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PubMed: 32310875 BACKGROUND: Bleeding during rhinoplasty leads to many undesirable effects, such as loss of vision in the surgery area, complications during the procedure, and postoperative complications. The most important effect that increases bleeding is hemodynamic changes during surgery. Considering that osteotomy is the most challenging process in rhinoplasty, this study aimed to examine the hemodynamic changes during osteotomy and changes in the depth of anesthesia. METHODS: A total of 50 patients, aged 18 to 65 years with an ASA (American Society of Anesthesiology) score of 1 and 2, who underwent osteotomy during rhinoplasty under general anesthesia, were examined retrospectively. After routine monitoring, the patients underwent general anesthesia induction and endotracheal intubation. Before the surgery, they received remifentanil 1??g/kg as an intravenous bolus followed by 0.5??g/(kg·min) as intravenous infusion until the end of the surgery. The hemodynamic parameters and depth of anesthesia [bispectral index (BIS) values] of the patients were examined before anesthesia, 10?minutes before osteotomy, during osteotomy, and 10?minutes after osteotomy. RESULTS: A significant difference was found in heart rate (beats/min), systolic and diastolic blood pressures (mm Hg), and BIS values of the patients measured before, during, and after osteotomy (P < 0.001). The heart rate, systolic and diastolic blood pressures, and BIS values were significantly higher during osteotomy. Until the 10th minute after osteotomy, all 4 parameters nearly reached the values measured before osteotomy. CONCLUSIONS: Osteotomy directly affects hemodynamic parameters and depth of anesthesia. Hence, it is of utmost importance that the analgesic need and depth of anesthesia are adequately monitored and adjusted during osteotomy. By suppressing hemodynamic stress responses, the amount of bleeding can be reduced, thus increasing the surgical success and the patient's comfort.

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.

WOS: 000316743600026 PubMed: 23381652 We present a technical modification of vertical reduction mammaplasty which provides a reliable pedicle that can be used in large and highly ptotic breasts with confidence when compared to vertical mammaplasty techniques without sacrificing conical breast shape and projection, in contrast to Wise pattern reduction techniques. Thirty-two patients under general anesthesia were operated on using this modification between 2008 and 2012. The surgical technique is as follows: after general anesthesia induction and local anesthetic infiltration, skin incisions are made according to preoperative drawings. The breast meridian is prepared by superior and inferior plication of the vertical pedicle, including two dermal and one central attachment to the chest wall. Lateral and medial tissue resections are performed, thus preparing medial and lateral pillars after skin undermining. The pillars are sutured to the meridian to reconstruct a projectile conical breast shape. Inverted-T scar (87.5 %, n = 28) and vertical scar (12.5 %, n = 4) were used for closure. All patients were satisfied with the outcome regarding breast projection, shape, and size at 12 (n = 30) and 24 months (n = 15) after surgery except for 12 cases that needed reoperations: 2 cases for bottoming out and lower pole deformity, 2 cases needed more reduction by liposuction or re-excision, and 8 scar revisions. Early and late results (up to 2 years) regarding breast shape and projection were found to be satisfactory while providing a reliable pedicle with less postoperative drainage. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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: 000273162300011 PubMed: 20023454 We describe herein a new technique for reconstruction of the orbital floor, using autologous nasal septal bone and report the Surgical results achieved in maxillofacial trauma patients. Prior to its clinical Surgical application, a cadaver practice was carried Out oil 5 formalin-fixed adult human cadavers to establish the feasibility and efficacy of the method. Fifteen patients with orbital floor fractures, operated between 2005 and 2008, using this technique, were included in the current study. Cadaveric practice revealed that an adequate and appropriate size of septal bone graft can be harvested for reconstruction of the orbital floor. All patients except one had satisfactory clinical and radiologic late results. One patient experienced persistent enophthalmos, possibly due to delayed repair and associated displaced zygomatic boric fracture. Autologous nasal septal bone as an orbital floor bone graft has many advantages, including low donor site morbidity, adequacy and appropriateness of size, and similarity of its bicortical morphology and histologic nature compared with the orbital floor bone. Our clinical results strongly support that this technique call become a satisfactory alternative to existing reconstruction methods.

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.

