Biomedical subjects

Sebat Karamürsel

Publications and source records attributed to Sebat Karamürsel.

10 recordsLinked to original sources

PubMed2006

Use of the medial side of the knee skin as a free flap: saphenous flap.

BACKGROUND: The knee region is a good free skin flap donor site, as it has minimal subcutaneous tissue and provides a hidden donor site. Acland et al. first used the skin over the medial side of the knee as a "saphenous flap" based on the saphenous branch of the descending genicular artery. METHODS: The authors studied the descending genicular artery and its saphenous branch in six cadaver limbs and elevated the skin over the medial side of the knee as a free flap in six patients to reconstruct lower extremity defects. RESULTS: In all clinical cases, the authors were able to elevate a skin flap from the skin on the medial side of the knee. The saphenous branch was absent in one cadaveric limb and one patient limb; instead, a direct cutaneous branch from the femoral artery reached the skin and had nearly the same caliber as the saphenous branch of the other cases. All the flaps survived and the defects healed well. CONCLUSION: The medial side of the knee is a good donor site, as it provides thin skin with innervation potential by means of the medial femoral cutaneous nerve and leaves an inconspicuous donor-site scar.

Adult↗

PubMed2006

Urethral advancement for recurrent distal hypospadias fistula treatment.

Hypospadias fistula may be persistently recurrent in some patients. In distal hypospadiac fistula cases, carrying the fistulous opening to the glans tip may be possible with extensive urethral mobilization and advancement. In 9 patients who were operated for urethrocutaneous fistula, we used the urethral advancement technique. Patient ages ranged from 5 to 14 years (mean, 8 years). In all of the cases, the urethra was mobilized proximally to at least penoscrotal junction, and in some cases, the bulbar urethra was mobilized partially. Follow-up ranged from 6 months to 16 months. In all but 1 child, a straight penis with the neomeatus at the glans tip was maintained without any urethrocutaneous fistula. In 1 child, chordee, which was already present, could not be prevented.Urethral advancement technique may effectively solve the problem of persistently recurrent hypospadias fistula. We recommend the technique to plastic surgeons' armamentarium.

Adolescent↗

PubMed2006

Reconstruction of the columella with bilateral nostril sill flaps.

The treatment of total columellar defects is very difficult, and there is not any first choice in reconstruction of these defects. Various techniques have been reported for this purpose. Each technique has its own drawbacks, and few can be performed in one stage. We report a pediatric patient with a defect involving the entire columella. Reconstruction of the defect was accomplished with laterally based bilateral nostril sill flaps. An acceptable cosmetic result was obtained. This method can be done as a single-stage operation with an excellent color and texture match. We think that this method leads to good aesthetic results, and should be considered for total columellar reconstruction.

Child↗

PubMed2005

Versatility of the lateral arm free flap in various anatomic defect reconstructions.

The free lateral arm flap may be harvested as a fascial, fasciocutaneous, or osteofasciocutaneous flap. Simultaneous flap elevation with preparation of the recipient site, easy dissection, minimal donor-site morbidity, and a constant vascular anatomy with long pedicle are advantages of the flap. In this study, the authors present 18 patients operated on between January, 2002 and August, 2003 in whom 18 free lateral arm flaps were utilized. There were four women and 14 men, and the mean patient age was 40 years. Thirteen fasciocutaneous, three fascial, and two osteofasciocutaneous flaps were used. Flaps were employed for the reconstruction of the lower extremity in five patients, upper extremity in nine patients, and head and neck in four patients. Thirteen flaps were elevated under axillary block and five flaps under general anesthesia. Aspirin, dipirydamol, dextran, and chlorpromazine were administered postoperatively. Venous insufficiency developed in two lower-extremity reconstructions on postoperative day 1. Venous thromboses were detected, anastomoses were re-done, and flaps healed uneventfully. No other postoperative complication was observed in the other patients. The free lateral arm flap may be used in various anatomic defects with various indications. It may be elevated under axillary block for extremity reconstructions.

Adolescent↗

PubMed2005

Use of medial arm skin as a free flap.

BACKGROUND: Free transfer of the medial arm flap has not gained popularity despite the hidden donor-site scar as well as the hairless and elastic skin. This may be because of variations in vascular anatomy, leading to confusion during dissection of the flap. METHODS: In five preserved cadaver arms, the vascular pattern of medial arm skin was examined. Twenty-two upper extremity angiograms were examined, and 12 free medial arm flaps were elevated for various defects in 12 patients. RESULTS: In cadaver and clinical dissections, the authors found that blood supply to the flap is multiple: from the superior ulnar collateral artery, the direct cutaneous artery, or both. A superficial brachial artery may also be present, which was observed in four angiograms and two clinical cases (15 percent). Dissections showed that the medial arm skin may be elevated based on the superficial brachial artery, direct cutaneous artery, or superior ulnar collateral artery. A neurosensory flap may be obtained by including the medial brachial cutaneous nerve of the arm. CONCLUSIONS: A medial arm free flap is a plausible reconstructive option with good knowledge of the anatomical variations, as the defect on the medial arm is cosmetically more acceptable and has a better color match for head and neck reconstructions.

Adult↗

PubMed2005

Reverse-flow first dorsal metacarpal artery flap for index fingertip reconstruction.

