A Yücel

Istanbul University, İstanbul, Istanbul, Turkey

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Publications (25)32.44 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Shallow upper buccal sulcus deformity, one of the secondary deformities after cleft lip-palate repair, causes both aesthetic and functional problems. This deformity also prevents or makes difficult orthodontic and prosthodontic procedures. An upper buccal sulcus deepening procedure was performed in 14 patients during the last 5 years. In 12 cases, premaxillary-based mucosal flaps were combined with one of the following: lip re-repair, Abbé flap, or bilateral buccal mucosal advancement flaps; in two cases, premaxilla was grafted with buccal mucosal graft together with bilateral buccal mucosal advancement flaps. The follow-up period was 2 to 5 years. Results were satisfactory for the surgeon, orthodontist, prosthodontist, and the patient. Upper buccal sulcus reconstruction with premaxillary thin mucosal flap or full-thickness mucosal graft combined with tissue-sparing techniques provides successful and durable results.
    Journal of Craniofacial Surgery 10/2001; 12(5):490-4. · 0.69 Impact Factor
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    ABSTRACT: Twenty-two elective free-tissue transfers for reconstruction of various defects were performed in 20 pediatric patients over a 7-year period. Patient ages ranged from 5 to 17 years (mean: 12.5 years). There were six open wounds, six unstable scars, five tumor resection defects, three facial gunshot wounds, one facial paralysis, and one penis agenesis. Ten free flaps were transferred to the head and neck region, seven to the lower extremity, four to the upper extremity, and one to the genital area. Ten fasciocutaneous flaps, seven muscle or myocutaneous flaps, and five vascularized bone grafts were transferred. All flaps survived, except for one in an electrical burn patient. The success rate was 95 percent. No vessel spasm was observed. Children tolerated long operation periods better than adults. The recovery time after surgery was considerably shorter than in adults. The mean operative time was 6 hr, and the average hospital stay was 12 days. The mean follow-up period was 27 months. Results of this study indicate that microvascular free-tissue transfer is a safe and reliable method for the reconstruction of various defects in children.
    Journal of Reconstructive Microsurgery 01/2001; 17(1):27-36. · 1.00 Impact Factor
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    ABSTRACT: An experimental study was planned to examine whether the blood supply of muscle would be maintained by reverse flow from the cutaneous arteriolar microcirculatory system via the musculocutaneous perforators. A flap model containing both muscle and skin based on the inferior superficial epigastric vessels was designed with the blood supplied directly from the cutaneous arteriolar microcirculatory system. A total of 154 male Wistar Albino rats were divided into three groups. Group I included the standard vertical rectus abdominis musculocutaneous flap based on the superior deep epigastric vessels (N = 48). Group II included the acute cutaneous muscle flap (N = 53). Group III contained the delayed cutaneous muscle flap (N = 53). Skin flap survival area, muscle scintigraphy with technetium-99m-methoxy-isobutyl-isonitrile, microangiography, and histopathological examination of the flaps were conducted. The mean percentage of surviving skin paddle area was 96.4 +/- 5.2%, 84.9 +/- 21.6%, and 91.0 +/- 16.8% in groups I, II, and III respectively. There was no significant difference between groups. Microangiography revealed the blood flow from skin to muscle through the musculocutaneous perforators. The radioisotope uptake of the muscle flap was expressed as A percentage of the intact contralateral muscle. Mean uptake in group I was 90.1 +/- 4.9% immediately after flap elevation, 62.5 +/- 13.5% on day 2, and 88.3 +/- 12.0% on day 7. These values were 53.7 +/- 7.1%, 63.6 +/- 14.1%, and 89.2 +/- 18.1% in group II, and 64 +/- 7.8%, 75.5 +/- 9.8%, and 92.8 +/- 40.1% in group III. Radioisotope uptake in group I was significantly higher than groups II and III immediately after flap elevation (p < 0.05, analysis of variance), whereas there was no significant difference on days 2 and 7. Histopathological examination revealed surviving muscle tissue without marked atrophy. There was no marked difference between groups histopathologically. These results indicate that muscle tissue may survive by reverse flow through the musculocutaneous perforators when elevated with an axial skin flap.
