-
Microsurgery 01/2013; · 1.61 Impact Factor
-
Omer Ozkan,
Munire Erman Akar, Ozlenen Ozkan,
Okan Erdogan,
Necmiye Hadimioglu,
Murat Yilmaz,
Filiz Gunseren,
Mehmet Cincik,
Elif Pestereli,
Huseyin Kocak,
Derya Mutlu,
Ayhan Dinckan,
Omer Gecici,
Gamze Bektas,
Gultekin Suleymanlar
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVE: To describe the first-year results of the first human uterus transplantation case from a multiorgan donor. DESIGN: Case study. SETTING: University hospital. PATIENT(S): A 21-year-old woman with complete müllerian agenesis who had been previously operated on for vaginal reconstruction. INTERVENTION(S): Uterus transplantation procedure consisting of orthotopic replacement and fixation of the retrieved uterus, revascularization, end to site anastomoses of bilateral hypogastric arteries and veins to bilateral external iliac arteries and veins was performed. MAIN OUTCOME MEASURE(S): Resumption of menstrual cycles. RESULT(S): The patient had menarche 20 days after transplant surgery. She has had 12 menstrual cycles since the operation. CONCLUSION(S): We have described the longest-lived transplanted human uterus to date with acquirement of menstrual cycles.
Fertility and sterility 10/2012; · 3.97 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In this report, we describe a case of difficult esophageal reconstruction with a pedicled colon segment interposition and a free jejunal flap. Laryngectomy and bilateral neck dissection for larynx carcinoma had been attempted in a 59-year-old patient 6 years previously. The patient then received radiotherapy. One year later, large resection was performed due to recurrence of the tumor. Since then the patient had been fed through a gastrostomy tube. Previous attempts at esophageal reconstruction in other institutions were unsuccessful. We reconstructed the total esophagus with subcutaneously tunneled pedicled colon segment interposition and a free jejunal flap using the diversionary loop technique to divert the passage of the foot from the pharynx to the new inlet at the buccogingival sulcus, thus keeping the native esophagus untouched. Following a postoperative training period, the patient learned to swallow successfully and smoothly via the new inlet. The patency of the newly reconstructed esophagus was corroborated by radiological imaging. In summary, although the technique requires complex surgical procedures, it is effective and may be considered as an alternative and reliable option in selected cases.
Microsurgery 01/2012; 32(3):235-9. · 1.61 Impact Factor
-
Annals of plastic surgery 07/2011; 67(1):92-3. · 1.29 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Vaginal ageneses are by no means rare anomalies. Complete Mullerian agenesis is the most common reason for vaginal agenesis requiring reconstruction. Patients usually present with pain, hematocolpos, or hematometra in puberty, and later with amenorrhea and dyspareunia. Detailed information is given here regarding etiologies, timing of surgery, and current treatment options for vaginal agenesis. Outcomes and short- and long-term complications of recent treatment options are also discussed.
Annals of plastic surgery 03/2011; 66(6):673-8. · 1.29 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To evaluate association between scar characteristics and intraabdominal adhesions at repeat cesarean delivery.
A prospective, cross-sectional study.
Tertiary Government Maternity Training Hospital in Ankara, Turkey.
295 pregnant women with at least one prior cesarean delivery.
All women were at least 36 weeks pregnant. Appearance of previous cesarean delivery scars was categorized into three groups - flat, depressed and elevated. Pigmentation status was also noted (non-pigmented or pigmented).
Intraoperatively detected adhesions, evaluated and classified into three groups (no adhesion, filmy adhesion and dense adhesion groups) by a modified Nair's classification.
Elevated scars had significantly more dense adhesion formation than depressed ones (31.4 vs. 12.7%, p=0.02). No difference was found for dense adhesions when depressed and flat scars were compared (12.7 vs. 6.8%, p=0.124). Of flat scars, 93.2% were free of dense adhesions. Pigmented scars had more dense adhesions than non-pigmented (26.6 vs. 9.3%, p<0.01). Using logistic regression analysis scar length, scar width and appearance of scar (flat or non-flat) were directly related to adhesion formation.
There is an association between scar type and adhesions, particularly for hypertrophic scars and dense adhesions.
