BACKGROUND The reverse posterior interosseous artery flap is useful for covering hand defects. Ho... more BACKGROUND The reverse posterior interosseous artery flap is useful for covering hand defects. However, its major drawback is the short pedicle that limits the reach of the flap up to the metacarpophalangeal level. The authors performed a new modification extending the distal reach of the flap by including the recurrent branch of the posterior interosseous artery and they aimed to present the results of reconstruction with this technique. PATIENTS AND METHODS Seven patients with a mean age of 35.2 years (range 17-64 years) underwent extended RPIAF surgery. Six patients were admitted to the emergency department with isolated hand trauma. One patient was present in elective settings with chronic osteomyelitis and skin loss of the thumb related to previous trauma. The defects were located on the distal metacarpophalangeal level (thumb and other fingers). PIA perforators and the recurrent branch were included into the pedicle (Type A) in five cases, whereas the flap was harvested based ...
Kafkas Universitesi Veteriner Fakultesi Dergisi, 2016
Chronic constriction injury (CCI) is a common clinical entity and characterized by allodynia or s... more Chronic constriction injury (CCI) is a common clinical entity and characterized by allodynia or spontaneous neuropathic pain. Treatment of neuropathic pain is difficult, because a lack of knowledge about the underlying mechanisms and limited effectiveness of the existing drugs. Surgical decompression enables a more radical treatment by releasing the compressed nerve. Beside the pain behaviour morphological changes occur in CCI. Ultrastructural morphological changes at the injury site of the sciatic nerve and in the dorsal root ganglia (DRG) are believed to play role in the pathogenesis of CCI and in the development of neuropathic pain behaviour in individuals. However, the effects of surgical decompression on the ultrastructure of constricted nerve site as well as in the dorsal root ganglia have not been studied in details. We investigated the effect of nerve decompression on ultrastructure of rat sciatic nerve and DRG by light and transmission electron microscopic methods. For this aim, CCI was established on the rat sciatic nerve with four loose ligatures. Surgical decompression was held at 1 st , 3 rd and 5 th the weeks after CCI by removing the ligatures. Our results suggest that the efficacy of decompression was superior when applied one week after compression. The results of the study verify the need for early surgical decompression to prevent irreversible damage of the peripheral nerve and DRG.
Background: The aim of this study was to investigate the effects of fucoidin on rat kidney and lu... more Background: The aim of this study was to investigate the effects of fucoidin on rat kidney and lung in an infraaortic ishemia reperfusion model. Methods: Forty Wistar rats were randomly divided into five groups ( n = 8) as sham, control (IR), before ischemia (BI), before reperfusion (BR), and before ischemia and before reperfusion (BI/BR). Rats were subjected to 120 minutes ischemia followed by 120 minutes reperfusion with application of infrarenal aortic clamping. BI received intravenous fucoidin (25 mg/kg) ten minutes before establishing ischemia and BR received ten minutes before reperfusion. BI/BR group received half equal doses of fucoidin both before ischemia (12.5 mg/kg) and reperfusion (12.5 mg/kg) periods, respectively. After sacrification blood and tissue samples were obtained for biochemical (Malondialdehyde (MDA), Nitric oxide (NO), Myeloperoxidase (MPO), Catalase (CAT), Plasma Chitotriosidase (CHIT) and serum ischemia modified albumin (IMA)) and histologic examinations....
on a nerve alters blood flow and leads to epineurial ischemia. This can cause inflammation, fibro... more on a nerve alters blood flow and leads to epineurial ischemia. This can cause inflammation, fibrosis, demyelination, and ultimately axonal loss (5). Such cells secrete pro-and antiinflammatory cytokines, such as tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and IL-10, and these substances play an important role on the initiation and development of chronic pain states (20). In addition, TNF-α also induces axonal damage (19). Consequently, spinal glial activation occurs, causing neuropathic pain progression (10). █ INTRODUCTION N europathic pain is defined as pain from lesions in both the central and peripheral nervous systems. Nerve entrapment syndromes such as carpal tunnel syndrome, spinal root compression, and trigeminal neuralgia due to vascular compression are the most common causes of neuropathic pain. This pain develops secondary to the chronic compression of peripheral nerves. Increased chronic pressure AIm: Nerve entrapment syndromes are the most common causes of neuropathic pain. Surgical decompression is the preferred method of treatment. The aim of this study was to compare the efficacy of curcumin, tramadol and chronic constriction release treatment (CCR), individually or together, in a rat model of sciatic nerve injury. mATERIAl and mEThODS: Eighty male rats were divided into eight study groups. Group 1 was the sham group. Group 2 was the control group with established chronic constriction injury (CCI). CCI was also established in Groups 3-8. Group 3 underwent chronic constriction release (CCR). Groups 4 and 5 received curcumin and tramadol. Groups 6 and 7 also received curcumin (100 mg/kg daily, oral) and tramadol (10 mg/kg daily, intraperitoneal, 14 days) after CCR, respectively. Combined curcumin-tramadol treatment was applied to Group 8. Behavioral tests (thermal hyperalgesia, dynamic plantar, cold plate test) were performed on days 0,3,7,13,17, and 21. Tissue tumor necrosis factor-α (TNF-α) and interleukin-10 (IL-10) levels were analyzed in the nerve and dorsal root ganglion (DRG) samples on day 21. Histopathological examination was performed on the nervous tissue and DRG. RESUlTS: Tramadol-CCR and tramadol-curcumin significantly attenuated mechanical allodynia and thermal hyperalgesia. In the CCI-CCR-tramadol treatment group, TNF-α levels were significantly lower in the sciatic nerve tissue, and DRG and IL-10 levels were significantly higher in the sciatic nerve tissue. CONClUSION: CCI-CCR-tramadol treatment is highly effective in the symptomatic treatment of neuropathic pain. CCR-curcumin is associated with less degeneration and high levels of regeneration in the nerve tissue.
