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Öğe Early and late term microsurgical free flap reconstruction and risks in high voltage electrical injury(Carbone Editore, 2013) Karabekmez, Furkan Erol; Duymaz, Ahmet; Tosun, Zekeriya; Keskin, Mustafa; Savacı, NedimThe aim of the study is to discuss and compare the early and late micro vascular flap reconstruction's outcomes, importance, risks, advantages and disadvantages with review of our 13 high voltage electrical burn injury cases. Medical records have been reviewed for electrical burns in last three years. 13 cases fitting the criterion were included into the study. Four of them have been hospitalized for late complication such as severe contracture; nine of them have been hospitalized for acute treatment. Five patients had latissimus dorsi muscle flap, three patients had parascapular flap, two patients had latissimus dorsi and scapula osteomusculo-cutaneous flap, two patients had reams abdominis musculocutaneous flap, and one patient had parascapular and scapular flap. Early reconstruction applied group showed a significant difference regarding to flap failure rates. Electrical injuries are more complex than regular burn injuries related with heat, and the reconstruction of these cases also should be special. One of the most important factor for free flap viability in electrical injury cases is surgery timing. All of the complications were seen in the patients who had surgery at 12th and 19th days after the electrical injury. No complication has seen in the group of patients who had surgery on late term period. However microsurgical reconstruction should be considered to cover exposed bony tissues on the extremities in the short term period in order to prevent possible limb shortening procedures.Öğe Management of neglected periorbital squamous cell carcinoma requiring orbital exenteration(Lippincott Williams & Wilkins, 2014) Karabekmez, Furkan Erol; Selimoğlu, Muhammed Nebil; Duymaz, Ahmet; Şen Karameşe, Mehtap; Keskin, MustafaWith its perineural invasion capacity, periorbital squamous cell carcinoma (SCC) may easily invade orbital structures. When SCC invades the orbital musculature or the orbit itself, orbital exenteration, one of the most disfiguring operations on the face, is required. We reviewed elderly patients with periorbitally localized SCC requiring orbital exenteration to evaluate reconstructive options and survival. A chart review of patients' records was conducted to identify all patients older than 65 years with periorbital malignancy requiring orbital exenteration from 2006 to 2011. A total of 9 patients who met the criteria were included in the study. The mean age at surgery was 77 +/- 6.7 years, and the mean defect size was 74.2 cm(2). All patients had a similar history of late presentation to a doctor because of hesitation to undergo surgery. The temporoparietal fascia flap, galeal flap, free gracilis flap, and free vastus lateralis musculocutaneous flap were the treatment options for reconstruction of the defects. All patients died during follow-up, and the mean survival was 15.7 months (range, 6-36 months). Only 2 of them had relapse before the death. Our small series suggest that elderly patients with periorbital SCC requiring orbital exenteration may not have enough survival to relapse because of the death from different causes without relapse or any sign of spreading cancer. Also, prolonged surgery with free flap reconstruction may increase the risk of postoperative intensive care unit requirement. Because local flaps may work very well for reconstructing the orbital exenteration defects, free flap option should be kept for selected cases.Öğe Pediküllü rektus abdominis kas deri flebinin uyluk ve sırt defektlerinde kullanımı(2014) Duymaz, Ahmet; Karabekmez, Furkan Erol; Keskin, MustafaAMAÇ: Daha önce tanımlanmış, fakat az kullanılan "ekstended" veya vertical rektus abdominis muskulokutan ("Ekstended" RAM, VRAM) fleplerinin çok nadir endikasyonlardaki kullanımları incelendi. GEREÇ VE YÖNTEM: Beş hastada, 28x8 ile 35x10 cm ebatlarında cilt adası içeren flepler kullanıldı. Dört flep uyluk ve diz proksimal bölgedeki defekt onarımları için inguinal ligamentin altından, bir flep lomber gölgedeki defekt onarımı için transabdominal olarak defekt alanlara taşındı. BULGULAR: Hiçbir olguda flep kaybı görülmedi. Bir olguda yara yeri enfeksiyonu gelişti ve cerrahi ile tedavi edildi. Uyluk ve lomber bölge defektleri onarımlarında düşük komplikasyon oranlarıyla "ekstended" RAM ve VRAM fleple başarılı transfer gerçekleştirildi ve çok güvenli ve uygun bir seçenek olduğu sunuldu.SONUÇ:Avantajları bol miktarda ve iyi kanlanan doku taşımasını sağlar, flep kolay ve hızlı hazırlanır ve mikrocerrahi deneyimi gerektirmezÖğe Using pedicled rectus abdominis musculocutaneous flaps in thigh and lumber defects(Turkish Assoc Trauma Emergency Surgery, 2014) Duymaz, Ahmet; Karabekmez, Furkan Erol; Keskin, MustafaBACKGROUND: A series of previously described but rarely used variations of the pedicled, extended or vertical rectus abdominis musculocutaneous flap ( Extended RAM, VRAM) were reviewed. METHODS: Skin paddle dimensions, ranged 8 to 28 cm in width and 10 to 35 cm in length, were used in five consecutive patients. Four flaps were placed deep to the inguinal ligament to repair the thigh as proximal to the knee region; the remaining one flap was passed transabdominally to cover the defect of the lumbar region. RESULTS: No flaps necrosis were seen and in one case wound healing problems required minimal operative intervention. Successful transfer of the VRAM and extended RAM with low rate of complication for the thigh and lumbar region defects were demonstrated to be safe and reasonable options of flap reconstruction. DISCUSSION: The flaps had the advantages of being robust and well- vascularized, easy and fast to harvest, and not requiring microsurgery experience.
