Person: GÜNEREN, ETHEM
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Publication Metadata only A Basic Algorithmic Surgical Approach for Nicolau Syndrome(2020-04-01T00:00:00Z) Yeniocak, Ali; Güneren, Ethem; Özkan, Mustafa; Temel, Metin; Kelahmetoğlu, Osman; YENİOCAK, ALİ; GÜNEREN, ETHEM; KELAHMETOĞLU, OSMANBackground: Nicolau syndrome (NS) is a rare complication that develops after the administration of intramuscular diclofenac sodium. The etiology and surgical treatments of 11 patients with NS were evaluated and studies in the literature were examined. The aim of this study was to compose a basic algorithm for surgical approaches to treat NS. Materials and methods: Eleven patients were evaluated for NS between December 2013 and January 2018. Two patients did not accept treatment, and nine patients underwent surgical debridement of necrotic tissues. The tissue defects of five patients were closed with a fasciocutaneous flap and, in four patients, the defects were repaired primarily. Results: No complications, such as wound infection, wound dehiscence, seroma, or flap necrosis, were encountered. Of the seven patients who received concurrent antibiotic therapy, no patient had any problems at their follow-up (2-30 months). The results were satisfactory from an aesthetic and functional point of view. Conclusion: NS was more frequent in women with a high body mass index and high fat in gluteal regions. We considered that any kind of medication could lead to NS. Different methods are discussed for treatment.Publication Metadata only The Role of Staged Cryosurgery and Three-Dimensional Computed Tomography Integrated Navigation System in the Surgical Management of Severe Involvement of Craniofacial Polyostotic Fibrous Dysplasia(2020-01-01T00:00:00Z) Dündar, Tolga Turan; YILDIZ, KEMALETTİN; DÜNDAR, TOLGA TURAN; MEHDIZADE, TURAN; GÜNEREN, ETHEMFibrous dysplasia (FD) is a developmental bone disorder caused by the hamartamatous proliferation of bone-forming cells. A 29-year-old male patient with diagnosis of FD was admitted to our clinic with the symptoms of severe craniomaxillofacial involvement of FD beginning from last year. Neurological examination revealed diplopia, horizontal nystagmus, conductive hearing loss, and partial vision loss. In his medical history, it was reported that he had undergone intramedullary nailing operation in his left femur due to a pathological fracture approximately 8 years ago in the orthopedics clinic of our institution. The patient underwent 3 consecutive surgeries by our plastic and neurosurgical team. The patient was followed-up in the neuro-intensive care unit between the surgical sessions and 1 week after the last operation. Afterwards, he was transferred to the neurosurgical department. No postoperative complication was detected. The preoperative signs were recovered. During his 6th month follow-up control-visit, all his preoperative symptoms were improved. In addition, the patient was satisfied with his postoperative cosmetic improvement. In conclusion, virtual surgical planning and intraoperative surgical navigation systems can make the challenging cases possible to operate with increasingPublication Open Access Generation of Bone Tissue Using Adipose Tissue-derived Stem Cells(2021-07-01T00:00:00Z) Baygol, Emre Gonenc; GÜNEREN, Ethem; Karaaltin, Mehmet Veli; Canter, Halil Ibrahim; Ozturk, Kahraman; Ovali, Ercument; Ozpur, Mustafa Aykut; YILDIZ, KEMALETTİN; Eyuboglu, Fatma; GÜNEREN, ETHEM; YILDIZ, KEMALETTİNObjective: Bone grafts and even bone substitutes do not meet all of the requirements of bony reconstructions. The aim of this study was to generate bone tissue from autologous adipose tissue-derived mesenchymal stem cells (ATDMSCs) and decellularised bone allografts. Methods: A 1.5 cm bone defect developed in the middle third of the rabbit's ulna. Reconstructions were carried out using miniplate and screws and interpositional autogenous bone grafts according to the designs of the groups: (1) No touch, (2) cryopreserved, (3) decellularised and (4) ATDMSCs-implanted decellularised bones. Before implantation, ATDMSCs in the last group were labelled with Q-dot and identified microscopically. Results: Graft recovery and irregular callus formation were observed in the first, second and forth groups. In the first group, the organisation of Haversian systems, the structure of the lacunae and the presence of canaliculi ossiums were observed; in the second group, approximately 40% of the Haversian canals contained blood vessels, and canaliculi ossiums in the form of thin filaments were