Background: Autologous nerve grafts are used to bridge peripheral nerve defects. Limited sources ... more Background: Autologous nerve grafts are used to bridge peripheral nerve defects. Limited sources and donor site morbidity are the major problems with peripheral nerve grafts. Although various types of autologous grafts such as arteries, veins and muscles have been recommended, an ideal conduit has not yet been described. Aims: To investigate the effectiveness of a small intestinal conduit for peripheral nerve defects. Study Design: Animal experimentation. Methods: Twenty-one rats were divided into three groups (n=7). Following anaesthesia, sciatic nerve exploration was performed in the Sham group. The 10 mm nerve gap was bridged with a 15 mm ileal segment in the small intestinal conduit group and the defect was replaced with orthotopic nerve in autologous nerve graft group. The functional recovery was tested monthly by walking-track analysis and the sciatic functional index. Histological evaluation was performed on the 12th week. Results: Sciatic functional index tests are better in autologous nerve graft group (-55.09±6.35); however, during follow-up, progress in sciatic functional index was demonstrated, along with axonal regeneration and innervation of target muscles in the small intestinal conduit group (-76.36±12.08) (p<0.05). In histologic sections, distinctive sciatic nerve regeneration was examined in the small intestinal conduit group. The expression of S-100 and neurofilament was observed in small intestinal conduit group but was less organised than in the autologous nerve graft group. Although the counted number (7459.79±1833.50 vs. 4226.51±1063.06 mm 2), measured diameter [2.19 (2.15-2.88) vs. 1.74 (1.50-2.09) µm] and myelin sheath thickness [1.18 (1.09-1.44) vs. 0.66 (0.40-1.07) µm] of axons is significantly high in the middle sections of autologous nerve graft compared to the small intestinal conduit group, respectively (p<0.05), the peripheral nerve regeneration was also observed in the small intestinal conduit group. Conclusion: Small intestinal conduit should not be considered as an alternative to autologous nerve grafts in its current form; however, the results are promising. Even though the results are no better than autologous nerve grafts, with additional procedures, it might be a good alternative due to harvesting abundant sources without donor site morbidity.
Genistein was shown to promote recovery in experimental peripheral neuropathy and chronic periphe... more Genistein was shown to promote recovery in experimental peripheral neuropathy and chronic peripheral nerve injury (23,24). However, the effect of genistein in animal models of acute crush injury or complete transection of peripheral nerve has not yet been investigated. The purpose of this study was to investigate the effects of genistein after experimental sciatic nerve crush injury and complete sciatic nerve transection in rats and to compare its effects with those of gabapentin. █ INTRODUCTION A lthough microsurgical techniques have been developed and positive effects of clinically and experimentally different neurotrophic drugs, steroids, hormones, and even low-dose radiation have been reported, desirable motor and sensory recovery after peripheral nerve injury is a clinical challenge (6,16,18,20,25). Methylprednisolone and gabapentin are considered as reference agents, against which the medical treatment of traumatic peripheral nerve injury is evaluated. However, their adverse effects are a major limitation associated with their clinical use (16). AIM: To investigate the effects of genistein in a rat model of sciatic nerve crush injury and complete sciatic nerve transection. The effects of genistein were compared with those of gabapentin, which is widely used in clinical practice for peripheral nerve injury. MATERIAL and METHODS: Forty-eight rats were randomly divided into six groups (8 rats in each group): group 1 (sham); group 2, sciatic nerve crush injury (control); group 3, sciatic nerve crush injury+genistein 20 mg/kg; group 4, sciatic nerve crush injury+gabapentin 90 mg/kg; group 5, sciatic nerve transection+genistein 20 mg/kg; group 6, sciatic nerve transection+gabapentin 90 mg/kg. The effects of genistein and gabapentin were assessed with immunohistochemical staining for growth associated protein-43 (GAP-43) and myelin basic protein (MBP). Interleukin-1β and tumor necrosis factor α levels in the injured nerve specimens were assessed as a measure of inflammatory response; walking track analysis and sciatic function index for neurological recovery and the paw mechanical withdrawal threshold were examined for neuropathic pain. RESULTS: On histopathological examination, genistein use was associated with a greater immunoreactivity for GAP-43 and MBP compared with that associated with gabapentin. Genistein and gabapentin had similar effects on anti-inflammatory activity, functional recovery, and neuropathic pain. CONCLUSION: Genistein and gabapentin exhibit positive effects on histopathology, inflammation, and clinical findings of peripheral nerve injury. When the systemic side effects of gabapentin are considered, genistein (a basic soy isoflavone that has no side effects) can be used as an alternative to medical treatment in peripheral nerve injury.
