Cihangir Tetik

Reliability of primary vein grafts in lower extremity free tissue transfers.

Free flaps transferred to the lower extremity have a higher risk of failure, which may be expected to increase further with the use of vein grafts. The results of 103 consecutive free flaps to the lower extremities of 98 patients who were operated from March 1994 to December 1999 were evaluated to assess the reliability of vein grafts in lower extremity reconstruction. Five flaps were lost and the overall success rate was 95.1%. Eighty-four free tissue transfers in 79 patients were performed for the reconstruction of traumatic cases, and 81 of these flaps were performed in a delayed manner, between 1 week and 4 months after the injury. Interpositional vein grafts were used primarily in 22 flaps—all in traumatic cases—and 21 of them survived completely (95.4%). Primary vein grafts were used both for arteries and veins in 15 flaps and for arteries only in 7 flaps. The most common cause of tissue loss in these patients was a crush injury in earthquake survivors, followed by electrical injuries, gunshot injuries, motor vehicle accidents, and chronic infections. Free muscle flaps in 13 patients, skin flaps in 4 patients, osseous flaps in 2 patients, and temporal fascial flaps in 2 patients were the flaps of choice in vein graft reconstructions. Although a higher incidence of flap loss has been reported with the use of interpositional vein grafts than with regular transfers, and the technical and pathophysiological problems in flap transfers are also high in the lower extremity, the success rate in vein-grafted free flaps did not differ from that of the simple free flap transfers in the current series. This appears to be the result of meticulous preoperative planning and proper selection of recipient vessels during optimal operative conditions.

Epineural sleeve neurorrhaphy: surgical technique and functional results--a preliminary report.

This study was conducted to evaluate the effect of epineural sleeve neurorrhaphy on peripheral nerve regeneration. A total of 12 Lewis rats were divided in two groups of 6 rats each. In group 1, the rat sciatic nerve was transected and repaired using the conventional epineural technique with four sutures. In group 2, the epineural sleeve technique was introduced with two sutures only. Functional recovery was evaluated at 1, 2, 4, 8, and 12 weeks by walking track analysis (sciatic function index [SFI]), mean limb circumference ratio, and severity of toe contracture. Although the SFI at 12 weeks revealed no difference between the two groups (−88.39 ± 10.75 conventional group, −77.35 ± 17.06 epineural sleeve group), significant differences in SFIs were detected at 4 and 8 weeks, with better functional recovery in group 2 rats (4 weeks: 125.92 ± 22.73 conventional group, −99.17 ± 5.45 epineural sleeve group; 8 weeks: −96.65 ± 4.73 conventional group, −72.82 ± 17.11 epineural group;p < 0.05 for both time points). Mean limb circumference ratio was not significant at all time points. At 12 weeks, all animals in the conventional nerve repair group developed severe toe contractures whereas only 2 animals in epineural sleeve repair group had contracture (p < 0.05). In this study, the epineural sleeve technique demonstrated a faster functional recovery when compared with the conventional technique, as confirmed by SFI and toe contracture grading.Siemionow M, Tetik C, Ozer K, Ayhan S, Siemionow K, Browne E. Epineural sleeve neurorrhaphy: surgical technique and functional results—a preliminary report.

Skin manifestations of rheumatoid arthritis: a study of 215 Turkish patients.

Objective  To investigate the frequency and clinicopathological features of skin involvement in rheumatoid arthritis (RA), to find out whether early and aggressive disease‐modifying treatment is changing the spectrum towards a milder disease pattern.

Transpedicular decancellation osteotomy in the treatment of peridural fibrosis.

Abstract From 1992 to 1997 a series of 12 multiply operated (averaging 2.5 previous operations) patients with recurrent peridural fibrosis and postlaminectomy kyphosis underwent surgery at our clinic. The surgery was designed to restore the physiological lordosis and relax tethered cord and epidural veins by transpedicular decancellation osteotomy at a vertebra other than the vertebra with peridural fibrosis. This paper presents the long-term functional outcome of these 12 patients. Clinical assessments were conducted pre-operatively and at 3-month intervals postoperatively and included X-ray assessment and evaluation of the patients’ functional status by Oswestry Disability Index (ODI) and of pain by visual analogue scale (pain VAS). All symptoms and the pain due to peridural fibrosis disappeared in the early postoperative period. Patients had lower disability and pain scores at their early and long-term follow-ups (follow-up period 24–74 months, mean 36.3 months). For patients with failed medical therapy for peridural fibrosis accompanied by lumbar kyphosis or hypolordosis, transpedicular decancellation osteotomy should be the surgical treatment of choice.

