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Gunduz, Ozgur/0000-0003-1021-5219 WOS: 000406359600015 Cutaneous collision tumors are known as two independent tumors which are close anatomically and separated from one another by well boundaries. We, herein report a 83-year-old female patient with two cutaneous collision tumors in two different localizations at the same time. First cutaneous collision tumor located on left ala nasi was squamous cell carcinoma and basal cell carcinoma and second one located on the right commisure was composed of malignant melanoma (Clark Level IV) and basal cell carcinoma. However, the presence of collision tumors is not uncommon and is often reported in the literature, to the best of our knowledge, it is the first case which shows the association of two synchronous cutaneous collision tumor in the same individual.

Soyer, Tutku/0000-0003-1505-6042 WOS: 000327254400051 PubMed: 23375616 Aim: Although absent cremasteric reflex is a significant clinical finding for testicular torsion (TT), there is limited information about microcirculation of the cremasteric muscle (CM) after TT. This experimental study was performed to evaluate CM microcirculation by intravital microscopy after TT. Materials and methods: Twelve Wistar rats were allocated into two equal groups: control (CG) and torsion (TG). After anesthetization of the CG rats, the CM flap was dissected through a left ventral inguinal incision with its vascular pedicle. In TG rats, TT was performed by rotating left testicles 720 degrees in clockwise direction for 1 h. Then, the CM flap was dissected as in CG, and was placed under an intravital microscope. Vessel diameters, functional capillary perfusion and leukocyte activation in post-capillary venules were measured and evaluated statistically. Results: There was a significant decrease in vessel diameter in TG compared to CG (p < 0.05). The median of perfused capillaries in CG and TG was 13 (11.75-14.30) and 5.5 (4.75-7.25), respectively (p < 0.05). Number of granulocytes (rolling, sticking, transmigrated) was greater in TG than CG (p < 0.05). Conclusion: Intravital microscopic evaluation of CM after TT showed decrease in vessel diameter and number of perfused capillaries, and increase in granulocyte activation. Clinical, electrophysiological alterations in CM after TT can be explained by deterioration of microcirculation of CM. (C) 2013 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Eccrine porocarcinoma is a rare malignancy of eccrine sweat glands. Standart treatment remains unclear. We presented metastatic eccrine porocarcinoma in advanced age that has a long history of a preexisting skin lesion. We have shown that asymptomatic patients in advanced age can be followed-up without treatment even in metastatic disease., Ekrin porokarsinoma ekrin ter bezlerinin nadir görülen bir malignitesidir. Standart tedavisi yoktur. Biz burada daha önceden uzun süredir cilt lezyonları olan ileri yaş bir metastatik ekrin porokarsinoma olgusunu sunduk. Özellikle ileri yaş ve asemptomatik hastaların metastatik bile olsa tedavisiz takip edilebileceğini gösterdik.

WOS: 000272313600040 PubMed: 19884840 Silent sinus syndrome is a clinical entity with the constellation of progressive enophthalmos and hypoglobus due to gradual collapse of the orbital floor with opacification of the maxillary sinus, in the presence of subclinical maxillary sinusitis. It occurs secondary to maxillary sinus hypoventilation due to obstruction of the ostiomeatal unit. In this paper, a 35-year-old woman with a complaint of asymmetry in her left eye and denting of upper eyelid was reported. In the left eye, upper sulcus was deepened and there was 3-mm hypoglobus. There was no diplopia or restriction of eye movements in any gaze positions. Hertel exophthalmometry revealed a 4-mm enophthalmos on the left eye. Computed tomographic scan of the orbita and paranasal sinuses showed left maxillary sinusitis, air-fluid level, and collapse of left maxillary sinus walls. In addition, inferior bulging in the left orbital floor was also reported. The treatment was a 2-stage operation. In the first stage, she underwent endoscopic septoplasty plus left maxillary antrostomy, and in the second stage, she underwent a subciliary orbital floor repair of the iliac bone resulting in the improvement of the enophthalmos and her cosmetic appearance. Regarding this case, the literature is also reviewed in detail.

