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Öğe An alternative to free flap for ankle and heel defects: Delayed reverse-flow sural Island flap(Turkish Society of Plastic Reconstructive, and Aesthetic Surgery, 2015) Karameşe, Mehtap; Yıldıran, Gökçe; Akdağ, Osman; Selimoğlu, Muhammed Nebil; Abacı, Malik; Tosun, ZekeriyaIn ankle and heel region, tissue defects can be occurred due to diabetes, osteomyelitis, trauma and tumor excisions and these defects should be repaired with flaps. Reverse-flow sural island flap is a reliable alternative for repairing these regions' defects. Delayed reverse-flow sural island flap procedure was applied for 11 smoker or diabetic patients who have tissue defects due to trauma. While we haven't seen flap failure in any patient, we also didn't have any difficulty except 2 minor problems. Besides clinical results, patient satisfaction was evaluated with "patient satisfaction rate scale". In this article, it is reported our ankle and heel reconstruction cases with delayed reverse-flow sural island flap as an alternative of free flap and their satisfaction rate.Öğe Altın İmplantla Lagoftalmus Tedavisi Teknik Detaylarının Olgular Eşliğinde Gözden Geçirilmesi(2016) Yıldıran, Gökçe; Akdağ, Osman; Karameşe, Mehtap; Abacı, Malik; Tosun, ZekeriyaAmaç: Üst gözkapağına altın ağırlık yerleştirilmesi, lagoftalmi tedavisinde genel kabul görmüş bir yöntemdir. İngilizce literatürde "custom-made" olarak geçen şekilde kişiye özel yapılabileceği gibi, hazır ticari form olarak veya kuyumcu aracılığıyla da temin edilebilir. İstenmeyen postoperatif sonuçları önlemek için kliniğimizde uygulanan algoritmanın paylaşılması amaçlanmıştır.Gereç ve Yöntemler: 2012-2014 yılları arasında lagoftalmi için altın implantla tedavi planlanan yedi hasta için preoperatif ağırlık testi, oturur pozisyonda bekletme, delikler açıldıktan sonraki ağırlığın saptanması, altın ağırlığın iki kez denenmesi ve sterilizasyon işlemleri uygulandı. Erken ve geç komplikasyonlar, altın gramajı ve maliyet değerlendirildi.Bulgular: Hastaların hiçbirinde erken veya geç komplikasyona rastlanmadı. Gözkapağında tam kapanma elde edildi. Hastaların estetik değerlendirmeleri, hekim değerlendirmesinden daha iyi olarak saptandı.Sonuç: Altın implant tedavisinin başarısını belirleyen en önemli etken altının ağırlığıdır. Maliyet etkin ve hasta memnuniyeti yüksek olan kuyumcu aracılığı ile temin yönteminde basit preoperatif kriterlere dikkat edilerek postoperatif morbiditeyi azaltmak ve başarıyı artırmak mümkündürÖğe Analysis of unilateral complex orbital fractures with a new treatment algorithm(TAYLOR & FRANCIS LTD, 2015) Karameşe, Mehtap; Akdağ, Osman; Selimoğlu, Muhammed Nebil; Koplay, Tuğba Gün; Bakbak, Berker; Koplay, Mustafa; Tosun, ZekeriyaThe aim of this study is to investigate preoperative and postoperative properties, the management of unilateral complex orbital fractures, and to offer an algorithm for orbital fractures. For this research study, 248 patients with orbital trauma were evaluated according to an offered algorithm. Diplopia, enophthalmos, dystopia, infraorbital nerve dysfunction, and ocular movement limitations were documented for clinical assessment. Orbital rim displacement and an orbital volume check with computed tomography (CT) were used for indication of surgery. The injured orbital volume was compared with the healthy orbital volume in the preoperative and postoperative periods. In total, 58 patients required operations among the 248 patients, according to the algorithm. The preoperative mean injured orbital volume measurements of the operated patients were statistically different than the healthy orbital volume measurements (30.13 cm(3) +/- 2.69 cm(3) and 27.15 cm(3) +/- 1.29 cm(3), respectively). In the postoperative period, there was no difference between the injured and healthy orbital volume. In conclusion, an algorithm may facilitate the approach to unilateral complex orbital fractures. Ophthalmic examination, rim displacement, and the measurement of orbital volume using computed tomography are key points of orbital fractures with regard to management.