Isolated volar surgical approach for the treatment of perilunate and lunate dislocations

Background: Volar and/or dorsal surgical approaches are used for surgical treatment of perilunate and lunate dislocations. There are no accepted approaches for treatment in the literature. We evaluated the functional results of isolated volar surgical approach for the treatment of perilunate and lunate dislocation injuries. Materials and Methods: 9 patients (6 male and 3 female patients average age 34.5 ± 3.6 years) diagnosed with perilunate or lunate dislocations between January 2000 and January 2009 were involved in the study. The reduction was performed through isolated volar surgical approach and K-wire fixation, fracture stabilization with volar ligament repair was performed. Range of wrist joint motion, fracture healing, carpal stability, grip strength, return to work were evaluated and also direct radiographs were taken routinely at each control. The scapholunate interval and the scapholunate angle were evaluated radiographically. Evaluations of the clinical results were done using the DASH, VAS and Modified Mayo Wrist Scores. Results: The physical rehabilitation was started at 6th week, after the K-wires were removed. The average followup was 18.2 months (range 12-28 months). At the final followup, the average flexion extension arc was 105.0 ± 9.6° (74.6% of the other side), the average rotation arc was 138.8 ± 7.8° (81.5% of the other side) and the average radioulnar arc was 56.1 ± 9.9° (86.4% of the other side). The grip strength was 0.55 bar; 83.2% that the uninjured arm. According to the Mayo Modified Wrist score, the functional result was excellent in five patients and good in four and the average DASH score was 22.8. The scapholunate interval was 2.1 mm and scapholunate angle was 51°. Conclusion: The clinical and radiological results of the isolated volar surgical approach were satisfactory. The dorsal approach was not needed for reduction of dislocations during operations. Our results showed that an isolated volar approach was adequate.

Flexor tendon complications in comminuted distal radius fractures treated with anatomic volar rim locking plates

Objective Anatomic volar rim locking plates are designed with the aim of treating intraarticular distal radius fractures. When used to treat comminuted distal radius fractures, these plates can damage the flexor tendons. In this study, we sought to determine the radiological and functional results and rate of complications of these plates. Methods We retrospectively reviewed the records of 36 patients (28 males, 8 females; mean age: 46.4 years) with AO/OTA Type C2-C3 distal radius fractures treated with anatomic volar rim distal radius plates between January 2011 and December 2014. Radial length, radial inclination and palmar tilt were compared with the intact wrist. Results were evaluated with the Mayo wrist and Lidstrom scores. Complications were documented throughout the follow-up period of 23.8 (range: 12 to 48) months. Results Postoperative measurements of the radial length, inclination and palmar tilt did not differ significantly. Mayo wrist and Lidstrom scores were good and excellent in 27 and 32 patients, respectively. Flexor tenosynovitis was symptomatic in 15 patients and asymptomatic (localized swelling only) in 21. Plates were removed from 15 patients due to symptomatic tenosynovitis and from six patients due to partial rupture of the flexor pollicis longus tendon. The flexor digitorum profundus tendon of the second finger was also partially ruptured in three patients. Conclusion Anatomic volar rim locking plates provide satisfying radiological and functional results in treating AO/OTA Type C2-C3 comminuted distal radius fractures. However, if these plates interfere with the union of the fracture, they should be removed to avoid potential tendon problems caused by their placement in the rim region. Level of Evidence: Level IV, Therapeutic study

Mid-term radiological and functional results of biological reconstructions of extremity-located bone sarcomas in children and young adults.

Biological reconstruction is a useful option for reconstruction following bone sarcoma resection in children. The mid-term functional and radiological outcomes of biological reconstructions after resection of bone sarcomas in children are presented in this study. Eighteen patients [average age 12.5 years (range 4–22 years)] with primary sarcomas of long bones underwent wide surgical resection and biological reconstruction. The bone defects were managed by intercalary (n=14), osteoarticular (n=3) reconstructions and arthrodesis (n=1) with a vascularized fibular graft (VFG). VFG was combined with a massive allograft in seven lower extremity reconstructions. The average follow-up was 45.7 months (range 25–78 months). Graft union and graft hypertrophy was observed in 17 (94.4%) of 18 patients at 12 months. The VFG–allograft osteointegration rate was 100% at 24 months. The average final follow-up Musculoskeletal Tumor Society (MSTS) scores for lower and upper extremity reconstructions were 79.7% (range 66.6–90%) and 80.9% (range 53.3–100%), respectively. Four (22.2%) complications, including nonunion (n=1), implant failure (n=1), infection (n=1) and skin necrosis (n=1), required reoperation. The disease relapsed in three (16.6%) patients. Defect size and VFG length did not correlate with MSTS scores and radiological parameters (P>0.05). Biological reconstruction with VFG can provide permanent stability and progressively increasing functional and radiological results.

The effect of dehydration and irrigation on tendon adhesion formation after tendon exposure

OBJECTIVE The aim of this study was to evaluate the effects of dehydration due to tendon exposure on adhesion formation on the tendon surface. METHODS Achilles tendons of 60 New Zealand white rabbits were surgically exposed and evaluated. In the control group (Group 1), the wound was closed immediately; and in the remaining two groups, Achilles tendons were exposed to air for 60 minutes without (Group 2) or with (Group 3) regular saline irrigation. After undergoing clinical examination, 50% of rabbits in each group were sacrificed 3 weeks postoperatively and 50% at the 6th postoperative week. RESULTS All tendons exposed to air exhibited mild or moderate degrees of adhesion. Compared to the control group, the incidence of adhesion formation was significantly higher in the groups where tendons had been exposed to air for 60 minutes, whereas no significant difference was found between the irrigated and non-irrigated groups. No limitations or contractures were detected in the hind limbs of the animals at the clinical examination. CONCLUSION Regardless of irrigation, tendons are not prone to form clinically apparent adhesions during operations under 60 minutes of duration.

