High lactoferrin levels in disseminated intravascular coagulation and its possible negative role in coagulation.
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Biomarkers↗
Biomedical subjects
F Demirkan
Publications and source records attributed to F Demirkan.
Assessment of muscle flap sensibility by evoked potentials in the rat.
This study investigated whether the sensory-to-motor reinervation of the muscle flap provides a better sensory recovery of an overlying skin graft. Fifty-four animals were studied in three groups of 18 rats each: group I (control): 1 cm of the gastrocnemius muscle motor nerve was excised and no repair was performed; group II (motor-to-motor repair): the motor nerve of the gastrocnemius flap was transected and repaired; group III (sensory-to-motor repair): the motor nerve of the gastrocnemius muscle and sural nerve were transected and their distal and proximal ends, respectively, were repaired. At follow-up periods of 6, 12, and 24 weeks, evaluation of hair growth, muscle atrophy, and sensory evoked potentials was performed. Somatosensory evoked potentials (SSEP) at 6 weeks in the sensory-to-motor repair (group III) revealed a significant (P < 0. 05) increase (104.4% +/- 22.9) in the relative response of peak-to-peak potentials when compared with group I (46.6% +/- 19) and group II (51.8% +/- 14.0). Muscle flap stimulation was most prominent at 6 weeks in sensory-to-motor reinvervated flaps (group III 133.1% +/- 25.4; group I 84.9% +/- 20.2). In this study, sensory-to-motor nerve repair significantly improved the sensibility of skin flaps at 6 weeks. Denervated flaps presented with 3 months of sensory recovery delay.
Animals↗
The versatile anterolateral thigh flap: a musculocutaneous flap in disguise in head and neck reconstruction.
In search of an alternative soft tissue free flap donor site to radial forearm flap and rectus abdominis flap in head and neck reconstruction, we used the anterolateral thigh flap for reconstruction of various defects in the head and neck in 59 patients. The aim was to demonstrate the versatility of this donor site and propose a new approach to achieve a safer flap dissection. With the exception of three cases, all defects resulted from excision of malignant tumours. The defects were categorised as full thickness defects of the mandible (33.9%), full thickness defects of the cheek (52.5%) and others (13.6%). During the flap dissection a direct septocutaneous pedicle was observed in 12% of the cases. In the remaining cases there were only musculocutaneous perforators and the flaps were raised either as a split vastus lateralis musculocutaneous flap (72%) or as a perforator flap (16%), depending on the required thickness. Total flap survival was 96.7% with one total and one partial failure and two re-explorations (3.3%). The mean follow-up time was 7.1 months (range: 1-12 months). In conclusion, the anterolateral thigh flap is a versatile and dependable flap that can be adapted to any type of defect by modifying the flap design and composition. It should be considered to be a musculocutaneous flap of the vastus lateralis muscle that can also be raised as a perforator flap. When harvested and used in this context, the flap dissection becomes very safe and consistent, nullifying the only major disadvantage associated with this donor site.
Adolescent↗
Oromandibular reconstruction using a third free flap in sequence in recurrent carcinoma.
Successful results of a second microsurgical reconstructive attempt have been reported previously in recurrent oral carcinoma. However, the feasibility of a third free flap following a third excision has remained to be determined. Six oral carcinoma patients with multiple recurrences, surgical excisions and free flap reconstructions on three separate occasions are presented. Resections had a curative intent in all cases in the first and second ablations and in four of the six cases in the third one. Five radial forearm flaps and one double free flap were used for the first reconstruction. During the second reconstruction two radial forearm, two fibula osteoseptocutaneous, one double free flap and one rectus femoris flap were used to reconstruct the larger defects resulting from excision of the recurrent tumours. However, no vascularised bone transfers were performed following the third excision and soft tissue free flap plus plate option was used for segmental mandibular defects. There was one partial flap loss among 21 free flaps performed. Three patients died within an average of 8 months following the third reconstruction while the others remained alive, surviving an average of 6 months. In conclusion, a third free tissue transfer for reconstruction in multiply recurrent oral carcinoma was found to be feasible, safe and effective. The use of free flaps contributed to the prevention of complications in these difficult cases and enabled the patients to spend the remaining days of their lives outside hospital.
Adult↗
Double free flaps in reconstruction of extensive composite mandibular defects in head and neck cancer.
