Browsing by Author "Cagri A. Uysal"

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Delayed Perforator Flaps for Reconstruction of Extensive Defects of the Posterior Trunk
(Başkent Üniversitesi, 2024-03) Burak Ozkan; Abbas Albayati; Suleyman Savran; Cagri A. Uysal
ABSTRACT OBJECTIVES: The delay phenomenon involves neovascularization of tissue after ischemic preconditioning. When employed, the delay phenomenon promotes flap survival and increases length-to-width ratio in conventional flaps. Although well-planned perforator flaps cover defects without tension, the success rate is unpredictable in extensive defects that are closed because of the unknown vascularity of perforasomes. We aimed to increase perforator flap size by utilizing the delay phenomenon for broad defects of posterior trunks. MATERIALS AND METHODS: Between 2019 and 2020, 10 patients (6 female, 4 male) underwent posterior trunk reconstruction with delayed perforator flaps. We retrospectively analyzed etiology, defect size, flap size and type, postoperative complications, and long-term results. The etiology of defects was meningomyelocele, soft tissue sarcoma, and pressure ulcers in 3, 3, and 4 patients, respectively. Defects were covered with delayed lumbar, intercostal, and thoracodorsal perforator flaps. Flaps were planned unilateral or bilaterally. Perforators were located preoperatively with a handheld Doppler. In the first session, delaying incisions and pedicle dissection were performed. The delayed incision was primarily sutured. Perforator flaps were elevated 1 week later, and defects were closed. RESULTS: Mean defect size was 375 cm2, and mean flap size was 420 cm2 (202-625 cm2). The donor site was closed primarily for 7 patients. Two patients required split-thickness skin grafts. One patient had donor site closed with secondary healing. No flap losses among patients were shown. Hematoma was seen in 2 patients in the immediate postoperative period. After 2 weeks, seroma and donor site dehiscence were shown in 2 and 1 patient, respectively. CONCLUSIONS: The delay phenomenon can be utilized in perforator flaps as in random pattern local flaps. Perforasome areas can be extended with delayed incision. In addition, broad defects of the posterior trunk can be safely covered with delayed perforator flaps.
Flap Options in Reconstruction of a Burned Hand
(Başkent Üniversitesi, 2021-12) Abbas Albayati; Mehmet Haberal; Cagri A. Uysal; Suleyman Savran; Burak Ozkan
ABSTRACT Hand burns are commonly seen in large burn injuries. Although the mortality of hand burns is imperceptible, morbidity can be of great importance. The possible disabling outcomes of hand burns necessitate a precise and accurate management, at both early and late stages, to allow optimal functional outcomes. The main goal of management is to maintain a favorable function that also preserves esthetics. Commonly used reconstructive options are skin grafts, skin flaps, and myocutaneous flaps. In this article, we discuss skin flap options in the reconstruction of a burned hand.
Necrotizing Fasciitis Due To Mosquito Bite
(Başkent Üniversitesi, 2022-09) Burak Ozkan; Abdullah Kizmaz; Orkhan Sahpazov; Cem Aydogan; Cagri A. Uysal; Mehmet Haberal
ABSTRACT Necrotizing fasciitis more often occurs in patients with diabetic vasculopathies, in those who are immuno-compromised, or in those exposed to blunt or penetrating trauma. Aggressive debridement and salvage of the relevant extremity are important in the treatment to prevent patients from entering sepsis. In this case report, we describe a 66-year-old male patient with diabetes mellitus who developed necrotizing fasciitis after a mosquito bite.
Never Give Up for Salvaging Extremities: A Case of High-Voltage Electrical Burn
(Başkent Üniversitesi, 2021-12) Suleyman Savran; Burak Ozkan,; Abbas Albayati; Cem Aydogan; Cagri A. Uysal; Mehmet Haberal
ABSTRACT High-voltage electrical injuries pose unique challenges. Here, we report a complicated third-degree bilateral hand and forearm high-voltage burn injury that underwent reconstruction with several free flaps and a pedicled flap to salvage the upper extremity. Maximum efforts to save an extremity and lengthen an amputation stump should be given to patients with high-voltage electric injuries.