Comparison of ulnar nerve repair according to injury level and type.

PurposeThe aim of the study was to evaluate the results of epiperineural suture repaired primary (clean transaction injury, massive soft-tissue associated injury) and secondary (delayed partial injury) ulnar nerve injuries according to lesion level and type.MethodsForty-two patients diagnosed with ulnar nerve injury between January 2008 and January 2012 were involved in the study. Ulnar nerve lesions were classified according to the level of injury into three types: type 1—lesion located above the flexor carpi ulnaris branch; type 2—lesion located between the flexor carpi ulnaris and the flexor digitorum profundus III and IV; type 3—lesion located below the flexor digitorum profundus III and IV and no more than 10 cm distal from the elbow crease. Additionally, ulnar nerve lesions were classified according to type into three groups: group 1 (n 17)—clean transaction injury; group 2 (n 14)—massive soft-tissue associated injury; group 3 (n 11)—delayed partial clean transaction injury. In follow-up evaluations, sensory and motor recovery was analysed with the most common Highet scale modified by Dellon et al. Functional results were evaluated according to the Disability of Arm, Shoulder, and Hand (DASH) score at final follow-up.ResultsThere were no statistically significant differences between groups according to men/women ratio, mean age, mean follow-up period and ulnar-nerve injury level. The DASH score was significantly better in the clean transaction injury group than the other groups and significantly better for type 3 than types 1 and 2 injuries in all groups. Sensory recovery of type 1 and 3 injuries in the massive soft-tissue associated injury group was significantly worse than the other groups. The worst motor recovery was evaluated in type 1 injury and the best in type 3 injury according to injury level. According to group, motor recovery of the massive soft-tissue associated group was significantly worse than the other groups in all injury types. There were no statistically significant differences between clean transaction injury and delayed partial clean transaction injury groups in all injury types.ConclusionsPrognostic factors that influenced motor–sensory recovery and functional results were found in interval between trauma and reconstruction, injury level (worse results from proximal to distal) and mechanism of injury (worse results from massive soft-tissue injury to clear, sharp-tissue injury).

Elde falanks yerleşimli osteoid osteom olgularının geç tanı açısından değerlendirilmesi

Objectives: Osteoid osteoma in the hand, especially in the phalanges is presented with nonspesific clinical and radiologic findings and are seen infrequently in that local - ization. Therefore, the diagnosis of osteoid osteomas in these localization is difficult. In present study, we evalu - ated seven phalangeal osteoid osteomas in hand with re- spect to late diagnosis. OZET Amac: Osteoid osteom elde ozellikle falankslarda spesifik olmayan klinik ve radyolojik bulgularla karsimiza cikar ve bu anatomik lokalizasyonlarda sik gorulmez. Bu nedenle bu lokalizasyonlardaki osteoid osteomlarin tanisi koymak guctur. Bu calismada el falanklarinda osteoid osteom ta- nisi konan 7 olgu tani guclugu acisindan degerlendirildi. Hastalar ve yontem: El falanks yerlesimli osteoid os- teom tanisiyla cerrahi tedavi goren yedi hasta (5 kadin, 2 erkek; ort. Yas 21; dagilim 17-23) incelendi. Lezyon 3 olguda sol elde, 4 olguda sag elde goruldu. 7 olgu icinde en uzun tani suresi 12 ay iken en erken tani suresi 4 ay (ortalama 9 ay) idi. Bulgular: Tum hastalarda lezyonlarin yerlesim yeri prok- simal falankslar idi. Dort hastada ikinci parmak, bir has- tada ucuncu parmak, iki hastada ise dorduncu parmak tutulumu goruldu. Tani oncesinde tum hastalar nonstero- id antiinflamatuar ilaclar ile tedavi edilmisti. Semptomlar gerileme goruldu fakat tamamen iyilesme saglanamadi. Konvansiyonel radyografi ile hicbir hastada tani konula - madi, sintigrafide aktivite artisi ve bazi olgularda bilgi - sayarli tomografide nidus lokalizasyonu ile tani konuldu. Tum olgularda peroperatif alinan biyopsilerin sonuclari osteoid osteom olarak onaylandi. 2 olguda lezyon yuksek hizli burr ile, diger 5 olguda kuret yardimi ile kuretaj uygu- lanarak tedavi edildi. Sonuc: El parmaklarinda travma olmaksizin gorulen ag- risiz sislik, minimal travma sonrasi uzayan agri ve sislik, tek parmakta comak parmak deformitesi gibi durumlarda osteoid osteom akilda bulundurulmalidir. Bu durumda grafinin yaninda ince kesitli bilgisayarli tomografi ve sin - tigrafi istenmelidir. Klin Den Ar Derg 2010; 1(3): 206-210