Öğe Applicability of self-inflating tissue expanders in pediatric patients with head and neck defects(SPRINGER, 2015) Karameşe, Mehtap; Akdağ, Osman; Yıldıran, Gökçe Ünal; Selimoğlu, Muhammed Nebil; Tosun, ZekeriyaBackground Self-inflating tissue expanders have been used successfully in breast reconstruction, alopecia, scars, and anophthalmos. The expanders contain an osmotic active hydrogel and a silicon shell. The purpose of this study was to analyze our clinical experience using self-inflating tissue expanders in the treatment of alopecia and cleft palate defects in pediatric patients. Methods Twenty-eight self-inflating tissue expanders were used in 13 patients with alopecia or large cleft palate defects. Expander dimensions were determined by the size of the defect in the scalp and by using a sizer for the palate. In some patients, it was necessary to use more than one expander. A visual analog scale (VAS) and Children's Hospital of Eastern of Ontario Pain Scale (CHEOPS) were used to determine pain levels. Results Sufficient tissue was gained in nine patients (69.2%) and 11 of the 16 defects were repaired successfully (68.75%). We observed four implant extrusions as a major complication (14.2 %). Three of these four extrusions were seen in cleft palate expansions. Pain levels were as low as 5 points with CHEOPS in patients younger than 5 years old and 40mmwith VAS in patients older than 5 years of age. Conclusions Self-inflating tissue expanders comfortably ensure sufficient tissue in patients with alopecia; however, there is high risk of extrusion in cleft palate applications. Level of Evidence: Level V, therapeutic study.Öğe Camouflaging Cleft Lip Scar Using Follicular Unit Extraction Hair Transplantation Combined with Autologous Fat Grafting(LIPPINCOTT WILLIAMS & WILKINS, 2018) Akdağ, Osman; Evin, Nuh; Karameşe, Mehtap; Tosun, ZekeriyaBackground: The scar that occurs after cleft lip surgery poses a serious cosmetic problem. One of the methods used to solve this problem in adult male patients is hair transplantation. However, satisfactory results with this method cannot always be achieved because of possible graft loss. The corrective feature of fat grafting has been reported in many studies. The authors' aim with this report is to share their results with hair transplantation combined with fat grafting in patients with cleft lip. Methods: This study included 20 patients who had both a scar and alopecia in the cleft lip area. The patients underwent fat grafting from the periumbilical region by means of miniature liposuction harvesting cannulas. Three months after fat injection, hair transplantation was performed with hair from the submental area and scalp using the folliculate unit extraction technique. Patients were followed for 12 months. Survival rate of transplanted hair and patient satisfaction were analyzed after the procedures. Results: After this camouflaging technique with fat grafting and hair transplantation, the scar was hidden quite well. The graft survival rate was also better compared with results from similar studies. Patient and observer satisfaction results with the scar tissue were significantly improved, which was confirmed statistically. Conclusions: This study demonstrates that this combined camouflaging technique is a very effective treatment in male patients with cleft lip who have serious secondary upper lip scars. The authors present a series of patients treated with this technique, which resulted in a high level of patient satisfaction.Öğe A case of renal cell carcinoma mimicking parotid tumor(Turkish Society of Plastic Reconstructive, and Aesthetic Surgery, 2015) Akatekin, Ahmet; Karameşe, Mehtap; Akdağ, Osman; Abacı, Malik; Tosun, ZekeriyaIntroduction: Renal cell carcinoma is a malignant tumor which arising from the renal cortex. Tumor has some symptoms such as flank pain, macroscopic hematuria, and a palpable abdominal mass. Rarely a group patients have metastasizes which cause paraneoplastic syndromes. Cutaneous metastases are quite rare. Case: In this article we will be discussed a rare renal cell carcinoma metastases case which mimicking parotid tumor. Results: After pathological examination, patient were diagnosed with renal cell carcinoma and for the primary tumor treatment, he was referred to the urology clinic. Conclusion: Clinics which are dealing with tumor, are very important to the pathological examination. Patients should be considered as a systemic and the surgeon should focus on other systemic point.