found in 90% of the microscopically examined areas; in the third group, most Haversian canals were empty, most osteocyte canals were devoid of cells, and canaliculi ossiums were absent; in the fourth group, some of the Haversian canals contained blood vessels, and there were partly lacunae containing cells due to decellularisation, whereas in approximately 50% of the examined microscope areas, the presence of canaliculi ossiums with evidence of mesenchymal stem cells differentiated into osteocytes was demonstrated by Q-dot traced cells. Conclusion: In this study, the establishment of a proper niche environment for adipose-derived mesenchymal cells promotes their development into osteogenic cells.Publication Open Access Recommendations for management of diabetic foot ulcers during COVID-19 outbreak.(2020-06-05T00:00:00Z) Kelahmetoglu, Osman; Camlı, Mf; Kirazoglu, A; Erbayat, Y; Guneren, E; Asgarzade, S; Durgun, U; Mehdizade, T; Yeniocak, A; Yildiz, K; Sonmez, Ergun; KELAHMETOĞLU, OSMAN; ERGÜN, SELMA; GÜNEREN, ETHEMCOVID-19 pandemia began in Wuhan, China, in December 2019. A total of 1 878 489 people were infected and 119 044 people were lost because of the disease and its complications by 15 April. Severe morbidity and mortality complications are mostly seen in elderly and patients having comorbidities. Diabetic foot ulcers (DFUs) are one of severe complications of diabetes mellitus and it may require urgent surgical interventions. In this paper, we aimed to create a management algorithm to prevent the unexpected complications that may occur in the patients and health care workers during the evaluation of COVID-19 in DFU patients who require urgent surgical intervention. We advise the use of thorax computerised tomography for preoperative screening in all DFU patients with severe signs of infection and especially those requiring urgent surgery for both the detection of the possible undiagnosed COVID-19 in the patient for the need for close follow-up and protection of the surgical and anaesthesiology team.Publication Metadata only Problematic Patient(2021-06-01T00:00:00Z) KIRPINAR, İSMET; Ayhan, M. Suhan; GÜNEREN, Ethem; KIRPINAR, İSMET; GÜNEREN, ETHEMThe group of patients defined as -problematic patient- in aesthetic plastic surgical practice has distinctive features. The -problematic patient- is the patient who blocks the establishment of a therapeutic relationship with him/her. In other words, the patient who does not adapt to the patient role that the health-care professional expects, has different values, beliefs, or personal characteristics than he/she expects to see, and sometimes causes the professional to even suspect himself/herself. They are not good candidates for esthetic surgery, and they should definitely not be operated, so to speak, these patients should be removed from the game by removing a red card, and somehow be disqualified from the process.Publication Metadata only Simplifying Free Nipple Graft Mammoplasty in Postmenopausal Obese Patients using Inferior Dermaglandular Flap(2021-06-01T00:00:00Z) Kelahmetoglu, Osman; ÇAMLI, MEHMET FATİH; ÜNAL, Mustafa; Yagmur, Caglayan; Firinciogullari, Remzi; GÜNEREN, Ethem; ÇAMLI, MEHMET FATİH; ÜNAL, MUSTAFA; GÜNEREN, ETHEMBreast hypertrophy causes medical problems ranging from back and neck pain to dermatitis creating a demand for breast reduction surgery along with aesthetic and psychological reasons. Free-nipple-graft breast reduction surgery is a safeguard procedure for patients who are at risk for nipple necrosis with pedicled techniques but has a disadvantage of resultant flat breasts with poor projection. Study included twenty-three postmenopausal women who underwent breast reduction with inferior pedicled dermaglandular flap and free-nipple-grafting, between September 2015 and January 2020. A rectangular 8 x 10 cm inferior-pedicled dermaglandular flap was dissected and anchored to the thoracic wall for better projection and upper pole fullness. All patients had at least one comorbidity. Visual analog scale was evaluated at 1-3 months. Mean age of the patients was 54.08 SD 4.65 years, and mean body mass index (BMI) was 33.56 SD 2.53. Mean follow-up period was 10.56 SD 5.6 months. Mean SN-N distance was 37.45 SD 3.77 and 38.86 SD 3.91 cm for right and left breasts, respectively. Mean resection weight was 1373 SD 440 g. Wound dehiscence was seen in 3 patients (13.0%) and treated medically. No other complications, including total nipple areolar complex (NAC) loss, were seen. Mean visual analog scale score for patient satisfaction was 7.7. All patients were