Papers by Nesrin tan başer
Plastic and Reconstructive Surgery, Oct 1, 2007
Romberg’s disease (also known as ParryRomberg syndrome or progressive hemifacial atrophy) is a ra... more Romberg’s disease (also known as ParryRomberg syndrome or progressive hemifacial atrophy) is a rare pathologic process involving progressive wasting of skin, subcutaneous fat, muscle, and occasionally bones of the face. The condition was first described by Parry in 1825 and later by Romberg in 1846 as “trophoneurisis facialis,” though Eulenberg has coined the term “progressive facial hemiatrophy.” The onset of the disease is slow and progressive and usually commences in the first or second decade of life, more often between the ages of 5 and 15 years.1 It is more common in the female population, with a female-to-male ratio of 1.5 to 1. The atrophy is unilateral in 95 percent of cases. The right and left sides of the face are affected with equal frequency. Pensler et al.,2 in an evaluation of 41 patients, have noted that in all patients the atrophic changes began in a localized area of the face and progressed within the dermatome of one or more branches of the trigeminal nerve. The average age of onset of the disease was 8.8 years, and the mean period of progression was 8.9 6 years. In a group of patients with skeletal involvement in their series, the mean age of onset was 5.4 years versus 15.4 years for patients without skeletal involvement. No correlation could be established between severity of soft-tissue deformity and age of onset. When bony hypoplasia is present, it affects predominantly the middle and lower face.3 The timing of surgery should be based on correction of the deformity after cessation of the ongoing atrophic process, usually after a period of at least 1 year.1 Soft-tissue reconstruction techniques should address the augmentation of deficient soft-tissue volume. There is a wide range of methods described, from dermal fat grafts to free tissue transfers. The myriad of methods reflects the lack of a single best method. The cause of the disorder is unknown, although many theories have been proposed. Among these, the most popular are infection,4 trauma, immunologic abnormality, heredity, trigeminal neuritis, scleroderma, and cervical sympathetic loss.5,6 Regardless of the cause, the resultant deformity is usually characterized by a stable “burned-out” appearance of the hemiface. The proposed theory of alteration in peripheral sympathetic stimulation has gained a certain popularity following studies reporting Romberglike changes observed in laboratory animals after superior cervical sympathectomy.5,7–10 Only one report of Romberg’s disease following thoracoscopic sympathectomy (performed for palmar hyperhidrosis) was reported for humans in the English literature. However, previously, Tebloev and Kalashnikov11 and Tebloev et al.7 reported a total of 28 patients in whom facial hemiatrophy developed after the onset of ganglionitis of the superior cervical sympathetic ganglion, brainstem encephalitis, trigeminal neuralgia, tumors of the gasserian ganglion, and syringobulbia. In contrast, if the sympathetic nervous system is responsible, it remains unclear whether facial atrophy results from postinflammatory hypofunction or sympathetic hyperactivity in the presence of active inflammation.12 Horner’s syndrome (Claude-Bernard-Horner syndrome) is characterized by an interruption of From the Department of Plastic and Reconstructive Surgery, Ankara Education and Research Hospital. Received for publication March 23, 2005; accepted July 28, 2005. Copyright ©2007 by the American Society of Plastic Surgeons
Journal of Plastic Surgery and Hand Surgery, Dec 1, 2011
We aimed to reduce the defect with a purse-string suture to minimise the deformity of the flap do... more We aimed to reduce the defect with a purse-string suture to minimise the deformity of the flap donor area and to assess the later efficiency at long-term follow-up. We studied 20 patients who required a sural flap for the reconstruction of defects of the lower extremity. The mean (SD) area of the donor defect was roughly 28.7 (20.3) cm 2. The mean (SD) defect area after closure with a purse-string was 8.2 (5.8) cm 2 (p < 0.001). The measurements made in the third year were 8.4 (5.3) cm 2. The pursestring can be used successfully in the distal lower extremity, the long-term cosmetic outcome is good, and the scar has not expanded since the postoperative period.