Acta Obstetricia Et Gynecologica Scandinavica 02/2011; 90(5):531-4. · 1.77 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The ideal reconstructive method for the palatal defect should provide durable, stable coverage, and a natural contour, while simultaneously minimizing morbidity of both the defect and donor sites. Although small and usual palatal defects can be repaired easily using local adjacent tissues, successful closure of large, complex defects is still a challenging problem. Numerous free tissue options have to date been described for large palatal defects. Although the radial forearm flap constitutes a good option for ideal reconstructive goals, the sacrifice of a major artery to the hand and the skin graft to the forearm with its high potential risk of complications are evident problems attendant upon this donor site. Since the first report of the anterolateral thigh flap, this has become one of the most commonly used flaps for the reconstruction of various soft-tissue defects. Between April 2005 and May 2009, 8 free anterolateral thigh flaps were used to reconstruct defects of the palate. The study involved 6 male and 2 female patients, their ages ranging from 3 to 45. Five patients had palatal defects due to congenital cleft palate deformity, 2 patients had defects due to tumor resection, and the remaining patient had a palatal defect due to a gunshot wound. The size of the flaps ranged from 8 to 14 cm in length and from 4 to 7 cm in width. Facial vessels were used as recipient vascular sources in all patients. Primary thinning of the flap was performed in all cases. Donor sites were closed directly and healed uneventfully in all patients. There were no postoperative complications and all flaps survived totally. No debulking was needed. All patients, and their families in the case of child patients, were satisfied with the results of their surgical treatment. In conclusion, although it has some irregularity in derivation from the main vessels, with its evident structural and cosmetic advantages the anterolateral thigh flap can be considered an excellent and ideal free flap option for most large palatal defects that cannot be closed by regional tissue in selected patients. It can reconstruct defects in single stage with well-vascularized tissue, resulting in minimal donor site morbidity.
Annals of plastic surgery 12/2010; 66(6):618-22. · 1.29 Impact Factor
-
Microsurgery 09/2010; · 1.61 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In the midface, two polyhedron-shaped maxillary units are separated by the central midportion, which includes the nasal area. The midface includes such facial features as the nose, cheek, and upper lip, and posteriorly it extends to the anterior skull base. In the superoinferior direction, the midface includes the soft and bony tissue from the orbital cavity to the oral cavity. Laterally, the midface extends to the temporal bone. Although most superficial skin defects of the midface can be covered by various standard reconstructive modalities, because of the need to evaluate the nature of the tissues involved and because of structural and also functional considerations, the management of large, full-thickness defects is a challenge for reconstructive surgeons. Advances in microsurgical techniques have permitted reliable wound closure and a substantial decrease in patient morbidity with low complication rates while allowing a variety of reconstructive flap options in a single stage. To create a reconstructive algorithm, several classification systems have been proposed, mostly relating to the extension, location, and tissue involvement of the defect. Defects can be classified as simple soft tissue defects and complex defects. The complex three-dimensional defect is classified under four types: types I to IV. Although maxillary prostheses are nonliving tissues and may cause discomfort for the patient, in special situations they can be reconstructive options requiring special experience. Essentially, the method of reconstruction should be selected on an individual basis, bearing in mind the medical situation; the age and prognosis of the patient; the size, extension, and composition of the defect; and the availability of local or distant tissues.
Seminars in Plastic Surgery 05/2010; 24(2):181-7.
-
[show abstract]
[hide abstract]
ABSTRACT: The ideal reconstructive method for a vagina should provide a durable, stable coverage, a patent tube passage for sexual intercourse, and a natural esthetic contour, while simultaneously minimizing morbidity in both the recipient and donor sites, and should be a single stage procedure obviating the use of stents, obturators, and lubrication. Twenty-two patients with absence of the vagina underwent vaginal reconstruction using the jejunal segment transfer technique. Two flaps required re-operation due to venous compromise postoperatively. The flaps were salvaged with venous anastomosis revisions. The overall flap success rate was thus 100%. No urinary tract or gastrointestinal system complication was observed in any case, nor any instance of vaginal introitus. The average follow-up period was 19 months (between 3 and 48 months). Both the depth and diameter of the neovagina were satisfactory postoperatively. After the immediate postoperative period, the only major and embarrassing problem was hypersecretion of the jejunal segment, but this gradually diminished, especially after the first 3 months. Those patients who engaged in sexual intercourse reported good patency and had no complaints in that regard. In conclusion with its evident advantages, the jejunal segment can serve as a reliable option for vaginal reconstruction. It provides quite satisfactory results from both the cosmetic and functional points of view.