Blood transfusion is recommended to prevent the harmful effects of tissue hypoxia. Whether transfusion alleviates hypoxia at the microcirculatory level is unknown. The objective of this study was to determine whether the effects of fresh blood transfusion on microcirculatory hemodynamics after blood loss are preferable to the effects of banked blood transfusion.Intravital microcirculatory hemodynamics was observed in the rat cremaster muscle flap by observers who were not blinded. Lewis rats were divided into 6 groups (8 rats per group): (1) untreated control; (2) blood withdrawal only (1 mL); (3) blood withdrawal and transfusion of rat fresh blood (1 mL); (4) blood withdrawal and transfusion with 1-day rat banked blood (1 mL); (5) blood withdrawal and transfusion with 1-week rat banked blood (1 mL); and (6) blood withdrawal and transfusion with 2-week rat banked blood (1 mL). Red blood cell velocity, blood flow, vessel diameter, functional capillary perfusion, red blood cell deformability, leukocytes (granulocytes and lymphocytes), and tissue oxygenation levels were monitored before transfusion and for 5 hours afterward. Histology was performed to evaluate tissue inflammation (hematoxylin and eosin [HE] stain and myeloperoxidase [MPO] immunoassay) and hypoxia (Hypoxyprobe assay).Fresh- and banked blood-transfused groups did not differ in vessel diameters or red blood cell velocities. Functional capillary density was greater in the fresh blood group when compared to 1- and 2-week banked blood-transfused groups. The overall number of granulocytes (rolling, sticking, and transmigrated) was greater in all groups after transfusion (P.001). Rats transfused with banked blood had a greater number of rolling lymphocytes and more inflammation. Tissue oxygenation levels were improved after fresh blood transfusion in comparison to banked blood (9.5 mm Hg vs 8 mm Hg, P = .02).Fresh blood transfusion is more effective in relieving effects of microcirculatory hypoxia. Banked blood, in particular 2-week stored blood, has limited capacity of improving tissue oxygenation.

Background: Extensive craniomaxillofacial deformities including bone and soft-tissue defects are always challenging for reconstructive surgeons. The purpose of this study was to extend application of the face/scalp transplantation model in the rat by incorporation of the vascularized calvarial bone, based on the same vascular pedicle, as a new treatment option for extensive craniomaxillofacial deformities with large bone defects. Methods: Seven composite hemiface/calvaria transplantations were performed across major histocompatibility complex barrier between Lewis-Brown Norway and Lewis rats. Seven donor and seven recipient rats were used in this study. Hemicalvarial bone and face grafts were dissected on the same pedicle of the common carotid artery andjugular vein and were transplanted to the deepithelialized donor faces. All rats received tapered and continuous doses of cyclosporine A monotherapy. Evaluation methods included flap angiography, daily inspection, computed tomographic scan, and bone histology. Results: Flap angiography demonstrated the vascular supply of the bone. The average survival time was 154 days. There were no signs of rejection and there was no flap loss noted at 220 days posttransplantation. Bone histology at days 7, 30, 63, and 100 after transplantation revealed viable bone at all time points, and computed tomographic scans taken at days 14, 30, and 100 revealed normal bones without resorption. Conclusions: For extensive face deformities involving large bone and soft-tissue defects, this new osteomusculocutaneous hemiface/calvaria flap model may serve to create new reconstructive options for covering during one surgical procedure.

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.

Environmental insults to animal body lead to critical times for the organism between life and death in which to be fighted without any organ sacrifice. Portrayed by Dylan Thomas during the case of his father’s larynx cancer; advises him to sleep in order to survive. An interesting understanding of nature by the poet (“stand-by” state of organism saves from death) just like trying to adress the main purpose of “cryopreservation”. In order to cope with extreme situations, nature provides strategies of decreasing metabolical activity to certain animal; letting them to survive in strict conditions such as cold/hot environments or hypoxia.

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.

Complex midfacial deformities including maxilla defects are always a challenge. Although debatable before the clinical introduction of face allotransplantation, midfacial defect reconstructions necessitated multiple stages of surgeries in order to support and reestablish the complex function of the nasal and maxillary regions (Gastman et al., Plast Reconstr Surg 130:419–422, 2012). The midfacial region as a part of viscerocranium harbors nasal passage, oral soft tissue, lips and dental structures including hard and soft palates and mucosal linings. As the starting point of alimentary and respiratory system and as an aesthetically important region reconstructive parameters are very demanding.

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: 000278102200075 PubMed: 20485090 In this article, we are introducing the use of galeal-frontalis flap to reduce hypertrophic sinus based on 1 case: a 25-year-old amateur boxer who had prominent frontal area due to hypertrophic frontal sinus. Three-dimensional reformatted computed tomography scans were obtained for evaluation of the hypertrophy and the morphology of the frontal sinus. Reduction of the hypertrophic frontal sinus was performed by resection and shaping of the anterior wall and obliteration of the frontal sinus by right-side galeal-frontalis flap excision via bicoronal approach. The trimmed anterior wall was inserted into the frontal sinus and secured with three 3.0 PDS sutures to the bone edges, and the incision was closed. The outcome was satisfactory without any complications during 1-year follow-up, and sixth-month computed tomography scans revealed no bone resorption. Here we are introducing a novel technique to reduce hypertrophic sinus based on a clinical report.