La Chirurgia Degli Organi Di Movimento, Oct 1, 2009
Skin grafts and local flaps are conventional methods for repairing simple syndactyly. Skin grafts... more Skin grafts and local flaps are conventional methods for repairing simple syndactyly. Skin grafts usually leave unsightly appearance and contracture formation. In this study, unipedicled distally based venous flap were raised from third or fourth metacarpal area of the hand for syndactyly treatment. The distally based venous flap was to provide skin coverage to one side of the finger, in order to avoid complications arising from using skin graft. Nine patients' syndactylies (5 simple incomplete and 4 simple complete syndactyly) were treated using this method. The mean follow-up period of the flaps was 14 months, ranging from 12 to 16 months. Mild edema and venous congestion occurred in all flaps. Superficial necrosis involving two flaps did not affect flap survival. All flaps survived completely. In this article, we have described a new surgical technique for the correction of syndactyly in a single surgical procedure that utilizes a distally based venous flap to provide skin coverage without skin graft.
The transplantation of support cells from various sources into the conduits has been proposed as ... more The transplantation of support cells from various sources into the conduits has been proposed as a method to promote peripheral nerve regeneration. Especially cultured Schwann Cells (SCs) from neural origin that play an integral role in regeneration of the peripheral nerves have been implanted into suitable conduits (9,10,16,22). Although SCs transplantation improved nerve regeneration experimentally, its clinical applications remained controversial because of its disadvantages. SCs are difficult to obtain in large amounts which may be attributed to the time-consuming process of isolation, cultivation and expansion of SCs in vitro because of their restricted mitotic activity (12). Another reason may AIm: To investigate whether nerve regeneration can be induced in the tubular bone between distal and proximal cut nerve ends. mATERIAl and mEThODS: Twenty adult Wistar rats were used for the study. Rats were divided into three groups; femoral bone conduit group, nerve transection group, sham group. The sciatic nerve was surgically cut and from both ends inserted into the adjacent femoral bone tunnel in the femoral bone conduit group. The sciatic nerve was cut transversely in the nerve transection group. In the Sham group, only sciatic nerve exploration was performed, without a nerve cut. The groups were evaluated functionally and morphologically. RESUlTS: All results showed that axonal growth existed through the osseous canal. CONClUSION: To the best of our knowledge, this is the first study to evaluate neural regeneration inside the bone. We can speculate that the bone marrow provides a convenient microenvironment for peripheral nerve regeneration. In addition to prefabricating peripheral nerves, this novel model may help to establish further strategies for engineering of other tissues in the bone marrow.
Many young women are satisfied with their large breasts but suffer from sagging due to heaviness.... more Many young women are satisfied with their large breasts but suffer from sagging due to heaviness. In this article; we present a novel modification of vertical scar breast reduction based on a special indication. From January 2006 to May 2012, twenty five individual patients underwent operation using modified technique with superior pedicle and vertical scar. Young women between ages 25-35 years with voluminous breasts who requested mastopexy rather than reduction were selected for the surgery. The mean patient age was 30 years and body mass index (BMI) was 27.8±1.07 kg/m(2). Mean nipple transposition was 6.5 cm. Mean weight for resected tissue was 415 g for left and 419 g for right breast. Mean operative time was 125 minutes. Patients were followed up for 9-22 months. No serious complications encountered in consecutive patient series. The only complication was permanent wrinkling probably due to vertical closure in 5 of 25 patients which did not resolve during the follow-up period. ...
Esthetic surgery of external female genitalia remains an uncommon procedure. This article describ... more Esthetic surgery of external female genitalia remains an uncommon procedure. This article describes a novel, de-epithelialized, labial rim flap technique for labia majora augmentation using de-epithelialized labia minora tissue otherwise to be excised as an adjunct to labia minora reduction. Ten patients were included in the study. The protruding segments of the labia minora were de-epithelialized with a fine scissors or scalpel instead of being excised, and a bulky section of subcutaneous tissue was obtained. Between the outer and inner surfaces of the labia minora, a flap with a subcutaneous pedicle was created in continuity with the de-epithelialized marginal tissue. A pocket was dissected in the labium majus, and the flap was transposed into the pocket to augment the labia majora. Mean patient age was 39.9 (±13.9) years, mean operation time was 60 min, and mean follow-up period was 14.5 (±3.4) months. There were no major complications (hematoma, wound dehiscence, infection) foll...
