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Öğe Bone induction capacity of the periosteum and neonatal dura in the setting of the rat zygomatic arch fracture model(American Medical Association, 2003) Özçelik, Derya; Turan, Tuğrul; Kabukcuoǧlu, Fevziye; Uğurlu, Kemal; Öztürk, ÖzcanObjectives: Osteogenic properties of the dura and periosteum are thought to contribute to the regenerative capacity of membranous bone tissue. The purpose of this investigation was to elucidate (1) whether dura without underlying neural tissues can induce osteogenesis, (2)to what extent the periosteum participates in membranous bone healing, and (3) the difference between durainduced and periosteum-induced osteogenesis. Methods: A standardized 2-mm defect was created within the middle portion of each zygomatic arch in 30 Wistar albino rats. The rats were divided into 3 groups, 10 animals in each group. In group 1, the periosteum was removed and neonatal dura grafts were transplanted onto the zygomatic arch bone defect circumferentially. In group 2, the overlying periosteum was preserved. In group 3, the periosteum was removed. At 3 and 10 weeks, animals from each group were killed, and specimens were obtained. Data were collected from the 3-dimensional computed tomographic scans and histologic studies to compare the extent of bony repair. Results: Fracture sites demonstrated osteogenesis associated with chondrogenesis in groups 1 and 2 and only limited osteogenesis with no chondrogenesis in group 3. In some animals in group 3, cortical bone ends underwent resorption. In groups 1 and 2, bone defects were obliterated by the formation of the mature compact bone at 10 weeks postoperatively. The difference between bone regeneration in these groups was not significant (P=.16). In group 3, the defects failed to heal by bony union, and in most of the samples the fibrous union was observed instead. The difference between groups 1 and 3 was significant (P=.03). The difference between groups 2 and 3 was not significant (P=.09). Conclusions: The trend toward significance is in agreement with the current clinical practice of preserving periosteum in the manipulations of the membranous bone defects. Newborn dura can exert a potentiating effect on osteogenesis. © 2003 American Medical Association. All rights reserved.Öğe Comparison of accuracy of three-dimensional spiral computed tomography, standard radiography, and direct measurements in evaluating facial fracture healing in a rat model(Lippincott Williams & Wilkins, 2004) Özçelik, Derya; Hüthüt, İlkay; Kuran, İsmail; Bankaoğlu, Müjdat; Orhan, Zafer; Mayda, Atilla SenihComplex maxillofacial fractures demand a detailed understanding of the three-dimensional (3D) pattern of injury. Evaluation of the outcome of the facial fracture repair additionally requires optimal demonstration of fracture gap, bony union, fibrous callus or incorporation of fracture ends, presence of incomplete fusion, or pseudoarthrosis. Although 3D computed tomography (CT) is reliably used for the diagnosis of complex facial fractures, its value in facial fracture healing is unknown. An experimental study was conducted to determine the accuracy of 3D spiral CT scans in evaluating facial fracture healing during the early and late postoperative periods. In 10 adult Wistar Albino rats, a standardized bone defect (3 mm) was created within the mid portion of each zygomatic arch (n = 20). At 10 and 20 weeks postfracture, gap distance displayed by 3D CT and plane radiography (posteroanterior) were measured. At 20 weeks postfracture, intraoperative measurement was also performed. A comparison between 3D CT, radiography, and intraoperative findings was performed. At 10 weeks postfracture, the fracture sites displayed larger bone defects in imaging with 3D CT than with plane radiography. The difference between groups was statistically significant (P < 0.05). The mean defect size imaged by 3D CT was 0.91 +/- 0.82 turn (standard deviation) and by plane radiography was 0.42 +/- 0.16 mm. At 20 weeks postfracture, the mean defect size imaged by 3D CT