Yavuzer, Reha/0000-0002-8549-0875 WOS: 000316676300148 PubMed: 23524791 …

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.

Comert, Ayhan/0000-0002-9309-838X WOS: 000306178000016 PubMed: 22438193 …

Comert, Ayhan/0000-0002-9309-838X WOS: 000289632400007 PubMed: 20871999 Purpose The surgical anatomy of the dorsal branch of the ulnar nerve and artery on the dorsal aspect of the hand is important in design of neurocutaneous flaps for reconstructive surgery and serves as a donor site for nerve grafts. In this study, the course, location, and diameter of the dorsal branches of the ulnar nerve and artery were studied from anatomical and reconstructive perspectives. Methods Upper limbs of 14 (7 left and 7 right) and 22 formalin-preserved adult cadavers (15 left and 7 right) were dissected in two different centers. Results The diameters of the ulnar nerve, artery, and their dorsal branches were measured at selected reference points. The distances to specific anatomical landmarks were also measured, during their courses from the proximal forearm towards the middle phalanges of the 4th and 5th fingers. Conclusions Our data may facilitate the design of neurocutaneous flaps nourished from the dorsal branches of the ulnar nerve and artery, and may aid in the harvesting of nerve grafts from the dorsal branch of the ulnar nerve, and provide a safe surgical approach to the dorsum of the hand.

WOS: 000296540300040 PubMed: 21496817 …

WOS: 000286195600060 PubMed: 21233742 In this clinical report, we are presenting the combination of demineralized bone matrix combined with bilateral galea frontalis flaps. Based on our 6-month results, this seems to be a reasonable combination to accomplish long-lasting restoration of forehead defects related to en coup de sabre linear localized scleroderma.

WOS: 000282003300088 PubMed: 20856077 …

In this study, we aimed to develop a new muscular neurotization technique, in which transection of the donor nerve is avoided. We investigated the outcome of insertion of the donor nerve within the denervated muscle following segmentary epineurectomy (lateral muscular neurotization). Thirty-five male Wistar rats were evaluated in five groups, including sham control, denervation control, denervation combined with segmentary epineurectomy, direct muscular neurotization, and lateral muscular neurotization. Electromyography, muscle weight measurements, and histological evaluations were performed at postoperative months 2 and 3. The denervation group was statistically successful for denervation as compared with the sham control group for all parameters. The lateral neurotization group was successful in preventing muscle atrophy and gaining reinnervation in electromyographic, histological, and weight parameters. The direct neurotization group was also successful in histological and weight parameters. Lateral muscular neurotization is promising because it does not interrupt the fascicular integrity and is successful in reinnervation; therefore, it seems to be a good alternative for direct muscular neurotization.

Comert, Ayhan/0000-0002-9309-838X WOS: 000257081300021 PubMed: 18580160 Introduction: The aim of this study is to present an anatomic study and a dissection technique to, prepare maxilla graft for transplantation. Methods: Six fixed adult human cadavers were used for dissection of the maxilla grafts. Retrospective reviews of archives of 10 MRI and 5 angiographies of the maxillary region were performed to demonstrate the vascular and soft tissue anatomy of this area. Results: We have harvested maxilla graft as a single unit (larger type of Le Fort II) based on arterial and venous pedicle ready for transplantation. MRI evaluation revealed the vascular structures in the masticatory space and its anterior pterygomaxillary extension. Angiographic observations have demonstrated the arterial blood supply of the maxillary region, which lies within the pterygomaxillary region that we have included in the graft. Conclusions: We are presenting a method for harvesting of the maxilla graft, with vascular supply based on certain anatomic landmarks.