    Annals of Plastic Surgery 12/2000; 45(5):500-8. · 1.38 Impact Factor
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    ABSTRACT: Seventy cases with malignant tumors requiring maxillary resection in the past 10 years were reviewed, retrospectively. The primary site of tumor was adjacent skin in 53%, maxillary sinus or maxilla in 20%, palate and alveolar arch in 13%, lip and buccal mucosa in 13%, and mandible in 1% of the cases. The most common histopathological diagnoses was squamous cell carcinoma (54%), followed by basal cell carcinoma (20%). Most of the patients had advanced tumors, either neglected or recurred. Orbital exenteration was performed in 28 cases, mandibulectomy in six cases, combined craniofacial resection in seven cases, and radical neck dissection in 18 cases. Major skin loss was present in majority of the patients. Postsurgical defects were reconstructed with pedicled flaps in 37 cases and free flaps in 12 cases. Lining of the maxillary sinus defects was provided with split-thickness skin grafts. Patients with palatal defects were encouraged to use prosthetic obturators. Postoperative radiotherapy was performed in 32 patients and combined radiotherapy and chemotherapy in 12 patients. Communication could be established with only 52 patients. Sixty-three percent of them have survived without recurrence and distant metastasis. Resection of the tumor with free surgical margins and appropriate evaluation of the surgical defect for the most suitable reconstruction are the mainstays of treatment of the midfacial tumors.
    Journal of Craniofacial Surgery 10/2000; 11(5):418-29. · 0.69 Impact Factor
  • Annals of Plastic Surgery 09/2000; 45(2):216-8. · 1.38 Impact Factor
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    ABSTRACT: Secondary venous ischemia caused by anastomotic failure is one of the major causes of failure after free tissue transfers and replantations. The effects of cyclosporin A (CsA) on secondary ischemic injury associated with neutrophil infiltration and lipid peroxidation were evaluated in a rat inferior epigastric island skin flap model. Primary ischemia was produced by arteriovenous occlusion for 2 hours. Twenty-four hours later, secondary venous ischemia was produced by 5 hours of venous occlusion. Nonischemic (n = 5), primary ischemic (n = 5), and secondary ischemic control groups (n = 10), and four treatment groups (n = 10) were created. Treatment groups received either 15 or 30 mg per kilogram per day oral CsA for 3 days before flap elevation, or 15 or 30 mg per kilogram intravenous CsA at 4 hours of secondary venous ischemia. Flap survival area, malondialdehyde (MDA) content, and myeloperoxidase (MPO) activity were assayed for each group. The mean flap survival area of the high-dose posttreatment group was significantly higher than the secondary ischemic control group (29% +/- 39% vs. 3% +/- 8%; p < 0.05, Student's t-test). The MDA and MPO levels of each treatment group were significantly lower than the secondary ischemic control group at hours 1 and 24 (p < 0.0001, Student's t-test). The lowest MDA and MPO levels were achieved in the high-dose posttreatment group. Results suggest that CsA may improve flap survival after secondary venous ischemia by attenuating neutrophil infiltration and by reducing lipid peroxidation.
    Annals of Plastic Surgery 08/2000; 45(1):54-60. · 1.38 Impact Factor
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    ABSTRACT: Temporalis muscle flap provides a good solution for the reconstruction of craniofacial defects after tumor resection. Nine patients with complicated defects located at the upper two thirds of the face, anterior cranial base, or mastoid region are presented. Five patients had orbital exenteration, two with total maxillectomy and two with anterior craniofacial resection. Temporalis muscle flap provided profuse well-vascularized tissue for the obliteration of orbital exenteration and total maxillectomy cavities and coverage of surface defects. Cranial, oral, and nasal spaces were separated successfully in all patients. Temporalis muscle flap is a very reliable technique with low complication rates and few donor site problems. This safe and technically easy flap can be preferred for the reconstruction of craniofacial defects after ablative tumor surgery, especially in older and debilitated patients.