Our Experience With Free Microvascular Tissue Transfer in Burn Reconstruction
(Başkent Üniversitesi, 2021-12) Burak Ozkan; Abbas Albayati; Suleyman Savran; Cem Aydogan; Cagri A. Uysal; Mehmet Haberal
ABSTRACT OBJECTIVES: Free microvascular tissue transfer can provide excess tissue in 1 stage for extensive injuries when locoregional flap options cannot be performed. Free flaps are an important reconstructive option in burn reconstruction whenever neurovascular and skeletal structures are exposed. This sophisticated technique needs surgical expertise and an understanding of burn physiology. Here, we have shared our experiences in burn reconstruction with free flaps. MATERIALS AND METHODS: Between 2017 and 2021, our center performed 26 free flap procedures in 20 burn patients. Fifteen flaps were performed in 12 patients at an early phase (first 21 days postinjury); 11 free flaps were performed in 8 patients for postburn contracture sequelae. Among these procedures, 60% were skin flaps (anterior lateral thigh, radial forearm, superficial circumflex iliac artery perforator flap, parascapular), 20% were musculocutaneous flaps (latissimus dorsi, vastus lateralis), 10% were fascia flaps (temporal fascia, serratus anterior), and 10% were pure muscle flaps (gracilis, latissimus dorsi). RESULTS: Two free flaps for early-phase reconstruction and 1 free flap for postburn contracture release were lost. Reasons for flap loss were venous congestion in 2 cases, with arterial occlusion due to hematoma formation in 1 case. All patients with flap loss had high-voltage electric burns. Debridement of the necrotic flaps was delayed until demarcation formation settled and until subflap granulation formation started. Skin grafts were performed after debridement of these flaps. All other flaps survived, with no recurrence of contractures or defects encountered in these patients. CONCLUSIONS: Although free flaps have changed the reconstructive ladder to a reconstructive elevator, performing these flaps have unique challenges in burn reconstruction, such as risk of thrombosis in those with electric burns, hemodynamic instabilities, and difficulties in patient positioning due to sedation. Meticulous care should be taken and the patient’s general condition should be well evaluated before free flap surgery.
Reconstruction of a Burn Sequel of the Hand With Long-Narrow Free Radial Forearm Flap
(Başkent Üniversitesi, 2021-12) Burak Ozkan; Cagri A. Uysal; Suleyman Savran; Abbas Albayati; Mehmet Haberal
ABSTRACT Skin grafting may not always be possible for deep burns of the hand, due to possible exposure of tendons and bones. Although planning and use of free flaps is easier when used to cover broad defects, reconstruction of long and narrow defects is challenging. Here, we describe a patient with severe burns to his right hand who underwent reconstruction of his hand with a long narrow free radial forearm flap in a one-stage reconstruction.
Reconstruction of Trochanteric Pressure Ulcers With Pedicled Vastus Lateralis-Anterior Lateral Thigh Flap
(Başkent Üniversitesi, 2021-09) Burak Ozkan; Abbas Albayati; Suleyman Savran; Cagri A. Uysal; Mehmet Haberal
OBJECTIVES: The trochanteric region is a frequent site for pressure ulcer development. The etiology is due to immobilization and prolonged hospitalization. Loss of the subcutaneous fat layer is another predisposing factor in cachectic patients. For patients with grade 3 to 4 sores with trochanteric major of femur exposition, flap reconstruction is generally needed. Musculocutaneous flaps are preferred to cover exposed bone and fill dead space. Although locoregional flaps such as tensor fascia lata and gluteus maximus muscle flaps have been used for trochanteric ulcers, these involve mandatory muscles for ambulation during rehabilitation. Another disadvantage is donor site complications due to pressure loading. Here, we describe the vastus lateralis-anterolateral thigh flap to decrease donor site morbidity and tension. MATERIALS AND METHODS: Between 2019 and 2021, we treated 9 trochanteric pressure ulcers in 8 patients (mean age of 38 years; range, 27-52 y). Defect sizes ranged from 5 × 5 to 10 × 12 cm. Flap sizes were planned according to exact defect size. Vastus lateralis muscle was retrieved according to dead space size. Donor sites could be closed in 5 patients, but 2 patients required split thickness skin grafts. Patients were hospitalized in lateral decubitus or supine position during follow-up. RESULTS: Mean follow-up time was 10 months (range, 6-18 mo). All flaps survived. One patient developed hematoma at donor site, which was treated with bedside debridement; no recurrence occurred during follow-up. No restrictions or morbidities were encountered during ambulation. CONCLUSIONS: The vastus lateralis-anterolateral thigh musculocutaneous flap provides both the required tissue for dead space filling and for defect closing. Advantages include lower donor site morbidity, perfect match in terms of skin quality and bulk, and protection of major muscles such as gluteus maximus and tensor fascia lata. The technique requires knowledge of quadratus femoris anatomy, which has a short learning curve.
Superficial Temporal Fascia Flap in Burn Patients: Old However Savior. A Case Report
(Başkent Üniversitesi, 2022-03) Abbas Albayati; Burak Ozkan; Cagri A. Uysal; Mehmet Haberal
ABSTRACT Deep burn wounds over hands and feet require thin and pliable flaps to cover underlying structures and to provide free range of motion. In the case reported here, we present the use of free superficial temporal fascia flap for coverage in a patient with third-degree burns on the lateral side of the left foot and ankle joint. We believe that this flap is a good alternative in patients with extensive burns where other options of thin flaps are not available or applicable.
Two Cases of an Unusual Presentation of Electrical Burn Injuries
(Başkent Üniversitesi, 2022-03) Burak Ozkan; Santiago J. Santelis; Abbas Albayati; Ayse Ebru Abali; Cagri A. Uysal; Mehmet Haberal
ABSTRACT Electric injuries have a wide variety of consequences ranging from disfigurements, extremity loss, and death. The limbs are the most affected sites because of the high resistance of muscles and tendons to electricity. The most common pathway of entry to exit point is upper limb to lower limb, so the thigh to foot pathway is exceptional. In this case report, we aimed to present the mechanisms in 2 construction workers who had high-voltage electric burns that followed this unusual pathwa