was 0.56 +/- 0.64 mm, and by plane radiography was 0.38 +/- 0.22 mm. The difference between groups was not statistically significant (P > 0.05). The defect size imaged by both plane radiography and 3D CT was significantly less than the measurement obtained from the intraoperative assessment (P < 0.05). It was concluded that 3D CT has limited benefit in the detection of newly formed bone at week 10 and in the detection of fibrous callus, which can eventually give rise to the bony tissue. Plane radiography is more valid during the early postoperative period (week 10), because it can detect the fibrous callus and newly formed bone more precisely. Gap distance between fracture ends could be determined by 3D CT accurately at week 20, although there was a tendency, which was not statistically significant, to overestimate the amount of bone defect measured by 3D CT when compared with that of plane radiography.Öğe Diyabetli bir hastada primer kutanöz aktinomikoz(2011) Aliaağaoğlu, Cihangir; Yıldırım, Ümran; Albayrak, Hülya; Göksügür, Nadir; Özçelik, DeryaAktinomikozis, endojen Gr (+) bakterilerin yol açtığı kronik, süpüratif bir enfeksiyondur. Enfeksiyon genellikle baş, boyun, toraks ve abdomeni tutar. Primer kutanöz aktinomikoz çok nadirdir ve genellikle dıştan travma ve lokal iskemi ile birliktedir. Biz burada, diyabeti ve dıştan travma hikayesi olan 68 yaşında erkek bir hastada dirsek bölgesinde primer kutanöz aktinomikoz vakası bildiriyoruz. Hasta poliklini¤imize 10-12cm boyutlarında mavi mor renkli plak şikayeti ile başvurdu. Deri biyopsisinde dermiste karakteristik sülfür granülleri gözlendi. Tanı sonrası ilk olarak Penisilin- cotrimaxazol ile tedavi edildi. Tedaviye yanıtı az oldu. Tedaviye amoksisilin-kotrimaxazol ile devam edildi.Bu ilaç tedavisine de kısmı yanıt verdi. İlaç tedavisi sonrası hastaya deri graft operasyonu yapıldı. Hastanın lezyonları graft operasyonundan altı ay sonra tekrarladı. İlaç tedavisi tekrar başlandı ve sürdürüldü.Öğe An easy way to convey the vascular pedicle of the free flap through the tunnel(Lippincott Williams & Wilkins, 2004) Uğurlu, Kemal; Hüthüt, İlkay; Baş, Lütfü; Özçelik, DeryaSafe dissection and transfer of the vascular pedicle are of crucial importance for successful transfer of free flaps. One cause of free flap failure is damage to the vascular pedicle caused by grasping or pulling of the vessels’ ends or by applying too much tension during the passage of the pedicle under different tissues.Öğe Epithelialization process of free fascial flaps used in reconstruction of oral cavity mucosa defects in dogs(Lippincott Williams & Wilkins, 2004) Uğurlu, Kemal; Hüthüt, İlkay; Özçelik, Derya; Özer, Kürşat; Sakız, Damlanur; Yıldız, Kemalettin; Baş, LütfüBare free fascial flaps are increasingly used for restoration of soft-tissue defects of the oral cavity because they provide thin, foldable tissues with high epithelialization capacity to preserve local anatomy as well as chewing, phonation, and deglutition. However, there are unanswered questions regarding the epithelialization process and other histopathologic changes occurring after transfer of these flaps into the oral cavity. To investigate these changes thoroughly, an experimental study was conducted in the dog model. Bare dorsal thoracic fascia was used as the free flap model. Ten adult dogs were used in this experiment. Oral mucosa defects measuring 6 x 5 cm were created. Free dorsal thoracic fascia flaps were harvested. The vascular pedicle of the fascia flap was anastomosed with the superior thyroidal artery and external jugular vein. Then, the flaps were transferred into the mucosa defects. The dogs were divided into groups, each composed of two animals. At 7, 14, 21, 30, and 60 days postoperatively, general anesthesia was administered to the groups 1, 2, 3, 4, and 5, respectively. First, clinical assessment was performed; then specimens were obtained. Initially, the flaps were gradually infiltrated by acute inflammatory cells coming from the circulation and then replaced by granulation tissue. Epithelial cells deriving from wound margins