Browsing by Author "Ertas, Nilgun Markal"

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Aesthetic Surgery in Transplant Patients: A Single Center Experience
(2018) Ozkan, Burak; Albayati, Abbas; Eyuboglu, Atilla Adnan; Uysal, Ahmet Cagri; Ertas, Nilgun Markal; Haberal, Mehmet; 0000-0003-3093-8369; 0000-0003-2806-3006; 0000-0002-9805-9830; 0000-0001-6236-0050; 0000-0002-3462-7632; 29528026; AAI-5063-2020; AAC-3344-2021; AIC-3493-2022; AAJ-2949-2021; AAJ-8097-2021
Objectives: Transplant patients, like the nontransplant population, can have surgical interventions for body shape disorders. Studies on aesthetic surgeries in transplant patients are scarce. Our aim was to share our experiences with various aesthetic procedures in solid-organ transplant recipients. Materials and Methods: Six (5 female, 1 male) transplant patients who received surgical corrections of the aging face, ptosis and lipodystrophy of the breast, and abdomen at the Baskent University Plastic Reconstructive and Aesthetic Surgery Department between 2010 and 2017 were included. Five patients had renal transplants, and 1 patient had liver transplant. Minimal aesthetic procedures, including botulinum toxin, dermal filler injections, and scar revisions, were excluded. All patients were consulted to transplant team preoperatively and hospitalized in the transplant inpatient clinic. Results: Mean age was 46 years. Aesthetic surgeries included breast reduction (2 patients), high suprasuperficial musculoaponeurotic system face lift (1 patient), blepharoplasty (2 patients), and dermofat grafting (1 patient). Mean hospitalization duration was 2.5 days. Four patients had no minor or major complications. One patient had skin flap necrosis, which healed with secondary intention. Another patient had ectropion after lower lid blepharoplasty, which was corrected with another procedure. Conclusions: Transplant patients are a special group of patients who receive long-term immunosuppressive treatment and medications like high-dose steroids. These treatments can lead to dermal atrophy and cause pseudo-skin laxity. Removal of excess skin and fat tissue should be considered. Efforts should be made to avoid complications such as skin necrosis and unpredictable wound healing problems when resetting the excess tissue. Preoperative consultation with transplant surgeons and keeping operative times short are other important factors. Body dysmorphologies that interfere with normal life activities and demand for younger appearance are the main reasons of aesthetic procedures. Transplant patients can be operated safely with preoperative planning, consultation with transplant surgeons, and close follow-up.
Augmented Reality-assisted Planning of Midpalmar Space Infection of the Hand
(2021) Ozkan, Burak; Akinci, Kadri; Savran, Suleyman; Uysal, Ahmet Cagri; Ertas, Nilgun Markal
Bilateral Isolated Blowout Fracture Due to Airbag Deployment
(2021) Ozkan, Burak; Akinci, Kadri; Uysal, Cagri Ahmet; Ertas, Nilgun Markal
The airbag is a lifesaver innovation in automobile industry, but the impact of airbag deployment may cause maxillofacial fractures. Airbag deployment in traffic accidents is a rare etiology of orbital fractures. Although there are reports about airbag-induced orbital fractures in the literature, isolated bilateral blowout fractures have not been published yet. We present a case of isolated bilateral blowout fracture due to airbag deployment in a traffic accident and its management in this study.
Clear Cell Acanthoma in an Unexpected Location
(2018) Togral, Arzu Karatas; Eyuboglu, Atilla Adnan; Akcay, Eda Yilmaz; Ertas, Nilgun Markal
Clear cell acanthoma (CCA) is an uncommon, benign, and slow progressing lesion originating from epidermal keratinocytes. Lesions are not gender specific and usually diagnosed at 50-60 years of age. It is generally represented in the lower extremities. CCA was first described by Degos et al. as "Degos acanthoma" for a lesion presented in the lower extremity. Clinically, it is hard to distinguish whether the lesion is benign or malignant. Final diagnosis can be made histopathologically. Biopsy material is periodic acid-Schiff positive. While CAA commonly presents itself in the lower extremities, our patient had a CAA in his abdominal region.
