Selahattin Özmen

A new composite facial and scalp transplantation model in rats

There are limited sources of autogenous tissue available for reconstruction of severe facial and scalp deformities caused by extensive tumor ablation, burns, or trauma. Allografts from cadaveric sources may serve as a reconstructive alternative. However, technical and immunological aspects of harvesting and transplanting face and scalp flaps limit the routine use of such procedures. For evaluation of the feasibility of composite-tissue reconstruction, an experimental model of composite face/scalp flap transplantation in rats was designed. Technical aspects of the model, survival rates, and the complications encountered during development of the model are presented. A total of 64 animals, in three experimental groups, were studied. In group I, the anatomical study group (n = 6), the anatomical features of the face and scalp region in rats were explored. Groups II and III were the transplantation groups. Isograft transplantations were performed between identical Lewis rats (RT11 to RT11), and allografts were transplanted, across major histocompatibility complex barriers, between Lewis-Brown Norway rats (RT1l/n) and Lewis rats (RT11). In group II (the control group, n = 8), transplantation of nonvascularized composite face/scalp isografts and allografts was performed. In group III (the transplantation group, n = 50), vascularized face/scalp isografts (n = 36) and allografts (n = 14) were transplanted. Complications included partial or total flap necrosis, death attributable to food aspiration, and poor general condition. To prevent acute and chronic allograft rejection, cyclosporine A (16 mg/kg per day) therapy was initiated 24 hours after transplantation; the dose was tapered to 2 mg/kg per day within 4 weeks and was maintained at that level thereafter. Long-term survival (>170 days) was achieved, without any signs of rejection, with low-dose (2 mg/kg per day) cyclosporine A therapy. This is the first report documenting successful composite face/scalp flap transplantation in the rat model.

Tolerance induction in composite facial allograft transplantation in the rat model.

Clinical application of composite tissue allograft transplants opened discussion on the restoration of facial deformities by allotransplantation. The authors introduce a hemifacial allograft transplant model to investigate the rationale for the development of functional tolerance across the major histocompatibility complex barrier. Eighteen rats in three groups were studied. The composite hemifacial allotransplantations including the ear and scalp were performed between Lewis-Brown Norway (RT1l+n) and Lewis (RT1l) rats and isotransplantations were performed between Lewis rats. Isograft controls (n = 6) and allograft controls (n = 6) did not receive treatment. Allografts in treatment group (n = 6) were treated with cyclosporine A 16 mg/kg/day during the first week; this dose was tapered to 2 mg/kg/day over 4 weeks and maintained at this level thereafter. Functional tolerance to face allografts was evaluated clinically and histologically. Donor-specific chimerism was assessed at days 21 and 63 by flow cytometry. In vitro evaluation of donor-specific tolerance was performed by mixed lymphocyte reaction at day 160 after transplantation. Isograft controls survived indefinitely. All nontreated allografts were rejected within 5 to 7 days after transplantation, as confirmed by histopathologic analysis. Five of six face allografts under the cyclosporine A protocol showed no signs of rejection for up to 240 days and remained alive and under evaluation, whereas one animal showed signs of rejection at day 140. This was reversed by adjustment of the cyclosporine A dose. At day 21 after transplantation, flow cytometric analysis of the donor-specific chimerism showed 1.11 percent of double-positive CD4FITC/RT1Ac-Cy7 and 1.43 percent of double-positive CD8PE/RT1Ac-Cy7 T-cell populations in the peripheral blood of hemiface allotransplant recipients. The chimerism level of double-positive CD4FITC/RT1Ac-Cy7 T cells increased to 3.39 percent, whereas it remained stable for the double-positive CD8PE/RT1Ac-Cy7 T-cell population at day 63 after transplantation (1.00 percent). The mixed lymphocyte reaction assay at day 160 after transplantation revealed donor-specific tolerance to donor (Lewis-Brown Norway) antigens and strong reactivity to the third-party (ACI) alloantigens. In this study, donor-specific chimerism and functional tolerance were induced in hemifacial allograft transplants across the major histocompatibility complex barrier under cyclosporine A monotherapy protocol. This model will allow further studies on tolerance induction protocols.

