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Biomedical subjects

Emrah Arslan

Publications and source records attributed to Emrah Arslan.

At least 19 recordsLinked to original sources
PubMed2006

Combined use of triple cartilage grafts in secondary rhinoplasty.

UNLABELLED: Secondary rhinoplasty on a patient with a middle vault deformity is one of the most challenging procedures for a plastic surgeon. In order to achieve proper nasal aesthetics and airway function, a surgeon most commonly chooses to engraft the nose with a spreader, dorsal onlay, or columellar graft. This paper examines the aforementioned techniques in the management of 25 patients who presented with a severe middle nasal vault deformity. METHODS: During the last 5 years, 25 patients received secondary rhinoplasty using triple cartilage grafts to repair severe middle vault deformities. Patients were then questioned at least 3 months postoperatively about both airway problems and cosmetic satisfaction. RESULTS: All the 25 patients indicated cosmetic satisfaction with 23 of the patients also achieving complete nasal airway function. Only two patients persisted to have an insufficient nasal airway. An endonasal examination revealed a slight nasal synechiae in one patient, while no anatomic problem was identified in the second patient. From a cosmetic standpoint, a straight dorsum with improved dorsal aesthetic lines and nasal profile, along with nasal-facial balance were achieved. When indicated, secondary rhinoplasty to repair a middle vault deformity using the combination of spreader, dorsal onlay, and columellar grafts to augment the nose has shown to have both functional and cosmetic benefits.

Adolescent↗
PubMed2006

An algorithm for deciding alternative grafting materials used in secondary rhinoplasty.

Severe middle vault deformity with disturbed nasal form and function is one of the most challenging procedures to correct in a secondary rhinoplasty. Reconstructing the deformity with autologous septal cartilage would be the primary choice of most surgeons, if it were always available. However in certain cases the lack of a sufficient quantity of autologous cartilage has forced surgeons to explore other viable options. This paper discusses our experience with the combined use of spreader and dorsal onlay grafts from various materials in the reconstruction of severe middle vault deformity in 110 patients. In follow up, (between 6 and 42 months; mean 21 months) all patients were noted to have improved in both aesthetics and function with no major complications noted. In summary, this study proposes that any engrafting material can be used safely when the proper surgical principals and technique are employed.

Adult↗
PubMed2005

The additive effects of carnitine and ascorbic acid on distally burned dorsal skin flap in rats.

BACKGROUND: The purpose of this study was to determine the effects of combined use of L-carnitine and vitamin C on partially burned skin flap in an experimental rat model. MATERIAL/METHODS: In the rat dorsal skin, a 10 x 3 cm flap was marked. The most distal 3 x 3 cm part was burned to full thickness. Twenty-four rats were randomized into four groups with 6 animals in each. Group 1 was simply followed up. Group 2 was given 0.5 mg/kg vitamin C per day for 7 days, group 3 100 mg/kg carnitine per day for 7 days, and group 4 both carnitine and vitamin C. On the eighth postoperative day, the animals were sacrificed and examined. The surviving and necrotic areas were determined by macroscopic examination and measured with a planimeter. RESULTS: The areas of flap necrosis were measured. The median surviving areas and areas of flap necrosis, respectively, of the groups were: group 1, 16.0 cm(2) and 14.0 cm(2); group 2, 18.25 cm(2) and 11.75 cm(2); group 3, 20.0 cm(2) and 10 cm(2) ; and group 4, 23.75 cm(2) and 6.25 cm(2). The surviving areas of the groups were found to be significantly different (p=0.000). CONCLUSIONS: The risk of ischemia-induced necrosis in flap attempts made in damaged tissues may be reduced by the combination of two promising agents, L-carnitine and vitamin C. L-carnitine appears to be the major contributing factor that reduces necrosis, and vitamin C an additive agent.

Animals↗
PubMed2005

Microcirculatory hemodynamics after acute blood loss followed by fresh and banked blood transfusion.