Öğe Comparison of Bone Dust With Other Types of Bone Grafts for Cranioplasty(LIPPINCOTT WILLIAMS & WILKINS, 2014) Karameşe, Mehtap; Toksöz, Mustafa Raşid; Selimoğlu, Muhammed Nebil; Akdağ, Osman; Toy, Hatice; Tosun, ZekeriyaPurpose: Split calvarial bone graft is preferred in the reconstruction of calvarial defects. However, it is not feasible for use in some challenging cases and in children. Particulate bone graft containing viable osteoblasts could be an attractive alternative. Materials and Methods: A total of 32 female rats were randomly separated into 4 groups. Full-thickness bone graft from rat calvaria was harvested in diameters of 8 x 8 mm. In group 1, the periosteum and skin were closed without any bone graft; bone dust particles were placed in group 2; bone fragments were placed in group 3; and full-thickness cranial bone graft was placed in group 4. After 12 weeks, all rats were killed. Degrees of resorption, foreign body reaction, and bone spicule length were assessed histologically, and an immunohistochemical study was used to show bone graft viability. Results: In graft viability, osteogenesis, and osteoblastic differentiation, groups 3 and 4 were similar and superior to groups 1 and 2. No osteoblastic activity and no viable bone dust were detected in groups 1 and 2. Resorption was observed in every preparate that contains bone tissue, and foreign body reaction was prominent in small bone groups, such as in group 2. Conclusions: In the full-thickness cranial bone graft group and the bone fragment group, the preservation of bone viability was obviously superior to the bone dust group and the periosteum-only group. In conclusion, bone dust behaved like the periosteum and could not create new bone, whereas bone particles behaved like the full-thickness cranial bone graft and were capable of preserving viability.Öğe Dupuytren-Like Contracture of the Foot: Ledderhose Disease(THIEME MEDICAL PUBL INC, 2016) Akdağ, Osman; Yıldıran, Gökçe; Karameşe, Mehtap; Tosun, ZekeriyaIntroduction Plantar fibromatosis is a rare hyperproliferative disease of plantar aponeurosis and is also called Ledderhose disease. Case properties and treatment are discussed in this report. Case Report A 30-year-old man presented with painful bilateral plantar nodules. He had multiple and bilateral fixed and solid nodules on the plantar and medial side of his feet measuring 1 cm each. Ultrasound was performed and hypoechoic homogeneous nodules were detected. The patient underwent surgery, and the nodes were removed via a plantar incision with 2-cm safety distance. Discussion Ledderhose disease is a rare, hyperproliferative disorder of the plantar aponeurosis. The nodules are slow growing and found in the medial part of the plantar fascia. The precise etiology remains unknown. The treatment options are conservative management, steroid injections, radiotherapy, and surgery. Conclusion The main cause of this disease remains uncertain. Related conditions should be evaluated, and a patient who presents with Dupuytren or Peyronie disease should also be investigated for Ledderhose disease.Öğe An Easy Way for Congenital Symmastia Correction(SPRINGER, 2014) Karameşe, Mehtap; Hancı, Mustafa; Abacı, Malik; Akatekin, Ahmet; Tosun, ZekeriyaCongenital symmastia is described as a connection between the breasts without macromastia. In this condition, there is accumulation of fat and glandular tissue between the breasts, which produces a unified appearance of the breast tissue across the chest. We report a case of congenital symmastia in a 21-year-old woman with normal-sized and -shaped breasts. We achieved satisfying aesthetic results using suction-assisted lipectomy and the patient's complaint was resolved without scar or major surgery. 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 Ektropion düzeltilmesinde etkin bir yöntem: Kuhnt Szymanowski tekniğinin smith modifikasyonu(2013) Akdağ, Osman; Karabekmez, Furkan Erol; Sütçü, Mustafa; Duymaz, Ahmet; Karameşe, Mehtap; Tosun, ZekeriyaAmaç: Ektropiyon göz kapağı kenarının dışa doğru kıvrılm asıdır. Bu çalışmanın amacı; involüsyonel ve paralitik ektrop i yon onarımında kullanılabilecek kolay ve etkin bir yöntem olan Kuhnt Szymanowski tekniğinin Smith modifikasyonunun etkinliğinin ve estetik olarak kabul edilebilirliğinin değerle n dirilme sidir . Yöntem: Alt göz kapağında ektropiyon şikayeti ile kliniğimize başvuran ve Kuhnt Szymanowski tekniğinin Smith modifikasyonu ile tedavi edilen 5 hasta klinik ve fotoğrafik olarak incelendi. Bulgular : Hiçbir olguda majör bir komplikasyon ya da nüks gözlenmedi. Ortalama 10 ay olan takip süresi sonunda tüm hastalar cerrahi sonuçtan memnundu. Sonuç : Alt göz kapağında horizontal gevşekliğin daha ön planda olduğu involüsyonel ve paralitik ektropiyon olgul arında Kuhnt Szymanowski tekniğinin Smith modifikasyo nu nun uygun bir cerrahi yöntem olduğu kanaatindeyiz.