Yavuzer, Reha/0000-0002-8549-0875 WOS: 000268292700009 PubMed: 18972153 Prominent ear deformity is a common congenital ear deformity. Prominent ear deformity includes components such as valgus of concha, failure of scaphal folding, conchal hypertrophy, and prominent lobule. The deformity and the elastic properties of the ear cartilage determine the method of surgical correction in each case. Concha-mastoid suture, conchal excision, and posterior auricular muscle excision are different treatment options for mild to severe cases of conchal hypertrophy and valgus deformity. In this article we present a method of conchal excision, combined with a posterior auricular muscle flap, to repair severe conchal hypertrophy or valgus deformity. Six patients (11 ears) were operated on using this method. The results obtained were satisfactory. Postoperative results at 6 months were satisfactory in all patients. The smoothness and the natural appearance of the conchal bowls were notable in all patients. In contrast to the early methods of utilizing the posterior auricular muscle by transposing to the scapha or excising, its usage as a muscle flap for conchal hypertrophy and valgus deformity may be a promising option for the future.

Introduction: The peripheral adipose tissue is a vital component of many procedures in reconstructive and esthetic surgery. There is a limited knowledge on hemodynamic changes of adipose tissue. A direct intravital microscopic observation method is needed for the measurement of microcirculatory changes occurring in peripheral fat tissue during different plastic surgical procedures. Here we are introducing a model allowing for the direct in vivo monitoring and measurements of microcirculatory hemodynamics of peripheral adipose tissue. Methods: Eight male Lewis rats weighing between 150 and 180 g were used in this study. Eight abdominal adipofascial flaps based on the left femoral artery, vein, and nerve were dissected after excision of the skin of the groin and lower abdominal region. Flap angiography using Indian ink was performed to demonstrate vascular anatomy of the flap. Standard intravital microscopy was used to monitor hemodynamic parameters such as vascular diameters, functional capillary perfusion, and leukocyte-endothelial interactions. Results: Under direct intravital microscopy, microcirculatory parameters including vascular diameters, capillary perfusion, and leukocyte-endothelial interaction behaviors of the abdominal adipofascial flaps were established. Conclusions: We have showed feasibility of monitoring microcirculatory hemodynamics of the abdominal adipofascial flap model in rat. This model can be applied for intravital recordings of peripheral adipose tissue physiology and in different research scenarios such as the effects of ischemia reperfusion injury, effects of surgical trauma and wound healing studies with application of different pharmacologic agents and treatment protocols.

Multiple failed hypospadias reconstructions may cause minimal residual skin, as a result of extensive scarring. However, extragenital full thickness skin grafts or mucosal grafts are often used for urethral substitutions; local tissue expansion can provide additional matched skin, which can be easily harvested and used for penile constructions. Though tissue expanders were used as the choice of treatment in children with multiple failed hypospadias repairs, the use of tissue expander in the management of staged proximal hypospadais repair has not been reported previously. A 3-year-old boy with proximal hypospadias is presented to discuss the use of tissue expansion in the management of staged proximal hypospadias repair. © 2010 Springer-Verlag.

WOS: 000286195600087 PubMed: 21239938 In this report, we are presenting a case in which we have split the paramedian forehead flap, thus providing 2 axially perfused skin flaps for simultaneous reconstruction of the upper and lower lid structures after resection of basal cell carcinoma from the left medial canthal area. We found that split forehead flap seems to be a favorable option for simultaneous reconstruction of the upper and lower eyelid defects by enabling nicely vascularized and abundant amount of regional skin.

Ischemia – reperfusion injury (IRI) is a serious complication of revascularisation that biases a result of many surgical procedures. The pathophysiology of IRI is very complex and still not fully understood. For years a laboratory model of muscle ischemia reperfusion have been developed to provide reliable scientific tool for observation of IRI and investigation of possible therapeutic strategies. Cremaster muscle model of IRI plays an important role in research of IRI due to its similarity to clinical scenarios of limb ischemia, transplantation, replantation. This model provides unique opportunity to visualize important events that occur during reperfusion like capillary perfusion, leukocyte-endothelial interaction, microvasculature response and endothelial permeability. It is a potent model for intravital investigation of muscle microcirculation subjected to IRI.

Well established techniques of oncological surgery and radiotherapy are very valuable tools of our fight against cancer. Although effective and widely performed regional lymph node dissections seems to progress enabling lesser morbidity and better results; they are the most common cause of secondary lymphoedema in the industrialized world. During our reconstructive surgery practice we commonly see secondary cases such as: lower limb lymphoedema secondary to treated gynaecological cancers or upper limb lymphoedemas secondary to breast cancer treatment. These cases varying from mild to severe, many of them benefit from lymphoedema surgery. Relatively new, microsurgical techniques are becoming the backbone of surgical lymphoedema treatment.