Clinical Experiences with Closed Incisional Negative Pressure Wound Treatment on Various Anatomic Locations
(2020) Ozkan, Burak; Ertas, Nilgun Markal; Bali, Ulas; Uysal, Cagri A.; 0000-0003-3093-8369; 0000-0001-6236-0050; AAI-5063-2020; AAJ-2949-2021
Background Closed incisional negative pressure wound treatment (ciNPWT) is one of the promising methods for the prevention of complications in surgical incisions. The mechanisms of ciNPWT have previously been elucidated and in this series, we demonstrate various, as of yet, underreported uses for the technology. Our aim is to share our experience with ciNPWT on various anatomic sites with novel indications. Materials and methods ciNPWT was used in 24 patients. The mean age was 49.6. All the incisions were sutured, clean, and non-infected. Patients' sex, age, comorbidities, anatomic location of the wound, and the indications for ciNPWT were recorded. Results The mean number of applications was three per patient. One suture dehiscence after one session of ciNPWT was encountered in a flap donor site of an infant operated for meningomyelocele. Late-term seroma and hematoma formation were encountered in two patients. No surgical site infection, wound dehiscence, and ciNPWT related complications were seen in other patients. The majority of the applications were on the trunk, lower extremity, pelvis, upper extremity, and scalp respectively. Indications for ciNPWT utilization were preventing dehiscence, seroma, and hematoma formation in the majority of the patients. Conclusion ciNPWT is reliable and effective in the prevention of post-operative wound dehiscence and surgical site infections. It can be used safely in various locations and different indications for preventing complications such as preventing dehiscence in revision surgeries, cerebrospinal fluid (CSF) fistula formation in the scalp, and wound breakdown in chronic corticosteroid use,
Double Layer Reconstruction of Exposed Cardiac Implantable Electronic Devices in Elderly Patients
(2021) Ozkan, Burak; Albayati, Abbas; Yilmaz, Kerem C.; Ciftci, Orcun; Ozin, Bulent; Uysal, Cagri A.; Ertas, Nilgun Markal; 0000-0001-8926-9142; 33542888; AAJ-1331-2021; W-5233-2018
Background Elderly patients with multiple comorbidities may not be candidates for cardiac implanted electronic device (CIED) explantation in cases of exposition. Excision of all unhealthy and inflamed scar tissue results in a skin defect that must be covered. Small- to moderate-sized local skin flaps and subpectoral placement of CIEDs have been described in the literature. However, these techniques still could not eliminate the risk of recurrence. In terms of minimizing the recurrence risk, we aim to increase the flap dimensions for getting better circulation and tension-free closure after subpectoral placement. Material and methods Six patients who were operated for a dual-layer reconstruction of exposed cardiac implants between 2017 and 2020 were included in the study. All patients were referred to plastic surgery as soon as the wound biopsy culture results were negative after systemic and topical antibiotic treatment by cardiology department. Results No flap loss or wound dehiscence was seen with a mean duration of 11 months follow-up. Early hematoma was encountered in a patient who was managed with irrigation and drain renewal. One patient developed suture abscess in the second month postoperatively. Knots were removed and wound healed without further intervention. Conclusion Double layer closure of exposed cardiac implants with large breast fasciocutaneous flap after subpectoral placement of pulse generator and leads suggest durable and reliable coverage in elderly patients with multiple comorbidities.