Ischemic preconditioning (IPC) is described as brief ischemia-reperfusion (I/R) cycles to induce ... more Ischemic preconditioning (IPC) is described as brief ischemia-reperfusion (I/R) cycles to induce tolerance to subsequent in response to longer I/R insults. Various IPC protocols can be performed in four combinations as follows: at early or late phases and on local or distant organs. Although many experimental studies have been performed on IPC, no consensus has been established on which IPC protocol is most effective. The aims of the present study were as follows: (1) to compare the variables of preconditioning in different combinations (in early versus late phases; local versus remote organ implementations) and (2) to determine the most therapeutic IPC protocol(s). A subtotal hind limb amputation model with clamping an intact femoral pedicle was used for I/R injury. IPC was induced using hind limb tourniquet with 3 × 10 min I/R cycles before longer I/R insult. Forty-nine rats were divided into seven groups (n = 7), sham, IsO (ischemia only), I/R, early ischemic preconditioning (e-IPC), late ischemic preconditioning (l-IPC), early remote ischemic preconditioning (e-RIPC), and l-RIPC (late-remote) groups, respectively. In the sham group, pedicle occlusion was not performed. Six hours ischemia was challenged in the IsO group. Three hours ischemia followed by 3 h reperfusion was performed in the I/R group. The e-IPC group was immediately preconditioned, whereas the l-IPC group was preconditioned 24 h before I/R injury on the same hind limb. In the e-RIPC and l-RIPC groups, the same protocols were performed on the contralateral hind limb. At the end of the experiments, skeletal muscle tissue samples were obtained for biochemical analysis (Malondialdehyde [MDA], catalase, myeloperoxidase [MPO], and nitric oxide end products [NOx]), light microscopy, and caspase-3 immunohistochemistry for determination of apoptosis. Tissue biochemical markers were improved in nearly all the IPC groups compared with IsO and I/R groups (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Similarly, the histologic damage scores were decreased in all the IPC groups (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). The lowest damage score was in the e-RIPC group followed by the l-RIPC, e-IPC, and l-IPC groups, respectively. The apoptosis scores were significantly high in the I/R group compared with the e-RIPC and l-RIPC groups (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Although apoptosis scores of the e-IPC and l-IPC groups were lower than the I/R group, this finding was not statistically significant (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). All IPC protocols were effective in reducing I/R injury. Among these protocols, e-RIPC achieved most protection.
The actual pathology of the Nicolau syndrome (NS) is still unknown. It is thought to involve dire... more The actual pathology of the Nicolau syndrome (NS) is still unknown. It is thought to involve direct vascular damage and vasospasm. Many NS cases were reported in the literature but a treatment protocol is still not established. However, after demarcation of the necrotic tissue, surgical intervention is mandatory. Five NS cases with extensive tissue necrosis on the upper lateral gluteal region were analyzed retrospectively. Operative technique was described in details for freestyle perforator-based fasciocutaneous flaps from the gluteal region to reconstruct defects of NS-related tissue necrosis. Freestyle perforator-based fasciocutaneous flaps were used for defect closure in all patients. All flaps survived totally. No complications occurred during the follow-up period. Although rare, NS is a serious complication of inadvertent intramuscular injections. Prevention is the best treatment. However, in case of large-tissue necrosis, freestyle perforator-based fasciocutaneous flaps harvested from the gluteal region is a satisfactory option for reconstruction.
Skin grafts and local flaps are conventional methods for repairing simple syndactyly. Skin grafts... more Skin grafts and local flaps are conventional methods for repairing simple syndactyly. Skin grafts usually leave unsightly appearance and contracture formation. In this study, unipedicled distally based venous flap were raised from third or fourth metacarpal area of the hand for syndactyly treatment. The distally based venous flap was to provide skin coverage to one side of the finger, in order to avoid complications arising from using skin graft. Nine patients' syndactylies (5 simple incomplete and 4 simple complete syndactyly) were treated using this method. The mean follow-up period of the flaps was 14 months, ranging from 12 to 16 months. Mild edema and venous congestion occurred in all flaps. Superficial necrosis involving two flaps did not affect flap survival. All flaps survived completely. In this article, we have described a new surgical technique for the correction of syndactyly in a single surgical procedure that utilizes a distally based venous flap to provide skin coverage without skin graft.
Fibro-osseous pseudotumor (FOPT) is a rare and benign ossifying lesion. Described as the superfic... more Fibro-osseous pseudotumor (FOPT) is a rare and benign ossifying lesion. Described as the superficial variant of myositis ossificans (MO), this rare entity mostly occurs in the subcutaneous tissues of the digits. The FOPT clinicopathological features may mimic a variety of benign and malignant soft tissue lesions, and the diagnosis can be difficult when it arises in an unusual anatomic location. In this report we describe the clinical and radiological features of a case of an FOPT that involved the hypothenar region of the hand.
Foam rubber, either industrial or medical, has been used clinically in plastic surgery for coveri... more Foam rubber, either industrial or medical, has been used clinically in plastic surgery for covering and immobilizing skin grafts since the 1980s. It is fixed in place by sutures and staples to prevent the graft and the dressing from slipping. 1-3
We describe a time-saving microsurgical exercise for continuing microsurgical training and resear... more We describe a time-saving microsurgical exercise for continuing microsurgical training and research. The rat tail replantation model was simplified by excluding bone detachment. Rats were divided into two groups: devascularization only ( N = 3) and revascularization after devascularization ( N = 7). The tail was devascularized by ligation and division of artery and veins in the first group to reveal if a collateral circulation from bone existed. The divided vessels were reanastomosed in the second group. The circulation of the rat tails was followed for 1 week. The tails showed total necrosis in the devascularization group, whereas only two of seven tails showed partial necrosis in the revascularization group. Reexploration showed thrombosis narrowing the lumen at the anastomotic site of the partially necrosed tails, most likely due to an anastomotic insufficiency. The present study revealed that total amputation is not necessary for tail devascularization. The rat tail revascularization model provides a practical tool for advanced and continuing microsurgical training and research.
