Mustafa Durgun

The reconstruction of full-thickness ear defects including the helix using the superior pedicle postauricular chondrocutaneous flap.

AbstractThe ear is a complex structure with specific anatomical landmarks and different surface contour properties. In this article, we present the results that we obtained after reconstruction of full-thickness defects of the upper and middle third of the ear including the helix using a superior auricular artery (SAA) pedicled chondrocutaneous flap.In this study, 8 patients underwent reconstructions with postauricular SAA pedicled chondrocutaneous flaps between March 2009 and May 2011. Seven patients were male (88%), and 1 patient was female (12%). The age range was between 27 and 78 years, with a mean age of 57 years. The causes of the defects were tumor excisions in 6 patients and trauma in 2 patients. No serious postoperative complications such as wound infection, wound dehiscence, or partial or total flap loss were observed in any of the patients. A good cosmetic result was obtained with this technique with maximum preservation of the anatomical landmarks and without an effect on the vertical height or projection of the ear.In our experience, the postauricular SAA pedicled chondrocutaneous flap can be used as an appropriate alternative for the treatment of full-thickness defects of the upper and middle thirds of the ear including the helix.

The effect of hyperbaric oxygen treatment on the healing of burn wounds in nicotinized and nonnicotinized rats.

The importance of oxygen in wound healing and the negative effects of cigarette smoking have been demonstrated in various studies. In this study, our aim was to investigate the effect of hyperbaric oxygen (HBO2) treatment on wound healing in nicotinized and nonnicotinized rats. The study was conducted on 32 Sprague Dawley rats. The rats were divided into four groups, with eight rats in each: group 1, nonnicotinized rats; group 2, nonnicotinized rats treated with HBO2; group 3, nicotinized rats; and group 4, nicotinized rats treated with HBO2. To prepare the nicotinized groups, the rats were given nicotine for 28 days. At the end of day 28, standard, deep, second-degree to third-degree burns were created on the rats. The HBO2-treated groups underwent HBO2 treatment once a day for 7 days after the creation of the burn damage. All rats were killed 21 days after injury, and the burns were subjected to macroscopic, histopathological, and microbiological evaluation. During this evaluation, the smallest necrotic areas and the lowest rate of fibrosis were observed in group 2. The largest necrotic areas and the highest inflammation and fibrosis rates were observed in the nicotine-treated group 3. When the nicotinized and nonnicotinized groups were compared separately, there was a significant difference in favor of the groups treated with HBO2. Bacterial growth was the highest in the nicotinized group 3, whereas no statistically significant difference was observed among the other groups. We conclude that HBO treatment accelerates the recovery of burn wounds and provides more effective healing by reducing the development of scars both in nicotinized and nonnicotinized rats.

Evaluation of the effect of thymoquinone treatment on wound healing in a rat burn model.

Thymoquinone (TQ) is a plant extract that has been shown to have antimicrobial, anti-inflammatory, and antioxidant effects. Because of these activities, the authors hypothesized that TQ would reduce inflammation and oxidative stress and accelerate wound closure in a rat model of deep second-degree burns. For the purposes of this study, 40 Sprague-Dawley rats were divided into five groups of eight rats each. Group 1 was the control group, group 2 was the silver sulfadiazine group, group 3 was treated with systemic TQ, group 4 received topical TQ, and group 5 was administered topical and systemic TQ. After the deep second-degree burn damage was created, daily dressing changes and TQ administration were continued in the study groups for a period of 21 days. Systemic TQ was administered intraperitoneally at a dose of 2 mg/kg/day, whereas the topical treatment was applied using a 0.5% solution. The changes in the wound site were observed macroscopically, histopathologically, microbiologically, and biochemically in all groups. The smallest necrotic areas were observed at the end of the study in the groups that were administered a combination of systemic and topical TQ, or solely topical TQ (6.1 ± 1.6 cm2 and 6.7 ± 0.4 cm2, respectively), whereas the largest necrotic areas were observed in the control group (11.2 ± 1.2cm2). The total antioxidant state levels in the control group were significantly lower than in the other groups (P < .05), whereas the total oxidative stress levels were lower in the TQ groups compared with the control group (P < .05). The lowest bacterial counts were observed in the groups treated with both topical and systemic TQ (P < .05). TQ given systemically and/or topically reduced inflammation and oxidative stress and accelerated the rate of wound closure or reepithelialization.