The Effect of Adipose Derived Stromal Vascular Fraction on Stasis Zone in An Experimental Burn Model
(2018) Eyuboglu, Atilla Adnan; Uysal, Cagri A.; Ozgun, Gonca; Coskun, Erhan; Ertas, Nilgun Markal; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0001-6236-0050; 0000-0002-9805-9830; 29032969; AAJ-8097-2021; AAJ-2949-2021; IQW-7940-2023
Background: Stasis zone is the surrounding area of the coagulation zone which is an important part determining the extent of the necrosis in burn patients. In our study we aim to salvage the stasis zone by injecting adipose derived stromal vascular fraction (ADSVF). Methods: Thermal injury was applied on dorsum of Sprague-Dawley rats (n=20) by the "comb burn" model as described previously. When the burn injury was established on Sprague-Dawley rats (30min); rat dorsum was separated into 2 equal parts consisting of 4 burn zones (3 stasis zone) on each pair. ADSVF cells harvested from inguinal fat pads of Sprague-Dawley rats (n=5) were injected on the right side while same amount of phosphate buffered saline (PBS) injected on the left side of the same animal. One week later, average vital tissue on the statis zone was determined by macroscopy, angiography and microscopy. Vascular density, inflammatory cell density, gradient of fibrosis and epithelial thickness were determined via immunohistochemical assay. Results: Macroscopic stasis zone tissue viability (32 + 3.28%, 57 + 4.28%) (p<0.01), average number of vessels (10.28 +/- 1.28, 19.43 +/- 1.72) (p<0.01), capillary count (15.67 +/- 1.97, 25.35 +/- 2.15) (p<0.01) vascular density (1.55 +/- 0.38, 2.14 +/- 0.45) (p<0.01) epithelial thickness (0.014 +/- 0.009mm, 0.024 +/- 0.0011mm) were higher on ADSVF side. Fibrosis gradient (1.87 +/- 0.51, 1.50 +/- 0.43) (p<0.01) and inflammatory cell density (1.33 +/- 0.40, 1.20 +/- 0.32) (p<0.01) were higher on the PBS side. Conclusion: Macroscopic and microscopic findings determined that ADSVF has a statistically significant benefit for salvaging stasis zone on acute burn injuries. (c) 2017 Elsevier Ltd and ISBI. All rights reserved.
The Effect of Adipose Stromal Vascular Fraction on the Viability of Transverse Rectus Abdominis Myocutaneous Flap after Abdominoplasty: An Experimental Study
(2021) Coskun, Erhan; Ozkan, Burak; Terzi, Aysen; Ozer, Eda Ozturan; Uysal, Cagri Ahmet; Borman, Huseyin; Ertas, Nilgun Markal; 0000-0002-1225-1320; F-7546-2013
Introduction: A prior abdominoplasty is considered as an absolute contraindication to transverse rectus abdominis musculocutaneous (TRAM) flap surgery. The aim of this study is to investigate the effect of nonexpanded adipose stromal vascular fraction (ASVF) on the viability of TRAM flap after abdominoplasty. Materials and Methods: Thirty-five male Sprague Dawley rats were divided into five groups. Reverse abdominoplasty model was used in all groups except Group 1. TRAM flap was performed 2 weeks after abdominoplasty in Groups 2 and 4 and 4 weeks after in Groups 3 and 5. ASVF cells were injected during abdominoplasty in Groups 4 and 5. The viable flap area (VFA) percentage and newly formed perforators were assessed. Capillary density and fibrosis gradient and plasma vascular endothelial growth factor (VEGF) levels were measured. Results: The mean VFA to total flap area was measured as 82.90% +/- 7.59%, 3.31% +/- 3.29%, 9.40% +/- 6.18%, 31.92% +/- 9.29%, and 64.98% +/- 10.95% in Group 1, Group 2, Group 3, Group 4, and Group 5, respectively (P < 0.05). The number of newly formed musculocutaneous perforating arteries was 0.29 +/- 0.49, 1.14 +/- 0.69, and 2 +/- 0.82 for Groups 3, 4, and 5, respectively (P < 0.05). The mean capillary density was 6.86 +/- 0.50, 0.67 +/- 0.13, 2.79 +/- 0.53, 3.71 +/- 0.47, and 7.01 +/- 0.70 in Groups 1, 2, 3, 4, and 5, respectively (P < 0.05). There was a statistically significant increase between the baseline VEGF values and the second VEGF values in Groups 4 and 5. Conclusions: The study showed that local injection of ASVF increases the viability of TRAM flap after abdominoplasty.