BACKGROUND The reverse posterior interosseous artery flap is useful for covering hand defects. Ho... more BACKGROUND The reverse posterior interosseous artery flap is useful for covering hand defects. However, its major drawback is the short pedicle that limits the reach of the flap up to the metacarpophalangeal level. The authors performed a new modification extending the distal reach of the flap by including the recurrent branch of the posterior interosseous artery and they aimed to present the results of reconstruction with this technique. PATIENTS AND METHODS Seven patients with a mean age of 35.2 years (range 17-64 years) underwent extended RPIAF surgery. Six patients were admitted to the emergency department with isolated hand trauma. One patient was present in elective settings with chronic osteomyelitis and skin loss of the thumb related to previous trauma. The defects were located on the distal metacarpophalangeal level (thumb and other fingers). PIA perforators and the recurrent branch were included into the pedicle (Type A) in five cases, whereas the flap was harvested based ...
Kafkas Universitesi Veteriner Fakultesi Dergisi, 2016
Chronic constriction injury (CCI) is a common clinical entity and characterized by allodynia or s... more Chronic constriction injury (CCI) is a common clinical entity and characterized by allodynia or spontaneous neuropathic pain. Treatment of neuropathic pain is difficult, because a lack of knowledge about the underlying mechanisms and limited effectiveness of the existing drugs. Surgical decompression enables a more radical treatment by releasing the compressed nerve. Beside the pain behaviour morphological changes occur in CCI. Ultrastructural morphological changes at the injury site of the sciatic nerve and in the dorsal root ganglia (DRG) are believed to play role in the pathogenesis of CCI and in the development of neuropathic pain behaviour in individuals. However, the effects of surgical decompression on the ultrastructure of constricted nerve site as well as in the dorsal root ganglia have not been studied in details. We investigated the effect of nerve decompression on ultrastructure of rat sciatic nerve and DRG by light and transmission electron microscopic methods. For this aim, CCI was established on the rat sciatic nerve with four loose ligatures. Surgical decompression was held at 1 st , 3 rd and 5 th the weeks after CCI by removing the ligatures. Our results suggest that the efficacy of decompression was superior when applied one week after compression. The results of the study verify the need for early surgical decompression to prevent irreversible damage of the peripheral nerve and DRG.
Background: The aim of this study was to investigate the effects of fucoidin on rat kidney and lu... more Background: The aim of this study was to investigate the effects of fucoidin on rat kidney and lung in an infraaortic ishemia reperfusion model. Methods: Forty Wistar rats were randomly divided into five groups ( n = 8) as sham, control (IR), before ischemia (BI), before reperfusion (BR), and before ischemia and before reperfusion (BI/BR). Rats were subjected to 120 minutes ischemia followed by 120 minutes reperfusion with application of infrarenal aortic clamping. BI received intravenous fucoidin (25 mg/kg) ten minutes before establishing ischemia and BR received ten minutes before reperfusion. BI/BR group received half equal doses of fucoidin both before ischemia (12.5 mg/kg) and reperfusion (12.5 mg/kg) periods, respectively. After sacrification blood and tissue samples were obtained for biochemical (Malondialdehyde (MDA), Nitric oxide (NO), Myeloperoxidase (MPO), Catalase (CAT), Plasma Chitotriosidase (CHIT) and serum ischemia modified albumin (IMA)) and histologic examinations....
on a nerve alters blood flow and leads to epineurial ischemia. This can cause inflammation, fibro... more on a nerve alters blood flow and leads to epineurial ischemia. This can cause inflammation, fibrosis, demyelination, and ultimately axonal loss (5). Such cells secrete pro-and antiinflammatory cytokines, such as tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and IL-10, and these substances play an important role on the initiation and development of chronic pain states (20). In addition, TNF-α also induces axonal damage (19). Consequently, spinal glial activation occurs, causing neuropathic pain progression (10). █ INTRODUCTION N europathic pain is defined as pain from lesions in both the central and peripheral nervous systems. Nerve entrapment syndromes such as carpal tunnel syndrome, spinal root compression, and trigeminal neuralgia due to vascular compression are the most common causes of neuropathic pain. This pain develops secondary to the chronic compression of peripheral nerves. Increased chronic pressure AIm: Nerve entrapment syndromes are the most common causes of neuropathic pain. Surgical decompression is the preferred method of treatment. The aim of this study was to compare the efficacy of curcumin, tramadol and chronic constriction release treatment (CCR), individually or together, in a rat model of sciatic nerve injury. mATERIAl and mEThODS: Eighty male rats were divided into eight study groups. Group 1 was the sham group. Group 2 was the control group with established chronic constriction injury (CCI). CCI was also established in Groups 3-8. Group 3 underwent chronic constriction release (CCR). Groups 4 and 5 received curcumin and tramadol. Groups 6 and 7 also received curcumin (100 mg/kg daily, oral) and tramadol (10 mg/kg daily, intraperitoneal, 14 days) after CCR, respectively. Combined curcumin-tramadol treatment was applied to Group 8. Behavioral tests (thermal hyperalgesia, dynamic plantar, cold plate test) were performed on days 0,3,7,13,17, and 21. Tissue tumor necrosis factor-α (TNF-α) and interleukin-10 (IL-10) levels were analyzed in the nerve and dorsal root ganglion (DRG) samples on day 21. Histopathological examination was performed on the nervous tissue and DRG. RESUlTS: Tramadol-CCR and tramadol-curcumin significantly attenuated mechanical allodynia and thermal hyperalgesia. In the CCI-CCR-tramadol treatment group, TNF-α levels were significantly lower in the sciatic nerve tissue, and DRG and IL-10 levels were significantly higher in the sciatic nerve tissue. CONClUSION: CCI-CCR-tramadol treatment is highly effective in the symptomatic treatment of neuropathic pain. CCR-curcumin is associated with less degeneration and high levels of regeneration in the nerve tissue.