Reconstruction of Traumatic Orbital Floor Fractures With Resorbable Mesh Plate

Various materials such as autogenous bone, cartilage and alloplastic implants have been used to reconstruct orbital floor fractures. A new material is needed because of disadvantages of nonresorbable alloplastic materials and difficulties in harvesting autogenous tissues. In this study safety and value of the use of resorbable mesh plate in the treatment of orbital floor fractures are discussed. Between 2002 and 2004 a total of 17 maxillofacial trauma patients complicated with orbital floor fractures were treated with resorbable mesh plate through subciliary or transconjunctival incisions. Pure blow-out fractures were determined in 6 patients and 11 patients had accompanying maxillofacial fractures. Resorbable plate was easily shaped to fit to the orbital floor by cutting with scissors. Patients were evaluated clinically and with computed tomography scans preoperatively and at 3-, 6- and 12-month intervals postoperatively. Twelve patients had preoperative enophthalmos. Two patients had diplopia that was corrected postoperatively. In all 17 cases there was no evidence of infection, diplopia and gaze restriction postoperatively. Scleral show appeared in three patients by the second postoperative week but resolved totally within 3 to 6 weeks except one patient. In this patient anterior displacement of mesh was evident which caused ectropion and enophthalmos and required re-operation. No any other mesh related problems were seen at 15 months mean follow-up time. The advantage of the resorbable mesh system in orbital floor fracture is the maintenance of orbital contents against herniation forces during the initial phase of healing and then complete resorption through natural processes after its support is no longer needed. Our experience represents that resorbable mesh is a safe and effective material for reconstruction of the selected, non-extensive orbital floor fractures.

The Impact of Breast Size on the Vertebral Column: A Radiologic Study

BackgroundMacromastia usually is associated with the physical and psychological symptoms reported comprehensively by many studies. Reduction mammoplasty seems to be the most reasonable solution for these symptoms, and many articles have reported improvement of these complaints after surgery. Some authors have postulated that the anatomic mechanisms of postural aberrations are heavy breasts and related pain symptoms. However, limited numbers of studies have tried to explain the effect of the heavy breasts on the vertebral column.MethodsThis study enrolled 100 females in four groups according to their breast cup sizes (groups A, B, C, D). All four groups were compared with each other statistically using one-way analysis of variance (ANOVA) followed by a post hoc test according to the body mass index (BMI) as well as the thoracic kyphosis, lumbar lordosis, and sacral inclination angles.ResultsThe BMI was significantly higher in the D cup–sized breast group. There was a statistically significant difference between groups A and D in terms of the thoracic kyphosis and the lumbar lordosis angles, and between groups B and D in terms of the lumbar lordosis angle. No statistically significant difference was detected between the groups in terms of the sacral inclination angle.ConclusionBreast size seems to be an important factor that affects posture, especially the thoracic kyphosis and lumbar lordosis angles.

Role of thymus in operational tolerance induction in limb allograft transplant model

Background. In this study, we evaluated the role of host thymus in tolerance induction in composite tissue allografts (CTA) across major histocompatibility complex (MHC) barrier during a 7-day αβ- T-cell receptor (TCR)/ cyclosporine A (CsA) protocol. Materials and Methods. A total of 62 limb allograft transplants were studied. Euthymic (group A) and thymectomized (group B) Lewis recipients (LEW, RT1l) received vascularized hind-limb allografts from hybrid Lewis × Brown-Norway (F1), (LBN, RT1l+n) donors. Mixed lymphocyte reaction (MLR) and skin grafting assessed donor-specific tolerance in vitro and in vivo, respectively. Flow cytometry determined the efficacy of immunosuppressive protocols and the presence of donor-specific chimerism. Immunocytochemistry revealed the presence of donor-specific cells in the lymphoid organs of recipients. Results. Isograft transplants survived indefinitely. For thymectomized rats, the median survival time (MST) of limb allograft in non-treated recipients was 7 days; monotherapy with αβ-TCR extended MST to 16 days, and CsA therapy extended it to 30 days. Using the αβ-TCR/CsA protocol, the MST of allografts was 51 days. For euthymic rats, the MST of limb allograft in non-treated recipients was 7 days; monotherapy with αβ-TCR or CsA extended MST to 13 or 22 days, respectively. Treatment with αβ-TCR/CsA resulted in indefinite allografts survival (MST=370 days). MLR and skin grafting confirmed donor-specific tolerance in euthymic recipients. Flow cytometry showed stable chimerism in the euthymic rats and transient chimerism in thymectomized limb recipients. Immunoperoxidase staining revealed the persistence of donor-derived cells in the lymphoid tissues of euthymic recipients. Conclusion. We found that the presence of thymus was imperative for the induction of donor-specific tolerance in rat hind-limb composite tissue allografts using a αβ-TCR/CsA protocol.

Prospects for facial allograft transplantation in humans.

The face is a functional as well as an esthetic part of the body. It is the window through which we interact with others: two thirds of our communication is through nonverbal facial expressions. Reconstructing partial or full facial deformities caused by burns, trauma, or tumors still challenges most reconstructive surgeons. The ideal reconstructive procedure should address both the functional and esthetic units of the face.

