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Haluk Duman

Publications and source records attributed to Haluk Duman.

10 recordsLinked to original sources
PubMed2005

Subacute reconstruction of lower leg and foot defects due to high velocity-high energy injuries caused by gunshots, missiles, and land mines.

The present study reviews 215 male patients suffering high velocity-high energy injuries of the lower leg or foot caused by war weapons such as missiles, gunshots, and land mines. They were treated in the Department of Plastic and Reconstructive Surgery at Gulhane Military Medical Academy (Ankara, Turkey) between November 1993-January 2001. Severe soft-tissue defects requiring flap coverage and associated open bone fractures that were treated 7-21 days (mean, 9.6 days) after the injury were included in the study. Twenty-three of 226 extremities (10.2%) underwent primary below-knee amputation. The number of debridements prior to definitive treatment was between 1-3 (mean, 1.9). Gustilo type III open tibia fractures accompanied 104 of 126 soft-tissue defects of the lower leg. Sixty-four bone defects accompanied 83 soft-tissue defects of the feet. Eighteen local pedicled muscle flaps and 208 free muscle flaps (latissimus dorsi, rectus abdominis, and gracilis) were used in soft-tissue coverage of 209 defects. Overall, the free muscle flap success rate was 91.3%. Bone defects were restored with 106 bone grafts, 25 free fibula flaps, and 14 distraction osteogenesis procedures. Osseous and soft-tissue defects were reconstructed simultaneously at the first definitive treatment in 94% of cases. The mean follow-up after definitive treatment was 25 (range, 9-47) months. The average full weight-bearing times for lower leg and feet injuries were 8.4 months and 4 months, respectively. Early, aggressive, and serial debridement of osseous and soft tissue, early restoration of bone and soft-tissue defects at the same stage, intensive rehabilitation, and patient education were the key points in the management of high velocity-high energy injuries of the lower leg and foot.

Adult↗
PubMed2005

Versatility of the reverse lateral arm flap in the treatment of post-burn antecubital contractures.

If they are not managed with proper treatment and rehabilitation, full thickness burns involving the cubital fossa may result in severe contractures that may impair upper extremity functions. Later release of these contractures discloses a large soft tissue defect that should be replaced. We used reverse lateral arm flaps for coverage of the cubital fossa in 11 selected cases of antecubital contracture. Ten flaps survived totally while we experienced one distal partial necrosis, which was later treated by skin grafting. We achieved considerable functional improvements in all cases. Although fasciocutaneous flaps offer the advantage of using regional tissue in a single stage, few versatile local flaps relying on the vascular anatomy around the elbow joint are available for cubital fossa coverage. Being a rapid, easy and one-staged procedure with no necessities for sacrifice of a major artery or muscle and for a long-term immobilization of the involved joints, reverse lateral arm flaps appears to be advantageous in comparison to other options for coverage of the cubital fossa defects after the release of antecubital contractures.

Adult↗
PubMed2005

Psychological evaluation of self-inflicted burn patients: suicide or parasuicide?

Self-inflicted burns have an increasing incidence all around the world. There is a high mortality and morbidity rate among these patients. We retrospectively analysed the psychiatric characteristics of self-inflicted burn patients. The results showed that these attempts are somewhat different from suicidal acts and may be defined as parasuicides. The treatment and rehabilitation strategies of so called parasuicidal burns are discussed.

Adult↗
PubMed2002

Radiotherapy: effects on expanded skin.

Although the combination of radiation and tissue expansion has been associated with a significant rate of complications, the specific pathophysiology has yet to be clearly elucidated. The objective of this study was to develop a model to identify and examine specific histologic changes associated with tissue expansion and irradiation. Rectangular 50-cc silicone tissue expanders were placed subcutaneously over the midline dorsum of 18 adult New Zealand white rabbits. Preoperative radiographic dosimetry demonstrated that the radiation portal was away from vital intraabdominal structures. The expanders were inflated with 10 cc of saline every other day for a total of 80 cc. Expanders were left in place for 2 to 3 weeks to allow fibrovascular capsule formation. The rabbits were then divided into three groups (six rabbits per group), each receiving one of three nonfractionated doses of radiation (20, 25, or 35 Gy). Half of the expanded skin was irradiated using a single dose, and the other half served as a nonirradiated control. Capsules and skin were harvested 6 weeks after the delivery of radiation, allowing the beginning of chronic radiation changes to occur. Using hematoxylin and eosin staining, histomorphometric analysis was performed. The data were analyzed using Student's test. Although irradiation did not affect dermal thickness, it did cause a statistically significant increase in epidermal thickness. At 20, 25, and 35 Gy the increase in epidermal thickness was 43, 90, and 130 percent, respectively. Although significant epidermal changes could be identified, capsular and dermal alterations were not evident. Further studies evaluating the long-term effects of alterations in capsular formation caused by radiation may be required.