satisfied with their final breast shapes. Utilizing inferior dermaglandular pedicled flap technique with free-nipple-graft breast reduction mammaplasty provides better nipple projection and a more aesthetically pleasing breast shape and contour. It helps achieve an effortless preoperative planning and a straightforward procedure with high patient satisfaction in postmenopausal obese women.Publication Metadata only A novel autologous dermal filler based on cultured fibroblasts and plasma gel for facial wrinkles: Long term results(2022-01-01T00:00:00Z) Oram, Yasemin; Akkaya, A. Deniz; GÜNEREN, Ethem; Turgut, Gursel; GÜNEREN, ETHEMAutologous cultured fibroblasts combined with plasma gel (Fibrogel(TM)) can be used as an injectable autologous soft tissue filler. Herein, we report the assessment of the long-term clinical efficacy and safety of Fibrogel for facial wrinkles. Ten healthy adults were treated for facial wrinkles with Fibrogel, an innovative autologous filler. Patients underwent three treatment sessions at 1-month intervals for the correction of infraorbital, nasolabial, and marionette folds. In each session, 6-8 mL of Fibrogel filler containing 4 million fibroblasts/mL, was injected into the deep dermis or subdermal plane. Three evaluators independently assessed the efficacy at 3, 6 and 12 months after the last treatment, using the validated Global Esthetic Improvement Scale at two different times in a blinded manner. Infraorbital area and lower face were evaluated separately. All patients showed immediate improvement after the first injection at the infraorbital area and lower face. Follow-ups at 3, 6 and 12 months revealed that the improvement was persistent. Adverse reactions were mild and the treatment was well tolerated. Delivering autologous cultured fibroblasts embedded in an autologous plasma gel (Fibrogel) to the skin can provide immediate volume effect and long-term improvement. Therefore, Fibrogel can be considered as a promising novel autologous filler.Publication Metadata only Afet Tıbbı Açısından Kimyasal Silah Yaralılarının Yönetimi(2020-05-01T00:00:00Z) ÖZTÜRK, İLHAN; GÜNEREN, ETHEM; MAYADAĞLI, ALPASLAN; ERDOĞAN, ÖZCAN; GÜNEREN, ETHEM; MAYADAĞLI, ALPASLAN; ERDOĞAN, ÖZCANPublication Metadata only Early Suspicion of Heparin-Induced Thrombocytopenia for Successful Free Flap Salvage: Reports of Two Cases(2020-06-01T00:00:00Z) Mehdizade, Turan; Kelahmetoğlu, Osman; Gürkan, Volkan; Çetin, Güven; Güneren, Ethem; KELAHMETOĞLU, OSMAN; GÜRKAN, VOLKAN; ÇETİN, GÜVEN; GÜNEREN, ETHEMHeparin-induced thrombocytopenia (HIT) is an underestimated complication of heparin treatment. Flap loss and related morbidity (even mortality) are caused by occlusion of the capillary vessels by a highly immunogenic complex formed by adherence of antiheparin antibodies to platelet factor 4. Early suspicion and effective treatment of HIT developing in two free flaps are described. We report on the management of two patients with HIT. Both patients were treated successfully by early suspicion and hematology consultation. Heparin products were discontinued; the patients were switched to a nonheparin anticoagulant. We emphasize the importance of early diagnosis, hematologist assessment, and a change to a nonheparin anticoagulant to prevent flap failure and possibly the catastrophic consequences of such failure.Publication Open Access Boneless Maxillary Reconstruction(2020-01-01T00:00:00Z) Kelahmetoğlu, Osman; Güneren, Ethem; Kuzu, Ismail Melih; Yıldız, Kemalettin; KELAHMETOĞLU, OSMAN; GÜNEREN, ETHEM; YILDIZ, KEMALETTİNObjective: Although the midface is supported by maxillary bone, reconstruction of maxillary bony defects does not always require osseous reconstruction. A series of maxillary facial defects of moderate to severe sizes (Brown and Shaw 4-6) uniformly reconstructed with myocutaneous free flaps is presented. Methods: Retrospective analysis was done for consecutive 10 cases between 2013-18. Seven of the cases had defects caused by oncological resection and 3 defects caused by trauma. Free vertically oriented rectus abdominis (fVRAM) flap was used to reconstruct these defects. The mean age of patients was 42.9 years (range=20-71 years). All flaps survived and 2 flaps had small skin island problems. Rapid recovery, low morbidity, acceptable oral competency, and satisfactory cosmetic appearance were obtained with the reconstruction using fVRAM flaps. Conclusion: According to our limited experience, acceptable reconstruction of extensive maxillary defects can be done with using only soft tissue flap, which is versatile and safe.