after the flap elevation. In group 3, minoxidil solution was applied topically to the flap surface during a 14-day period. On day 7 after the flap elevation, the rats were killed. The average area of flap survival was determined for each rat. Subdermal vascular architecture and angiogenesis were evaluated under a light microscope after two full-thickness skin biopsy specimens had been obtained from the midline of the flaps. The lowest flap survival rate was observed in group 1, and no difference was observed between groups 1 and 2. Compared with groups 1 and 2, group 3 had a significantly increased percentage of flap survival (P < 0.05). Intense and moderate angiogenesis also was observed respectively at the proximal and distal areas of the flaps in group 3. The results of this experiment seem to show that the early effect of minoxidil is vasodilation and that prolonged use before flap elevation leads to angiogenesis, increasing flap viability. This journal requires that authors assign a level of evidence to each article. 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.Öğe Longitudinal Evaluation of Hospitalized Burn Patients in Sivas City Center for Six Months and Comparison with a Previously Held Community-based Survey(MEDKNOW PUBLICATIONS & MEDIA PVT LTD, 2016) Erin, Omer Faruk; Yilmaz, Sarper; Gumus, NazimObjective: This study was designed to longitudinally demonstrate the rate and epidemiology of hospitalized burn patients in Sivas city center within 6 months. The second aim was to compare the results of the current study with those of a previously held community-based survey in the same region. Material and Methods: Patients who were hospitalized due to burn injuries in Sivas city for six months were longitudinally evaluated. Epidemiological data of these patients were analyzed. Results: During the course of the study, 87 patients (49 males and 38 females) were hospitalized. The ratio of burn patients to the total number of hospitalized patients was 0.38%. The most common etiologic factor was scalds (70.1%). Burns generally took place in the kitchen (41.4%) and living room (31.4%), and majority of the patients received cold water as first-aid treatment at the time of injury. The vast majority of patients were discharged from the hospital without the need of surgical intervention (83.9%), and the duration of treatment was between 1 and 14 days for 73.6% of the patients. Sixty patients (68.9%) had a total burn surface area under 10%. The total cost of the hospitalization period of these patients was 137.225 Turkish Lira (83.308-92.908$), and the average cost per patient was 1.577 Turkish Lira (957-1067$). Conclusion: Our study revealed a considerable inconsistency when compared with the results of the community-based survey, which had been previously conducted in the same region. We concluded that hospital-based studies are far from reflecting the actual burn trauma potential of a given district in the absence of a reliable, standard, nation-wide record system. Population-based surveys should be encouraged to make an accurate assessment of burn rates in countries lacking reliable record systems.Öğe Management of scar contractures of the hand using Z advancement rotation flap(ELSEVIER SCI LTD, 2013) Gumus, Nazim; Yilmaz, SarperFunctional consequences of hand contractures may lead to extreme impairment in hand functions so repair of the contractures can solve the problems related to hand functions. Different forms of z plasties have widely been used for the release of scar contractures. In this study, a useful z plasty technique, z advancement rotation flap (ZAR) was adapted for the release of hand contractures in the way of using only local tissues. Fourteen consecutive patients who had hand contractures, were treated successfully with z advancement rotation flap technique. They suffered from hand contractures for at least one year which were localized in wep spaces, flexor surfaces of the digits, first wep space, palmar area and extensor surface of the hand. Contractures are all in mild severity, restricting some of the hand motions moderately. In all patients, hand contractures released completely and clinically normal joint motions were achieved, improving extension, flexion and abduction ranges of fingers without any difficulty. All advanced and rotated flaps healed uneventfully. No major complications appeared such as infection, hematoma, suture dehiscence, flap congestion or necrosis. When dealing with this technique for release of hand contractures, it may offer a versatile alternative to well known z-plasty methods used particularly for hand contractures. (C) 2012 Elsevier Ltd and ISBI. All rights reserved.Öğe Otoplasty with an unusual cartilage scoring approach(TAYLOR & FRANCIS LTD, 2016) Gumus, Nazim; Yilmaz, SarperBackground: An ideal otoplasty procedure should minimise the possible risk of severe complications of otoplasty and provide a good aesthetic outcome; however, there is no standart technique to be applied to all types of auricular deformities in different populations. The aim of this study was to present an otoplasty technique with posterior approach in which small incomplete cartilage incisions and suture fixations were used to form the auricle without a need for anterior skin incision and dissection. Methods: This study involved 42 patients who had bilateral prominent ears with unfurled antihelixes associated with or without conchal excess. The otoplasty procedure mainly consisted of a posterior skin excision, incomplete cartilage incisions in the shape of greater mark, ">", mattress sutures of the posterior cartilage, earlobe correction, and conchal reduction if necessary. Results: This otoplasty technique consists of easy, simple, and rapid surgical steps without a need for anterior skin dissection and cartilage scoring, so it has a low rate of complications in both early and late postoperative periods. Follow-up time of patients ranged from 1-9 years, with an average of 3 years. No major complications such as haematomas, chondritis, wound infection, skin necrosis, asymmetry, recurrence, hypertrophic scars, granulomas, or irregularities developed in the early and late postoperative periods. A good symmetry and natural appearence were achieved with this otoplasty technique. Patients were satisfied with the results. All over complication rate in the postoperative period was 7%. Conclusion: The presented technique overcomes the drawbacks of anterior skin dissection and anterior scoring, and minimises the risk of severe complications such as anterior skin necrosis, cartilage necrosis or destruction, and ear irregularities. It also reduces the operation time, swelling, bruising, and possibility of suture extrusion and recurrence.