Extensive composite defects of the lower jaw are defined as those that involve skin, mandible, oral mucosa, and soft tissues. The enormous size and multilayered nature of these defects challenge most of the current reconstructive techniques. For reconstruction of extensive composite mandibular defects in 36 advanced oral cancer patients, two free flaps were used simultaneously in a complementary fashion. The aim was to provide bone reconstruction and adequate soft-tissue coverage in an optimal form. Primary reconstruction was carried out in 34 of 36 cases. The fibula osteoseptocutaneous-radial forearm fasciocutaneous flap combination was most commonly used (n = 20), followed by the fibula osteoseptocutaneous-rectus abdominis myocutaneous flap (n = 11). The other combinations included the fibula osteoseptocutaneous-tensor fasciae latae, the fibula osteoseptocutaneous-rectus femoris, the iliac crest-radial forearm, and the iliac crest-tensor fasciae latae flaps. In 11 cases, the second free flaps were attached to the distal runoff of the first free flaps because of unavailability of recipient vessels. The mean operation time was 12 hours 10 minutes. The complete flap survival rate was 93 percent (67 of 72 flaps) with 2.8 percent total (2 of 72) and 4.2 percent partial (3 of 72) flap failures. Median follow-up time was 14 months, and 44 percent of the patients were alive at the time of evaluation, surviving an average of 36 months. The average survival time for those who died was 11.1 months. The authors believe that in selected cases the double free-flap procedure for one-stage reconstruction of massive mandibular defects is justified because it is safe and effective and improves the quality of life and the number of days spent outside of the hospital for these patients.
Adult↗
Toe transplantation for isolated index finger amputations distal to the proximal interphalangeal joint.
Functional deficit following single distal index finger amputations has been considered insignificant, and reconstruction is usually not recommended. Herein, 19 cases of second toe transplantation for reconstruction of isolated index finger amputation distal to the proximal interphalangeal joint are presented with long-term functional results. There are 14 men and 5 women. The average age was 26 years. The toe transplantations were performed either as a primary procedure (5 patients) while the wounds were still open or as a secondary procedure (14 patients) after the wounds healed. In 11 patients, the dominant hand was involved. All toes survived completely, although re-exploration was required in three cases (16 percent). The functional evaluation included (1) sensory recovery, where the average static and moving two-point discrimination were 8 mm (range 4 to 15 mm) and 6 mm (range 2 to 15 mm); (2) motor function, where the average of index-thumb pulp-to-pulp pinch compared with the normal hand was 67.5 percent (range 36 to 96 percent); (3) average range of motion in index finger joints (extension/flexion), where metacarpophalangeal joint was 14/90, proximal interphalangeal joint was 0/94, and distal interphalangeal joint was 19/38; and (4) functional and cosmetic results, where percentage of involvement in daily activities and functional capacity of the reconstructed index were 69 percent and 70.5 in average, respectively, over a total score of 100. Average scores of aesthetic appearance and acceptability of donor-site deformity were 74 and 87.5 over a total score of 100, respectively. Toe transplantation for distal index finger amputations improved hand function when performed in selected patients with specific job requirements or high motivation.
Adolescent↗
Microsurgical reconstruction in recurrent oral cancer: use of a second free flap in the same patient.
Primary microsurgical reconstruction is the treatment of choice for ablative defects of oral carcinoma. As a result of this trend, more and more patients with recurrent oral carcinoma who have been initially treated with surgical excision and reconstructed with free flaps are being seen. However, a second microsurgical reconstruction attempt in these cases raises questions about the flap choices, availability of recipient vessels, and effects of previous treatment modalities. Herein, 35 patients with perioral carcinoma who had two successive tumor resections and reconstruction with free flaps on each occasion are presented. A total of 75 free tissue transfers were carried out for the first and second reconstructions. After the first tumor resection, 28 radial forearm fasciocutaneous flaps, 7 fibula osteoseptocutaneous flaps, 1 iliac osteomyocutaneous flap, and 2 rectus abdominis myocutaneous flaps were used. For reconstruction after the recurrence, 17 radial forearm fasciocutaneous flaps, 13 fibula osteoseptocutaneous flaps, 3 rectus abdominis myocutaneous flaps, 2 anterolateral thigh flaps, 1 jejunum flap, and 1 tensor fasciae latae flap were used. More vascularized bone transfers were performed during the second reconstruction since the excision for the recurrence frequently required segmental mandibulectomy. The complete flap survival rate was 97.3 percent and 94.6 percent with a reexploration rate of 7.9 percent and 13.5 percent for the first and second free tissue transfers, respectively. The mean follow-up time throughout the procedures was 37.5 months. Disease-free interval between reconstructions was 20.8 months. At the time of evaluation, 54.3 percent of the patients were surviving an average of 19 months since the second reconstruction. The results suggest that free flaps represent an important option in reconstruction of recurrent perioral carcinoma cases undergoing reexcision. When used in this indication they are as safe and effective as the initial procedure.