Öğe Endoscopic treatment of maxillofacial fractures(Turkish Society of Plastic Reconstructive, and Aesthetic Surgery, 2015) Akdağ, Osman; Karameşe, Mehtap; Selimoğlu, Muhammed Nebil; Akatekin, Ahmet; Abacı, Malik; Tosun, ZekeriyaEndoscopic treatment of maxillofacial fractures is a minimally invasive method and which is the application of a different way of open reduction internal fixation (ORIF) procedure. Between April 2013-December 2013, 13 patients admitted with maxillofacial trauma were treated with this method. All patients were evaluated clinically and radiographically. In the course of postoperative evaluation, two minor and one major complications were observed in 3 patients in total. In other patients, satisfactory results were obtained. In our study, in accordance with the data obtained from these patients, operative techniques have been described in detail and the results were compared with literature. We suppose that endoscopic surgery, which we consider as a different and innovative method for maxillofacial trauma surgery, will take part of standard treatment protocols with appropriate patient, equipment and experience.Öğe Extracorporeal Septoplasty Combined With Valve Surgery in Rhinoplasty Patients(LIPPINCOTT WILLIAMS & WILKINS, 2016) Karameşe, Mehtap; Akdağ, Osman; Akatekin, Ahmet; Koplay, Tuğba Gün; Koplay, Mustafa; Tosun, ZekeriyaExternal nasal deviation is caused primarily by severely a deformed septum. The nose functions as a whole composed of the septum, valve systems, and mucosal structures. Patients with severely deviated septums also have deformed nasal valve systems. Extracorporeal septoplasty is advocated for an extremely deviated nasal septum. Nasal valve dysfunctions can be resolved successfully with spreader grafts. Application of extracorporeal septoplasty in combination with spreader grafts in patients with nasal valve dysfunction not only enables nasal respiration but also supports aesthetic appearance. The 19 patients in our study had undergone aesthetic rhinoplasty and presented with breathing problems and septal deviations. The patients were treated with extracorporeal septoplasty and spreader grafts. The patients were followed with clinical measures and computed tomographic scanning. No complications such as relapse, perforation, or saddling were encountered during follow-up. Aesthetically and functionally satisfactory results were obtained.Öğe Face Burn Due to Airbag Trauma(WOLTERS KLUWER MEDKNOW PUBLICATIONS, 2017) Yıldıran, Gökçe; Akdağ, Osman; Karameşe, Mehtap; Tosun, Zekeriya[Abstract not Available]Öğe Fingertip Reconstruction With Reverse Adipofascial Homodigital Flap(LIPPINCOTT WILLIAMS & WILKINS, 2015) Karameşe, Mehtap; Akatekin, Ahmet; Abacı, Malik; Koplay, Tuğba Gün; Tosun, ZekeriyaDue to the importance of hand functions, fingertip injuries should be reconstructed by flap coverage. Although reverse homodigital island flap is an option that is widely used, the classical homodigital flap, which includes a skin graft for the donor site, leads to many donor-site problems such as maceration, and primary or secondary contraction. Reverse homodigital adipofascial flap (RHAF) has been chosen to prevent donor-site complications. To emphasize the efficacy of this flap, we report the outcome of 14 RHAFs, which were used for fingertip reconstruction following traumatic amputations. Materials and Methods From May 2010 to June 2012, 14 fingertip amputations were reconstructed with reverse adipofascial homodigital flap. Six months following surgery, the patients were evaluated with examination using 2-point discrimination, measurement of the range of motion of the proximal interphalangeal joint (PIP) and distal interphalangeal joint (DIP), pain [evaluated with the Visual Analogue Scale (VAS)], and the time to return to their previous activities. Results All flaps survived completely. Donor sites healed without any complication. Two-point discrimination was a mean of 4.86 +/- 0.95 mm. The range of motion of the PIP and DIP joints was similar to that of the contralateral finger. The VAS score was a mean of 0.9 (range 0-2). All patients returned to their previous occupations within 30 to 60 days (average 40 days). The operation did not impair functional and other activities. Conclusions Reverse adipofascial homodigital flaps maintain the perpetuation of digital length, volume of pulp, and service of finger function. The donor site on the lateral surface of the proximal phalanx can be primarily closed. For traumatic fingertip amputation, this flap delivers consistent aesthetic and functional results.