    Journal of Craniofacial Surgery 06/2000; 11(3):258-64. · 0.69 Impact Factor
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    ABSTRACT: Development of malignant tumors in chronic burn wounds is a well-known complication. These tumors are almost always squamous cell carcinomas, although other types of malignancies such as basal cell carcinoma, malignant melanoma and sarcomas can be seen rarely. There are only three previously reported cases of malignant fibrous histiocytoma developed in chronic burn scar in the literature. Two cases with malignant fibrous histiocytoma developed in chronic, badly treated burn wounds are presented. One of the tumors was multifocal and overexpression of the p53 gene was present. Both tumors were excised widely and skin grafted. Regional lymph node dissection was performed in one case. One of the patients died due to tumor recurrence and lymphatic metastases. These cases represent a very uncommon complication of burn injury and indicate the importance of the appropriate primary treatment of the burn wound.
    Burns 06/2000; 26(3):305-10. · 1.80 Impact Factor
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    ABSTRACT: Reconstruction of the weight-bearing surface of the foot is a challenging problem for the reconstructive surgeon. Because local tissues are not usually available for reconstruction, distant tissue transfers are often necessary. The authors report 20 patients with sole and heel defects that were reconstructed with free flaps. Two patients had bilateral reconstruction. Three patients were younger than 10 years. Etiological causes were burn scar (N = 7), trauma (N = 7), chronic wound (N = 3), and tumor resection (N = 5). All defects were located at a weight-bearing area. Gracilis muscle (N = 11), neurosensorial radial forearm (N = 7), latissimus dorsi muscle (N = 2), rectus abdominis muscle (N = 1), and posterolateral thigh flaps (N = 1) were used for reconstruction. Muscle flaps were preferred for the deep and irregular defects or chronic, open infected wounds. All flaps survived except for one total and two partial complications of necrosis. Recurrence of ulceration was observed in 1 patient with spinal cord trauma. The mean follow-up period was 33.7 months (range, 1-84 months). Patients were evaluated by direct gait observation, footprints, pedograms, and the Semmes-Weinstein monofilament test. All patients returned to normal daily activity with individual gait patterns. Functional outcomes of both muscle and fasciocutaneous flaps were satisfactory. Presence of deep sensation, preservation of musculoskeletal integrity, and patient compliance are the main factors for durability of reconstruction.
    Annals of Plastic Surgery 04/2000; 44(3):259-68; discussion 268-9. · 1.38 Impact Factor
  • A Yücel, M Bayramiçli
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    ABSTRACT: The effects of hyperbaric oxygen (HBO) and heparin on the survival of the rat inferior epigastric venous flap were investigated. Preliminary transcutaneous oxygen measurements showed that partial oxygen pressure values of venous flaps increased at 2.5 ATA pressure while inhaling 100% oxygen. During the experiment, 128 venous flaps of two different sizes and 50 composite grafts were prepared bilaterally in 89 rats. Perivenous areolar tissue was removed from the pedicle vein in all flaps. Half of the venous flaps were isolated from the wound bed. Initial flap perfusion was tested by fluorescein injection during flap elevation. Four treatment groups were created: control, heparin, HBO, and HBO+heparin. After 6 days of treatment, the mean surviving flap area was calculated for each group. Surviving flaps were reelevated, final flap perfusion was tested by fluorescein injection, and flaps were harvested for histological examination. The mean survival rates of the HBO (26.56%) and the HBO+heparin (36.87%) groups were significantly higher than the control (0%) and the heparin (0%) groups (p<0.01). None of the composite grafts survived. Smaller flaps and nonisolated flaps survived better, although not significantly (p>0.05). Veins were enlarged both clinically and histologically. Fluorescein uptake was delayed during initial flap elevation but was normal during reelevation. These findings imply that the rat inferior epigastric venous flap may be an ischemic flap with capillary circulation through a single venous pedicle, but it needs HBO treatment to survive, especially during the acute period. Heparin treatment, reducing the flap size, and presence of a vascular wound bed also improve survival rates.
