Search PubMed⌕ Search

Biomedical subjects

T Safak

Publications and source records attributed to T Safak.

At least 37 records · Page 2Linked to original sources
PubMed1999

A new technique for microvascular anastomosis: external metallic circle.

Vessel anastomosis is the most critical step in free tissue transfers and replantation surgery. We report on a new microvascular anastomosis technique that uses a metallic circle around the anastomotic circumference. Sutures are first passed inside the circle and tied outside and over the circle so as to stretch open the anastomotic site. By retraction of vessel ends, the circle is totally exteriorized and thus there is no contact with blood. In 48 rats, the external circle method was compared with the conventional technique for constructing end-to-end anastomosis between carotid arteries (1 to 1.2 mm) and femoral veins (1 to 1.5 mm). The external circle method proved to be superior to the conventional end-to-end technique in speed of execution for both arterial and venous anastomoses. Patency rates at the third week were significantly higher in the venous group using the metallic circle (100 percent versus 70.8 percent, p < 0.05). This new method may be applicable in clinical microvascular surgery.

Anastomosis, Surgical↗
PubMed1998

A new experimental flap model in the rabbit: scapular osteomyocutaneous flap.

Despite the use of various types of osteomyocutaneous flaps in clinical practice, there are many unanswered questions regarding their basic physiology. Simple and reliable flap models are needed to investigate these problems. However, very few of these flap models have been described in small animals to date. The purpose of this study was to develop a new osteomyocutaneous flap model in the rabbit. Twenty adult New Zealand white rabbits, weighing 2.5 to 3.0 kg, were used in the reported experiment. In seven rabbits, the anatomy of the axillary vessels was studied by anatomic dissection and selective angiography. Based on this anatomic study, a new osteomyocutaneous flap, namely, the scapular osteomyocutaneous flap, is described in the rabbit model. The flap is composed of a skin island (16 x 8 cm) in the scapular region, the latissimus dorsi and intrinsic shoulder muscles, and the whole scapula as the bony component The flap is based on the axillary vessels, while the skin island and the latissimus dorsi muscle are independently supplied by branches of the thoracodorsal vessels. The flap could thus also be considered as a combined flap model. As an island flap, the flap was replaced in situ in eight rabbits, and transferred to the anterior chest in two rabbits. In the remaining three animals, the flap was transferred to the groin as a free flap. The viability of each component of the flap was demonstrated by direct observation, microangiography, bone scintigraphy, India ink injection study, and histologic examination. The authors concluded that the flap is a simple and reliable osteomyocutaneous flap model, since its dissection is easy; there is a long vascular pedicle with large vessel diameters; and large amounts of skin, muscle, and bone are included.

Animals↗
PubMed1998

Head and neck reconstruction with the latissimus dorsi musculocutaneous pedicled flap: functional preservation of the muscle by staged transfer.

The reconstruction of soft-tissue defects in the head and neck region with the latissimus dorsi musculocutaneous pedicled flap is traditionally carried out with dissection of a transaxillary subcutaneous tunnel, which may result in compression of the vascular pedicle in the tunnel, a contour deformity of the neck, or morbidity to the tissues in the axilla and the neck (such as hematoma and seroma). Furthermore, the flaps are often bulky and require secondary defatting. Loss of the muscle causes contour deformity in the back, and its functional loss may be a concern for the patient. To overcome such drawbacks of the traditional use of the flap, we devised a technique of regional transfer of the latissimus dorsi musculocutaneous pedicled island flap to the head and neck region over a pectoral skin bridge rather than utilizing a transaxillary subcutaneous tunnel. This is a two-stage procedure. During the first stage the musculocutaneous flap is transposed in an extracutaneous route to the recipient site. Following a 3-week neovascularization period, the second stage is performed, during which the muscle is detached from its overlying skin island and replaced in situ. This technique was utilized successfully in 5 patients for reconstruction of various head and neck defects with no complications. We conclude that this staged technique of latissimus dorsi musculocutaneous flap transfer to the head and neck region enables functional preservation of the muscle and overcomes many of the complications of the traditional method of utilizing a transaxillary subcutaneous tunnel.

Cicatrix↗
PubMed1998

Fibrosarcoma following radiotherapy for breast carcinoma: a case report and review of the literature.

The 17 patients with fibrosarcoma occurring after radiotherapy for breast carcinoma reported in the literature are the disastrous results of a treatment modality. All the reports concerning the sarcomas share the same feature-aggressive nature with a latent period of 4 years or more. A patient report of fibrosarcoma occurring 2 years after radiotherapy for breast carcinoma with the shortest latent period in the literature is presented and the literature is reviewed. The tumor was localized within an irradiated area and there was a clear histological distinction between the previous and current tumors. The tumor was found to encase the axillary artery and the brachial plexus. For a curative resection, a forequarter amputation was performed and the defect was closed by means of a posterior arm flap. Despite the aggressiveness of the tumors the patient had no distant metastases 1 year after the diagnosis of fibrosarcoma.

Breast Neoplasms↗
PubMed1998

Arterialized venous dorsal digital island flap for fingertip reconstruction.