The effect of adipose stromal vascular fraction on transverse rectus abdominis musculocutaneous flap: an experimental study
(2016) Ataman, Murat Gorkem; Uysal, Cagri A.; Ertas, Nilgun Markal; Bayraktar, Nilufer; Terzi, Aysen; Borman, Huseyin; 0000-0002-7886-3688; 0000-0001-6236-0050; 0000-0002-1225-1320; 27010192; Y-8758-2018; AAJ-2949-2021; F-7546-2013
Effect of long-term intermittent hypothermia on random skin flap viability and new vessel formation
(2020) Caglar, Ibrahim Baris; Ozkan, Burak; Albayati, Abbas; Uysal, Ahmet Cagri; Ertas, Nilgun Markal; 0000-0001-6236-0050; 0000-0003-2806-3006; AAJ-2949-2021; AAC-3344-2021
Background: Preconditioning is the improving the overall viability of the flaps before surgery. Hypothermia is one of preconditioning methods. In literature, the effect of short time hypothermia in skin flap viability has been studied. However, there is no information about the effects of long-term application of hypothermia on skin flap viability. In this study, we investigated the effect of long-term local hypothermia on flap viability and new vessel formation on random pattern skin flaps. Materials and Methods: Thirty-six adult male Sprague-Dawley rats were used. The flap model was, 3 cm x 9 cm sized random pattern skin flap. Three groups were composed as control group, continuous hypothermia induction group with ice bags, and intermittent hypothermia induction with chloroethyl spray. Flaps were raised on the 15th day of hypothermia sessions. Flap viability was measured in the software program. Microangiography and blood vascular endothelial growth factor (VEGF) levels were assessed for the detection of new vessel formation. Results: Average flap viabilities were found to be 64.87% in Group I, 57.69% in Group II, and 62.22% in Group III. The difference between Group II and other groups were statistically significant. When microangiographies were examined macroscopically, diameters, and amount of vascular branches of vessels in Group II were found to be higher than other groups. The difference between blood VEGF levels day 1 values among groups was not statistically significant. When day 4 values were compared to baseline values difference in Group III was statistically significant. At days 7 and 15, differences between groups and corresponding baseline values were not statistically significant. Conclusion: Continuous long-term application of hypothermia with ice-water bags causes a significant increase in neovascularization in random pattern skin flaps without an increase in skin flap viability. Hence, we can say that 2 weeks of hypothermia on random pattern skin flaps is not an efficient preconditioning method in clinical use.
The Effects of Adipose Derived Stromal Vascular Fraction and Platelet-Rich Plasma on Bone Healing of a Rat Model With Chronic Kidney Disease
(2020) Eyuboglu, Atilla Adnan; Arpaci, Enver; Albayati, Abbas; Uysal, Ahmet Cagri; Terzi, Aysen; Bozalioglu, Sema; Turnaoglu, Hale; Balcik, Cenk; Ozkan, Burak; Ertas, Nilgun Markal; 0000-0002-0781-0036; 0000-0003-2806-3006; 0000-0001-6236-0050; 32784349; AAK-8242-2021; AAC-3344-2021; AAJ-2949-2021
Background Chronic kidney disease (CKD) impairs osteoblast/osteoclast balance and damages bone structure with diminished mineralization and results in bone restoration disorders. In this study, we investigate the effects of adipose-derived stromal vascular fraction and platelet-rich plasma (PRP) on bone healing model in rats with CKD. Methods Sprague-Dawley rats were separated into 4 groups. All groups except group I (healthy control) had CKD surgery using 5/6 nephrectomy model. All groups had intramedullary pin fixation after receiving bone fracture using drilling tools. Group II rats were used as control group for CKD. Group III rats received PRP treatment on fracture site. Group IV rats received PRP and stromal vascular fraction treatment on fracture site. Weight loss and blood samples were followed at the time of kidney surgery, third, sixth, and 12th weeks. Bone healing and callus formations were compared, biomechanically, radiologically, histopathologically, and immunohistochemically. Osteoblastic transformation of stem cells was assessed with DiI staining. Results Negative effects of CKD on bone healing were reduced by increasing mechanical, histological, radiological, and biochemical properties of the bone with stromal vascular fraction and PRP treatments. Although thickness of callus tissue delayed bone healing process, it also enhanced biomechanical features and bone tissue organization. Conclusions Platelet-rich plasma and adipose-derived stromal vascular fraction treatments were effective for bone healing in animal model, which can be promising for clinical trials.
