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Mithat Akan

Publications and source records attributed to Mithat Akan.

33 records · Page 2Linked to original sources
PubMed2003

An alternative method to minimize pain in the split-thickness skin graft donor site.

In the art of plastic surgery, the reconstruction of tissue defects to obtain cosmetic and functional recovery is the major concern. Skin grafting is the most frequently used procedure for reconstructing defects of various size and anatomical localizations. On the other hand, donor-site problems associated with this invaluable procedure are inevitable. Various methods are used in the postoperative management of the partial-thickness donor site created during the harvest of a split-thickness skin graft. Each technique has the potential for complications of fluid loss, excessive pain, prolonged period of healing and immobilization, hypertrophic scarring, and undesirable pigmentation. Donor-site pain is probably the most disturbing complication in the early postoperative period. The aim of this article is to point out the significance of donor-site pain, which has not been emphasized thoroughly in the literature, and to introduce flap skin as a potential graft donor site for patients in whom reduction of donor-site morbidity is of primary concern. The principal goal of the technique described in this article is to eliminate donor-site pain by harvesting the graft from the flap that is insensate after the elevation. In 15 patients, the overlying skin of the flap that had been used for reconstructive purposes was used as the donor site (group I). In the remaining 23 patients, the posterolateral thigh was used as the donor site (group II). Donor-site discomfort was recorded during the first 8 days postoperatively using a visual analogue scale. To analyze the data, we used the Friedman test, Dunn's multiple comparison test, and Mann-Whitney U test. It was observed that the visual analogue scale of both of the groups showed a significant decrease within days (group I, p < 0.0001; group II, p < 0.0001). The mean pain scores were significantly lower in group I than in group II (p < 0.0001). When donor-site pain is of primary concern, this procedure provides uneventful and comfortable healing while avoiding postoperative pain in the donor site. For that reason, this technique might be used in appropriate cases to minimize donor-site pain.

Adolescent↗
PubMed2003

Phalangeal osteotomy for the treatment of metacarpal synostosis: a case report.

Congenital synostosis between the fourth and fifth metacarpals is a rare congenital anomaly. We present a case of type IIIB metacarpal synostosis according to the Buck Gramcko's classification with the camptodactyly of the little finger. It was treated successfully with the phalangeal angulation osteotomy and soft tissue release procedures.

Child↗
PubMed2003

Digital neurovascular compression due to a forgotten tourniquet.

The surgeon may, on occasion, wish to perform a relatively minor procedure on a single finger with some types of tourniquet at the base of the finger. A potential complication of a digital tourniquet is neurovascular damage due to excessive tissue pressure and prolonged application time. We presented a case where a hand surgery and digital tourniquet was forgotten on the finger for one and a half days. Although neurovascular compromise had occurred, the left index finger was successfully saved after extensive medical treatment and leech therapy.

Adolescent↗
PubMed2003

[The management of size discrepancies in microvascular anastomoses].

OBJECTIVES: Microvascular anastomosis is the main component of flap transfer and replantation surgery. The aim of this study was to evaluate size discrepancies encountered during microvascular surgery, techniques to handle the problems, and the results of anastomoses performed. METHODS: We evaluated 99 microsurgery operations (103 artery, 125 vein anastomoses) performed in 96 patients with respect to size discrepancy. These operations included free flap transfer (n=67), replantation (n=23), revascularization (n=6), and toe-to-hand transplantation (n=3). Size discrepancy was defined as the inequality of vessel diameters at a ratio of 1:1.5 or greater. RESULTS: Size discrepancy was found in 32.5% (n=74) of 228 anastomoses, the most frequent being in vein anastomoses performed during free flap transfers. Simple discrepancies were dealt with by dilatation with the use of a jeweller's forceps in 14 anastomoses. In nine discrepancies exceeding 1:1.5, the oblique cut, fish mouth cut, and sleeve techniques were employed in four, three, and two anastomoses, respectively. End-to-side anastomosis was used in six patients in whom free flap transfer was carried out for extremity defects. The remaining 45 anastomoses were performed using a modification of the Xiu and Song's method. Venous grafts were used because of tension of the anastomosis and insufficient vessel lengths in three, eight, and three patients who underwent replantation, free flap transfer, and revascularization, respectively. CONCLUSION: An appreciation of various techniques is essential to avoid discrepancy-related problems both during and following microvascular surgery.

