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Mandibular reconstruction is important for providing good functional and cosmetic results after the resection of a mandibulary segment. Reconstruction plates and titanium meshes are usually used to reconstruct the bony defects in mandible. Although their complications are well known there is not a report on the fractures of a titanium mesh after mandible reconstruction in the literature. We reported a case of a broken titanium mesh after mandible reconstruction.

Prilocaine (Citanest (R), AstraZeneca Pharmaceuticals, Wilmington, Del) is a commonly used agent in infiltrative anesthesia, and its adverse effects are well known. The authors report a full-thickness skin necrosis after using prilocaine as a local anesthetic that resulted in a flop closure. To the authors' knowledge, there have been no previously described cases of skin necrosis after use of the local anesthetic prilocaine. Possible adverse reactions to preservatives that are added to local anesthetics in pharmaceutical preparations may play a role in skin necrosis secondary to prilocaine usage. Multifactorial adverse effects may cause unexpected reactions with the use of prilocaine, a safe and frequently used pharmaceutical.

Primary or secondary bone tumours are not uncommon in pelvic girdle. In some cases, after radical resection, there is a big bony defect where the prosthesis is not applicable; arthrodesis is the only choice for good functional results. In this instance, the major problem is to achieve the fusion. In this case report, we focused on easy harvesting and minimal time consumption with free vascularized rib graft to achieve the fusion between the resected segments. Two year follow up showed fusion with good functional result.

Bu klinik çalışmada, 1997-2003 yılları arasında Uludağ Üniversitesi Tıp Fakültesi Plastik, Rekonstrüktif ve Estetik Cerrahi Anabilim Dalı Yanık Merkezinde yatırılarak tedavi edilen 15 yaşın altında 186 olgu ile ilgili epidemiyolojik faktörler sunulmaktadır. Olgular yaş, cinsiyet, yanık nedenleri, toplam yanık yüzey alanı ve yanık lokalizasyonları dikkate alınarak incelendi. Toplam 186 olgunun 103’ü erkek, 83’ü kız olup, yaş ortalamaları 3,4 yıl idi. Yanıklar 128 olguda haşlanma yanığı, 40 olguda alev yanığı, 9 olguda elektrik yanığı ve 7 olguda sıcak cisim ile temas sonucu oluşan yanık şeklindeydi. Yanıkların çoğu üst ekstremitede lokalize idi ve olguların ortalama yanık yüzey alanları %23 idi. Sonuç olarak epidemiyolojik çalışmalar, yanıkların oluşumundaki tehlikeleri belirlemesi ve en sık oluşum nedenlerini göstermesi açısından önemlidir. Bu çalışmanın da, Türkiye’deki çocukların yanıklardan korunması için çeşitli koruyucu programların geliştirilmesinde yararlı olacağını düşünüyoruz. In this clinical study, the epidemiological factors about 186 child burns under 15 years old, who were treated between the years 1997-2003 in the Burn Unit of the Department of Plastic, Reconstructive and Aesthetic Surgery of Uludag University Medical School were presented. Cases were investigated in regard to the age, sex, cause of the burn, total burn surface area and the localisation of the burn. Totally, 103 of 186 cases were boys and 83 were girls. The mean age was 3,4 years. The etiologic factors were scald in 128 cases, flame in 40 cases, electrical burn in 9 cases and contact burn in 7 cases. The upper extremities were the most affected sites in these cases and the mean total burn surface area was %23. In conclusion, epidemiological surveys provide objective information on hazardous agents and on the settings in which burns are most likely to occur. It is suggested that the findings of this study would be used as a basis for developing targeted preventive programs to protect Turkish children from burns.

Central-type, 8-toed polydactyly is a distinctly rare congenital foot anomaly. In this report, a new subtype of the metatarsal type of the central ray polydactyly of the foot is presented. This includes a triplication, one of which is Y-shaped of the second metatarsal and 8 toes. In the literature, polydactyly of the foot has been usually operated during childhood after walking age. We performed the surgery at 6 months of age. After ray amputation of the extra toes, we reapproximated the muscle pieces that remained on the original first and second metatarsals and repaired the transverse metatarsal ligament. Despite the early surgery, we did not encounter any problems intraoperatively and postoperatively.