Background: Autologous nerve grafts are used to bridge peripheral nerve defects. Limited sources ... more Background: Autologous nerve grafts are used to bridge peripheral nerve defects. Limited sources and donor site morbidity are the major problems with peripheral nerve grafts. Although various types of autologous grafts such as arteries, veins and muscles have been recommended, an ideal conduit has not yet been described. Aims: To investigate the effectiveness of a small intestinal conduit for peripheral nerve defects. Study Design: Animal experimentation. Methods: Twenty-one rats were divided into three groups (n=7). Following anaesthesia, sciatic nerve exploration was performed in the Sham group. The 10 mm nerve gap was bridged with a 15 mm ileal segment in the small intestinal conduit group and the defect was replaced with orthotopic nerve in autologous nerve graft group. The functional recovery was tested monthly by walking-track analysis and the sciatic functional index. Histological evaluation was performed on the 12th week. Results: Sciatic functional index tests are better in autologous nerve graft group (-55.09±6.35); however, during follow-up, progress in sciatic functional index was demonstrated, along with axonal regeneration and innervation of target muscles in the small intestinal conduit group (-76.36±12.08) (p<0.05). In histologic sections, distinctive sciatic nerve regeneration was examined in the small intestinal conduit group. The expression of S-100 and neurofilament was observed in small intestinal conduit group but was less organised than in the autologous nerve graft group. Although the counted number (7459.79±1833.50 vs. 4226.51±1063.06 mm 2), measured diameter [2.19 (2.15-2.88) vs. 1.74 (1.50-2.09) µm] and myelin sheath thickness [1.18 (1.09-1.44) vs. 0.66 (0.40-1.07) µm] of axons is significantly high in the middle sections of autologous nerve graft compared to the small intestinal conduit group, respectively (p<0.05), the peripheral nerve regeneration was also observed in the small intestinal conduit group. Conclusion: Small intestinal conduit should not be considered as an alternative to autologous nerve grafts in its current form; however, the results are promising. Even though the results are no better than autologous nerve grafts, with additional procedures, it might be a good alternative due to harvesting abundant sources without donor site morbidity.
Genistein was shown to promote recovery in experimental peripheral neuropathy and chronic periphe... more Genistein was shown to promote recovery in experimental peripheral neuropathy and chronic peripheral nerve injury (23,24). However, the effect of genistein in animal models of acute crush injury or complete transection of peripheral nerve has not yet been investigated. The purpose of this study was to investigate the effects of genistein after experimental sciatic nerve crush injury and complete sciatic nerve transection in rats and to compare its effects with those of gabapentin. █ INTRODUCTION A lthough microsurgical techniques have been developed and positive effects of clinically and experimentally different neurotrophic drugs, steroids, hormones, and even low-dose radiation have been reported, desirable motor and sensory recovery after peripheral nerve injury is a clinical challenge (6,16,18,20,25). Methylprednisolone and gabapentin are considered as reference agents, against which the medical treatment of traumatic peripheral nerve injury is evaluated. However, their adverse effects are a major limitation associated with their clinical use (16). AIM: To investigate the effects of genistein in a rat model of sciatic nerve crush injury and complete sciatic nerve transection. The effects of genistein were compared with those of gabapentin, which is widely used in clinical practice for peripheral nerve injury. MATERIAL and METHODS: Forty-eight rats were randomly divided into six groups (8 rats in each group): group 1 (sham); group 2, sciatic nerve crush injury (control); group 3, sciatic nerve crush injury+genistein 20 mg/kg; group 4, sciatic nerve crush injury+gabapentin 90 mg/kg; group 5, sciatic nerve transection+genistein 20 mg/kg; group 6, sciatic nerve transection+gabapentin 90 mg/kg. The effects of genistein and gabapentin were assessed with immunohistochemical staining for growth associated protein-43 (GAP-43) and myelin basic protein (MBP). Interleukin-1β and tumor necrosis factor α levels in the injured nerve specimens were assessed as a measure of inflammatory response; walking track analysis and sciatic function index for neurological recovery and the paw mechanical withdrawal threshold were examined for neuropathic pain. RESULTS: On histopathological examination, genistein use was associated with a greater immunoreactivity for GAP-43 and MBP compared with that associated with gabapentin. Genistein and gabapentin had similar effects on anti-inflammatory activity, functional recovery, and neuropathic pain. CONCLUSION: Genistein and gabapentin exhibit positive effects on histopathology, inflammation, and clinical findings of peripheral nerve injury. When the systemic side effects of gabapentin are considered, genistein (a basic soy isoflavone that has no side effects) can be used as an alternative to medical treatment in peripheral nerve injury.