migrated onto the granulating flaps with eventual coverage of highly organized epithelium after 4 weeks, and the fascia flap could not be differentiated from the native mucosa. The flaps were replaced by normally maturated fibrous tissue containing regular collagen fibers, instead of atypical scar tissue. Wound contraction was calculated as 18 percent at postoperativc day 60. It was detected that bare free fascia flaps used in the repair of mucosa defects act as a scaffold and complete epithelialization from surrounding margins. They can be accepted as the main surgical option for the reconstruction of oral cavity mucosa defects.Öğe Experimental fascial flap model in the dog: free flap of the dorsal thoracic fascia(Thieme Medical Publ Inc, 2003) Uğurlu, Kemal; Özer, Kürşat; Hüthüt, İlkay; Özçelik, Derya; Tatlıdede, Soner; Egeman, Onur; Baş, LütfüFor years, various types of fascial flaps have been used in clinical practice; however, there are many unanswered questions regarding their basic physiology, anatomy and histopathologic changes occurring after transfer. Simple and reliable flap models are needed to investigate these questions, but very few of these flap models have been described in experimental animals to date. The purpose of this study was to describe a new reliable fascia flap model in the dog-the dorsal thoracic fascia flap. This fascia is defined as the anatomic layer that contains the blood supply to the scapular and parascapular fasciocutaneous flaps. Fourteen adult dogs were used in this experiment. The vascular anatomy of the dorsal thoracic fascia was studied by anatomic dissection and micro angiography. Anatomic dissection revealed that the main axial vessel supplying the dorsal thoracic fascia was the superficial branch of the thoracodorsal vessel. Based on the vascular pedicle, fascia flaps generally measuring 15x24 cm were created. At gross observation, all of these large flaps based solely on the vascular pedicle were observed to be well-perfused. Microangiographic examination revealed the intense vascularity of the superficial branches of the thoracodorsal vessels in the whole area of all flaps. It was concluded that this is a simple and reliable fascial flap model which can be prepared as a free or pedicled flap. It has a consistent, long vascular pedicle with large vessel diameters supporting a large fascial flap.Öğe Extensive traction alopecia attributable to ponytail hairstyle and its treatment with hair transplantation(Springer, 2005) Özçelik, DeryaAlopecia is experienced by both men and women in all racial and ethnic populations. It can be nonscarring or scarring alopecia. Telogen effluvium, alopecia areata, traction chemical alopecia, and androgenetic alopecia are nonscarring alopecias, accounting for more than 90% of all causes of hair loss [8]. Other nonscarring alopecias include trichotillomania, tinea capitis, and hair shaft abnormalities. Scarring alopecia is caused by trauma, infection, discoid lupus erythematosus, or lichen planus.Öğe Malign melanom olgularında sentinel lenfadenektomi çalışması(2004) Tatlıdede, Soner; Karşıdağ, Semra; Özçelik, Derya; Atay, Murat; Kuran, İsmail; Baş, LütfüAmaç: Lenfatik harilalama, tümörün drene okluğu efferent lenfatik kanalın açıldığı ilk lenf nodümın (sentinel lenf nodu "SLN") tayin edilmesidir ve metastatik hastaların mevcudiyetini araştırmada kullanılan ve halen üzerinde çalışılan bir yöntemdir. Bu çalışma, lenfatik harilalama yönteminin evrele-me ve tedaviyi yönlendirmedeki rolünü araştırmak amacı ile planlandı. Gereç ve Yöntem: Son 1,5 yılda kliniğimizde lenfatik haritalama yöntemini 5 malign melanomlu hastada evreleme ve tedaviyi yönlendirme amacı ile kullandık. Tc 99m ile işaretlenmiş albümin kolloid perilezyoner olarak inlradermik enjekte edildikten sonra lenfosintigrafi çekildi. Operasyon sonrasında Neoprobe 1500 ile tespit edilen sentine! lenf nodlarınm çıkarılması ve patolojik incelemesi sonrası bölgesel lenf nodu diseksiyonu yapılıp yapılmayacağına karar verildi. Bulgular: Olgularımızda melanomların yerleşimleri occipital bölge, sağ cruris, epigastrik bölge, sol supraclaviküler ve sağ lateral plantar bölgedeydi. Birinci olguda klinik lenfadenopa-ti mevcuttu. Patolojik incelemeler sonrası ilk üç hastaya bölgesel lenf diseksiyonu uygulandı. Lenfadenopatisi olan ve sonradan metastaz gelişen ilk olgu haricinde diğer hastalarda 1,5 yıllık izi em sonrasında nüks tümör oluşumuna rastlanmadı. Sonuç: Lenfatik harilalama - sentinel lenfadenektomi çalışması prognoz tayininde gerçek evre/emenin yapılabilmesini ve adjuvan terapi için hasla seçimini sağlar. Ayrıca hastaların gereksiz ameliyat olmalarını engelleyerek, morbidite , komplikasyon riskleri ve maliyeti azaltır. Özel ekipman ve tecrübe gerektiren bu teknik malign melanomlu vakalarımızda tedaviyi yönlendirmek için kullanımımıza girmiştir.Öğe Preparation and In vivo evaluation of gelatine implants containing EGF-PLGA microspheres in tendon healing(University of Istanbul, 2007) Orhan, Zafer; Cevher, Erdal; Gül, Mine Orlu; Alper, Murat; Özçelik, Derya; A?artan, Canan; Öner, FilizEpidermal Growth Factor (EGF) has been shown to improve tissue healing according to several well-design experimental studies. The possible role of EGF in tendon healing has not been defined. However, the main drawback of studies on the efficiency of EGF is to provide a long-term constant supply of EGF to target cells. In this respect, we hypothesized that the microspheres contained EGF would overcome this problem by providing a constant local supply of EGF. This study had investigated the role of EGF-loaded microspheres in a rat model for tendon heali*ng. EGF-loaded particles were prepared by double emulsion solvent evaporation method and embedded into gelatine implant. Implants containing microspheres which are equivalent to 10?g EGF (I-MS EGF10) and 2?g EGF (I-MSEGF2) were applied to Wistar albino rats. Histological and biomechanical studies were performed on to 21 days treated rats. I-MSEGF10 group showed prominent fibrosis and increased neoangiogenesis. Although, there was no major difference between I-MSEGF10 group and negative control group for the fibroblast and collagen proliferation (p>0.05), the difference for inflammation was statistically significant between same groups (p<0.05). Consequently, the approach of combining EGF and microspheres to extend the EGF release and in the same time increasing the contact time of EGF to tendon tissue was achievable. However, according to the obtained histological and biomechanical results, gelatine implants including EGF loaded microspheres were not found effective in tendon healing.Öğe Primer cutaneous actinomycosis in diabetic patients(2011) Alia?ao?lu, Cihangir; Yildirim, Ümran; Albayrak, Hüya; Göksugur, Nadir; Özçelik, DeryaActinomycosis is a chronic suppurative granulomatous infection caused by gram positive bacterium. Enfection especially affects the head, neck, thorax and abdomen. Primary cutaneous involvement is uncommon and has an association with trauma and local ischemia. We present one such case of primary cutaneous actinomycosis on the elbow of a 68 year old man with diabetes and external trauma. This patient was admitted to our clinic with a 10-12cm size blue-purple plaque. Skin biopsy revealed the characteristic 'sulphur granules' of actinomycosis in the deep dermis After the diagnosis, initially he was treated with penisilin and cotrimaxazol with a little effect. Treatment was continued with amoksisilin and cotrimaxazol and he respond to this medical treatment partially. After this medical therapy skin graft operation was performed. Lesions relapsed six months later. Medical therapy was repeated and still continues.Öğe Repair of proboscis lateralis(Informa Healthcare, 2005) Uğurlu, Kemal; Karşıdağ, Semra; Özçelik, Derya; Sadıkoğlu, Buğra; Baş, LütfüWe report an 8-year-old girl presented with a proboscis on the right nasal nostril, right heminasal hypoplasia, hypertelorism, and cleft lip and palate on the other side. After repair of the cleft lip and palate and the hypertelorism, we succesfully reconstructed the heminose with a V-Y advancement flap containing the proboscis tube.