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Öğe Algorithmic approach to the prevention of unnecessary fasciotomy in extremity snake bite(Elsevier Sci Ltd, 2016) Turkmen, Arif; Temel, MetinBackground: In the literature, there is a lack of a consensus about the occurrence of the compartment syndrome due to the snake bites. There are different concepts for the surgical treatment of the threshold value of the chamber pressure. There are many different classifications and assessment criteria for the snakebites. Purpose: There is not any appropriate classification in order to the assessment of extremity snake bites while making a decision for fasciotomy. We aimed to standardize the follow-up and decision making to perform fasciotomy with a new classification system for the snakebites using objective data. Patients and methods: The data of all patients were recorded prospectively between 2006 and 2011. A total of 97 patients (64 male, 33 female) with a mean age of 30.94 +/- 14.04 were followed-up. During the evaluation of the patients, we used a new classification system that was improved for the extremity bites. We classified the patients due to their signs into four groups as for the classification system. Results: 40 patients with compartment like symptoms were carefully followed for 48-72 h, and only three patients required fasciotomy where full recovery was achieved in 37 patients. Coverage of the defects was performed with full thickness skin grafting in 4 patients and cross finger flap in two patient. In two patients, the defects were located on the palmar aspect of the thumb. Thus, we applied Kite flap for skin coverage. Reverse dorsal digital artery flap was performed in eight patients and dorsal interosseous metacarpal flap in six patients. Four patients underwent an amputation. Two patients had web reconstruction due to first web contracture. Conclusions: We present a large series of snake bite injuries and propose a classification and treatment recommendations. Fasciotomy should only be done while the measurement of intra-compartment pressure is above 55 mm Hg as snakebite can mimic the compartment syndrome. Level of evidence: III-IV. (C) 2016 Elsevier Ltd. All rights reserved.Öğe The Dermal Internal Brassiere Flap, A New Modification of Inferior Pedicle Breast Reduction Technic(Springer, 2015) Temel, Metin; Karakas, Ali O.; Dokuyucu, Recep; Turkmen, ArifThe inferior pedicle mammaplasty is particularly applied to large breasts with a long sternal notch to nipple distance. The present study reports modifications developed to solve the bottoming-out deformity, the lack of upper pole fullness and the wound healing problems seen at the reverse T-zone, known disadvantages of the inferior pedicle reduction mammaplasty, and evaluates postoperative sensation. A total of 110 patients with a mean age of 32 underwent the same technique. In this technique, two pairs of quadrangular and triangular flaps were planned from the skin of resection sites. The triangular dermal flaps and quadrangular flaps were suspended from the periosteum of the 2nd and 4th ribs, respectively. The distance from the nipple to inframammary fold was measured at the postoperative 1st month and 1st year. In the postoperative period, a nipple-inframammary fold distance increase of over 2 cm was determined as bottoming-out deformity. Sensation evaluations were performed by subjective and objective tests. The mean sternal notch to nipple distance was 35.00 cm. After operation, the mean distance between the sternal notch and the nipple was 20.00 cm. NAC examination revealed normal sensation in all patients. Whereas the preoperative mean areolar threshold value was 36.70 g/mm(2), the postoperative first-year mean areolar pressure threshold value was 35.50 g/mm(2) (p < 0.0001). The preoperative mean nipple pressure threshold value was 25.30 g/mm(2), whereas the postoperative first-year mean nipple pressure threshold value was 26.00 g/mm(2) (p = 0.5471). The postoperative first-month mean sternal notch to nipple distance value of the patients was 20.00 cm, whereas the postoperative first-year mean sternal notch to nipple distance value of the patients was 20.00 cm, (p = 0.0648). The postoperative first-month mean nipple to submammary fold distance value of the patients was 10.50 cm, the postoperative first-year mean nipple to submammary fold distance value of the patients was 11.00 cm (p < 0.0001) There were no patients determined as having bottoming-out deformity. No breast asymmetry was encountered at the late follow-up period. All patients, except the scarred ones, were satisfied with the results. In this study, we achieved an internal fascial reconstruction using a pair of triangular and quadrangular dermal flaps suspended to the rib periosteum. We believe that our modifications will contribute to decreasing the disadvantages of the inferior pedicle breast reduction technique. 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.