Öğe TRAUMATIC HAIR BEARING SKIN WOUND COMBINED WITH KERION CELSI: A RARE CASE(Medknow Publications & Media Pvt Ltd, 2011) Yilmaz, Sarper; Gumus, Nazim; Erin, Omer Faruk; Celik, Ugur Recep; Ercocen, Ali Rizantroduction: Kerion celsi is a hypersensitivity reaction to a dermatophytic infection in hair bearing skin which is caused by dermatophyte species such as T mentagrophytes, T verrucosum, T rosaceum (T megninii), T tonsurans, T violaceum, and T soudanense in children who have hypersensitivity againist the components of dermatophytes. Differential diagnosis is very difficult when a scalp wound is associated with the history of traumatic scalp injury. Presented here was a rare case of kerion celsi who had traumatic scalp wound. Material and Methods: A 7-year-old boy presented to our clinic, complaining of a head wound which caused from hitting it to a heater 15 days ago. On the examination, a 5x5 cm wound on the vertex of the scalp was diagnosed with painful draining scalp abscesses, purulent discharge, itchy plaques, hair loss, pruritus and scaling. It seemed to be an infected and traumatic wound of hair bearing skin. For the treatment, wound care and a parenteral antibiotic were initiated, and then a surgical debridement was performed to take out necrotic tissues and drain abscess formations. However, any evident for healing didn't appear. Results: After considering kerion celsi, by using fungal cultures, examination of scalp brush samples under microscope and histopathologic investigation of the debridement materials, diagnosis was achieved. Systemic and topical antifungal treatment healed the wound completely. Conclusions: Although association of a traumatic scalp wound with a dermatophytic infection is a rare instance, if there is a scalp wound with crusting, serious ooze, pus, and keratin debris in childhood, and especially if there is a resistant againist usual treatment modalities, kerion celsi should be considered in differential diagnosis.Öğe Vascular pressure monitorization for necessity of vascular augmentation in a rat extended abdominal perforator flap model(WILEY-BLACKWELL, 2012) Gumus, Nazim; Erkan, Muhammet; Ercocen, Ali RizaIn case blood perfusion compromises, vascular enhancement with arterial supercharge or venous superdrainage can increase viability of the flap. In this study, vascular pressure monitorization was used in a rat extended abdominal perforator flap model to reveal intraoperative vascular compromise and the need for vascular augmentation. A rat abdominal perforator flap was designed, which was based on the right second cranial perforator of epigastric artery. Vascular pressures of the flap were monitored continuously for 60 min, by catheters placed in the right superficial inferior epigastric artery and vein. Forty rats were divided into four experimental groups, as follows: group 1 (n = 10, no vascular augmentation), group II (n = 10, arterial supercharge), group III (n = 10, venous superdrainage), and group IV (n = 10, arterial and venous augmentation). Arterial supercharge and/or venous superdrainage were performed by using the left superficial inferior epigastric artery and vein. After the rats were sacrificed on the 7th day, total flap area and necrotic regions were evaluated. Mean arterial blood pressure was found significantly lower (P < 0.05) and mean venous blood pressure was measured significantly higher (P < 0.05) in group I than the groups II, III, and IV. Flap survival area was also larger in the groups II, III, and IV than the group I (P < 0.05). The results of this experimental study demonstrate that arterial insufficiency and venous congestion are almost always present in the rat extended abdominal perforator flap model, similar to deep inferior epigastric perforator flap. When such an extended perforator flap is used, arterial and venous pressure monitorization may be considered as a tool to support intraoperative clinical findings to reveal the need of vascular augmentation and ascertain flap viability. (C) 2012 Wiley Periodicals, Inc. Microsurgery, 2012.Öğe A versatile modification of dermoglandular hammock flap for mastopexy: Extended hammock(INFORMA HEALTHCARE, 2013) Gumus, NazimBreast ptosis commonly develops in response to ageing and breastfeeding. Clinical studies now focus on both filling the upper pole of the breast with parenchymal flaps and long-term maintenance of the breast projection without recurrence of upper pole concavity and a significant change in breast shape over time. This study presents a modification for a well-known mastopexy technique, the dermoglandular hammock flap, which provides not only autoaugmentation for the breast but also suspension for the breast parenchyma. This technical modification involving a hammock flap extended in both width and length dimensions, was performed in 17 patients aged 28-43 years with an average age of 31 years. They had minimal, moderate, and severe ptosis. Of these, eight patients had mastopexy only without needing any resection of the breast tissue. In four patients, there was significant asymmetry, needing excision of the breast tissue. In five patients, it was necessary to resect less than 290 g of glandular tissue from both breasts to provide enough reduction of the breast volume. There were no severe complications either in the early or late postoperative period, such as nipple-areolar necrosis, haematoma, infection, or dehiscence of the suture line. However, in one patient, skin depression developed at the end of the vertical scar line in one breast. In the follow-up, medial and upper pole fullness of the breast maintained without recurrence of the ptosis, providing satisfactory shape and projection. With this modification, dermoglandular suspension flap turns to be a more effective procedure and suitable for all types of ptosis. As the sagged lower pole of the breast is used as a flap behind the nipple-areola complex and upper pole, it makes not only parenchymal reposition, but also autoaugmentation in the breast, leading to successful breast fullness.