Adult↗
Free fibula osteoseptocutaneous-pedicled pectoralis major myocutaneous flap combination in reconstruction of extensive composite mandibular defects.
Lateral composite mandibular defects resulting from excision of advanced oral carcinoma often require mandible, intra-oral lining, external face, and soft-tissue bulk reconstruction. Ignorance of importance soft-tissue deficit in those patients may cause significant morbidity and functional loss. Such defects, therefore, can be reconstructed best with a double free flap technique. However, this procedure may not be feasible for every patient or surgeon. An alternative procedure is a free fibula osteoseptocutaneous flap combined with a pedicled pectoralis major myocutaneous flap. This combination was used in reconstruction of extensive composite mandibular defects in 14 patients with T3/T4 oral squamous cell carcinoma. All patients were men, and the average age was 54.3 years. The septocutaneous paddle of the fibula flap was used for the mucosal lining of the defects while the bony part established the rigid mandibular continuity. The pectoralis major flap then covered the external skin defect in the face and cheek, and the dead spaces left by the extirpated masticator muscles, buccal fat, and parotid gland. One free fibula flap failed totally, and one pectoralis major flap developed marginal necrosis. At the time of final evaluation, nine patients (64.3 percent) were alive, surviving an average of 25.7 months. All patients eventually regained their oral continence and an acceptable cosmetic appearance. In conclusion, the fibula osteoseptocutaneous flap plus regional myocutaneous flap choice is a successful and technically less demanding alternative to the double free flap procedures in reconstruction of extensive lateral mandibular defects.
Adult↗
Management of secondary soft-tissue deficits following microsurgical head and neck reconstruction by means of another free flap.
Secondary soft-tissue deficits may develop following a microsurgical reconstruction in the head and neck region because of inadequate planning or chronic effects of radiotherapy. Although most cases could be managed with alternative methods, free flaps might be necessary in difficult cases. Herein are described 11 cases of microsurgical head and neck reconstruction in which secondary soft-tissue deficits required transfer of another soft-tissue free flap. All patients had malignant tumors treated with surgical resection, and their defects were reconstructed with free flaps. Seven patients received either preoperative or postoperative adjunctive radiotherapy. These patients gradually developed signs and symptoms of soft-tissue deficiency in the reconstructed area, and a soft-tissue free flap transfer was required for treatment within an average of 21.5 months of their initial reconstruction. Five rectus abdominis, one rectus femoris, one latissimus dorsi, one tensor fasciae latae myocutaneous, one radial forearm, one medial arm, and one dorsalis pedis flap were used for this purpose. All flaps survived completely. The average follow-up time was 32 months. Significant improvement was achieved in all cases, and no further major surgical procedures were required. Secondary soft-tissue deficits that could not be predicted or prevented during the initial microsurgical reconstruction may be treated successfully by a subsequent free soft-tissue transfer in selected cases.
Adult↗
One-stage reconstruction of eye socket and eyelids in orbital exenteration patients.
Reconstruction of the exenterated orbit is a difficult problem with several advantages and disadvantages. Satisfactory reconstructive results for both the physician and the patient may need multistage operations that are time consuming and disfiguring. A simple and effective one-stage technique that combines two regional flaps is described for reconstruction of deformities of orbital exenteration. A temporalis muscle flap is transposed for orbital filling, and a prefabricated frontal island flap based on superficial temporal vessels is used for eye socket and eyelid reconstruction. For patients who oppose living with exenteration deformity and request quicker reconstruction, this new and simple technique may be used successfully.
Adolescent↗
Reliability of the venae comitantes in venous drainage of the free radial forearm flaps.
The radial venae comitantes are usually considered as an accessory venous outflow tract in the free radial forearm flap because of their smaller size and thinner structure when compared with those of the cephalic vein. To evaluate the reliability of the deep venous system, a single radial vena comitans anastomosis was performed to serve as the sole venous outflow tract in 94 consecutive radial forearm free flap transfers. The suprafascial dissection technique was used in flap elevation, which allowed preservation of the cephalic vein and the dorsal branch of the radial nerve. In all cases, the external diameter of at least one vena comitans was adequate (< or = 1.5 mm) to perform a smooth microvascular anastomosis; in none of the cases was a venous anastomosis failure detected. Preselected use of a single vena comitans for the venous drainage of radial forearm free flaps was proven to be reliable and was preferred because of the ease of flap dissection and better donor site appearance.
Adult↗
Anti-ICAM-1 antibodies protect allografts against microvascular and parenchymal cell damage.