Objective: To investigate the effect of laser photostimulation in rehabilitation of human digital flexor tendons with a placebo-controlled double-blind prospective study model. Background Data: Low-energy laser therapy has been applied in several rheumatoid and soft tissue disorders with a varying rate of success and it has also been shown to have a positive effect on tendon healing in animal experiments, but no clinical study on laser photostimulation in the treatment of human tendons has been reported to date. Materials and Methods: This study was performed in a total of 25 patients with 41 digital flexor tendon injuries in five anatomical zones. In Group I (21 digits in 13 patients), whirlpool and infrared GaAs diode laser with a frequency of 100 Hz. was applied between the 8(th) and 21(st) days postoperatively and all patients were given the Washington rehabilitation program until the end of the 12(th) week. In Group II (20 digits in 12 patients), the same treatment protocol was given but the laser instrument was switched off during applications. Results: The results of the study showed a significant improvement in the laser-treated group only for the parameter of edema reduction (p < 0.01) but the difference between the two groups was non-significant for pain reduction, hand grip strength, and functional evaluation performed according to Strickland and Buck-Gramcko systems using total active motion and fingertip-to distal palmar crease distance parameters (p > 0.05). Conclusions: Significant improvement obtained in edema reduction both immediately and 12 weeks after supplementary GaAs laser application in our study has been interpreted as an important contribution to the rehabilitation of human flexor tendon injuries because edema is known to have a detrimental effect on functional recovery during both early and late stages of tendon healing. However, our study has failed to show a significant positive effect of supplementary GaAs laser application on the other functional recovery parameters of human flexor tendon injury rehabilitation and we suggest further clinical study in this topic be done using different laser types and dosages in order to delineate the role of this promising treatment modality.

The correction of vaginal agenesis requires the creation of a neovaginal cavity that is dissected between the bladder and the rectum. To protect the length of the cavity, it is necessary to ensure the complete epithelialization of the apex of the ncovaginal cavity. The author prefers to tailor 2 pieces of full-thickness skin grafts longitudinally oil a vaginal stent that is molded into bullet shape. Six girls with vaginal agenesis underwent neovaginal construction using this method. The apex of the neovaginal cavity was perfectly epithelialized using this vaginal stent. The length of the ncovaginal cavity that is dissected during the operation was protected. The follow-up period ranged from 24 to 93 months (median, 57.2 months). Postoperative stricture or contracture of the neovagina did not occur in all patients. As a result, full-thickness skin graft is an efficient method for vaginal construction in patients with vaginal agenesis.