BACKGROUND: Red blood cell (RBC) conformational changes occur when blood is stored. This study was designed to be a preliminary evaluation to assess how these changes affect the microcirculation. METHODS: The rat cremaster muscle flap model was used to evaluate in vivo microcirculatory changes after withdrawal of 1 mL blood with subsequent administration of fresh blood (group I, n=6) and banked blood (group II, n=6). Each group underwent a 3-stage evaluation: baseline, after blood withdrawal, and after transfusion. Using intravital microscopy, RBC velocity, vessel diameter, functional capillary perfusion, and leukocyte-endothelial interactions were noted. RESULTS: After blood withdrawal, changes in RBC velocity, vessel diameter, functional capillary perfusion, and number of activated leukocytes were observed in both groups, but these changes were more significant in stored blood compared with fresh blood (P<or=.05). CONCLUSIONS: Further work is needed to validate these findings, but these preliminary data suggest that stored blood may have a deleterious effect on the microcirculation.

Animals↗
PubMed2005

The relationship between patient stress and the blood levels of acute phase proteins in rhinoplasty: the report of a prospective study.

OBJECTIVE: This study aims to interrogate the relationship between patient stress and the levels of acute phase proteins (APP) in rhinoplasty. METHODS: Twenty-six primary rhinoplasty patients were asked about the most stressful step of the rhinoplasty process, which were (1) deciding on the operation, (2) waiting in the preoperative room, (3) the first few postoperative hours, and (4) withdrawing the nasal pack, in order beginning from the most stressful one, preoperatively, and then postoperatively. C-reactive protein (CRP), alfa-1-acide glycoprotein (AAG), ceruloplasmin (CER), haptoglobulin (HPT), and alfa-1-antitrypsin (AT) have been studied in blood to detect a relation between the patient stress and the levels of APP. RESULTS: Preoperatively, the "imagined" most stressful step was Step 4 (61.53%). Postoperatively, the "declared" most stressful step was Step 3 (50%). The blood levels of APP matched with the imagined rather than the declared stress. CONCLUSION: Patient stress could be a preoperative issue, which should be eliminated preoperatively. Detailed description of the surgery and some pharmaceutics can inhibit the negative effects of the stressors and have a contribution to patient comfort.

Acute-Phase Proteins↗
PubMed2005

Analysis of skin-graft loss due to infection: infection-related graft loss.

This prospective study was performed to analyze the causes of infection-related skin-graft loss in a general population of plastic and reconstructive surgery patients. One hundred thirty-two patients who received either full- or split-thickness skin grafts to reconstruct soft-tissue defects were included. The tissue defects were grouped according to the cause as follows: vascular ulcers (9.2%), burns (14.5%), traumatic tissue defects (36.6%), and flap donor-site defects (39.7%). In all cases, the preoperative evaluation indicated an adequate wound-bed preparation. However, graft loss secondary to infection was recorded in 31 patients (23.5%). The microbiological cultures revealed Pseudomonas aeruginosa in 58.1% of the cases (P<0.05), followed by Staphylococcus aureus, Enterobacter, enterococci, and Acinetobacter; 58.3% of grafts in vascular ulcers, 47.4% of grafts in burns, 16.7% of grafts in traumatic-tissue defects; and 13.5% of grafts in donor-site defects were lost due to infection. Vascular ulcers and burns were more commonly associated with graft losses due to infection than other tissue defects (P<0.001). No correlation was found between the etiological cause of the defects and the microorganisms cultured. However, Pseudomonas infections were more fulminant and caused an increased reoperation rate 4.2 times (P<0.05). Full-thickness grafts were more resistant to infection than split-thickness grafts (P<0.05). Graft loss due to infection was also more common in grafts applied to the lower extremities or when performed at multiple sites. In conclusion, 23.7% of skin grafts were lost due to infection in a group of general plastic surgery patients. Infection-related graft loss was more commonly encountered in vascular ulcers and burn wounds, and the most common cause was Pseudomonas aeruginosa.

Adult↗
PubMed2004

Ischemia/reperfusion injury: a review in relation to free tissue transfers.