Microsurgery 12/2009; 30(2):125-31. · 1.61 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Although there is no distinct, absolute, and ideal method for vaginal reconstruction, intestinal transfers are preferable to the other described techniques in the main clinics. In this report, we describe the transfer of a jejunal segment for vaginal reconstruction in a 20-year-old female patient, harvesting the flap based on its vascular pedicle by means of a laparoscopic technique that obviates the use of midline laparotomy. To prevent any vascular compromise, two different vascular supply sources were provided for the flap performing additional arterial and venous microvascular anastomosis. The results have confirmed the feasibility of the technique. The functional, structural, and esthetic advantages of the jejunal flap and the lower donor site morbidity of the laparoscopy-assisted technique that were rather encouraging are described and discussed.
Microsurgery 11/2008; 28(8):671-5. · 1.61 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The ideal reconstructive method for a urethral defect should provide durable, stable coverage, a patent tube passage for voiding and ejaculation, and a natural aesthetic contour, while simultaneously minimising morbidity of both the recipient and donor sites. Since the first report of the anterolateral thigh flap in 1984, this has become one of the most commonly used flaps for the reconstruction of various soft tissue defects. In this report we present our experience with a prefabricated anterolateral thigh flap used for a full-thickness defect of the urethra. The flap was used in a 40-year-old male patient with a defect located on the proximal penile region, including full-thickness urethra and ventral penile skin measuring 2.5x4 cm after delay and prefabrication. To the best of our knowledge this is the only report in the literature to date of an anterolateral thigh flap being used for a urethra defect. The authors conclude that with its evident structural and cosmetic advantages, the anterolateral thigh flap can be considered an excellent and ideal flap option for selected defects of the urethra.
Journal of Plastic Reconstructive & Aesthetic Surgery 09/2008; 62(3):380-4. · 1.49 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We describe a simple and reliable technique for tunneling of the vascular pedicle of the free flap with a long pedicle, that may otherwise cause twisting and/or kinking of the pedicle. There are two modifications of the technique. In the cross-groin anastomosis modification, using a haemostat in a blunt manner, a suprapubic subcutaneous tunnel is created between two groin regions. The vascular pedicle of the flap is pulled and passed through this tunnel to the contralateral region. While the anastomoses are done on one site, the flap is inserted to the contralateral groin. In the second modification ('groin anastomosis-cross dorsum flap insert procedure'), the flap is transferred to the dorsum of the rat at approximately the same level of the groin. Using a haemostat, a large subcutaneous tunnel safe enough for the pedicle is created between the groin region and the rat dorsum lateral to the hip region. The anastomoses are done in the groin region, and the flap is inserted on the dorsum. This technique was used in 16 animals, with a free cutaneous maximus muscle musculocutaneous flap transfer based on the axillary vessels being done in eight animals; and a posterior thigh perforator-based flap based on the popliteal vascular pedicle in the remaining eight. Both groups had a pedicle length of approximately 4 cm, with a 100% survival rate. In conclusion, the technique is simple, reliable, and can be easily carried out without necessitating special procedures. It provides a straight course for the vascular pedicle with tension-free anastomosis by appropraitely adjusting the distance of the vascular anastomosis and flap insertion site.
Journal of Plastic Reconstructive & Aesthetic Surgery 08/2008; 62(9):1202-4. · 1.49 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Herein we report the case of a patient with primary amenorrhea and cyclic menouria. The patient was a 20-year-old woman with primary amenorrhea and inability to achieve sexual intercourse. Clinical examination revealed normally developed labia majora and minora, clitoris, and external urethral orifice, but no vaginal opening. A mature female pubic hair pattern was present, and axillary hair development was normal. Breasts were normally developed. Abdominopelvic magnetic resonance imaging demonstrated a remnant upper vagina and unicornuate uterus filled with fluid, and left-sided renal agenesis. Intraoperatively, a congenital vesicouterine fistulous tract was observed. The fistulous tract was completely resected. Vaginal reconstruction using a sigmoid colon pedicled flap was performed. The proximal part of the neovagina was connected to the remnant cervix, and a Foley catheter was left in the uterine cavity for 7 days to prevent obstruction. The patient has been menstruating regularly since the operation. Menouria might be an early sign of congenital vesicouterine fistula. Resection of the fistulous tract with uterine preservation might be considered in patients with vaginal agenesis.
Journal of Minimally Invasive Gynecology 18(5):682-5. · 1.74 Impact Factor