l.ÖZET Araştırma ikinci derece yüzeysel yanıklarda antibiyotikti pomad ile steril likide vazelin kullanımının yara iyileşme sürecine etkisinin karşılaştırılması amacıyla planlanmış deneysel bir çalışmadır. Şubat 2003 - Kasım 2003 tarihleri arasında Uludağ Üniversitesi Tıp Fakültesi Eğitim, Uygulama ve Araştırma Hastanesi Plastik ve Rekonstrüktif Cerrahi Anabilim Dalı Polikliniğinde gerçekleştirilmiştir. Araştırmanın evrenini, Uludağ Üniversitesi Eğitim, Araştırma ve Uygulama Hastanesinde Şubat 2003- Kasım 2003 tarihleri arasında Plastik ve Rekonstrüktif Cerrahi Anabilim Dalı Polikliniğine başvuran ikinci derece yüzeysel yanıklı 50 hasta, örneklemini ise sistemik hastalığı olmayan ve o sırada antibiyotik tedavisi almayan araştırmaya katılmayı kabul eden 37 hasta oluşturmuştur. Araştırmanın deney ve kontrol grubunu aynı hastalar oluşturmuştur. Çünkü; araştırmada belirli bir ayran (yaş, cinsiyet gibi...) yapılmamıştır ve her bireyin yara iyileşme süreci farklı olduğu için çalışmanın sonucunu etkileyeceği düşünülerek her iki yöntem de aynı hastada kullanılmıştır. Çalışmada ilk pansumanda hastanın yanık bölgesine tülle gress koyulmuş, yaranın sağ tarafına yada üstte kalan kısmına antibiyotikli pomad (nitrofurazon pomad), sol tarafına yada altta kalan kısmına ise steril likid vazelin sürülmüş, diğer pansumanlarda tülle gres kaldırılmadan aynı işlemler tekrarlanmış ve her iki tarafta da epitelizasyon oluşma zamanı gözlenmiştir. Hastalara dört günde bir pansuman yapılmıştır. Veri toplama aracı olarak hastanın tanıtıcı özellikleri, yanık oluş biçimi, bölgesi ve yanığın oluştuğu yer ile bilgileri ve epitelizasyon oluşma zamanlarını içeren, araştırmacı tarafından hazırlanan bir form kullanılmıştır.Verilerin değerlendirilmesinde lisanslı SPSS ( Statistical Packgage for Social Sciences ) paket programından yüzde dağılımları ve oranlar arası farkı bulmak için `z` testi kullanılmıştır. Hastaların % 56,7' sinin erkek, yaş ortalamalarının 28, 53 ± 2, 77, % 43, 3' ünün lise mezunu olduğu saptanmıştır. Olgulara yapılan pansumanlarda nitrofûrazon pomad ile steril likid vazelin kullanılan bölgelerinde epitelizasyon oluşumu karşılaştırılmış ve istatistiksel olarak anlamlı bir farklılık bulunamamıştır. Olguların; beden kütle indeksleri, yanık oluş biçimleri, tedaviden önce ve tedavi sırasında ağırlıklı olarak aldıkları besinler ile nitrofûrazon pomad ve steril likid vazelin kullanımına göre epitelizasyon oluşumları arasında da anlamlı bir fark bulunamamıştır, (p > 0,05) Çalışma sonucunda ikinci derece yüzeyel yanıklı vakalarımızda hem epitelizasyon oluşumu hem de enfeksiyon gelişmemesi açısından antibiyotikli pomad kullanımının mutlaka gerekli olmadığı, yalnızca steril likid vazelin kullanılmasının yeterli olduğu görüşüne varılmıştır. 2. SUMMARY THE COMPARISON OF THE IMPACT OF USING ANTIBIOTIC POMADE (NITROFURAZON POMADE) AND STERHJE LIQUTD VASELIN DURING THE HEALING PROCESS OF SECOND DEGREE SUPERFICIAL BURN WOUNDS The study has been planned experimentally in order to compare the impact of using antibiotic pomade and sterile liquid vaselin during the healing process of second degree superficial burn wounds. The research has been carried out in Plastic and Reconstructive Surgery Department's Policlinic of Education, Application and Research Hospital of Uludağ University in Bursa between the months of February and November in 2003. The universe of the research was, the patients who were applied for second degree superficial burn injuries. The group is made of 37 randomly chosen patients out of 50 patients who do not have systemic disease, and who do not use antibiotics lately. The experiment and control groups were also made of the same patients. The main reason for this is, no specific segmentation amoung the group members is considered (i.e. age, sex ) and also each individual healing process is different from another and this has an influence on the research results, both methods were applied to the same patient. As a first step of the experiment, tulle gress was placed on the wounded area during the first wound dressing process, and antibiotic pomade was applied to the upper or right side of the wounded area, where as sterile liquid vaselin was applied to the bottom or left side, and for the rest of the wound dressings was applied by using the same technique but without replacing the tulle gress, and as a result of this epitelisation period is observed on both parts.During the evaluation of the results SPSS (Statistical Package for Social Sciences) licenced software `z` test was used in order obtain percentages and differenciation between them. 56,7 % of the patients were man, age-avarage were 28, 53 ± 2, 77, and 43,3 % high- school graduated. Epitelisation period was compared on the both nitrofurazon pomade & sterile vaselin applied areas, and no specific differenciation statistically worthed was observed. There are also no other specific differenciations found by comparing the patients body - weight indexes, cause of the burn injury, patients' eating habits before and during the healing period with epitelisation period on the both nitrofurazon pomade & sterile vaselin applied areas. As a result of the experiment, it is decided that antibiotic pomade is not a must for healing second degree superficial burn injuries in order to protect patients from infection or to accelerate epitalisation period, and sterile liquid vaselin is only enough to heal injuries by itself. 108