Journal of Plastic Reconstructive and Aesthetic Surgery, Oct 1, 2012
Notching, or 'whistle deformity', is a common vermilion deformity among patients with cleft lips.... more Notching, or 'whistle deformity', is a common vermilion deformity among patients with cleft lips. Vermilion volume deficiency may also be present secondary to trauma or tumour excision. Herein, we present a new flap model to repair such vermilion deformities. Six patients were included in the study. Running V-flaps prepared from the oral mucosa were used. While the underlying cause of vermilion deficiency was cleft-lip surgery in four of the patients, the indication for surgery was trauma related in two patients. In all patients, the volume deficiency was corrected. No patient exhibited scarring, colour mismatch or asymmetry. We believe that our new flap model can be a reliable alternative in secondary vermilion deficiencies.
Turkish journal of trauma & emergency surgery, 2011
İzole orbita taban kırıklarının cerrahi endikasyonu, zamanlaması, kullanılacak rekonstrüksiyon ma... more İzole orbita taban kırıklarının cerrahi endikasyonu, zamanlaması, kullanılacak rekonstrüksiyon materyali hakkında halen görüş birliği yoktur. GEREÇ VE YÖNTEM 2002-2010 yılları arasında izole orbita taban kırığı tanısı alarak ameliyat edilen hastalar (41 erkek, 13 kadın) geriye dönük olarak değerlendirildi. BULGULAR İzole orbita taban kırığı tanısı alan 54 hastadan, ameliyat edilen 49 hastanın cerrahi endikasyonuna bakıldığında, %20,4'ünde göz hareketlerinde kısıtlılık ve belirgin enoftalmi, %79,6'sında koronal planda çekilen bilgisayarlı tomografi görüntülerinin etkili olduğu görüldü. Hastaların %36,7'si ilk 16 saat içinde %10,2'si en geç 72-96 saat içinde ameliyat edildi. Orbita taban onarımı için ultra ince poröz polyetilen kullanıldı. Bu çalışma nedeniyle kendilerine ulaşılan 12 hastanın enoftalmi-egzoftalmi açısından normal sınırlarda olduğu, hiçbir hastada ektropiyon ya da skleral show bulgusu olmadığı, hastaların skara bağlı herhangi bir şikayetlerinin olmadığı görüldü. SONUÇ Tedavi edilmediğinde enoftalmi ve çift görme ile sonuçlanabilecek olan orbita taban kırığında, iyi prognoz doğru cerrahi endikasyon, erken cerrahi girişim ve uygun materyal ile onarıma bağlı olduğunu düşünmekteyiz. Anahtar Sözcükler: Bilgisayarlı tomografi; orbita kırıkları; orbita implantları; X-ışınları. BACKGROUND A common consent regarding repair indications, timing of repair and choice of reconstruction materials for isolated orbital base fractures does not yet exist. METHODS We retrospectively reviewed our patients (41 male, 13 female) who were operated due to a diagnosis of isolated orbital floor fracture between 2002 and 2010. RESULTS Fifty-four patients diagnosed with isolated orbital base fracture were found; 49 of 54 patients required surgery. The indications for surgery were restricted ocular motility and marked enophthalmos in 20.4% of the patients, whereas in 79.6%, surgical intervention was decided largely based on the coronal computed tomography images. 36.7% of the cases were operated earliest, in the first 16 hours, and 10.2% were operated the latest, in 72-96 hours. Ultra-thin porous polyethylene was used in the orbital base repair. Twelve patients contacted for this study were evaluated. Enophthalmia and exophthalmia were in normal limits in patients, and none of the patients displayed ectropion or scleral show findings or reported any complaints related to scar formation. CONCLUSION When not treated in a timely manner and with appropriate materials, orbital base fractures might result in enophthalmia and diplopia. We believe that a good prognosis of orbital base fractures relies on the right decision for surgical indication, early surgical intervention, and repair with appropriate material.