Repair of Full-Thickness Nasal Alar Defects Using Nasolabial Perforator Flaps.

BackgroundThe repair of full-thickness nasal alar defects presents difficulties because of their complex 3-dimensional structure. Reconstructions using inappropriate methods may lead to asymmetries and dissatisfying functional results. In this study, our aim was to present the repairs of full-thickness alar defects performed using cartilage-supported nasolabial perforator flaps. Materials and MethodsEight patients who presented to our clinic between January 2011 and April 2014 with full-thickness defects in the alar wings were included in this study. The nasolabial perforator flap was prepared on the basis of the closest perforator to the defect area and in a way to include 2 to 3 mm of subcutaneous adipose tissue. The medial section of the flap was adapted to form the nasal lining. In the 7 patients in whom cartilage support was used, the cartilage graft was obtained from the septum nasi. After the cartilage was placed on the flap, the lateral section of the flap was folded over the medial section and the defect was repaired. In 1 patient in whom cartilage support was not required, the flap was folded over itself before the repair was performed. The flap donor area was primarily repaired. ResultsNo detachment around the suture lines, infection, venous insufficiency in the flap, or partial or total flap losses were observed in any of the patients. Retraction developed in 1 patient in whom no cartilage support was used. No retraction was observed in any of the patients in whom cartilage support was used. The results were functionally and esthetically satisfying in all the patients. ConclusionsThe greatest advantage of perforator-based nasolabial flaps is the greater mobilization achieved in comparison with the other nasolabial flaps. Thus, full-thickness defects can be repaired in 1 session in some patients, no revision is required around the flap pedicle, and much less donor area morbidity occurs. Nasal alar reconstructions performed using this type of flap lead to both esthetically and functionally satisfying results.

The Versatile Facial Artery Perforator-Based Nasolabial Flap in Midface Reconstruction.

Introduction:Defects in the lower two thirds of the face occur due to trauma, tumoral masses, or infections. In this study, repairs of various defects located in the midface using facial artery perforator-based nasolabial flaps are presented. Patients and Methods:Between January 2009 and June 2013, 15 patients with defects in the lower two thirds of the face or the intraoral region underwent repairs with facial artery perforator-based nasolabial flaps. The etiology was malignant skin tumor excisions in 11 patients, infection in 2 patients, and trauma in 2 patients. Among the patients, 10 were male and 5 were female. Their mean age was 65.1 (range: 20–86) years. The mean duration of follow-up was 14 (7–24) months. The defects were located at the upper lip, cheek, lower lip, intraoral region, and the nasal area. The size of the defects varied between 10 × 10 mm and 40 × 50 mm. All the flaps were prepared as perforator flaps. The flap donor area was primarily closed. Results:No partial or total flap loss was observed in any of the flaps. The flap donor areas healed without problem. Full patient satisfaction was achieved both aesthetically and functionally. Conclusion:The nasolabial perforator flap has certain advantages such as the 1-stage application, repair using a similar tissue, a wider rotation arc around the pedicle compared to the other regional flaps, and the primary closure of the donor area. Based on these characteristics, it is an ideal alternative for the repairs of the defects located in the lower two thirds of the face or the intraoral region.

An alternative surgical procedure for anterosuperior dislocation of intact mandibular condyle.

Superolateral and anterolateral dislocations of the intact mandibular condyle can be easily overlooked because of their rarity among maxillofacial injuries. In this report, we present the surgery of delayed anterosuperior dislocation of intact mandibular condyle into the temporal fossa. A 17-year-old adolescent girl with anterosuperior dislocation of left intact condyle and associated mandible and zygomatic body fracture underwent surgery 33 days after trauma because of priority accompanied life-threatening intracranial and intra-abdominal injuries. Temporalis muscle shortening with soft tissue attachment prevented closed reduction of the temporomandibular joint; therefore, the temporalis muscle was divided from its insertion on coronoid in a process that, to our knowledge, has never before been described. Although good occlusion was achieved at operation, open bite deformity and laterognathism were observed at the sixth month of follow-up.