Background The objective of this study was to perform complex characterization of cryopreserved and then autotransplanted ovaries including determination of the ability to respond to in vivo follicle stimulating hormone (FSH)-treatment, fertilizability of retrieved oocytes, and morphology, vascularization, cellular proliferation and apoptosis in sheep. Methods Mature crossbred ewes were divided into two groups; an intact (control) group (n = 4), and autotransplanted group (n = 4) in which oophorectomy was performed laparoscopically and ovaries with intact vascular pedicles frozen, thawed and transplanted back into the same animal at a different site. Approximately five months after autotransplantation, estrus was synchronized, ewes were treated with FSH, and ovaries were collected. For all ovaries, number of visible follicles was determined, and collected cumulus oocyte complexes (COC) were matured and fertilized in vitro. Remaining ovarian tissues were fixed for evaluation of morphology, expression of factor VIII (marker of endothelial cells), vascular endothelial growth factor (VEGF; expressed by pericytes and smooth muscle cells), and smooth muscle cell actin (SMCA; marker of pericytes and smooth muscle cells), and cellular proliferation and apoptosis. Two fully functional ovaries were collected from each control ewe (total 8 ovaries). Results Out of eight autotransplanted ovaries, a total of two ovaries with developing follicles were found. Control ewes had 10.6 +/- 2.7 follicles/ovary, oocytes were in vitro fertilized and developed to the blastocyst stage. One autotransplanted ewe had 4 visible follicles from which 3 COC were collected, but none of them was fertilized. The morphology of autotransplanted and control ovaries was similar. In control and autotransplanted ovaries, primordial, primary, secondary, antral and preovulatory follicles were found along with fully functional vascularization which was manifested by expression of factor VIII, VEGF and SMCA. Proliferating cells were detected in follicles, and the rate of apoptosis was minimal in ovaries of control and autotransplanted ovaries. Conclusion These data demonstrate successful autotransplantation of a portion of frozen/thawed ovaries manifested by restoration of selected ovarian function including in vitro maturation of collected oocytes, presence of follicles from several stages of folliculogenesis and blood vessels expressing specific markers of vascularization, and proliferation and apoptosis of ovarian cells. Thus, heterotopic autotransplantation of a whole frozen/thawed ovary allows for development of preovulatory follicles, oocyte growth, and for restoration of vascularization and cellular function. However, additional improvements are required to enhance the efficiency of autotransplantation of frozen/thawed ovaries to produce more oocytes.

WOS: 000253680200041 PubMed: 18092187 …

We developed a rat model to test the effects of vascularized maxilla allotransplantation on composite maxillary substructures. Allograft maxilla transplantations were performed across the major histocompatibility barrier between 10 Lewis-Brown-Norway (RT1(n+l)) and 10 Lewis (RT1(l)) recipient rats under cyclosporin A monotherapy. Grafts were dissected along Le-Fort II osteotomy lines based on the common carotid artery and external jugular vein and transplanted to the anterior abdominal wall via microvascular anastomosis. Allografts were examined by tomography, flow cytometry, angiography, and histology. Three of the allografts survived up to 105 days without any signs of rejection. High level of donor-specific chimerism for T-cell and B-cell lineages was maintained in the peripheral blood. The incisors continued to grow; teeth buds, bone, cartilage, and mucosa remained intact. Moderate inflammation of the nasal, oral mucosa, and keratinous metaplasia was noted histologically. We created a maxilla allotransplantation model that allows the study of immunologic responses and demonstrates potential clinical applications based on the growth properties of the allograft.

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).

usta, gulsah/0000-0002-0065-4384; WOS: 000316676300109 PubMed: 23524748 The thin-walled structure of veins leads them to stay collapsed during anastomoses, thereby the incidence of technical failures is more common than arterial anastomoses. In order to overcome this problem, we are introducing the use of viscoelastic material based on our experience on rats. Six rats were used in order to study the technical feasibility of the viscoelastic material during microsurgical vein anastomosis. End-to-end anastomoses were performed on rat jugular veins using 0.5-1 mL of the viscoelastic medium applied to the ends of the veins and surgical field under X30 operating microscope magnification. Then 1.8% (n:3) and 3.0% (n:3) hyaluronic acid was used as a viscous medium in order to keep the vein lumens open during anastomosis. In conclusion, we have found that 3.0% hyaluronic acid viscoelastic medium facilitates microvenous anastomosis in rat. Studies involving human practice are needed for further evaluation of this technical refinement.

Yavuzer, Reha/0000-0002-8549-0875 WOS: 000257020900033 PubMed: 18299916 …

Comert, Ayhan/0000-0002-9309-838X WOS: 000272313600058 PubMed: 19884829 In this article, we present the use of triangulation for end-to-si I de microvascular arterial anastomosis. The classic end-to-side anastomosis starts by putting 2 Sutures 180 degrees apart to the lateral arteriotomy aperture that is parallel to the longitudinal axis. We are performing triangulation in end-to-side microvascular artery anastomoses by putting 3 Stay Sutures, securing 2 of them to visualize vascular lumen and reduce the risk of passing suture from the back wall. We have been using this method for the last 5 years and found that triangulation seems to be a safer technique to teach and practice end-to-side microvascular anastomosis.