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Biomedical subjects

Nedim Savaci

Publications and source records attributed to Nedim Savaci.

16 recordsLinked to original sources

Pyoderma gangrenosum in a battered child.

Pyoderma gangrenosum is an uncommon cutaneous ulceration, which continues to be a difficult disorder to diagnose and treat. A pediatric case of pyoderma gangrenosum with no associated systemic disorder is presented. The disease was precipitated by physical trauma. The disease was controlled with systemic corticosteroid therapy and then the wound was successfully covered with a split-thickness skin graft from the thigh without any healing problem at the donor site. Although pathergy is well described in the etiopathogenesis of the disease, this is the first case reported that was precipitated after physical assault.

Child↗

Effects of isoflurane and sevoflurane on the survival of skin flaps in rats.

The effects of inhalational anaesthetic agents on survival of flaps are not well known. We investigated the effect of isoflurane and sevoflurane anaesthesia on survival of flaps using a caudally-based McFarlane skin flap in 20 male Wistar rats. Sevoflurane 1 minimum alveolar concentration (MAC) and isoflurane (1 MAC) in oxygen mixture was given to the animals. A 4 x10 cm caudally-based standard McFarlane flap was raised. There were no differences in any haemodynamic values or blood gases between the sevoflurane group and the isoflurane group. Skin flaps were assessed on the seventh day. The isoflurane group had a significantly smaller area of skin flap necrosis and an increased area of flap surviving than the sevoflurane group. We conclude that survival is significantly improved when isoflurane is used as the inhalational anaesthetic rather than sevoflurane.

Anesthesia↗

Maxillofacial morphology in children with complete unilateral cleft lip and palate treated by one-stage simultaneous repair.

BACKGROUND: There is a common belief among the majority of surgeons occupied with cleft lip-cleft palate repair that early one-stage simultaneous repair of hard and soft palates affects maxillofacial development adversely. This proposition has not been proven with long-term clinical studies. In this study, the effects of one-stage repair on the maxillofacial development of children with complete unilateral cleft lip-cleft palate were investigated, and the results were compared with those of the cleft children treated with conventional two-stage repair. METHODS: The study was designed as follows. Group 1 consisted of 19 children (mean age, 85.4 +/- 12.8 months) treated with a one-stage procedure. In this group, cleft lip, palate, and alveolus were repaired simultaneously at a single surgical session in the first 10 months of life (mean age at time of surgery, 6.8 +/- 1.2 months). Group 2 consisted of 22 children (mean age, 90.1 +/- 13.0 months) treated in two stages as follows: lip repair was performed at a mean age of 4.8 +/- 1.0 months and palate repair was performed at a mean age of 14.6 +/- 2.0 months. The follow-up period was approximately 6.3 years for both study groups. Group 3 (control) consisted of 27 children (mean age, 87.1 +/- 11.7 months) without cleft who were matched for age. RESULTS: Compared with the control group, the children in both cleft groups revealed a greater maxillomandibular retrognathism, a more open palatal plane, larger anterior facial heights, and decreased posterior vertical maxillofacial heights. No significant difference was determined between study groups 1 and 2. CONCLUSIONS: Because both of the surgical treatment procedures give rise to similar maxillofacial development outcomes, regardless of the timing of surgery, the one-stage procedure offers several important advantages, such as less psychosocial trauma, low cost, and possibly an improvement in speech results because of less scarred palatal fields and the low rate of palatal fistula.

Cephalometry↗

Delaying the reverse sural flap provides predictable results for complicated wounds in diabetic foot.

Defective wounds in diabetic foot are difficult to manage. Several studies reported the use of reverse sural flap in a small number of patients with varying success. We presented our experience with the reverse sural island flap (RSIF) in a series of 37 patients associated with diabetic foot using the delay procedure. The ages of the patients ranged between 36 and 73 years. We did not perform angiographic evaluation to determine the existence of vascular connections between the branches of the peroneal and posterior tibial artery; however, Doppler ultrasound evaluation was done to determine the patency of anterior and posterior tibial arteries, as well as lesser saphenous vein before the operation. The flaps were transferred using a 3-step delay procedure. While all the first and second steps of the operations were done under local anesthesia, the third steps were performed using general anesthesia in 12 and spinal anesthesia in 25 patients. All flaps survived except 4 showing partial necrosis due to venous insufficiency. Delaying the RSIF is a reliable procedure for diabetic foot skin defects.

Adult↗

Reconstruction of microform cleft lip.

Partial cleft of the orbicularis oris muscle without skin and mucosa can also be called "discontinuity of the orbicularis oris muscle" or "subepithelial cleft". Microform cleft lip or mini-cleft lip are better definitions. We present two women aged 25 and 29 years old who complained of vermilion notching, vertical depression on the upper lip, and asymmetry of lower lateral cartilage of the nose. The "discontinuity of the muscle" was found at operation in both cases and reconstructed successfully.

Adult↗

A simple method for breast implant placement using a drainage tube.

Silicone breast implants have been used for augmentation mammoplasty. In most cases, the surgery is performed for cosmetic purposes. Although the incision line must be of minimal length, it is difficult to replace silicone prosthesis in these patients by a minimal incision. A Drainage tube is a choice for draining the air and facilitates replacement of the prosthesis. The authors have used this method successfully for 13 cases. There were no complications. The described technique can be used for all augmentation mammoplasties using silicone breast implants.

Breast Implantation↗

No-vertical-scar technique versus inverted T-scar technique in reduction mammoplasty: a two-center comparative study.

Currently, a reverse T-shaped scar remains in the infraareolar area after most of the frequently used techniques for reduction mammoplasty. A two-center study was performed for an understanding of the effects from the amount of scars on the aesthetic satisfaction of patients. Long-term follow-up results for 24 patients who underwent the McKissock (inverted T-scar) technique (group 1) in a university hospital were compared with the results for 29 patients who underwent a "no-vertical-scar technique" (group 2) at another hospital in terms of aesthetic results. With this aim, a questionnaire was designed to assess the patients' degree of aesthetic satisfaction with different aspects. Additionally, the most current photos of each patient were evaluated for aesthetic results by four physicians and four medical students. Areola-fold and nipple-notch distances were measured as an objective evaluation. The significance of the results was tested using dependent or independent sample t tests. Notch-nipple and areola-fold distances both were greater in group 2 than in group 1, both preoperatively and postoperatively (p < 0.001). The personal satisfaction questionnaire showed that the group 2 patients rated scar satisfaction and postoperative activity levels higher (p < 0.001) than the group 1 patients (p < 0.05), but that group 1 rated nipple position higher (p < 0.05). There was no significant difference between the two groups in terms of general aesthetic satisfaction. Physicians who evaluated patient photos ranked the scars of group 2 as significantly superior to those of group 1 (p < 0.01), whereas they did not rate other features as significantly different. However students could not determine any superiority of any feature between the two groups. The no-vertical-scar technique gives the impression of a breast that has not undergone surgery because it leaves no scars in the infraareolar area and invisible scars in other areas. This situation improves the degree of satisfaction for patients in the postoperative period. When the general aesthetic success and the ratio of complications were evaluated, the no-vertical-scar technique was found to be just as successful as the T- scar technique, which is practiced widely.

Adult↗