Events during ischemia/reperfusion (I/R) injury include: neutrophil-mediated endothelial cytotoxicity and activation, generation of free radicals, triggering of cytokines and chemokines, and activation of adhesion molecules and complement system. This article briefly reviews events occurring during tissue ischemia and reperfusion in relation to free tissue transfers. The consequences of tissue damage at the microcirculatory level are presented. Preventive measures of I/R injury are outlined.

Complement System Proteins↗
PubMed2004

The effect of alprostadil on ischemia-reperfusion injury of peripheral nerve in rats.

OBJECTIVE: To determine the effect of alprostadil on the ischemia-reperfusion (I/R) injury of the sciatic nerve in rats. MATERIALS AND METHODS: Pre-reperfusion administration of alprostadil (0.05 microg kg(-1)) was assessed in the I/R injury model of the rat sciatic nerve. In this model, blood samples were investigated for the I/R injury markers namely malondialdehyde (MDA), an indicator of lipid peroxidation, and nitrite/nitrate levels, products of nitric oxide (NO) metabolism. RESULTS: A significant decrease in MDA, and increase in NO levels were observed in the groups which received alprostadil before reperfusion, when compared to their corresponding untreated controls (I/R only) at all time intervals (P=0.0001). There was a statistically significant difference in both MDA, and NO levels between certain time intervals. There was no statistical linear correlation between MDA and NO levels. CONCLUSION: Alprostadil may be suggested as a protective anti-inflammatory and a vasodilator pharmacological agent for I/R injury in peripheral nerves. Also, measurements of NO and MDA may be complementary to the generally accepted evaluation parameters of I/R injury including electromyography and nerve histopathology.

Alprostadil↗
PubMed2004

Enhanced frontalis sling with double-fixed, solvent-dehydrated cadaveric fascia lata allograft in the management of eye ptosis.

The article describes an enhanced frontalis sling procedure in the management of blepharoptosis with poor or no levator function. This modified method were used in the care of three patients and based on the principal of two-point fixation of the graft material that was prepared from solvent-dehydrated cadaveric fascia lata onto the frontalis muscle. After more than 1 year of follow-up, no recurrence was noted. With no extra incision over the skin, this surgical approach could be useful in the correction of difficult ptosis cases.

Adolescent↗
PubMed2003

Comparison of ischemic and chemical preconditioning in jejunal flaps in the rat.

Jejunum is one of the most frequently used free flaps in esophagus reconstruction. However, the sensitivity of intestinal tissue to ischemia decreases the margin of safety of this donor site while increasing the risk of postoperative complications such as fistula formation and stenosis. Ischemic preconditioning can increase the tolerance of jejunal tissue to ischemia. In this study, the authors investigated the effects of chemical preconditioning with adenosine infusion on ischemia reperfusion injury in the rat jejunum, and evaluated the presence of any additive effects of adenosine administration when used together with ischemic preconditioning. Forty Sprague-Dawley rats weighting 200 to 250 mg were used in the study. Rats were randomly divided into five groups. In group I (sham-operated controls), only laparotomy was performed. In group II (ischemia-reperfusion injury), the superior mesenteric artery was clamped for 40 minutes to induce ischemia in the small bowel, followed by 60 minutes of reperfusion. In group III (ischemic preconditioning), two cycles of 5-minute ischemia and 5-minute reperfusion were performed before implementation of the ischemia-reperfusion protocol used in group II. In group IV (chemical preconditioning), adenosine (1000 microg/kg) was infused into the internal jugular vein before the group II ischemia-reperfusion schedule was implemented. In group V (adenosine-enhanced ischemic preconditioning), adenosine (1000 microg/kg) was infused into the internal jugular vein before ischemic preconditioning, followed by 40 minutes of ischemia and 60 minutes of reperfusion. At the end of the reperfusion period, samples from the jejunum were harvested and myeloperoxidase activity was determined as a measure of leukocyte accumulation. Malondialdehyde levels were measured to assess lipid peroxidation. Histopathologic sections stained with hematoxylin-eosin were evaluated for the presence of mucosal damage according to the Chiu scoring method. Immunohistochemical staining by M30 monoclonal antibodies was performed to quantify the number of ischemia-induced apoptotic cells in the intestinal mucosa. The myeloperoxidase and malondialdehyde levels were significantly lower in groups I, III, IV, and V when compared with group II. Although there were no significant differences among myeloperoxidase and malondialdehyde levels in groups III, IV, and V, group I had significantly lower levels of activity compared with the other three groups. Histological scoring reflected significantly less damage in groups I, III, IV, and V compared with group II. Similarly, the number of apoptotic cells was significantly lower in groups I, III, IV, and V when compared with group II. However, no difference was detected among these four groups with regard to either histopathological scoring or apoptosis numbers. This is the first study showing that adenosine administration is as effective as ischemic preconditioning in inducing ischemic tolerance in the rat jejunum. However, there was no enhancement of ischemic preconditioning with prior adenosine infusion.