Extraocular Sebaceous Carcinoma in Muir-Torre Syndrome
(2022) Albayati, Abbas; Ozkan, Burak; Ayva, Ebru Sebnem; Uysal, Ahmet Cagri; Ertas, Nilgun Markal; 0000-0003-2806-3006; 36092191; AAC-3344-2021
Isolated Upper Eyelid Coloboma
(2017) Eyuboglu, Atilla Adnan; Cologlu, Harun; Uysal, Cagri Ahmet; Albayati, Abbas; Ertas, Nilgun Markal; 0000-0002-9805-9830; 0000-0002-8605-9032; 0000-0001-6236-0050; 0000-0003-2806-3006; AIC-3493-2022; AAO-4286-2020; AAJ-2949-2021; AAC-3344-2021
A New Oval Advancement Flap Design for Reconstruction of Pilonidal Sinus Defect
(2018) Arpaci, Enver; Altun, Serdar; Orhan, Erkan; Eyuboglu, Atilla; Ertas, Nilgun Markal; 0000-0002-9805-9830; 29713735; AIC-3493-2022
Backgrounds Pilonidal sinus is a common chronic disease of the sacrococcygeal region. Although many surgical methods have been described for treating pilonidal sinus disease, controversy still exists as to the best surgical technique. The aim of this study is to present a new modified advancement flap technique named omega flap for the treatment of pilonidal sinus disease. Materials and methods This study included 18 patients with pilonidal sinus who were treated between March 2012 and August 2014. All cases underwent oval excision and omega advancement flap reconstruction. Defect size, postoperative complications, postoperative pain, painless sitting time, patient satisfaction and recurrence were evaluated retrospectively. Results All patients were discharged on the first postoperative day. There was no flap necrosis. No recurrence and no major complication were observed during follow-up period. The outcomes were also satisfactory regarding functionally and aesthetically, and the patients were satisfied with the results. Conclusions Presented method has a different geometry than classical advancement flap methods. Our technique provides two-layered repair with minimal tension and off-midline closure for the reconstruction of pilonidal sinus defect. It is easily performed, reliable, associated with no recurrens and good aesthetic results.
Non Melanoma Skin Cancers in Solid Organ Transplant Recipients: A Single Center Experience
(2018) Ertas, Nilgun Markal; Uysal, A. Cagri; Albayati, Abbas; Ozkan, Burak; Haberal, Mehmet; 0000-0003-2806-3006; 0000-0003-3093-8369; 0000-0002-3462-7632; AAC-3344-2021; AAI-5063-2020; AAJ-8097-2021
Nonmelanoma Skin Cancers in Solid-Organ Transplant Recipients: A Single Center Experience
(2018) Albayati, Abbas; Ozkan, Burak; Eyuboglu, Atilla Adnan; Uysal, Ahmet Cagri; Ertas, Nilgun Markal; Haberal, Mehmet; 0000-0003-2806-3006; 0000-0003-3093-8369; 0000-0002-9805-9830; 0000-0001-6236-0050; 0000-0002-3462-7632; 29528001; AAC-3344-2021; AAI-5063-2020; AIC-3493-2022; AAJ-2949-2021; AAJ-8097-2021
Objectives: Skin cancers are one of the most common malignancies in solid-organ transplant recipients. Increased age and immunosuppressive drug use are risk factors for posttransplant skin malignancies. We evaluated nonmelanocytic skin cancer incidence and development time in transplant patients. Materials and Methods: We reviewed 1833 patients who received kidney, liver, and heart grafts between 1996 and 2016 at Baskent University. We excluded melanocytic skin cancers, premalignant lesions, and benign skin tumors. Results: Of 1833 patients, 1253 were male (68.4%) and 580 were female (31.6%), composed of 1133 kidney (61.8%), 512 liver (27.9%), and 120 heart recipients (6.5%). Of these, 22 patients (18 kidney/3 liver/1 heart) developed 23 different types of skin cancer. Prevalence of skin cancer was 1.20%. Mean age at presentation was 55.8 years (range, 37-71 y). Average time from transplant to skin malignancy was 6.1 years (range, 1-13 y), with the most common being basal cell carcinoma (43%, 10 cases), followed by squamous cell carcinoma (39%, 9 cases) and Kaposi sarcoma (13%, 3 cases). Tumor sites included head and neck (15 case), trunk (2 cases), lower extremity (2 cases), and upper extremity (2 cases). Neither local recurrence nor distant metastasis was shown. Conclusions: Skin cancer risk is increased in solid-organ transplant recipients versus the general population. Although squamous cell carcinoma is the most common tumor in this patient population, followed by basal cell carcinoma, we found this reversed in our patients. The low prevalence of skin malignancy (1.20%) may be associated with close clinical follow- up to detect premalignant skin lesions and the low-dose immunosuppressive drug regimen. We believe that local recurrence and distant metastasis were absent because we use a wide surgical margin of excision and provide strict follow-up. Routine dermatologic follow-up visits of transplant recipients are recommended to detect and treat early skin cancer and premalignant lesions and thus lower morbidity and mortality.