Odontogenic keratocyst: an unusual location and review of the literature.

Odontogenic keratocyst is an epithelial developmental odontogenic cyst most commonly occurring in the jaws. It comprises approximately 11% of all cysts of the jaws. It has an aggressive behavior including high rates of recurrence, rapid growth, and extension into adjacent tissues. Odontogenic keratocyst is commonly found in the mandible with a predilection for angle and ascending ramus of the mandible. We document a case of odontogenic keratocyst that is unusually originated from the temporomandibular joint and we review the existing literature concerning odontogenic keratocyst. As far we know this is the first case of the odontogenic keratocyst originating from the temporomandibular joint in the English-written literature.

The effect of gradually increased blood flow on ischemia-reperfusion injury.

Even with excellent operative techniques, prolonged ischemic periods may cause unwanted results because of a complex mechanism called reperfusion injury. Various pharmacological and immunological agents have been used to prevent this type of injury. Another known way to diminish reperfusion injury is the gradual reperfusion of the ischemic tissues. In this study, the effect of a gradual increase in blood flow on ischemia-reperfusion injury of the skeletal muscle was investigated. The right hind limbs of 15 rats were partially amputated, leaving the femoral vessels intact. Preischemic femoral arterial blood flow was measured by using a transonic small-animal blood flowmeter (T106) in all animals. The rats were divided into three groups: Group I consisted of control rats; no ischemia was induced. Group II was the conventional clamp release group. Clamps were applied to the femoral vessels to induce 150 minutes of ischemia. The clamps were then released immediately and postischemic blood flow was measured. Group III was the gradual clamp release group. After 150 minutes of ischemia, clamps were released gradually at a rate so that the blood flow velocity would reach one fourth the mean preischemic value at 30 seconds, one half at 60 seconds, three fourths at 90 seconds, and would reach its preischemic value at 120 seconds. Total clamp release was allowed when blood flow was less than 1.5 fold of the preischemic values. Postoperatively the soleus muscles were evaluated histopathologically, and malonyldialdehyde and myeloperoxidase levels were measured. The mean preischemic blood flow was 13.6 ± 2.24 ml per kilogram per minute in all groups. In the conventional release group, postischemic flow reached four to five fold its preischemic values (61.06 ml per kilogram per minute). Histopathology revealed more tissue damage in the conventional release group. Malondialdehyde and myeloperoxidase levels were also significantly lower in the gradual release group. Depending on histological and biochemical findings, a gradual increase in blood flow was demonstrated to reduce the intensity of ischemia-reperfusion injury in the soleus muscle of this animal model.Ünal Ş, Özmen S, Demİr Y, et al. The effect of gradually increased blood flow on ischemia-reperfusion injury. Ann Plast Surg 2001;47:412–416

Gluteal Region Morphology: The Effect of the Weight Gain and Aging

Abstract. The gluteal region is an important secondary sexual character itself and it has its place in the concept of the beauty in all communities. Interestingly, as far as we know, there is not any previous study addressing gluteal region morphology in an objective way in the aesthetic surgery literature. The aim of this study was to define the changes of the gluteal region morphology with aging and weight gain.Beside body weight, a total of five distances between predetermined anatomic points in gluteal region were measured on randomly selected 115 female volunteers, with their age ranging from 17 to 48 years (mean 22.7). All the records were analyzed by a correlation matrix using computer-based SPSS 7.5 program.As women grow older, the width of the gluteal region decreases and the gluteal sulcus elongates laterally and inferiorly. Contrary to aging, with weight gain the gluteal region becomes wider as the gluteal sulcus gets shorter.Although the subject does not sound new, our study is the first, documenting the changes in morphology of the gluteal region in relation to weight gain and aging in an objective way.

Upper lateral cartilage fold-in flap: a combined spreader and/or splay graft effect without cartilage grafts.

Dorsal hump reduction almost always breaks the internal nasal valve and nasal obstruction is likely to occur postoperatively, unless reconstructed. One hundred eighty patients were operated using both open and closed rhinoplasty approaches. Upper lateral cartilages were meticulously separated from their junction with septum. Following bony and septal cartilaginous hump removal, upper lateral cartilages were folded inward. Either transcartilaginous horizontal mattress/simple sutures or perichondrial sutures were used depending of the desired width of the middle vault and the necessity for a splay-graft effect. In 7 patients unilateral, and in 1 patient bilateral, nasal synechia occurred and they were all treated under local anesthesia. All patients but 9 stated significantly improved nasal breathing. There was no inverted-V deformity or middle-vault narrowing observed. This technique is simple and physiologic, might be applicable for almost all primary rhinoplasty patients. Although it is possible with closed rhinoplasty approaches, it is easier with an open approach.