Öğe Effects of Reduction Mammaplasty Operations on the Spinal Column: Clinical and Radiological Response(Springer, 2015) Berberoglu, Omer; Temel, Metin; Turkmen, ArifWomen with macromastia suffer from bodily disproportions like increased spinal curvature owing to the mass effect caused by severely large breasts. In such cases, the erector spinae muscles generate an overcompensatory pressure to maintain a normal posture, resulting in neck, back, and lumbar pain. This study aimed to objectively show the improvement of physical symptoms after reduction mammaplasty and evaluate psychological and physical changes of patients. Pre- and postoperative cervical, thoracic, and lumbar bidirectional (anteroposterior and lateral) radiographs were obtained from 40 patients who underwent reduction mammaplasty. Cervical lordosis, thoracic kyphosis, lumbar lordosis, and lumbosacral angles were evaluated. Body mass index, breast tissue volume, and excised tissue amount were recorded for each patient. Visual Analog Scores (VAS) were used to qualify the severity of neck, back, and lumbar pain, the Nottingham Health Profile (NHP) to evaluate quality of life (QoL), and the Beck Depression Inventory (BDI) to evaluate depression severity. Cervical lordosis, thoracic kyphosis, lumbar lordosis, and lumbosacral angle improved, and patients' neck, back, and lumbar pain decreased. The positive correlation between the excised glandular tissue amount and the decrease in neck, back, and lumbar pain was reflected in the results of VAS, NHP, and BDI tests. After reduction mammaplasty, depression symptoms caused by macromastia decreased. Parameters of QoL, including physical activity, socialization, fatigue, sleeping, and emotional reactions, significantly improved. Patients with macromastia should be considered for reduction mammaplasty before the onset of postmenopausal osteoporosis to improve QoL.Öğe Improvements in Vertebral-Column Angles and Psychological Metrics After Abdominoplasty With Rectus Plication(Oxford Univ Press Inc, 2016) Temel, Metin; Turkmen, Arif; Berberoglu, OmerSubstantial fluctuations in body weight can result in diastasis recti and weakening of the connections between the lateral abdominal muscles and the rectus sheath. The authors sought to determine the postural and psychological effects of abdominoplasty with vertical rectus plication. Forty women with substantial back and lumbar pain owing to abdominal lipodystrophy were evaluated in a prospective study. Preoperatively and 6 months postoperatively, patients underwent bidirectional radiography of the thoracic and lumbar regions. A visual analog scale (VAS), the Beck Depression Inventory (BDI), and the Nottingham Health Profile (NHP) were applied to assess physical, psychological, and quality-of-life changes following surgery. Significant improvements in posture, assessed in terms of lumbar lordosis, thoracic kyphosis, and the lumbosacral angle, were observed 6 months after abdominoplasty with rectus plication. Results of the VAS and BDI indicated significant improvements in pain and quality of life, respectively. Results of the NHP indicated significant postoperative improvements in fatigue, pain, and sleep. Abdominoplasty with rectus plication improves posture by tightening the thoracolumbar fascia. In selected patients, abdominoplasty can reduce back and lumbar pain, thereby improving quality of life. Therapeutic.Öğe A novel tumor suppressor gene in basal cell carcinoma: inhibition of growth factor-2(Springer, 2015) Temel, Metin; Turkmen, Arif; Dokuyucu, Recep; Cevik, Cengiz; Oztuzcu, Serdar; Cengiz, Beyhan; Mutaf, MehmetIn loss of heterozygosity (LOH) studies at the chromosome 4q22-35 region, it was shown that the amount of deletion was high in basal cell carcinoma (BCC). It has been proposed that genes located in this chromosomal region could be tumor suppressor genes in BCC. It has been thought that deletions in the ING2 gene located in the same region can play a role in the pathophysiology of BCC and that deletions occurring in this region may influence the level of ING2 expression in BCC. Tumoral and non-tumoral tissues from 75 patients with BCC (45 men and 30 women) were included to the study. Lesions were excised by a surgical margin of 0.5 cm. After excision, RNA was isolated from tumoral and non-tumoral tissue samples. ING2 messenger RNA (mRNA) expression level was determined in tumoral and non-tumoral tissues by the real-time polymerase chain reaction (RT-PCR). It was detected that ING2 mRNA expression level decreased in tumoral tissues when compared to non-tumoral tissues from BCC patients (p = 0.0001). It was found that expression levels of this gene were comparable among patients with primary, recurrent, or multiple BCC. It is thought that ING2 gene expression level could contribute to the development of BCC but not be associated with the stage and the prognosis of the tumor.Öğe Response to Comment on ''Effects of Reduction Mammaplasty Operations on the Spinal Column: Clinical and Radiological Response''(Springer, 2016) Temel, Metin; Berberoglu, Omer; Turkmen, Arif[Abstract Not Available]