La Chirurgia Degli Organi Di Movimento, Oct 1, 2009
Skin grafts and local flaps are conventional methods for repairing simple syndactyly. Skin grafts... more Skin grafts and local flaps are conventional methods for repairing simple syndactyly. Skin grafts usually leave unsightly appearance and contracture formation. In this study, unipedicled distally based venous flap were raised from third or fourth metacarpal area of the hand for syndactyly treatment. The distally based venous flap was to provide skin coverage to one side of the finger, in order to avoid complications arising from using skin graft. Nine patients' syndactylies (5 simple incomplete and 4 simple complete syndactyly) were treated using this method. The mean follow-up period of the flaps was 14 months, ranging from 12 to 16 months. Mild edema and venous congestion occurred in all flaps. Superficial necrosis involving two flaps did not affect flap survival. All flaps survived completely. In this article, we have described a new surgical technique for the correction of syndactyly in a single surgical procedure that utilizes a distally based venous flap to provide skin coverage without skin graft.
The transplantation of support cells from various sources into the conduits has been proposed as ... more The transplantation of support cells from various sources into the conduits has been proposed as a method to promote peripheral nerve regeneration. Especially cultured Schwann Cells (SCs) from neural origin that play an integral role in regeneration of the peripheral nerves have been implanted into suitable conduits (9,10,16,22). Although SCs transplantation improved nerve regeneration experimentally, its clinical applications remained controversial because of its disadvantages. SCs are difficult to obtain in large amounts which may be attributed to the time-consuming process of isolation, cultivation and expansion of SCs in vitro because of their restricted mitotic activity (12). Another reason may AIm: To investigate whether nerve regeneration can be induced in the tubular bone between distal and proximal cut nerve ends. mATERIAl and mEThODS: Twenty adult Wistar rats were used for the study. Rats were divided into three groups; femoral bone conduit group, nerve transection group, sham group. The sciatic nerve was surgically cut and from both ends inserted into the adjacent femoral bone tunnel in the femoral bone conduit group. The sciatic nerve was cut transversely in the nerve transection group. In the Sham group, only sciatic nerve exploration was performed, without a nerve cut. The groups were evaluated functionally and morphologically. RESUlTS: All results showed that axonal growth existed through the osseous canal. CONClUSION: To the best of our knowledge, this is the first study to evaluate neural regeneration inside the bone. We can speculate that the bone marrow provides a convenient microenvironment for peripheral nerve regeneration. In addition to prefabricating peripheral nerves, this novel model may help to establish further strategies for engineering of other tissues in the bone marrow.
Many young women are satisfied with their large breasts but suffer from sagging due to heaviness.... more Many young women are satisfied with their large breasts but suffer from sagging due to heaviness. In this article; we present a novel modification of vertical scar breast reduction based on a special indication. From January 2006 to May 2012, twenty five individual patients underwent operation using modified technique with superior pedicle and vertical scar. Young women between ages 25-35 years with voluminous breasts who requested mastopexy rather than reduction were selected for the surgery. The mean patient age was 30 years and body mass index (BMI) was 27.8±1.07 kg/m(2). Mean nipple transposition was 6.5 cm. Mean weight for resected tissue was 415 g for left and 419 g for right breast. Mean operative time was 125 minutes. Patients were followed up for 9-22 months. No serious complications encountered in consecutive patient series. The only complication was permanent wrinkling probably due to vertical closure in 5 of 25 patients which did not resolve during the follow-up period. ...
Esthetic surgery of external female genitalia remains an uncommon procedure. This article describ... more Esthetic surgery of external female genitalia remains an uncommon procedure. This article describes a novel, de-epithelialized, labial rim flap technique for labia majora augmentation using de-epithelialized labia minora tissue otherwise to be excised as an adjunct to labia minora reduction. Ten patients were included in the study. The protruding segments of the labia minora were de-epithelialized with a fine scissors or scalpel instead of being excised, and a bulky section of subcutaneous tissue was obtained. Between the outer and inner surfaces of the labia minora, a flap with a subcutaneous pedicle was created in continuity with the de-epithelialized marginal tissue. A pocket was dissected in the labium majus, and the flap was transposed into the pocket to augment the labia majora. Mean patient age was 39.9 (±13.9) years, mean operation time was 60 min, and mean follow-up period was 14.5 (±3.4) months. There were no major complications (hematoma, wound dehiscence, infection) foll...