Dorsum of the hand is an ideal skin-flap donor site for coverage of hand or finger defects. We elevated 8 reverse-flow first dorsal metacarpal artery flap in 9 patients for soft-tissue cover of index fingertip injuries distal to distal interphalangeal joint with exposed bone. In 3 patients, the digital branch of the superficial radial nerve was coapted to the digital nerve. All flaps healed uneventfully, except for 1 patient in which partial necrosis of the flap occurred. Postoperative follow-up was 4-12 months (mean, 8 months). Reverse-flow first dorsal metacarpal artery flap is a good alternative for reconstruction of index fingertip injuries.

Adolescent↗

PubMed2005

Rat penis as a replantation model.

The aim of this study is to assess the feasibility of rat penile replantation as a new microsurgical training model. The study was performed in 2 parts. ANATOMIC STUDIES: Fifteen Wistar albino rats were used to study and document the penile vascular anatomy. In 5 rats, dissections were performed after colored silicone injections, while 5 rats were operated under anesthesia to develop the strategy of flap elevation. In the remaining 5 rats, microangiographic study was performed with silicone-lead oxide mixture. FLAP STUDIES: As flap studies in 5 rats, penis were elevated based on right-side internal pudendal artery and internal pudendal vein and resutured. In 6 rats, penis were elevated as free flaps, and in 3 rats the penis were implanted in right thigh of the rats being the femoral artery and vein recipient. In the remaining 3 rats, penis were resutured in their original place, with saphenous artery and vein being the recipient and rerouted to the pubic region. At postoperative fifth day, the penis were examined for viability, and selected ones were histologically examined. Rat penis has a dual blood supply from bilateral internal pudendal arteries. Venous drainage is via both crural veins and dorsal vein. One side of the internal pudendal artery and anastomotic vein (branch of pudendal plexus) may be used as the vascular pedicle of the flap. Rat penis may be successfully elevated as a free flap and also may be replanted in its original place.

Animals↗

PubMed2004

External metallic circle in hepaticojejunostomy.

BACKGROUND: Biliary-enteric anastomosis especially Roux-en Y hepaticojejunostomy is frequently used for biliary diversion in benign biliary strictures. In this study, we present the results of hepaticojejunostomy with external metallic circle. METHODS: Hepaticojejunostomy with external metallic circle were performed in eight male Sprague-Dawley rats. At the end of the third month, anastomoses were analysed for patency and stability of external circles. RESULTS: Relaparotomy revealed that all the anastomoses were patent and circles were in original places. CONCLUSION: To provide the patency of narrow hepaticojejunostomy anastomoses, external metallic circle can be a good alternative to use of internal stents in suitable cases.

Anastomosis, Roux-en-Y↗

PubMed2004

Free microvascular transfer of coccygeofemoral muscle in rabbits.

A new experimental free flap model, the cocygeofemoral muscle flap of the rabbit, is introduced in this study. The coccygeofemoral muscle is a superficially located triangular muscle originating from the sacrum and inserting into the lateral condyle of the tibia, and it abducts the thigh. Anatomical dissection and microangiographic studies revealed that it has a major and a minor pedicle, the former originating from the caudal gluteal artery, and the latter originating from the caudal femoral artery. Its major pedicle contains the 0.7-mm artery, 1-mm vein, and the single nerve originating from the inferior gluteal nerve. In flap studies in 10 animals, the distal minor pedicle was ligated, and muscle was dissected up to its major pedicle and denervated, and the free muscle was transferred to the contralateral inguinal region via end-to-end anastomosis to the recipient vessels (i.e., the femoral artery and vein). At postoperative day 7, the transferred muscles were harvested and histologically examined. Nine of 10 muscles were viable; the coccygeofemoral muscle free flap is believed to be an easy-to-dissect and bulky flap model, having a relatively thick pedicle. It may serve as a good model in free muscle flap studies.

Animals↗

PubMed2004

A new epineural nerve repair technique with external metallic circle.

BACKGROUND: Despite the existence of various nerve coaptation techniques, functional results of nerve repair are still inadequate. Potential benefits of developing modified coaptation techniques cannot be disregarded. METHODS: The authors report a new coaptation technique in which the epineural sutures were performed with an external metallic circle to increase the coaptation surface. The sciatic nerves of 30 male Wistar albino rats were used in the study. RESULTS: The mean Sciatic Function Index values in external metallic circle repair (n:11) and conventional epineural repair (n:10) groups were -42.35 +/- 22.95 and -69.34 +/- 17.96, respectively (p = 0.020). Electrophysiological studies revealed that the duration of compound muscle action potentials (CMAP) was (p = 0,012) shorter in conventional nerve repair group than it was in external metallic nerve repair. When external metallic circle repair and conventional epineural repair groups were examined for distal nerve segments, there were significant findings for the diameter of axons (p = 0.005), diameter of nerves (p = 0.000), and for G ratios (p = 0.000). The mean intraepineural cross sectional areas of external metallic circle repair and conventional epineural repair groups were 3.57 +/- 0.21 and 2.92 +/- 0.23 mm(2), respectively (p = 0.000). CONCLUSION: The external metallic circle repair technique enhances nerve regeneration by enabling a larger sprouting and contact area for nerve fibers.

Animals↗