Fingertip resurfacing is a challenging reconstructive problem; despite the existence of many different surgical methods, enthusiasm on developing versatile flap techniques has been continuing. In this report, we describe an arterialized venous dorsal digital island flap for fingertip reconstruction. The vascularity of the reverse dorsal digital island flap is augmented by performing an arteriovenous anastomosis between a dorsal vein in the flap and one of the proper digital arteries at the fingertip. Eight flaps were used in eight patients for the reconstruction of their fingertip defects. The ages of the patients ranged from 19 to 41 years, with an average of 28.4 years. In two cases, the flap was used as a neurosensorial flap by coapting the dorsal digital radial nerve to the digital nerve. The mean follow-up was 11 months, and all but one flap totally survived. The operative technique is easy except for the necessity of performing standard microvascular surgery. The flap may be a good alternative for repairing fingertip defects in selected cases.

Adult↗
PubMed1997

Closure of upper extremity soft-tissue defects using the new "supra-crest" fasciocutaneous free flap.

A fasciocutaneous island (15 x 10 cm) can be elevated from the inferolateral abdominal wall in a region encompassing the iliac crest and extending to the lower costal margin. This new fasciocutaneous flap was named the "supra-crest flap," in accordance with its anatomic location and vascular pattern. The blood supply stems from the direct cutaneous branches of the lumbar arteries (L2-3), which pierce the abdominal musculature approximately 2.0 cm above the iliac crest in the midaxillary line. The arteries and two vena comitantes have an average external diameter of 2.0 mm, and their dissection can be extended deep into the iliac fosa to provide a pedicle 8 or more cm in length. Two cutaneous nerves accompany the lumbar arteries, furnishing the possibility of a sensate flap. These structures have been transferred as a free flap with the donor site concealed by conventional underwear and bathing suits. Additionally, this region could be harvested as an island flap wherein the arc of rotation may be sufficient to cover defects of the thoracic wall and lumbosacral regions.

Adolescent↗
PubMed1997

A case of popliteal pterygium treated along with nerve expansion.

The presence of a short sciatic nerve in the free edge of a popliteal pterygium makes this syndrome a surgical challenge. We present a case of popliteal pterygium that was treated by nerve expansion. The range of motion of the patient's knee joint was between 30 and 120 degrees. A 75-cc tissue expander was placed under the sciatic nerve and filled with 5 cc of saline solution weekly. When a total of 60 cc was reached, wound dehiscence was observed, and the procedure had to be stopped. The maximum extension obtained was 160 degrees. Since the expansion process had to be stopped early, the elongation attained by expansion was less than expected. We conclude that the nerve expansion method can be used as a good alternative treatment modality for patients with popliteal pterygium.

Child, Preschool↗
PubMed1997

A new design of the iliac crest microsurgical free flap without including the "obligatory" muscle cuff.

The iliac crest free flap has undergone a gradual evolution to provide more functional and cosmetic oromandibular reconstructions. The soft-tissue cutaneous component has largely resisted refinement and currently constitutes the flap's principal drawback. Conventionally, the cutaneous vessel's soft-tissue encasement and a protective cuff of abdominal muscle are harvested to ensure skin perfusion. These protective measures, however, produce a bulky flap that is tethered to the bone and difficult to inset into complex three-dimensional defects. A series of anatomic and clinical investigations has confirmed that in 30 percent of individuals, the skin island can be elevated on a dominant cutaneous branch from the deep circumflex iliac artery. Harvesting the skin as an axial pattern flap greatly increases its independence from the bone, improving maneuverability. A small collar of abdominal muscle is incised around the pedicle, obviating the need for the customary 2.5-cm protective muscle cuff. Exclusion of the abdominal muscular component reduces the flap's volume, decreases the need for secondary debulking, and reduces the donor site morbidity.

Adult↗
PubMed1996

Sharing the radial forearm flap in reconstruction of two separate defects in the same patient.

The radial forearm flap is used extensively to cover defects for which a thin skin flap is needed. It can be used either as a pedicle or a free flap in various designs. In this case report, a new application of this flap is presented in which two flaps were created out of a single radial forearm flap to cover two separate defects. One of the flaps was a distally based reverse island flap. We used this flap to cover a defect developed by releasing a burn contracture on the flexor surface of the thumb. The other flap consisted of the proximal portion of the forearm flap and was transferred to the neck region as a free flap to cover a defect resulting from the release of a burn contracture. The radial artery allows sharing the fasciocutaneous unit of the forearm into two different flaps and transferring them to separate areas. Thus, donor site morbidity is reduced when there is more than one defect to be reconstructed.

Adult↗
PubMed1996

The subcutaneous pedicle tensor fascia lata flap.

The presence of a consistent subcutaneous vascular plexus allows carrying of a distal skin island safely on the iliotibial tract. A distal skin island can be designed on the lateral thigh and can be raised on a subcutaneous pedicle that is proximally supplied by the lateral femoral circumflex artery. This technique preserves the lateral thigh skin and employs subcutaneous tunneling to overcome the traditional drawbacks of the conventional extended tensor fascia lata flap. The subcutaneous pedicle tensor fascia lata flap's sensate potential, thin skin, durable fascia, extensive reach, and 360 degree arc of rotation make it an appealing donor site for coverage of lower midsection and pelvic defects or for penile reconstruction.

Abdominal Muscles↗