YazarınınSoyadı: ÖZYAMANER Adı: GüldenDanışmanlarının Adı: Şule Soyadı: ECEVİT ALPARAdı: Selçuk Soyadı: AKINTezin Kabul Tarihi: 24.11.2004Program : Yüksek Lisans Anabilimdalı: Hemşirelik Esasları AnabilimdalıTürkçe Tez Başlığı: İkinci Derece Yüzeyel Yanıklarda Antibiyotikli Pomad (Furacin Pomad) İle Steril Likid Vazelin Kullanımının Yara İyileşme Sürecine Etkisinin KarşılaştırılmasıTürkçe Özet:Araştırma ikinci derece yüzeysel yanıklarda antibiyotikli pomad ile steril likide vazelin kullanımının yara iyileşme sürecine etkisinin karşılaştırılması amacıyla planlanmış deneysel bir çalışmadır.Şubat 2003 - Kasım 2003 tarihleri arasında Uludağ Üniversitesi Tıp Fakültesi Eğitim, Uygulama ve Araştırma Hastanesi Plastik ve Rekonstrüktif Cerrahi Anabilim Dalı Polikliniğinde gerçekleştirilmiştir. Araştırmanın evrenini, Uludağ Üniversitesi Eğitim, Araştırma ve Uygulama Hastanesinde Şubat 2003- Kasım 2003 tarihleri arasında Plastik ve Rekonstrüktif Cerrahi Anabilim Dalı Polikliniğine başvuran ikinci derece yüzeyel yanıklı 50 hasta, örneklemini ise sistemik hastalığı olmayan ve o sırada antibiyotik tedavisi almayan araştırmaya katılmayı kabul eden 37 hasta oluşturmuştur. Araştırmanın deney ve kontrol grubunu aynı hastalar oluşturmuştur. Çünkü; araştırmada belirli bir ayrım (yaş, cinsiyet gibi...) yapılmamıştır ve her bireyin yara iyileşme süreci farklı olduğu için çalışmanın sonucunu etkileyeceği düşünülerek her iki yöntem de aynı hastada kullanılmıştır. Çalışmada ilk pansumanda hastanın yanık bölgesine tülle gress koyulmuş, yaranın sağ tarafına yada üstte kalan kısmına antibiyotikli pomad (nitrofurazon pomad), sol tarafına yada altta kalan kısmına ise steril likid vazelin sürülmüş, diğer pansumanlarda tülle gres kaldırılmadan aynı işlemler tekrarlanmış ve her iki tarafta da epitelizasyon oluşma zamanı gözlenmiştir. Hastalara dört günde bir pansuman yapılmıştır. Veri toplama aracı olarak hastanın tanıtıcı özellikleri, yanık oluş biçimi, bölgesi ve yanığın oluştuğu yer ile bilgileri ve epitelizasyon oluşma zamanlarını içeren, araştırmacı tarafından hazırlanan bir form kullanılmıştır. Verilerin değerlendirilmesinde lisanslı SPSS ( Statistical Packgage for Social Sciences ) paket programından yüzde dağılımları ve oranlar arası farkı bulmak için "z" testi kullanılmıştır. Hastaların % 56,7' sinin erkek, yaş ortalamalarının 28, 53 ± 2, 77, % 43, 3' ünün lise mezunu olduğu saptanmıştır. Olgulara yapılan pansumanlarda nitrofurazon pomad ile steril likid vazelin kullanılan bölgelerinde epitelizasyon oluşumu karşılaştırılmış ve istatistiksel olarak anlamlı bir farklılık bulunamamıştır. Olguların; beden kütle indeksleri, yanık oluş biçimleri, tedaviden önce ve tedavi sırasında ağırlıklı olarak aldıkları besinler ile nitrofurazon pomad ve steril likid vazelin kullanımına göre epitelizasyon oluşumları arasında da anlamlı bir fark bulunamamıştır. (p > 0,05) Çalışma sonucunda ikinci derece yüzeyel yanıklı vakalarımızda hem epitelizasyon oluşumu hem de enfeksiyon gelişmemesi açısından antibiyotikli pomad kullanımının mutlaka gerekli olmadığı, yalnızca steril likid vazelin kullanılmasının yeterli olduğu görüşüne varılmıştır. İngilizce Tez Başlığı: The Comparıson Of The Impact Of Usıng Antıbıotıc Pomade (Nıtrofurazon Pomade) And Sterıle Lıquıd Vaselın Durıng The Healıng Process Of Second Degree Superfıcıal Burn Woundsİngilizce Tez Özeti:The study has been planned experimentally in order to compare the impact of using antibiotic pomade and sterile liquid vaselin during the healing process of second degree superficial burn wounds. The research has been carried out in Plastic and Reconstructive Surgery Department's Policlinic of Education, Application and Research Hospital of Uludağ University in Bursa between the months of February and November in 2003. The universe of the research was, the patients who were applied for second degree superficial burn injuries. The group is made of 37 randomly chosen patients out of 50 patients who do not have systemic disease, and who do not use antibiotics lately. The experiment and control groups were also made of the same patients. The main reason for this is, no specific segmentation amoung the group members is considered (i.e. age, sex ) and also each individual healing process is different from another and this has an influence on the research results, both methods were applied to the same patient. As a first step of the experiment, tulle gress was placed on the wounded area during the first wound dressing process, and antibiotic pomade was applied to the upper or right side of the wounded area, where as sterile liquid vaselin was applied to the bottom or left side, and for the rest of the wound dressings was applied by using the same technique but without replacing the tulle gress, and as a result of this epitelisation period is observed on both parts.During the evaluation of the results SPSS (Statistical Package for Social Sciences) licenced software "z" test was used in order obtain percentages and differenciation between them. 56,7 % of the patients were man, age-avarage were 28, 53 ± 2, 77, and 43,3 % high-school graduated. Epitelisation period was compared on the both nitrofurazon pomade & sterile vaselin applied areas, and no specific differenciation statistically worthed was observed. There are also no other specific differenciations found by comparing the patients body - weight indexes, cause of the burn injury, patients' eating habits before and during the healing period with epitelisation period on the both nitrofurazon pomade & sterile vaselin applied areas.As a result of the experiment, it is decided that antibiotic pomade is not a must for healing second degree superficial burn injuries in order to protect patients from infection or to accelerate epitalisation period, and sterile liquid vaselin is only enough to heal injuries by itself.