Turkiye Klinikleri Tip Bilimleri Dergisi, 2007
The morbidity and social cost is found to be very high for upper extremity nerve injuries. Despit... more The morbidity and social cost is found to be very high for upper extremity nerve injuries. Despite the fast advances in scientific studies and technology, a complete recovery following peripheral nerve injuries is still not possible, though, comprehensible progression in this field is obtained especially following microsurgery techniques. The aim of this study, is to present the anatomical locations of upper extremity nerve injuries treated in our clinic and the relationship between nerve injuries with other vital organ and soft tissue injuries. 111 patients with 134 nerve injuries treated in our clinic between January 2001 and December 2003 were included in this study. A high association of soft tissue injuries was found for all nerve types. The functional deficits observed following upper extremity nerve injuries, generate deep marks on the psychosocial life of the patients. It is a known fact that, an accompanying muscle, tendon or artery injury reveals a worse prognosis. It is clearly observed from our study that an isolated nerve injury is an exception than a rule. This should be a major concern when consequences of upper extremity injuries and the results of treatments are being evaluated. The accompanying soft tissue injuries may overall change the fate of an otherwise successful nerve repair.
European Journal of Plastic Surgery, Mar 16, 2006
Infantile digital fibromatosis is a rare childhood benign tumor that mainly affects digits of han... more Infantile digital fibromatosis is a rare childhood benign tumor that mainly affects digits of hands and feet. Spontaneous regression has been reported, leaving the treatment options of observation or surgery a controversial topic. In this article, two cases of infantile digital fibromatosis treated with different approaches are presented. Observation alone was utilized in the first case. No spontaneous regression was observed after 2 years of follow up. In the second case, extended tumor excision and grafting was the chosen treatment. Recurrence was not observed at the 24th month postsurgery. We believe that to prevent recurrence, the tumor must be widely excised.
Surgical Innovation, Jul 6, 2017
Capsular contracture is the most common complication of breast augmentation. Oxidized regenerated... more Capsular contracture is the most common complication of breast augmentation. Oxidized regenerated cellulose can be used as a matrix for drug transport. Colchicine is an antimitotic drug that interferes with various steps of wound healing. The aim of this study was to evaluate the effects of oxidized regenerated cellulose alone or in combination with colchicine on capsular contracture. Twenty-one adult female Wistar-Albino rats were divided into 3 groups. In group 1 silicone blocks only, in group 2 oxidized regenerated cellulose-wrapped silicone blocks, and in group 3 colchicine-impregnated oxidized regenerated cellulose-wrapped silicone blocks were inserted in the dorsal region. Four weeks later, implants were removed and histopathological examination was performed. Capsular thickness, inflammatory infiltrate degree, collagen fiber organization, and myofibroblast density were evaluated. Macroscopic examination revealed a distinct capsule formation only in group 1 animals, with average measurement being 134.65 µm on histopathological examination. In groups 2 and 3 animals, no distinct capsule formation was seen. Inflammatory infiltrate degree was found to be less in groups 2 and 3 animals than in group 1 animals. Collagen fiber organization around the implants was found to be parallel and organized in group 1 animals, whereas it was random and disorganized in animals in both groups 2 and 3. High myofibroblast density was observed in animals in groups 1 and 2, while no myofibroblast was found in animals in group 3. The results of our study suggest that coating silicone implants with oxidized regenerated cellulose or with colchicine-impregnated oxidized regenerated cellulose may be effective in preventing capsular contracture.
European Journal of Plastic Surgery, Aug 7, 2008
The use of split-thickness skin grafts (STSG) as a reconstructive technique in the diabetic foot ... more The use of split-thickness skin grafts (STSG) as a reconstructive technique in the diabetic foot is common. Studies on the ideal dressing for donor-site care have not included subjects such as diabetics who have woundhealing problems. The aim of this study was to determine the efficacy of high-valve water vapor transmission rate (WVTR) polyurethane film dressing in the management of the STSG donor site compared to the clinical standard fine mesh gauze dressing in diabetic patients. Twenty diabetic patients were observed for healing, scarring, and pain. Healing times were recorded. Pain was monitored using a visual analog pain scale and recorded. Scarring of the donor sites was assessed using the Vancouver scar scale 6 months after surgery. The WVTR dressing was found to be significantly better than mesh gauze dressing for the healing of STSG donor sites. Healing occurred more rapidly and with less pain. Moreover, it has some advantages of dry wound dressings such as ease of application and follow-up. Dressings should retain enough moisture to stimulate good healing and yet should not cause maceration to the surrounding skin, and also should not cause allergic reactions. In this study it was shown that high-valve WVTR polyurethane film dressing provided many qualities of the ideal split-thickness skin graft donorsite dressing.
