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Background/Aim: The power of free flaps for lower extremity injury reconstruction is no longer a matter of debate; however, contrasting views remain regarding the timing of reconstruction. The mainstay article of Godina reported that reconstruction within the first three days after injury was more advantageous than surgery at later times, but different views about the best day for reconstruction have also been described in the literature. With developments in the field of microsurgery, plastic surgeons have become more experienced, shortened the times needed for surgery, and achieved flap success. We have also become more experienced with surgical times, and reconstruction on the day of injury has been performed as an emergency reconstruction (ER) procedure since 2018. However, despite the disadvantages of a delayed wait period, patients still experience delayed reconstruction (DR) due to their pre-operative conditions and dispatches from peripheral centers over delayed time periods. This study aimed to present our experiences with lower extremity reconstruction in emergency situations and after delayed periods with descriptions of technical tips for each situation. Methods: Between 2018 and 2021, patients who underwent lower extremity reconstructions were examined as retrospective case-control study. Twenty-four patients (17 male and seven female) underwent lower extremity reconstructions with microsurgical free flap coverage. Patients’ ages ranged from 6 to 75 years old. Ten patients underwent ERs (on the day of injury), and 14 patients underwent DRs. Twenty anterolateral thigh, two medial sural artery perforator, one latissimus dorsi, and one radial forearm flaps were chosen for reconstructions. Flaps were chosen for one-third of the distal lower extremity reconstructions (n=11) and Gustilo type 3B injuries (n=11), Gustilo type 3C injuries (n=1), and one-third for middle lower extremity soft tissue reconstructions (n=1). Infections, length of hospital stays, time spent during the reconstructive surgery, vascular complications, and additional debridement necessity counts were recorded and compared with previous statistical analyses. Results: One venous thrombosis in the emergency group and three venous and one arterial thrombosis in the delayed group were reported. The patients were taken to the operating room immediately after which re-anastomoses were performed successfully, and all flaps survived. The hospital stay was between 4 and 60 days in the emergency group and 20 and 99 days in delayed group. Infections (P=0.03), vascular complications (P=0.04), and hospital stays (P=0.01) were statistically significantly lower in the emergency group than in the delayed group. Conclusion: ER has many advantages, such as preventing time consuming surgeries and providing short hospital stays and low complication rates, over DR. However, DR is inevitable for some reasons, and despite its more complicated nature, meticulous flap follow-up and salvage procedures may provide the same flap success as found with ERs.

Bu tez çalışmasında fonksiyonel polimerik ince filmler grafen oksit (GO) nano tabakalar üzerine çevre dostu bir teknik olan plazma destekli kimyasal buhar biriktirme yöntemi (PECVD) ile kaplanmıştır. Yüzeyi ince polimerik film kaplı GO nano tabakalar yağ-su ayrımı için kullanılacak gelişmiş yüzey özelliklerine sahip ultrafiltrasyon (UF) membran üretimi için kullanılmıştır. Fonksiyonel polimer kaplamalar olarak hidrofobik özellikte poli(hekzaflorobütil akrilat) (PHFBA) ve hidrofilik özellikte poli(dietilaminoetil metakrilat) (PDEAEMA) çalışılmıştır. Kaplanan filmlerin kimyasal yapıları FTIR ve XPS analizleri ile açığa çıkarılmıştır. Fonksiyonel ince filmler ile kaplanmış GO katkılı ultrafiltrasyon membranlarının yağ-su ayırımı performansını açığa çıkarmak için su akış hızı ve yağ tutma testleri yapılmıştır. Hidrofilik PDEAEMA-GO nano tabakaları ile katkılanmış membranlarda, hidrofobik PHFBA-GO nano tabakalar ile katkılanmış olan membranlara göre yağ-su ayırımı, kirlilik önleyici direnç ve su geri kazanım oranı bakımından daha iyi sonuçlar elde edilmiştir. Bu durumun PDEAEMA-GO ile polimer matris etkileşiminin daha iyi olmasının yanı sıra, modifiye edilmiş GO nanotabakalar arasındaki aglomerasyonun azalmasından kaynaklandığı sonucuna varılmıştır. PDEAEMA-GO ile katkılanan membranların saf su akısı değerlerinin modifiye edilmemiş GO ile katkılanmış membranlara göre %85 daha yüksek olduğu; bununla birlikte yağ giderme hızının ise neredeyse değişmediği sonucuna ulaşılmıştır.Anahtar Kelimeler: PECVD, Grafen Oksit, Ultraflitrasyon, Yağ-Su Ayırımı, Yüzey Modifikasyonu In this work, an environmentally friendly surface modification method based on plasma enhanced chemical vapor deposition (PECVD) was employed to deposit functional polymeric thin films onto graphene oxide (GO) nanosheets which were subsequently used to develop ultrafiltration (UF) membrane with improved surface properties for oily solution treatment. Two different monomers, namely hexafluorobutyl acrylate (HFBA) and diethylaminoethyl methacrylate (DEAEMA) were individually used to modify GO via PECVD method and the results from instrumental analyses confirmed the successful deposition of respective functional material onto the nanomaterials. All the developed membranes were characterized with a series of analytical instruments to support the findings of membrane filtration performance. The results indicated that the membrane incorporated with DEAEMA-GO (coated with hydrophilic polymer) could achieve better results in terms of oil rejection, antifouling resistance and water recovery rate than the membrane incorporated with HFBA-GO (coated with hydrophobic polymer). This is due to the reduced agglomeration between modified GOs as well as better interaction of hydrophilic-coated GOs with polymer membrane. Compared to the pure water flux of the membrane incorporated with unmodified GO, the membrane incorporated with DEAEMA-GO achieve approximately 85% higher value with oil removal rate remained almost unchanged.Keywords: PECVD, Graphene Oxide, Ultrafiltration, Oil/Water Separation, Surface Modification 73