Öğe Foot and ankle reconstruction with vertically designed deep inferior epigastric perforator flap(WILEY, 2018) Akdağ, Osman; Karameşe, Mehtap; Yıldıran, Gökçe Ünal; Sütçü, Mustafa; Tosun, ZekeriyaIntroductionThe deep inferior epigastric perforator (DIEP) flap is one of the most commonly utilized flaps of reconstructive surgery. Although the horizontal flap design is the most commonly used, this flap can be vertically designed to avoid drawbacks such as excessive tissue dissection, relatively reduced flap perfusion, and scarification of the contralateral flap opportunity. The aim of this report is to present our case series for foot and ankle reconstruction with vertical designed DIEP flap. Patients and methodsThe free vertically designed DIEP flaps (VDIEP) were used in eight patients (7 male, 1 female) whose age is in a range of 20-66 years for soft tissue reconstructions in the ankle and foot region over a five-year period. The range of defects' size was from 8 x 5 cm to 15 x 7 cm and the causes were electrical burn, trauma and diabetic foot infections. ResultsFlap dimensions varied from 10 x 6 cm to 17 x 9 cm. All the flaps had two or more perforators, and all flaps survived completely. There were no early or late complications. We followed up the patients for 10 months in average. We observed no functional problems, especially in main motions of foot and ankle like eversion, inversion, flexion or extension except one patient. Donor site scars were acceptable in all patients. ConclusionsThe VDIEP flap may be an option for selected lower extremity soft tissue reconstructions, and it may be an alternative to classically designed abdominal flaps.Öğe Hava Yastığı Travmasına Bağlı Yüz Yanığı(2017) Yıldıran, Gökçe; Akdağ, Osman; Karameşe, Mehtap; Tosun, Zekeriya[Abstract not Available]Öğe İmperfore himen operasyonu sonrasında gelişen stenoz ve Z-plasti yöntemi ile düzeltilmesi(2014) Kebapcılar, Ayşe Gül; İlhan, Tolga Tuyan; Karameşe, Mehtap; Gençoğlu, Berat Berrinİmperfore himen (IH), dişi genital sistem anomalilerinden en sık karşılaşılanıdır. Vaka sunumumuzda IH nedeniyle opere edilen ve sonrasında himenal stenoz gelişen bu nedenle Z-plasti yöntemi ile himenoplasti yapılan olgu sunulmuşturÖğe An impulse control disorder that may cause tissue defects(2013) Akdağ, Osman; Sütçü, Mustafa; Karameşe, Mehtap; Karabekmez, Furkan; Tosun, ZekeriyaMany factors experience with tissue defects in plastic surgery, which is an impulse control disorder, trichotillomania and skin picking are rare causes. Trichotillomania is a chronic impulse control disorder characterized by people to pull out the hair from their scalp, eyelashes, eyebrows, or other parts of the body. This conscious or subconscious habit is most commonly performed by young children, adolescents and women. To cause tissue defects is extremely rare. Factors that plastic surgery is a rare skin defects, two cases have been presented in this psychiatric disorder.Öğe İskeletsel Sınıf III Hastanın Ortodontik Tedavi ve Ortognatik Cerrahi ile Kombine Tedavisi ve Ortaya Çıkan Komplikasyon: Subkondiler Kırık(2012) Karameşe, Mehtap; İleri, Zehra; Abacı, Malik; Akıncı, Özlem; Tosun, Zekeriya; Demir, AbdullahIn this case report, combined treatment of female patient with skeletal and dental Class III malocclusion with orthodontic-orthognathic surgery, and subcondylar fracture which is a rare complication of surgical treatment are discussed.Öğe Lichen Simplex Chronicus That Accompanies Anogenital Warts During the Childhood(Hindawi Limited, 2012) Seçilmiş Kerimoğlu, Özlem; Doğan, Nasuh Utku; Tazegül, Aybike; Karameşe, Mehtap; Beyhekim, Hasan; Çelik, ÇetinAnogenital warts and lichen simplex chronicus (LSC) are rarely seen during the childhood. A 9-year-old girl has been presented to hospital by her parents with itching in the anogenital area. There were anogenital warts and a different erythematous lesion in the perianal region. On the pulpa of the right thumb, there was a wart extending under the nail. The lesions are surgically removed. The results of the histopathological examination were reported as condyloma acuminata and LSC. Children with anogenital warts should be examined carefully to discover the transmission route and other possible concomitant cutaneous diseases.