A double lip is an infrequent deformity that may be either congenital or acquired. The deformity ... more A double lip is an infrequent deformity that may be either congenital or acquired. The deformity characterized by a horizontal fold of redundant mucosal tissue located on the inner aspect of the lip. We presented an acquired double lip deformity which has hemangioma as an etiologic factor and not yet been reported in the literature.
Turkish Journal of Medical Sciences, Aug 22, 2005
This article concerning the rate of accurate diagnosis of keratinocyte carcinoma is reported by e... more This article concerning the rate of accurate diagnosis of keratinocyte carcinoma is reported by experienced surgeons. Keratinocyte carcinoma (KC) has been recently used in order to define basal cell carcinoma and squamous cell carcinoma. Although an histopathologic analysis is standard for diagnosis, clinical diagnosis is still important for the choice of proper treatment. In this prospective study, 204 lesions were excised following clinical pre-diagnosis of keratinocyte carcinoma. The lesions were excised from the proper surgical limit for clinical diagnosis and sent for histopathologic examination. We have seen that we frequently confuse BCC s and SCC s with actinic keratosis. According to these results, we found that our accurate diagnosis rate was 82% for BCC and 78.8% for SCC. When compared with the results in the literature, our accurate diagnosis rate is high. We believe that the gross examination of the lesion should be assessed with details such as age of the patient, sex, profession, and commencement and development of the lesion, as these factors are very useful in achieving a high rate of accuracy in the definitive diagnosis. We consider that accurate clinical pre-diagnosis is very important in the pigmented lesions, since the surgeon will define the excision margin in accordance with this. In the case of wrong pre-diagnosis of benign tumor, the residue tumor risk will increase. These lesions must be assessed by experienced doctors before excision.
European Journal of Plastic Surgery, 2006
Infantile digital fibromatosis is a rare childhood benign tumor that mainly affects digits of han... more Infantile digital fibromatosis is a rare childhood benign tumor that mainly affects digits of hands and feet. Spontaneous regression has been reported, leaving the treatment options of observation or surgery a controversial topic. In this article, two cases of infantile digital fibromatosis treated with different approaches are presented. Observation alone was utilized in the first case. No spontaneous regression was observed after 2 years of follow up. In the second case, extended tumor excision and grafting was the chosen treatment. Recurrence was not observed at the 24th month postsurgery. We believe that to prevent recurrence, the tumor must be widely excised.
International journal of dermatology, 2008
Numerous chemical agents are used in the topical treatment of warts. Monochloroacetic acid (MCAA)... more Numerous chemical agents are used in the topical treatment of warts. Monochloroacetic acid (MCAA) is one of these agents, which is used in low or high concentrations in most European countries. MCAA is a strong organic acid which is irritating and corrosive to the skin and has a high systemic toxicity. In addition to wart treatment, it is used for industrial purposes, such as the synthesis of certain organic chemicals. We present a case of joint deformity manifesting after the use of a preparation containing MCAA for topical wart treatment. This underlines the need to reassess the safety of MCAA use for topical wart treatment.
Journal of Plastic Surgery and Hand Surgery, 2011
We aimed to reduce the defect with a purse-string suture to minimise the deformity of the flap do... more We aimed to reduce the defect with a purse-string suture to minimise the deformity of the flap donor area and to assess the later efficiency at long-term follow-up. We studied 20 patients who required a sural flap for the reconstruction of defects of the lower extremity. The mean (SD) area of the donor defect was roughly 28.7 (20.3) cm 2. The mean (SD) defect area after closure with a purse-string was 8.2 (5.8) cm 2 (p < 0.001). The measurements made in the third year were 8.4 (5.3) cm 2. The pursestring can be used successfully in the distal lower extremity, the long-term cosmetic outcome is good, and the scar has not expanded since the postoperative period.