Öğe Soft tissue closure and plastic surgical aspects of large dorsal myelomeningocele defects (review of techniques)(Springer, 2005) Özçelik, Derya; Yıldız, Kartal Hakan; İş, Merih; Döşoğlu, MuratThe large myelomeningocele defects that cannot be closed reliably by simple skin undermining require a close cooperation between the neurosurgeon and the plastic surgeon. In this study, a 3-year review was undertaken of nine consecutive patients with a myelomeningocele defect treated in our hospital. The aim of the study was to analyze the size, location of myelomeningocele defects, features of the surrounding tissue, and type and results of the reconstruction method for skin closure. Of the nine patients, five were repaired within the first 48 h of life, two within the 1st month of life, and two were repaired within the 1st year of life. Of the nine patients, seven (78%) underwent repair with direct skin approximation by the Neurosurgical Service. For three patients (33%) with large lumbosacral meningomyelocele defects, including one patient who had failed direct skin approximation, the Plastic Surgery Service achieved the skin closure by bilateral paralumbar fasciocutaneous rotational flaps. Minimal area in the patients referred to the Plastic Surgery Service was 24 cm(2) ( range 24 - 48 cm(2)); patients having 18 cm2 or less skin defect were not referred for closure. In conclusion, fasciocutaneous rotational flaps provided tension-free, durable, innervated and well-vascularized skin coverage over the dural repair in all three referred patients, without using skin graft. Since myelomeningocele defects vary in size, shape, and location, no single procedure applies to all. Therefore, other reconstruction methods involving skin grafts, fasciocutaneous flaps, and musculocutaneous flaps are reviewed in this report.Öğe Unilateral linear verrucous epidermal nevus of the face and the oral mucosa(Lippincott Williams & Wilkins, 2005) Özçelik, Derya; Parlak, Ali Haydar; Öztürk, Ayhan; Kavak, Ayşe; Çelikel, NuranVerrucous epidermal nevi are linear hamartomas of epidermal structures that usually appear at birth or during infancy. They are usually found on the lower extremities and have resistance to treatment and risk of recurrence. They are rarely seen on the face and very rarely involve the oral mucosa. In the literature, only nine patients1–6 have been reported with the diagnosis of epidermal nevus involving oral mucosa since oral lesions were described by Brown and Gorlin7 in 1960. Here, we report a patient with an extensive verrucous epidermal nevus located on the face with intraoral extension.Öğe The use of sentinel lymph node biopsy in squamous cell carcinoma of the foot: A case report(2004) Özçelik, Derya; Tatlidede, Soner; Hacikerim, Semra; Uǧurlu, Kemal; Atay, MuratSquamous cell carcinoma (SCC) is the second most common skin cancer in humans. Because the incidence of metastasis from SCC of the skin is rare, regional lymphadenectomy is generally not recommended for the patients with clinically node-negative disease. However, in patients with an intermediate and high risk of metastasis, evaluation of the lymph nodes to detect the absence of metastatic nodal disease is a difficult task. Here, we present a patient with a large SCC on the dorsum of the foot with clinically negative inguinal and popliteal lymph nodes. Intraoperative lymphatic mapping technique was used to make the decision of the inguinal node dissection. Two sentinel lymph nodes that were biopsy negative were found; therefore, only tumor excision was performed without adding complete inguinal node dissection. The defect was reconstructed with the free flap. After a 4-year carcinoma-free period, we determined that the pathology of the sentinel lymph nodes reflected that of the inguinal region.The use of selective lymphadenectomy technique in extremity SCC is very new. However, it might be useful in staging patients with SCC of the lower extremity by being able to detect absence or presence of occult metastatic nodal disease and avoid unnecessary complete inguinal node dissection.