Nekrotizan fasiit, fasya ve subkutan dokunun nekrozu ile karakterize, nadir görülen, ciddi seyirli bakteriyel bir enfeksiyondur. Hastalık sıklıkla ekstremite, gövde ve perineal bölgeleri tutar. Göğüs ön duvarının tutulumu nadirdir. Bu makalede, göğüs ön duvarında nekrotizan fasiit tanısı ile tedavi edilen 2 olgu sunulmaktadır. Necrotizing fasciitis is an uncommon severe bacterial infection that is characterized by necrosis of the fascia and subcutaneous tissue. It is most commonly seen in the extremities, trunk and perineum. It scarcely affects the chest wall. In this report, two patients with necrotizing fasciitis of chest wall were presented.

Bu klinik çalışmada, Uludağ Üniversitesi Tıp Fakültesi Plastik, Rekonstrüktif ve Estetik Cerrahi Kliniği’nde 1996-2002 yılları arasında mandibulada kist tanısı ile opere edilen 35 olgu ile ilgili deneyimlerimiz sunulmaktadır. Olgular, yaş, cinsiyet, kistin lokalizasyonu, radyolojik belirtiler, histopatolojik tanı, tedavi yöntemleri ve sonuçlar dikkate alınarak incelendi. Olguların 21’i erkek, 14’ü kadın olup yaş ortalaması 42.8 yıl idi. Histopatolojik incelemeler sonucunda, 15 olguda radiküler kist, 12 olguda keratokist, 5 olguda folliküler kist ve 3 olguda gingival kist saptandı. Keratokist en sık mandibulanın ramus ve angulus (9 olgu), radiküler kist simfizis (7 olgu), foliküler kist (2 olgu) ve gingival kist (3 olgu) korpus bölgesinde tespit edildi. Radyolojik görüntüler, 9 olguda multiloküler iken, 26 olguda uniloküler idi. Tedavide bütün olgularda intraoral yaklaşımla cerrahi enukleasyon yöntemi uygulandı. Olgular 7 ay ile 6 yıl arasında takip edildi. Komplikasyon olarak sadece 2 keratokist olgusunda nüks saptandı. In this clinical study, our experiences with 35 cases who were treated for mandible cyst between the years 1996-2002 in the Department of Plastic, Reconstructive and Aesthetic Surgery of Uludağ University Medical School were presented. These cases were evaluated according to the age, sex, localization of the cyst, radiologic findings, histopathology, treatment methods and results. Twenty-one cases were men and 14 cases were women. The mean age was 42.8 years. Histologic examinations revealed that 15 cases were radiculer cyst, 12 cases were keratocyst, 5 cases were folliculer cyst and 3 cases were gingival cyst. Most commonly, keratocysts occured in the angulus and ramus (9 cases), radiculer cysts occurred in the symphysis (7 cases), follicular cysts (2 cases) and gingival cyst (3 cases) occurred in the corpus region of the mandible. The radiologic appearances were multilocular in 9 cases and unilocular in 26 cases. In all cases, surgical enucleation was performed through an intraoral approach. Cases were followed up between 7 months and 6 years. As a complication, in only two cases of keratocysts, recurrence was observed.

Bu çalışma, 1-2 Nisan 2002 tarihleri arasında Eskişehir[Türkiye]’de düzenlenen 2002 Burn Symposium’da bildiri olarak sunulmuştur. Medicinal plant extracts are commonly used worldwide. Their use relies mostly on historical and anecdotal evidence and might be so hazardous. Phytophotodermatitis is a well-known entity that is caused by the sequential exposure to certain species of plants containing furo-coumarins and then to sunlight. In this article, superficial burn lesions caused by fig leaf decoction that was applied to a patient's both upper extremity as a remedy for a dermatitis of unknown etiology is reported. Direct sun exposure is an essential component of phytophotodermatitis. All reported cases to date have in common that patients are exposed to direct sunlight or to artificial UVA lights (like solarium) of varying durations. In our case neither direct sun exposure, other than inevitable indoor UVA influence, nor blister formation was present. The etiologic factors, symptoms, signs, course, and treatment alternatives for phytophotodermatitis are also reviewed briefly. Turkish Soc Aesthet Plast & Reconstruct Surg