    Annals of Plastic Surgery 03/2000; 44(3):295-303. · 1.38 Impact Factor
  • M Altintaş, Y Aydin, A Yücel
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    ABSTRACT: Insufficiency of tissues and progressive contraction usually restrict the application of prosthetic devices in anophthalmic eye sockets. To achieve a successful reconstruction, the plastic surgeon has to form a socket that has proper dimensions and is completely covered by a well vascularized epithelial surface. Eye socket reconstruction with free skin, mucous membrane, or dermis-fat grafts usually remains unsatisfactory in severe cases. We have used a prefabricated temporal island flap to solve this difficult problem since 1983. In this method, a full-thickness skin graft is applied over the temporal fascia to create a prefabricated island flap based on the superficial temporal vessels. This flap is transposed into the eye socket 3 weeks later. Some modifications in flap design have been done to get better fitting of the prosthesis since that time. Thirty-three patients with constricted eye sockets that could not use prosthetic devices were treated with prefabricated temporal island flaps since 1983. The follow-up period was between 1 and 13 years. Eye sockets with adequate size and volume were created in all patients, and the results were successful. This method prevented secondary graft shrinkage, and the prefabricated island flaps preserved their dome shape during the follow-up period. We believe this method is a useful one in the treatment of the contracted socket.
    Plastic &amp Reconstructive Surgery 10/1998; 102(4):980-7. · 3.54 Impact Factor
  • F Orak, A Yücel, Y Aydin
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    ABSTRACT: Treatment of bulbous nasal tip is difficult. In the presence of thick, inelastic skin, cartilaginous framework should be supported in special areas. Many tip grafting techniques have been described but the results usually are not satisfactory. We developed a new tip grafting technique to provide extra support and extra length to the nasal tip. The graft is prepared from the septal cartilage and has an extended "A" appearance. The tip graft is supported with a columellar strut graft. Both grafts are inserted into small separate pockets through separate incisions. If necessary, the alar base is reduced with a modified Weir technique. Fifty-two patients were treated with this technique over the last 3 years. Results were satisfactory in all patients without any complications such as graft displacement, infection, or resorption. Extrasupported tip graft is an effective method in the treatment of bulbous nasal tip with thick skin.
    Aesthetic Plastic Surgery 06/1998; 22(4):259-66. · 1.26 Impact Factor
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    ABSTRACT: An experimental study in rats was designed to determine the effects of z-plasty on the patency of microvascular anastomosis. Eighty Sprague-Dawley rats of mixed sex were divided into two groups. In all animals, the left carotid arteries were used. In the first group (n = 40), a single z-plasty was done at the anterior side of the carotid artery before end-to-end anastomosis was performed. In the second group (n = 40), end-to-end anastomosis with interrupted sutures was done. Patency and the appearance of the anastomosis were evaluated 1 hr later, on the seventh postoperative day, and at the end of the third postoperative week. There was no vasospasm demonstrated in the first group. Patency rates were 100 percent for both groups after 1 hr. On the seventh postoperative day, one anastomosis in the first group (patency rate, 97.5 percent) and two anastomoses in the second group had failed (patency rate, 95 percent). Patency rates were similar at the third week. The difference was not statistically significant (p = 0.5). Histologic examinations demonstrated that z-plasty did not cause any adverse effects at the vessel wall or at the anastomosis.
    Journal of Reconstructive Microsurgery 02/1998; 14(2):117-20. · 1.00 Impact Factor
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    ABSTRACT: The behavior, under burn scars, of three different alloplastic materials, silicone, Medpor and Proplast, was compared in an animal model. A standard burn wound was created in rats, and 3 months later silicone, medpor and proplast alloplasts were placed under the burn scar. The rats were followed for another 3 months and ulceration and/or alloplast exposure rates were evaluated. At the end of this period specimens were examined histologically for the thickness of the fibrous capsule around the implant, thickness of the overlying tissue, tissue ingrowth and vascularization of the implants. Ulceration and exposure occurred in 2 of the 12 Medpor, 2 of the 12 Proplast and none of the 12 silicone implants. Fibrous capsule was significantly thicker around the silicone implants. Tissue ingrowth and vascularization were most prominent in Medpor implants while thickness of the overlying tissue was maximum in Proplast implants. These findings suggest that complications with silicone implants may be less than with other porous implants when used under burn scarred tissue.