European Journal of Plastic Surgery, 2008
The use of split-thickness skin grafts (STSG) as a reconstructive technique in the diabetic foot ... more The use of split-thickness skin grafts (STSG) as a reconstructive technique in the diabetic foot is common. Studies on the ideal dressing for donor-site care have not included subjects such as diabetics who have woundhealing problems. The aim of this study was to determine the efficacy of high-valve water vapor transmission rate (WVTR) polyurethane film dressing in the management of the STSG donor site compared to the clinical standard fine mesh gauze dressing in diabetic patients. Twenty diabetic patients were observed for healing, scarring, and pain. Healing times were recorded. Pain was monitored using a visual analog pain scale and recorded. Scarring of the donor sites was assessed using the Vancouver scar scale 6 months after surgery. The WVTR dressing was found to be significantly better than mesh gauze dressing for the healing of STSG donor sites. Healing occurred more rapidly and with less pain. Moreover, it has some advantages of dry wound dressings such as ease of application and follow-up. Dressings should retain enough moisture to stimulate good healing and yet should not cause maceration to the surrounding skin, and also should not cause allergic reactions. In this study it was shown that high-valve WVTR polyurethane film dressing provided many qualities of the ideal split-thickness skin graft donorsite dressing.
Turkish Journal of Trauma and Emergency Surgery, 2011
İzole orbita taban kırıklarının cerrahi endikasyonu, zamanlaması, kullanılacak rekonstrüksiyon ma... more İzole orbita taban kırıklarının cerrahi endikasyonu, zamanlaması, kullanılacak rekonstrüksiyon materyali hakkında halen görüş birliği yoktur. GEREÇ VE YÖNTEM 2002-2010 yılları arasında izole orbita taban kırığı tanısı alarak ameliyat edilen hastalar (41 erkek, 13 kadın) geriye dönük olarak değerlendirildi. BULGULAR İzole orbita taban kırığı tanısı alan 54 hastadan, ameliyat edilen 49 hastanın cerrahi endikasyonuna bakıldığında, %20,4'ünde göz hareketlerinde kısıtlılık ve belirgin enoftalmi, %79,6'sında koronal planda çekilen bilgisayarlı tomografi görüntülerinin etkili olduğu görüldü. Hastaların %36,7'si ilk 16 saat içinde %10,2'si en geç 72-96 saat içinde ameliyat edildi. Orbita taban onarımı için ultra ince poröz polyetilen kullanıldı. Bu çalışma nedeniyle kendilerine ulaşılan 12 hastanın enoftalmi-egzoftalmi açısından normal sınırlarda olduğu, hiçbir hastada ektropiyon ya da skleral show bulgusu olmadığı, hastaların skara bağlı herhangi bir şikayetlerinin olmadığı görüldü. SONUÇ Tedavi edilmediğinde enoftalmi ve çift görme ile sonuçlanabilecek olan orbita taban kırığında, iyi prognoz doğru cerrahi endikasyon, erken cerrahi girişim ve uygun materyal ile onarıma bağlı olduğunu düşünmekteyiz. Anahtar Sözcükler: Bilgisayarlı tomografi; orbita kırıkları; orbita implantları; X-ışınları. BACKGROUND A common consent regarding repair indications, timing of repair and choice of reconstruction materials for isolated orbital base fractures does not yet exist. METHODS We retrospectively reviewed our patients (41 male, 13 female) who were operated due to a diagnosis of isolated orbital floor fracture between 2002 and 2010. RESULTS Fifty-four patients diagnosed with isolated orbital base fracture were found; 49 of 54 patients required surgery. The indications for surgery were restricted ocular motility and marked enophthalmos in 20.4% of the patients, whereas in 79.6%, surgical intervention was decided largely based on the coronal computed tomography images. 36.7% of the cases were operated earliest, in the first 16 hours, and 10.2% were operated the latest, in 72-96 hours. Ultra-thin porous polyethylene was used in the orbital base repair. Twelve patients contacted for this study were evaluated. Enophthalmia and exophthalmia were in normal limits in patients, and none of the patients displayed ectropion or scleral show findings or reported any complaints related to scar formation. CONCLUSION When not treated in a timely manner and with appropriate materials, orbital base fractures might result in enophthalmia and diplopia. We believe that a good prognosis of orbital base fractures relies on the right decision for surgical indication, early surgical intervention, and repair with appropriate material.