The limited sliding capacity of the V-Y advancement flaps has always been a problem. The mobility and reliability of the V-Y flap have been enhanced by raising it as an island flap based on perforators of the axial arteries in the extremities. The author elevated a new V-Y advancement island flap based on the dorsal perforator of the anterior interosseous artery on the dorsal aspect of the forearm for the dorsal defects of the wrist. This flap was used in the reconstruction of the dorsal defects of the wrist after tumor resection in two patients. Dissection was performed over the dorsal muscle fascia until the perforator was seen. The fascia was only incised all around the perforator. The donor sites were closed primarily in a V-Y fashion together with split thickness skin graft in patient 1 and only in a V-Y fashion in patient 2. The patients were followed-up from 13 to 15 months. All flaps survived completely. This flap is an alternative option for closure of medium to large defects on the dorsum of the wrist.

The shower technique for hydrotherapy was used in the treatment of the burn patients in our burn center. Before showering, the shower trolley (stretcher) was draped with a sterilized disposable plastic sheet to decrease the potential for seeding surface bacteria to open burn wounds. The patients were washed on the draped shower trolley. Samples for culture were taken from the surface of the shower trolley (stretcher) before it was draped with the sterilized disposable plastic sheet following the treatment of a patient. The samples were taken once a week for the first 6 months and only once a month for the last 42 months. At the period of 48 months (4 years), a total of 67 samples were obtained. Results of cultures of all the samples were negative. No patients were contaminated from the surface of the shower trolley during the shower. The use of the sterilized disposable plastic sheet proved to be a most effective procedure to decrease the risk of contamination between patients during the shower.

Bu çalışmada, 1993-2001 yılları arasında, Uludağ Üniversitesi Tıp Fakültesi Plastik ve Rekonstrüktif Cerrahi Kliniğinde opere edilen 30 malign melanomlu olgu ile ilgili deneyimlerimiz sunulmaktadır. Olgular yaş, cinsiyet, lezyonun yerleşimi, histolojik tipi ve evresi, lenf nod tutulumu ve nüks dikkate alınarak incelendi. Onsekizi erkek, 12’si kadın hasta olan olguların yaş ortalaması 61'dir. Histolojik incelemeler sonucunda, 17 olguda nodüler tip, 6 olguda yüzeyel yayılan tip, 4 olguda akral lentiginöz tip ve 3 olguda lentigo tip malign melanom saptandı. Clark'ın yaptığı evrelendirmeye göre; %43.3’ü evre IV ve V, % 13.3’ü evre III ve %43.3’ü evre II olarak tespit edildi. Olguların %53,3’ünde başvuru sırasında bölgesel lenf nod tutulumu saptanırken, olguların %10’unda operasyon sonrasında değişik zamanlarda lokal nüks görüldü. Bu çalışmada, malign melanomlu olguların lezyonları 3 cm salim doku ile birlikte fasya da dahil edilmek üzere eksize edildi. Bölgesel lenf nod metastazı saptanan olgularda lenf nodu disseksiyonu yapılırken, bölgesel lenf nod metastazı olmayan olgularda ise sentinel lenf nodu biopsisi yapıldı. In this study, our experiences with 30 cases who were treated for melanoma between the years 1993-2001 in the Department of Plastic and Reconstructive Surgery of Uludağ University Medical School were presented. These cases were evaluated according to the age, sex, localization, histologic type and level, nodal status and recurrence. Eighteen cases were men and 12 cases were women. The mean age was 61 years. Histologic examinations revealed that 17 cases were nodular, 6 cases were superficial, 4 cases were acral lentiginous and 3 cases were lentigo melanoma. According to the Clark's level, 43.3% of the cases were classified in level IV-V, 13.3% in level III and 43.3% in level II. At the admission, 53.3% of the cases were found to have regional lymph node metastasis. Local recurrence was seen in 10% of the cases at different time points following the operation. We excised the lesions with 3-cm free margin including the fascia. Regional lymph node dissection was performed in cases who had regional lymph node metastatis. In cases who had no lymph node metastasis, sentinel lymph node biopsy was performed.

A vascularized bone segment of the ulna together with a posterior interosseous fasciocutaneous flap is harvested, including a cuff of the extensor pollicis longus muscle, The authors treated five male patients with metacarpal bone and soft-tissue defects of the hand using a distally based island osteocutaneous posterior interosseous flap. Their ages at the time of surgery ranged front 15 to 37 years (mean, 24 years). The bone defects were in the first metacarpal in three cases, the fourth metacarpal in one, and the fifth metacarpal in one. The length of the donated ulna ranged from 3 to 7 cm (mean, 5 cm). The follow-up period ranged front 5 to 92 months (mean, 39 months). All flaps survived completely. The posterior interosseous flap provides thin skin of good texture, together with vascularized bone, for a one-stage reconstruction of the metacarpal bone and soft-tissue defects in the hand.