    Burns 10/1997; 23(6):484-9. · 1.80 Impact Factor
  • C Senyuva, A Yücel, I Yildirim
    Plastic &amp Reconstructive Surgery 07/1997; 99(7):2099-100. · 3.54 Impact Factor
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    ABSTRACT: Free latissimus dorsi free flaps were used for the treatment of three patients with malignant tumors localized at the distal end of the femur. In all cases, a knee prosthesis was used after tumor resection. In two patients, the prosthesis was covered with a free latissimus dorsi flap immediately after insertion. In one patient, the exposed prosthesis that was inserted 9 months previously was also covered with a free latissimus dorsi flap. Histopathologic diagnosis of the tumors was osteosarcoma in two cases and fusiform cell sarcoma in one case. Free-tissue transfers were successful in spite of preoperative chemotherapy and/or radiotherapy. Chemotherapy was started 3 weeks postoperatively in all cases. Patients ambulated 6 weeks after surgery and knee functions were satisfactory during a 1 year follow-up.
    Journal of Reconstructive Microsurgery 06/1997; 13(4):277-84. · 1.00 Impact Factor
  • F Orak, A Yücel, C Senyuva
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    ABSTRACT: The ideal reduction mammaplasty technique should create a pleasing breast shape with minimal scarring. The long and conspicuous scar associated with the classic inverted "T" pattern mammaplasty techniques are not acceptable for many patients. Periareolar mammaplasty techniques cause less scarring, but they have major disadvantages such as scar widening, areolar distortion, and insufficient breast projection. We used a new pattern for vertical mammaplasty to overcome the insufficient breast projection caused by the round block technique and applied it to 51 patients during the last 3 years. This method results in a single vertical scar and a periareolar scar, allows sufficient volume reduction, and provides good breast shape and projection; the results are durable. This procedure is safe, causes few complications, and is easy to learn and perform.
    Aesthetic Plastic Surgery 04/1997; 21(3):180-6. · 1.26 Impact Factor
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    ABSTRACT: Extracorporeal septoplasty is a radical solution for the severely deviated nose. The major problems associated with this procedure are fixation of the septal cartilage graft and dorsal irregularities. Extracorporeal septoplasty was performed in combination with open rhinoplasty in 17 patients with severe nasal deformities. In this technique septum was totally removed through the columellar incision of open rhinoplasty, corrected outside, and replaced as a free "L" shaped cartilage graft. The cartilage graft was fixated to the upper lateral cartilages to restore the natural relations of the anatomical structures. Additional rhinoplastic manipulations were also performed. The follow-up period was up to 18 months. The overall result was successful in all patients. Nasal deviation did not recur and secondary revisions were not needed for any patient during follow-up.
    Aesthetic Plastic Surgery 01/1997; 21(4):233-9. · 1.26 Impact Factor
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    ABSTRACT: Although liposarcoma is one of the most common soft-tissue sarcomas, facial localization is extremely rare. The buccal fat pad is an important anatomic structure located in the face that recently gained interest as a result of increasing research on facial anatomy. In this paper, we report a case of giant liposarcoma originating from the buccal fat pad. The precise localization of the tumor was determined preoperatively with computed tomography examination. The liposarcoma that invaded the body and the extensions of the buccal fat pad was resected completely. The pathological examination revealed a sclerosing, well-differentiated liposarcoma, which is known to be very rare in the head and neck region. Chemotherapy and radiotherapy were not necessary because of the favourable histological type of the tumor and the advanced age and poor general condition of the patient. Local recurrence and distant metastasis were not observed during the 1-year follow-up.
    Annals of Plastic Surgery 11/1996; 37(4):439-43. · 1.38 Impact Factor
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    ABSTRACT: Neurosurgical procedures may lead to mortal complications. Exposure of the dura mater, brain, or other intracranial structures; persistent cerebrospinal fluid fistulas; and connection between the extradural space and the nasopharynx and paranasal sinuses are complications that can be best treated with microvascular free tissue transfers. We report two patients with complications that occurred after neurosurgical operations. Both patients were treated by a team, including a plastic surgeon, ear, nose, and throat surgeon, and a neurosurgeon. Free rectus abdominis muscle flap was the choice of treatment for reconstruction.
    Journal of Craniofacial Surgery 08/1996; 7(4):317-21. · 0.69 Impact Factor