European Journal of Plastic Surgery, 2014
Created arteriovenous fistulas for hemodialysis in patients with renal failure can cause problems... more Created arteriovenous fistulas for hemodialysis in patients with renal failure can cause problems in the upper extremity. Thrombosis, bleeding, infection, and distal ischemic changes can be seen. Steal is considered as a rare phenomenon. High blood-flow volume through an arteriovenous fistula may cause stealing of blood from forearm arteries which can lead to distal hypoperfusion and peripheral ischemia as well as distal fingertip amputations and even spontaneous ulcerations. Herein, two patients admitted to our outpatient clinic by finger necrosis have been reported, and the aim of this paper is to highlight a rare but serious complication of arteriovenous fistula and discuss what should be done to prevent finger necrosis and the strategies that can be done in the case of finger necrosis which might be of interest for the clinicians. Level of Evidence: Level V, risk/prognostic study.
Plastic and Reconstructive Surgery, 2007
Romberg’s disease (also known as ParryRomberg syndrome or progressive hemifacial atrophy) is a ra... more Romberg’s disease (also known as ParryRomberg syndrome or progressive hemifacial atrophy) is a rare pathologic process involving progressive wasting of skin, subcutaneous fat, muscle, and occasionally bones of the face. The condition was first described by Parry in 1825 and later by Romberg in 1846 as “trophoneurisis facialis,” though Eulenberg has coined the term “progressive facial hemiatrophy.” The onset of the disease is slow and progressive and usually commences in the first or second decade of life, more often between the ages of 5 and 15 years.1 It is more common in the female population, with a female-to-male ratio of 1.5 to 1. The atrophy is unilateral in 95 percent of cases. The right and left sides of the face are affected with equal frequency. Pensler et al.,2 in an evaluation of 41 patients, have noted that in all patients the atrophic changes began in a localized area of the face and progressed within the dermatome of one or more branches of the trigeminal nerve. The average age of onset of the disease was 8.8 years, and the mean period of progression was 8.9 6 years. In a group of patients with skeletal involvement in their series, the mean age of onset was 5.4 years versus 15.4 years for patients without skeletal involvement. No correlation could be established between severity of soft-tissue deformity and age of onset. When bony hypoplasia is present, it affects predominantly the middle and lower face.3 The timing of surgery should be based on correction of the deformity after cessation of the ongoing atrophic process, usually after a period of at least 1 year.1 Soft-tissue reconstruction techniques should address the augmentation of deficient soft-tissue volume. There is a wide range of methods described, from dermal fat grafts to free tissue transfers. The myriad of methods reflects the lack of a single best method. The cause of the disorder is unknown, although many theories have been proposed. Among these, the most popular are infection,4 trauma, immunologic abnormality, heredity, trigeminal neuritis, scleroderma, and cervical sympathetic loss.5,6 Regardless of the cause, the resultant deformity is usually characterized by a stable “burned-out” appearance of the hemiface. The proposed theory of alteration in peripheral sympathetic stimulation has gained a certain popularity following studies reporting Romberglike changes observed in laboratory animals after superior cervical sympathectomy.5,7–10 Only one report of Romberg’s disease following thoracoscopic sympathectomy (performed for palmar hyperhidrosis) was reported for humans in the English literature. However, previously, Tebloev and Kalashnikov11 and Tebloev et al.7 reported a total of 28 patients in whom facial hemiatrophy developed after the onset of ganglionitis of the superior cervical sympathetic ganglion, brainstem encephalitis, trigeminal neuralgia, tumors of the gasserian ganglion, and syringobulbia. In contrast, if the sympathetic nervous system is responsible, it remains unclear whether facial atrophy results from postinflammatory hypofunction or sympathetic hyperactivity in the presence of active inflammation.12 Horner’s syndrome (Claude-Bernard-Horner syndrome) is characterized by an interruption of From the Department of Plastic and Reconstructive Surgery, Ankara Education and Research Hospital. Received for publication March 23, 2005; accepted July 28, 2005. Copyright ©2007 by the American Society of Plastic Surgeons
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Papers by Nesrin tan başer