The advantages of end-to-side anastomoses have been well documented in microvascular surgery. The vessels of the fibular flap do not usually permit end-to-side anastomosis to recipient vessels in the proximal part of the lower leg because the pedicle length of the free fibular Rap is usually too short. Therefore, vein grafts are used to elongate the vessels, If a harvested long free fibular flap that is used to bridge a massive defect of the tibia is reversed and placed into the medullary cavity of the tibia, the flap vessels can be anastomosed, using the end-to-side technique, to the recipient vessels without vein grafts in the distal part of the lower leg. Thus, the flap artery (the peroneal artery) fills in a retrograde fashion. The patient reported was reconstructed with a reversed long free fibular Rap. The postoperative period was uneventful. The patient can stand and walk with a protective shoe 2 years postoperatively.

We performed percutaneous A1 pulley release on 34 trigger fingers in 30 patients with an angiocath needle. Complete release was achieved in all fingers. There were no complications and no recurrences during mean 0.5 (1-2) years follow-up.

Free microvascular transfer of the second metatarsophalangeal joint was performed for the treatment of temporomandibular joint ankylosis in a 15-year-old male patient. The result is excellent in one-year follow-up. The technique seems to be a good alternative to the problem in selected patients.

Polydactyly of the foot has been classified according to anatomic differences in bony structures, external appearance of involved digits and associated anomalies. A new subtype of the metatarsal type of the medial ray (preaxial) polydactyly of the foot is present ed. This includes triplication of the first metatarsal triplication of the tendons and three separate big toes. In addition, associated anomalies were present: short tibia and pes varus.

A lateral arm free flap including vascularized triceps tendon was transferred to reconstruct the tibialis anterior tendon and skin defects over the anterior distal third of the left cruris of a patient who was injured by gunshot. Four months after surgery, the patient walked and ran well, and dorsiflexed his ankle joint actively to 10 degrees, Considering cosmetic appearance, it was obvious that the flap suited the recipient area perfectly.

A flap with double pivot points based on the second dorsal metacarpal artery was used in 13 cases with no complete failures, In 2 cases, the branches of the radial nerve were included in the flap. In 1 case, the flap was used as a tenocutaneous flap with a segment of the extensor indicis proprius tendon. To obtain a flap with double pivot points, the dissection of the vascular pedicle of a distally based second dorsal metacarpal flap is continued proximally under the second dorsal metacarpal artery up to its origin, In this flap the main pivot point coincides with the origin of the SDR IA and the second pivot point with the entry point of the recurrent cutaneous branch into the flap, We found this flap to be very versatile, reliable, and quite easy and quick to raise, We report our experience with this flap as a very useful addition to reconstructive procedures, especially for thumb defects.

Bu çalışma, 23-25 Ekim 1991 tarihlerinde Nevşehir[Türkiye]’de düzenlenen XIII. Türk Plastik ve Rekonstrüktif Cerrahi Kongresi‘nde bildiri olarak sunulmuştur. Kliniğimizde kapiller hemanjiomu olan 15 olgu lezyon içi (intralezyonal) kortikosteroid (triamcinolone acetonid) enjeksiyonu ile tedavi edildi. Olgular tedavi bitiminde ve tedaviden 2 yıl sonra değerlendirildi. Sonuçlar estetik olarak tatmin edici olmamakla birlikte, çalışmamızda kortikosteoridin hemanjiomun involusyonunu hızlandırdığı ve sistemik komplikasyonlarının çok az ve geçici olduğu tespit edildi. 15 cases with capillary hemangioma were treated by intralesional corticosteroid (triamcinolone acetonid) injection. The cases were evaluated at the end of treatment and 2 years later following the treatment. Although the results were not found to be estheticaly satisfactory, it was obvious that corticosteroid treatment accelerated the involution of hemangioma. Systemic complications due to corticosteroid injection were found to be rare and temporary.

27-30 Ekim 1990 tarihinde Kuşadası'nda yapılan XII. Türk Plastik ve Rekonstrüktif Cerrahi Kongresi'nde tebliğ olarak sunulmuştur. Kemik ve yumuşak doku yaralarının sıklıkla birlikte bulunduğu, alt ekstremite defektlerinin onarımı için çeşitli yerel ve uzak flepler olmasına karşın; mikrocerrahinin kullanımına girmesiyle bu alanda yeni bir çığır açmıştır . Bu çalışmada üç farklı serbest flep yöntemi uygulanan sekiz olgun sunulmaktadır . Olgulardan biri başarısız olmuş. iki olguda kısmi , beş olguda ise tam başarı elde edilmiştir. Although there have been many local and distant flaps for reconstruction of lower extremity defects comprising both safi tissue and bone injuries; after the introduction of microsurgery into plastic surgery, a new era has begun in this field. In this study eight cases of tower extremity reconstruction with three different free flap techniques are represented. We have failed in one case, had two partial and five complete success.