Ischemic preconditioning (IPC) is described as brief ischemia-reperfusion (I/R) cycles to induce ... more Ischemic preconditioning (IPC) is described as brief ischemia-reperfusion (I/R) cycles to induce tolerance to subsequent in response to longer I/R insults. Various IPC protocols can be performed in four combinations as follows: at early or late phases and on local or distant organs. Although many experimental studies have been performed on IPC, no consensus has been established on which IPC protocol is most effective. The aims of the present study were as follows: (1) to compare the variables of preconditioning in different combinations (in early versus late phases; local versus remote organ implementations) and (2) to determine the most therapeutic IPC protocol(s). A subtotal hind limb amputation model with clamping an intact femoral pedicle was used for I/R injury. IPC was induced using hind limb tourniquet with 3 × 10 min I/R cycles before longer I/R insult. Forty-nine rats were divided into seven groups (n = 7), sham, IsO (ischemia only), I/R, early ischemic preconditioning (e-IPC), late ischemic preconditioning (l-IPC), early remote ischemic preconditioning (e-RIPC), and l-RIPC (late-remote) groups, respectively. In the sham group, pedicle occlusion was not performed. Six hours ischemia was challenged in the IsO group. Three hours ischemia followed by 3 h reperfusion was performed in the I/R group. The e-IPC group was immediately preconditioned, whereas the l-IPC group was preconditioned 24 h before I/R injury on the same hind limb. In the e-RIPC and l-RIPC groups, the same protocols were performed on the contralateral hind limb. At the end of the experiments, skeletal muscle tissue samples were obtained for biochemical analysis (Malondialdehyde [MDA], catalase, myeloperoxidase [MPO], and nitric oxide end products [NOx]), light microscopy, and caspase-3 immunohistochemistry for determination of apoptosis. Tissue biochemical markers were improved in nearly all the IPC groups compared with IsO and I/R groups (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Similarly, the histologic damage scores were decreased in all the IPC groups (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). The lowest damage score was in the e-RIPC group followed by the l-RIPC, e-IPC, and l-IPC groups, respectively. The apoptosis scores were significantly high in the I/R group compared with the e-RIPC and l-RIPC groups (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Although apoptosis scores of the e-IPC and l-IPC groups were lower than the I/R group, this finding was not statistically significant (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05). All IPC protocols were effective in reducing I/R injury. Among these protocols, e-RIPC achieved most protection.
The actual pathology of the Nicolau syndrome (NS) is still unknown. It is thought to involve dire... more The actual pathology of the Nicolau syndrome (NS) is still unknown. It is thought to involve direct vascular damage and vasospasm. Many NS cases were reported in the literature but a treatment protocol is still not established. However, after demarcation of the necrotic tissue, surgical intervention is mandatory. Five NS cases with extensive tissue necrosis on the upper lateral gluteal region were analyzed retrospectively. Operative technique was described in details for freestyle perforator-based fasciocutaneous flaps from the gluteal region to reconstruct defects of NS-related tissue necrosis. Freestyle perforator-based fasciocutaneous flaps were used for defect closure in all patients. All flaps survived totally. No complications occurred during the follow-up period. Although rare, NS is a serious complication of inadvertent intramuscular injections. Prevention is the best treatment. However, in case of large-tissue necrosis, freestyle perforator-based fasciocutaneous flaps harvested from the gluteal region is a satisfactory option for reconstruction.
Skin grafts and local flaps are conventional methods for repairing simple syndactyly. Skin grafts... more Skin grafts and local flaps are conventional methods for repairing simple syndactyly. Skin grafts usually leave unsightly appearance and contracture formation. In this study, unipedicled distally based venous flap were raised from third or fourth metacarpal area of the hand for syndactyly treatment. The distally based venous flap was to provide skin coverage to one side of the finger, in order to avoid complications arising from using skin graft. Nine patients' syndactylies (5 simple incomplete and 4 simple complete syndactyly) were treated using this method. The mean follow-up period of the flaps was 14 months, ranging from 12 to 16 months. Mild edema and venous congestion occurred in all flaps. Superficial necrosis involving two flaps did not affect flap survival. All flaps survived completely. In this article, we have described a new surgical technique for the correction of syndactyly in a single surgical procedure that utilizes a distally based venous flap to provide skin coverage without skin graft.
Fibro-osseous pseudotumor (FOPT) is a rare and benign ossifying lesion. Described as the superfic... more Fibro-osseous pseudotumor (FOPT) is a rare and benign ossifying lesion. Described as the superficial variant of myositis ossificans (MO), this rare entity mostly occurs in the subcutaneous tissues of the digits. The FOPT clinicopathological features may mimic a variety of benign and malignant soft tissue lesions, and the diagnosis can be difficult when it arises in an unusual anatomic location. In this report we describe the clinical and radiological features of a case of an FOPT that involved the hypothenar region of the hand.
Foam rubber, either industrial or medical, has been used clinically in plastic surgery for coveri... more Foam rubber, either industrial or medical, has been used clinically in plastic surgery for covering and immobilizing skin grafts since the 1980s. It is fixed in place by sutures and staples to prevent the graft and the dressing from slipping. 1-3
We describe a time-saving microsurgical exercise for continuing microsurgical training and resear... more We describe a time-saving microsurgical exercise for continuing microsurgical training and research. The rat tail replantation model was simplified by excluding bone detachment. Rats were divided into two groups: devascularization only ( N = 3) and revascularization after devascularization ( N = 7). The tail was devascularized by ligation and division of artery and veins in the first group to reveal if a collateral circulation from bone existed. The divided vessels were reanastomosed in the second group. The circulation of the rat tails was followed for 1 week. The tails showed total necrosis in the devascularization group, whereas only two of seven tails showed partial necrosis in the revascularization group. Reexploration showed thrombosis narrowing the lumen at the anastomotic site of the partially necrosed tails, most likely due to an anastomotic insufficiency. The present study revealed that total amputation is not necessary for tail devascularization. The rat tail revascularization model provides a practical tool for advanced and continuing microsurgical training and research.
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Papers by Emre Kocman