Anastomosis, Surgical↗
PubMed2002

Distally-based neurofasciocutaneous flaps in electrical burns.

Distally-based neurocutaneous flaps have been used successfully for reconstruction of the lower extremity for some decades. The reconstruction of deep wounds exposing tendons, bones and/or vessels in electrical burns requires flap coverage. It is known that there is often some sub-clinical vascular damage in electrical burn injury. Therefore, an important part of the procedure is modification to improve flap viability during the reconstruction of electrical burn wounds. In this paper, we report our experience with the use of distally-based sural and saphenous neurocutaneous flaps for coverage of defects in the lower leg and foot in 14 electrical burn patients. In 12 patients, the flaps survived completely, in two patients the flaps underwent partial necrosis. In these cases, the width of the pedicle of the neurocutaneous flap was increased from 3.5 to 5cm and the neurovenous pedicle was decreased to give a delay effect several days before the flap harvesting. We believe that these modifications positively effect the viability of the flap and should be used to improve neurocutaneous flap circulation in high risk patients.

Adult↗
PubMed2002

Soft-tissue reconstruction of the foot with distally based neurocutaneous flaps in diabetic patients.

Soft-tissue coverage of the foot in diabetic patients is often a difficult problem to undertake. The aim of this study was to evaluate the efficiency and safety of distally based neurocutaneous flaps for foot reconstruction in diabetic patients. The authors describe their experience with a series of 10 diabetic patients in whom reconstruction of defects of the foot (range, 6 x 11-10 x 12 cm) were performed using distally based sural and saphenous neurocutaneous flaps. In 9 patients the flap survived completely and in only 1 patient was superficial marginal necrosis of the flap observed. Partial skin graft loss at the donor site occurred in 1 patient, but no additional surgical revision was needed and healing occurred by secondary intention. In these diabetic patients, defects were reconstructed successfully using neurocutaneous flaps, and good results were achieved.

Adult↗
PubMed2002

Complications of the reverse homodigital island flap in fingertip reconstruction.

Twenty-four digital artery island flaps with reversed flow were used to reconstruct 23 patients with fingertip injuries in the authors' clinic between June 1998 and August 2000. No nerve coaptation was performed in these patients. Patient age ranged between 18 and 35 years. All patients were evaluated at clinical follow-up for active range of motion, appearance, patient satisfaction, two-point discrimination, hypersensitivity and cold intolerance, previous hand injury, and flap viability in the repaired finger. Based on their experience, the authors consider that this procedure has several disadvantages: relatively high flap loss, sacrifice of one of the two major arteries of the finger, it is a time-consuming method, it is a difficult flap dissection, there is a requirement for loupe and microsurgical equipment. The authors think that this flap should not be the first choice for fingertip reconstruction especially for patients who have possibility of reinjuring their hands because of their jobs.

Adolescent↗
PubMed2002

Localization and removal of ferromagnetic foreign bodies by magnet.

Foreign bodies should be removed from wounds during the primary wound management stage whenever possible. Metallic fragments can be identified and localized by conventional radiography, computed tomography, sonography, x-ray image intensifier, or electromagnetic metal detector. Locating metallic objects may still cause problems for the surgeon during the removal procedure. Detection and removal of superficial ferromagnetic fragments (iron, nickel, and cobalt) by a magnet is possible. In the literature the authors found no report about using the magnet for this purpose. Having conferred with the manufacturer KANAT (Istanbul, Turkey), the authors used a magnet made of neodymium. The power of the magnet was 12,000 gauss. It was cylindrical and 1.3 x 0.8 cm in diameter. This method was used in 6 patients successfully for localization and removal of ferromagnetic foreign bodies. Use of a magnet is an easy and cost-effective method that does not require education and specific staff.

Ferric Compounds↗
PubMed2002

Penile agenesis and clavicular anomaly in a child with an oral facial digital syndrome.