Adenosine↗
PubMed2003

Irradiated homologous costal cartilage: versatile grafting material for rhinoplasty.

For most surgeons, nasal septal cartilage is the first choice in septoplasty. However, when this source is depleted, an alloplastic implant material might be preferable over other autogenous donor sites in order to avoid additional scars, morbidity, and lengthened operating time. In the alloplastic spectrum, irradiated costal cartilage (ICC) has certain advantages. Herein, we present our results with ICC in a wide range of septorhinoplasties to show its versatility and reliability. Sixty-five patients were included in the study. There were 42 male and 23 female patients. According to the indications, there were four groups of patients: (I) secondary septorhinoplasty (n = 24), (II) traumatic deformity (n = 21), (III) primary septorhinoplasty (n = 13), (IV) deformity due to previous septal surgery (n = 7). The mean follow-up period was 33 months. No significant resorption was detected in any of the patients. Minor complications developed in four cases (6%), including deformity in the dorsal graft, excessive graft length, and erythematous nasal tips. Aesthetic and functional results were satisfactory in the remaining cases. The low incidence of major complications and the versatility of ICC make it a safe and reliable source of cartilage graft for both primary and secondary septorhinoplasties when autogenous septal cartilage is either insufficient or unsuitable.

Adult↗
PubMed2003

The effects of carnitine on distally-burned dorsal skin flap: an experimental study in rats.

OBJECTIVE: In ischemia and burn injuries, there are major alterations threatening tissue survival. Increased energy flow requirements are among the major problems in these disorders. Carnitine is an endogenous cofactor, which has a regulatory action on the energy flow from different oxidative sources. The purpose of this study was to determine the effects of carnitine in an experimental flap model. Biochemically, nitric oxide (NO), malondialdehyde (MDA), and acetylcholinesterase levels, and histopathologically tissue examination under light microscope were studied. METHODS: In the rat dorsal skin, a 10 cm x 3 cm flap was marked. The most distal 3 cm x 3 cm of the flap was burned to full-thickness. The dorsal flap was elevated, and sutured back to its original site. Sixteen rats were divided into two groups (a control (1) and a study group (2)), consisting of eight rats in each. While the animals in the control group were just followed, the animals in the study group were administrated carnitine with a dose of 100 mg/kg per day for 7 days. RESULTS: At the end of the experiment: the mean surviving areas of the flaps were 15.22 cm(2) (50.73%) in group 1, 20.53 cm(2) (68.43%) in group 2, and the difference was statistically significant (P=0.008). In the analysis of blood samples; the mean levels of NO were 22.63 and 40.78 micromol/l; of MDA were 6.74 and 3.79 ng/ml; and of acetylcholinesterase were 136.14 and 222.85 U/l in groups 1 and 2, respectively. The differences in the levels of NO (P=0.001), MDA (0.027) and acetylcholinesterase (P=0.006) were statistically significant. Histopathological examination revealed a full-thickness muscle necrosis in addition to skin tissue in the control group, while healing tissue was present with marked cellularity including mixed inflammatory cells and fibroblast proliferation with an increased vascularity in the form of capillary budding in the study group. CONCLUSION: Carnitine has a positive effect in such a model, particularly in preventing the progressive effect of burn, and limiting the necrosis in the full-thickness burned part.

Acetylcholinesterase↗