Although, one out of every eight women has a risk of developing breast cancer. the reported incidence of breast carcinoma detection in reduction mammaplasty materials is rather low. To our knowledge, specimen radiography, which is used for breast biopsies has not been used for the assessment of breast reduction materials. We investigated the applicability of specimen radiography and its potential benefits in detection of the breast pathologies, especially malignancies in reduction mammaplasty materials. Forty patients scheduled for reduction mammaplasty operation were included. In all cases an inferior pedicle reduction technique was preferred and the radiographs of the resected breast tissues were taken immediately. The radiographs were evaluated for any possible pathologic appearance and all abnormal findings were marked. For the histopathologic evaluation, in addition to the random sampling of the pathologist, any marked areas were also microscopically examined. In two cases fibrocystic changes were found in radiographs and the same results were obtained in the histological examination. No false negative mammogram was seen. Specimen radiography. which is applicable for breast reduction materials is an easy and cheap method and does not cause any patient discomfort. It seems that the radiographs of reduction mammaplasty materials are useful to provide guidance to the pathologist during tissue sampling for microscopic examination especially when large a-mounts of breast tissue is excised.

WOS: 000318991000030 PubMed: 22704466 …

In order to overcome some of the drawbacks of conchal reduction and to present another reliable prominent ear correction technique, the author has used the posterior auricular muscle. The purpose was to overcome the risks of conchal reduction surgery and to utilize the muscle combined with perichondrioplasty (perichondrial flap tacked posteriorly) for better results with repositioning. The author describes the technique of using the posterior auricular muscle flap in otoplasty. © Springer-Verlag Berlin Heidelberg 2013.

WOS: 000296540300040 PubMed: 21496817 …

Bayram, Cem/0000-0001-8717-4668; Soyer, Tutku/0000-0003-1505-6042 WOS: 000365177200015 PubMed: 25964198 Background Autologous fat grafts are rich in adipose-derived stem cells, providing optimal soft-tissue replacement and significant quantities of angiogenic growth factor. Although fat grafts (FG) are used in several clinical conditions, the use of FG in urethral repairs and the effects of FG to urethral repairs have not yet been reported. Objective An experimental study was performed to evaluate the effect of FG on urethral angiogenesis and tissue growth factor (GF) levels. Study design Sixteen Wistar albino, adult, male rats were allocated into two groups: the control group (CG) (n = 8) and the experiment group (EG) (n = 8). After anesthetization of all rats, 3-mm vertical incisions were made on the urethras, and then sutured with interrupted 5/0 vicryl sutures. The operations were performed under a stereo dissecting microscope under magnification (x20). In the CG, no additional procedure was performed. In the EG after the same surgical procedure, 1 mm(3) FG was removed from the inguinal region by sharp dissection with a knife. The grafts were trimmed to 1 x 1 mm dimensions on millimeter paper. The FGs were placed on the repaired urethras. The skin was then closed. Samples from urethral and penile skin were taken 21 days after surgery in both groups. Density and intensity of staining with vascular-endothelial GF (VEGF), VEGF-receptor, and endothelial-GF receptor (EGFR) in the endothelial and mesenchymal cells of the penile urethral vessels were immunohistochemically evaluated. Data obtained from immunohistochemical evaluations were analyzed with SPSS 15.0. The P-values lower than 0.05 were considered as significant. Results Density of VEGF staining was significantly decreased in the vascular endothelium of the EG compared to the CG (P < 0.05). Density of the EGFR staining was significantly decreased in the vascular endothelium of the EG compared to the CG (P < 0.05) (Table). Intensity of VEGF, VEGF-R and EGFR staining was not significantly different between the two groups. There were no significant differences between groups regarding to VEGFR staining and mesenchymal examination. Discussion Decreased density was found in the VEGF staining in the vascular endothelium. This could be explained by the day that the tissues were harvested or because autologous fat grafts might cause decreased growth factor levels, which is contrary to the literature data. Conclusion Fat grafting has an immunohistochemical effect on the growth factor levels that are related to angiogenesis after urethral repair. It is difficult to make a firm conclusion about the role of fat grafting on urethral healing. Therefore, future studies are needed to see if FG can be used as an alternative to other procedures in order to avoid complications. Kirikkale University Scientific CouncilKirikkale University [KU-2011/47] This study was presented at the 31st Congress of Turkish Pediatric Surgeons 2013, in Eskisehir, Turkey. It is supported by the Kirikkale University Scientific Council (KU-2011/47).