Omega (Omega) Advancement Flap: A Circular Flap Design for the Aesthetic Closure of Circular Skin Defect
(2017) Arpaci, Enver; Altun, Serdar; Ertas, Nilgun Markal; Uysal, Ahmet Cagri; Inozu, Emre; 28039499
Background Most skin defects that require reconstruction with a local skin flap have a circular-or oval-shaped pattern. The majority of the skin flaps are planned in an angled shape. Therefore, it may be necessary to modify the shape of the defect or the distal flap border to minimize tissue distortion. We have designed a circular-shaped advancement flap to be compatible with the circular defect. Methods Eighteen cases of reconstruction of skin defects in the face, chest wall, hand and buttock area were performed using the omega advancement flap between 2010 and 2014. In this technique, a circular-shaped flap that has an equal diameter with the defect is planned adjacent to the defect. To facilitate the advancement of the flap and to avoid standing cones, deepithelialized equilateral triangular flaps are designed on both sides of the main circular flap. The circular flap is easily moved to the defect by pulling of the triangular flaps with minimal tension. Results All flaps survived without complication such as infection, hematoma or flap necrosis. No secondary surgery was required to correct contour deformities such as standing cones and trap-door deformities. The results were satisfactory aesthetically and functionally. Conclusions The omega advancement flap is an easy and reliable procedure for reconstruction of circular skin defects located on various anatomical regions.
Platelet-Rich Plasma Increases Pigmentation
(2017) Uysal, Cagri A.; Ertas, Nilgun Markal; 0000-0001-6236-0050; 27438442; AAJ-2949-2021
Platelet-rich plasma (PRP) is an autologous solution of plasma containing 4 to 7 times the baseline concentration of human platelets. Platelet-rich plasma has been widely popular in facial rejuvenation to attenuate wrinkles and has been practically used. The authors have been encountering various patients of increased hiperpigmentation following PRP applications that were performed to attenuate the postinflammatory hiperpigmentation especially after laser treatment. The authors have been using PRP for facial rejuvenation in selected patients and in 1 patient the authors have encountered increased pigmentation over the pigmented skin lesions that were present before the application. The authors recommend that the PRP might increase pigmentation especially in the face region and precautions might be taken before and after the application. Platelet-rich plasma should not be used for the treatment of post inflammatory hiperpigmentation.
Stewart-Treves Syndrome: A Case Report and Review of Literature
(2018) Albayati, Abbas; Eyupoglu, Atilla Adnan; Cologlu, Harun; Bal, Nebil; Ertas, Nilgun Markal; 0000-0002-8605-9032; AAO-4286-2020
Stewart-Treves syndrome (STS) is defined as angiosarcoma arising in the setting of chronic lymphedema. It is typically presented in breast cancer patients who underwent axillary dissection. A 79-year-old woman presented to our clinic with a wound that developed secondary to lymphedema. Pathologic examinations diagnosed the lesion as angiosarcoma. STS is a rare and deadly entity. It is hard to diagnose and has 10% mean survival rate for 5 years. We emphasize the importance of early diagnosis that can be a lifesaver.