We report a male patient with the clinical characteristics of an OFDS (oral facial digital syndrome). He also has penile agenesis, clavicular flattening and cerebellar anomalies. This patient was classified as a severe form of OFD type II-Mohr syndrome but the possibility of this being OFDS VI-Varadi syndrome or a new form of OFDS cannot completely be excluded.

Abnormalities, Multiple↗
PubMed2002

Multiple tendons of the abductor pollicis longus muscle.

In the case presented below, we observed abductor pollicis longus (APL) dividing into five sections shortly after exiting the first compartment. Many variations of APL may be seen and it is essential to know these variations in the practice of hand surgery.

Adult↗
PubMedDate not supplied

Combination of different techniques for the treatment of earlobe keloids.

Management of keloids is still controversial. Many different treatment modalities may be used for this purpose, however, no one method has been found completely successful. Therefore, we combined these techniques to improve therapeutic outcomes for earlobe keloids. Nine patients with earlobe keloids of a total number of 12 with auricular keloids were treated with a combined approach between 1995 and 2001. The keloids varied in size 2 x 1 to 5 x 3 cm and the patient age ranged 15-63 years. The patient group consisted of nine females, three males. Ear piercing was the main etiological factor for females. In the first session, surgical excision of the keloids was performed. It was followed with triamcinolone acetonide injection to the surgical field on the postoperative second week. Slight pressure was applied by silicone gel sheet coated earring for four months. No recurrence was noted in eight patients over longterm followup. One of nine patients had keloid recurrence. The authors found the results promising a combination of four techniques for treatment of ear lobe keloids is recommended even for recurrent lesions.

Adolescent↗
PubMedDate not supplied

If you continue to smoke, we may have a problem: smoking's effects on plastic surgery.

Smoking causes various aero-digestive neoplasms, some cardiovascular diseases, respiratory pathologies, and cardiovascular disorders. Surgeons have observed an association between impaired wound healing and smoking. In plastic surgery, cigarette smoking should be forbidden before and after surgery to prevent poor surgical results. In this retrospective study, we presented four major complications related with continuous smoking immediately after surgery. Although we have strongly forbidden smoking for every patient, 4 patients did not follow our advice and continued to smoke. One of them had a breast reconstruction with a pedicled transverse rectus abdominis musculocutaneous flap. Another patient had an abdominoplasty. The third and fourth patients had digital replantation and they were chronic smokers. After their poor surgical outcomes, these heavy smokers received close supervision, but managed to smoke, anyway. Education, psychologic consultation, and sometimes refusing to perform aesthetic or reconstructive surgery are required to minimize postoperative complications.

Adult↗
PubMedDate not supplied

Ice application to minimize pain in the split-thickness skin graft donor site.

Reconstruction of tissue defects with skin grafts is one of the most used processes in soft tissue defects. While any part of the body can be used as a donor site of split-thickness skin grafts, the posterolateral thigh is the most used one. Pain in the graft donor site may be the primary concern of patients in the postoperative period. Various kinds of donor site dressings and procedures have been described for this purpose. The main goal of this practice is the fast recovery of the donor site. Nevertheless, avoiding infection, decreasing the pain in the donor site, and minimizing the cost should be considered. To minimize pain in the graft donor site, ice pack application, used for its local anesthetic effect, was utilized for patients postoperatively in our clinic. Thirty-six patients were included in this study between June 2001 and May 2002. Patients were divided into two groups, with 18 patients in-group I, to whom ice was applied, and 18 patients in group II, which was specified as the control group. The patients were evaluated according to the pain in the graft donor site. The visual analog scale (VAS) was used to evaluate the pain of the patients. The data were statistically evaluated with the Mann-Whitney U test procedure. In addition to this, infections, recovery periods, and cost benefit effects were also determined. The mean pain scores in the graft donor site were found to be quite low in patients in the group with ice application (p < 0.05). No significant difference was determined between the two groups when their pain scales were compared on the fourth and the fifth days (p > 0.05). Ice can be safely used in patients for whom donor site pain is the primary concern, with advantages such as ease of application, low cost (almost free), and a significant decrease in pain in the donor site.

Denervation↗