Animals↗
PubMed2002

Flow-through use of the osteomusculocutaneous free fibular flap.

A case of a forearm defect resulting from a high-velocity firearm injury was reconstructed by flow-through free transfer of the osteomusculocutaneous fibular flap harvested from the remaining stump of the patient's left leg that was amputated below the knee. The dimensions of the bone defect and damage to anatomic structures of more than one type (including ulnar artery, ulnar bone, and overlying soft tissue) were the reasons for the treatment approach with a composite tissue transfer including vascularized bone. Preoperative radiographic and angiographic examination revealed that the amputation stump offered a fibular shaft with adequate length and a peroneal artery patent up to the most distal point of the bone. Instead of the usual osteocutaneous fibular harvest, flap harvest was performed in an osteomusculocutaneous manner with incorporation of a segment of soleus muscle with an overlying skin paddle. In addition to the replacement of the bone defect, transfer of the flap in a flow-through manner reestablished the dual blood supply of the hand by replacing the ulnar artery gap, whereas the muscle and skin of the flap allowed three-dimensional reconstruction of the complex defect. In severe injuries of the upper extremity, flow-through free transfer of the fibular flap provides not only replacement of the resulting composite defect but also may offer salvage, or at least revascularization, of the extremity when complicated by arterial damage.

Adult↗
PubMed2002

Retrospective study of the management of chemotherapeutic extravasation injury.

Despite the now widespread experience with the administration of chemotherapeutic agents in oncology, extravasation injuries still occur. Furthermore, the most appropriate management of such injuries is not known. The authors examined the current treatment options for extravasation injury and the incidence of this problem. All cases of extravasation referred to the plastic surgery service at one institution from 1994 through 1996 were examined. During a 6-year period there were 44 cases of extravasation injury identified in 42 patients. Comparison with a previous study conducted 15 years before at the same institution revealed a significant reduction in the incidence of extravasation injuries during that time (0.01% vs. 0.1%; = 0.00). The site of extravasation was peripheral in 32 cases and central in 12. Paclitaxel and doxorubicin were the two most common drugs involved. The local infusion of antidotes was not performed routinely. Only 26 of the 42 patients were referred to the plastic surgery service for care. Only 10 of those 26 patients required local ulcer excision and closure to achieve a healed wound. The mean time between injury and referral was 40 days. This time did not predict the subsequent need for a surgical procedure. Most patients, including the remaining 16 referred to the plastic surgery service, did not require surgical intervention. All were watched expectantly, and their injuries healed spontaneously. In conclusion, the incidence of extravasation is decreasing, most likely as a result of the diligence in the administration and identification of extravasation injuries as well as the result of the use of more central infusion sites. Most cases can be managed conservatively, with directed surgical treatment of the ulceration when appropriate.

Adolescent↗
PubMed2002

Versatility of the medial plantar flap: our clinical experience.

The medial plantar flap presents an ideal tissue reserve, particularly for the reconstruction of the plantar and palmar areas, which require a sensate and unique form of skin. In the past 5 years, the authors performed 16 free flaps, 10 locally pedicled flaps, and five cross-leg flaps on 31 patients for the reconstruction of palmar and plantar defects. All flaps transferred to the palmar area survived, providing good color match and sufficient bulkiness. The overall results were satisfactory in terms of function and sensation, and no complications related to flap survival in the plantar area were observed. All flaps used to cover defects in the heel and ankle region adapted well to their recipient areas, and all lower extremities remained functional. Because the medial plantar flap presents glabrous, sensate skin with proper bulkiness and permits the movement of underlying structures, the authors advocate its use and view this procedure as an excellent alternative in the reconstruction of palmar and plantar weight-bearing areas.

Adult↗
PubMedDate not supplied

Early-onset unilateral electric cataract: a rare clinical entity.

Electrical injury may result in cataracts, which usually occur bilaterally. In this report, we present a rare complication of such an injury presenting as a unilateral cataract in a 33-year-old woman with a painless but gradual worsening of vision in her left eye 3 weeks after sustaining a high-voltage electrical injury. A cataract did not develop in the right eye during 26 months of follow-up. The patient underwent successful cataract surgery with an excellent return of vision. Electrical injuries may result in the formation of a unilateral cataract and therefore an ophthalmic examination should be performed regularly in the early recovery period of such injuries. Cataract surgery with intraocular lens implantation results in an excellent return of vision in patients with electrical cataract who do not have any other ocular damage.

Adult↗