Anti-ICAM-1 (anti-intercellular adhesion molecule-1) monoclonal antibodies (CD54) were tested for treating composite tissue allografts in the rat hindlimb-cremaster transplantation model for intravital microcirculatory studies. Twenty-four transplantations were carried out across major histocompatibility barriers between Lewis-Brown Norway and Lewis rats. Isograft control transplants were compared to nontreated allograft control transplants and to allografts treated with 1 mg/kg of anti-ICAM-1 monoclonal antibodies. At 24 and 72 hours, microcirculatory vessel diameters, red blood cell velocities, functional capillary perfusion, endothelial edema index, and leukocyte-endothelial interactions were measured. At 24 and 72 hours, the number of sticking leukocytes, sticking lymphocytes, transmigrating leukocytes, and the endothelial edema index in the treated allografts were significantly decreased more than in the other 2 groups (p < .05 for all variables). Anti-ICAM monoclonal antibodies significantly reduced leukocyte-endothelial interactions, protecting the allografts from acute microvascular and parenchymal injury.
Animals↗
Triplicated thumb.
A polydactyly anomaly of the thumb with three nails, two metacarpals, and seven phalanges is presented. This anomaly is named triplicated thumb, and its place in Wassel's classification is discussed. The patient was treated according to the principles of surgery of polydactyly anomalies. Good motor function with acceptable aesthetic appearance was obtained.
Child↗
Delayed effect of denervation on wound contraction in rat skin.
Neuronal supply in soft tissues may be an important part of cutaneous wound healing. In order to observe the effect of denervation on wound contraction, rectangular full-thickness skin defects were created on the dorsum of two groups of Wistar rats. In the experimental group (n = 20), spinal nerves corresponding to the area of the open wound (T11 to L2) were isolated and divided bilaterally. In the control group (n = 20), the same pairs of spinal nerves were dissected but left intact. Limits of denervation were verified by the pinprick test. Wound healing, which is primarily in the form of wound contraction in this model, was evaluated by tracing wound margins onto millimetric paper weekly. Wound contraction was delayed significantly in the experimental group (p < 0.05) at all follow-up periods when compared with the controls. Loss of neuropeptide secretion from the nerve endings in denervated tissues may be responsible for the retarded wound contraction, since neuropeptides are thought to exert trophic effects on skin wound healing.
Animals↗
A method of enhancing regeneration of conventionally repaired peripheral nerves.
The effect of axoplasmic fluid injection on regeneration of conventionally repaired nerve was studied. Twenty New Zealand rabbits were studied in two experimental groups: immediate nerve repair (Group 1A, no axoplasm; Group 1B, axoplasm injection) and delayed nerve repair (Group 2A, no axoplasm; Group 2B, axoplasm injection group). A total of 40 sciatic nerve repairs were performed. After epineurial nerve repair, axoplasmic fluid collected from the proximal and distal nerve stumps was injected under epineurium proximally and distally to the anastomotic site. In the two control groups (immediate nerve repair and delayed nerve repair, both without axoplasm), 0.9% saline was injected in a similar way. Nerve regeneration was assessed by measuring hair and nail growth, plantar and dorsal foot temperature, muscle atrophy, and the toe spread test. In the 3- and 6-month follow-up periods, nerve samples were taken for histological evaluation. Specimens were stained with toluidine blue, and 50% of the nerve cross-section area was counted from microphotographic reconstructions. After immediate repair in Group 1, axoplasmic fluid-treated animals showed a 27% increase in the number of myelinated axons at 3 months when compared with saline-treated controls (3,768 vs. 2,962 +/- 1,921 SD). After delayed repair in Group 2, a 32% increase in myelination axon counts was detected at 3 months in axoplasm-treated animals compared with saline-injected controls (1,040 +/- 684 SD vs. 786 +/- 389 SD). In addition, a positive toe spread test result was seen at 6 months in the axoplasmic fluid-treated animals.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Spontaneous peritonitis due to Brucella melitensis in a patient with cirrhosis.
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Brucellosis↗
Mediastinal hematoma: a rare complication of subclavian catheterization for hemodialysis.
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Catheters, Indwelling↗
Effect of desmopressin (DDAVP) on protein C and protein C inhibitors in uremia.
The effect of desmopressin (DDAVP) on protein C (PC) and PC inhibitors was investigated in 7 uremic predialysis patients, 7 hemodialysis patients and 7 controls. Significant decrease in PC activity was observed in all groups after DDAVP administration. Desmopressin did not influence PC antigen and two well-known PC inhibitors, plasminogen activator inhibitor-3 and alpha 1-antitrypsin. Thus, it is suggested that DDAVP-induced decrease in PC activity is not related to the changes in PC inhibitors; further studies are needed to clarify the precise mechanisms of the effect of DDAVP on PC in uremia.
Adult↗