Effect of 2100 MHz mobile phone radiation on healing of mandibular fractures: an experimental study in rabbits

ABSTRACT Fractures in the maxillofacial region are among the most frequent incidences in patients exposed to trauma. The aim of this study was to evaluate the effect of 2100 MHz electromagnetic radiation on the healing of mandibular fractures in rabbits. The study was carried out on 12 mature male New Zealand rabbits. After producing a left mandibular osteotomy, the fracture was repaired by using a plate screw. The rabbits were divided into two groups – control and experimental. The experimental group was exposed for 3 h daily to a 2100 MHz radiofrequency (RF) for 28 d. Biomechanical, histopathological and radiological tests were performed during the healing of the mandibular bone. According to the biomechanical tests, the energy absorption capacity, toughness and maximum strength of the mandibular bone were increased compared to the control group (6.84 vs. 2.57, 0.135 vs. 0.041 and 22.21 vs. 10.32, respectively). No significant differences between the two groups were found during the radiological assessment. However, the histopathological examination revealed that the fracture healing score was higher in the experimental group when compared to the control group (8.0 vs. 2.75, respectively). In conclusion, the results of this study showed that a 2100 MHz RF radiation positively affected fracture healing.

Yanık sonrası boyun kontraktürlü çocuk hastada i-gel kullanarak hava yolu yönetimi

I-gel is a supraglottic airway device that has been used for emergency airway management. In this report, we present a case in which airway management is facilitated using I-gel. Scar revision was planned in a 12-year-old male patient with limited ability to extend the neck and restricted oral opening because of post-burn contracture. The patient was ventilated successfully achieved using the supraglottic I-gel method. This new airway device may appropriate in cases with asymmetric airways in which airway management is difficult. J Clin Exp Invest 2014; 5 (2): 301-303

Functional assessment of autologous platelet-rich plasma (PRP) after long-term storage at −20 °C without any preservation agent

Abstract Background: Platelet-rich plasma (PRP) is increasingly being used in the treatment of chronic wounds, pathologies of the musculoskeletal system, and in cosmetic medicine; however, the preparation of platelet-rich plasma is both time-consuming and requires invasive intervention. Additional costs are introduced if special equipment is used during preparation. The aim of the present study is to test whether autologous platelet-rich plasma (PRP) preserves the feature of growth factor release when stored at −20 °C after preparation. Method: Autologous PRP concentrates were prepared using whole blood samples obtained from 20 healthy subjects and divided into three parts to form three groups. Epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), platelet derived growth factor-AB (PDGF-AB), insulin-like growth factor 1 (IGF-1), transforming growth factor-beta (TGF-β), and P-Selectin levels were immediately analysed in the control group. The other groups were defined as the experimental groups and were stored at −20 °C and analysed on the 7th and the 14th days. The same growth factors were tested in the experimental groups. Results: The growth factors (EGF, VEGF, PDGF-AB, IGF-1, TGF-β) and P-selectin levels were significantly decreased in the autologous PRP samples stored at −20 °C compared to the control group. Conclusion: The growth factor levels on days 7 and 14 suggest that autologous PRP can be stored at −20 °C without preservative agents, although in vivo studies are required in order to evaluate the clinical efficacy of the detected growth factor levels.

Clinical Experiences in the Surgical Treatment of Accessory Tragus

Objective: Tragus is a part of the external ear that develops from the first branchial arch. Accessory ear is a congenital external ear anomaly and has skin elevation containing remnant cartilage. The auricle develops between the 4th and 12th week of the embryonic stage, which groove the tissue from the 1st and 2nd branchial arches. Histologically, the lesions include a rugated epidermis with a thin layer stratum corneum, tiny mature hair follicles, fat lobules, and connective tissue framework that may include a central cartilage core. The aim of this study was to evaluate the accessory tragus lesions with our clinical surgical treatment results. Material and Methods: Lesions usually located anterior to the tragus and along an imaginary line drawn from the tragus to the angle of the mouth. Twelve patients admitted to our clinic between October 2011 and November 2014 were included in this study. Results: Seven boys and five girls between two–13 years old underwent operation. In total, 28 accessory ears were excised. No complications were observed during the procedure, and no complaints were noted in the postoperative period. Conclusion: Generally, limited anomaly is associated with the first and second branchial arch anomalies. Surgical excision is the standard treatment for the lesions which usually due to the esthetic concerns.