Krural defektlerin onarımında fasiokütan fleplerin popiilarilesi günden güne artmaktadır. "İnferior lateral thigh flep"; çapraz bacak "cross leg", fokal ada veya serbest flep olarak kruris defektlerinde kullanalabilecek fasiokütan fleplere iyi bir örnektir. İnferior lateral thigh flep" aterosklerotik vasküler yapıya sahip ve her iki bacakta dolaşım problemi olan bir sağ krural açık fraktürlü olguda kullanıldı ve tatminkar sonuç alındı. Popularity of fasciocutaneous flaps for the repair of cranial defects has been increasing day by day. inferior Lateral Thigh Flap is one good example of fasciocutaneous flaps that could be used as cross leg, local island or free flap in chiral defects. Inferior Lateral Thigh Flap was performed at a right crural open fracture case in spite of atherosclertic vascular stnicture and circulatory problems at both cruris and it was obtained a satisfactory result.

23-25 Ekim 1991 tarihinde Nevşehir'de yapılan XIII. Türk Plastik ve Rekonstrüktif Cerrahi Kongresi'nde tebliğ olarak sunulmuştur. Kliniğimizde 1988-1991 yılları arasında dupuytren kontraktürü 20 hasta opere edilmiştir. Bunlardan 11 tanesin fasiektomi, 9 tanesine de fasyotomi +tam kalınlıkta deri grefti uygulanmıştır. Hastalar 1-4 yıl boyunca izlenmiş ve bu iki grup arasında fonksiyon ve rekürrens açısından anlamlı bir fark bulunmamıştır. 20 cases with dupuytren contracture were operated in our clinic between 1988 and 1991. On 11 cases fasciectomy and 9 cases fasciotomy +full thickness skin grafting were performed. The patients were followed minimum 1 year and maximum 4 years and, no significant difference of function and recurrens were found between the two groups.

27-30 Ekim 1990 tarihinde Kuşadası'nda yapılan XII. Türk Plastik ve Rekonstrüktif Cerrahi Kongresi'nde tebliğ olarak sunulmuştur. Uterusu normal ve serviksi yeterli olan vaginal agenesisli bir olguda kısmi kalınlıkta deri grefti ile vajina ve tam kalınlıkta deri grefti ile servikal oluşturularak olgunun normal adet görmesi sağlanmıştır. In a case with vaginal agenesis whose cervix was sufficient in size and whose uterus was normal, vaginal construction with split-thickness skin grafling and cervical canal construction with full-thickness skin grafting were performed, enabling her to have normal menstruation.

Kozmetik cerrahide kullanım dışında "liposuction" cerrahisinin eksizyonel cerrahiye mükemmel bir alternatif olmaya başladığı giderek artan sayıda hastalık vardır. Lipomların cerrahide ekstirpasyonu sonrası ortaya çıkan; uzun postoperatif iyileşme dönemi, yara ayrılması, kötü skar gibi olumsuzlukların önüne geçmek için liposuction uygulanması önerilmektedir. Kliniğimizde vücudunun değişik yerlerinde multiple lipom bulunan üç olguya liposuction uygulanmış, sonuçlar yeterli bulunarak literatür verilerinin ışığı altında incelenmiştir. Other than its use in cosmetic surgery, liposuction has come into common use alternatively to excisional surgery at an increasing number of diseases. Liposuction is now advocated in order to avoid the problems encountered after surgical extirpation of lipomas; such as long healing period, wound dehiscence and bad scar. Liposuction has been applied to three cases with multiple lipomas at our clinic and results have been found to be satisfactory and reviewed in the light of literature.

A patient with a benign clear-cell hidradenoma of the index finger is presented. Clear cell hidradenoma is a rare tumor originating from the eccrine sweat glands and infrequently appears on the hand.

El tümörleri arasında kistik lenfangiomun görülmesi son derece nadirdir. Olgumuzda böyle bir tümörün el bileğinden gelişerek carpal tünel içinde N. Medianusa bası yaptığı resimlerle dökümante edilmiştir. Cystic lymphangioma is encountered rarely among the hand tumors. As documented with the photographs, a case is presented here where the tumor had developed in the wrist and penetrated into the carpal tunnel pressing the median nerve.