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Öğe The effect of dobutamine treatment on salvage of digital replantation and revascularization(Springer Heidelberg, 2023) Ince, Bilsev; Uyanik, Orkun; Ismayilzade, Majid; Yildirim, Mehmet Emin Cem; Dadaci, MehmetPurposeOne of the most common causes of a failure after replantation and revascularization surgeries is 'no reflow' from proximal artery that occurs, especially following crush and avulsion injuries. In this study, we aimed to evaluate the effect of dobutamine treatment on salvage of replanted and revascularized digits.MethodsThe patients with no reflow phenomenon detected in the salvage operations of replanted/revascularized digits between the years 2017 and 2020 were included in the study. Dobutamine treatment was infused at a rate of 4 & mu;g & BULL;kg(-1)& BULL;min(-1) intraoperatively and of 2 & mu;g & BULL;kg(-1) min(-1) postoperatively. Demographic data (age, sex), digit survival rate, ischemia time, and level of injury were retrospectively analysed. Pre-infusion, intraoperative and postoperative values of cardiac index (CI), mean arterial pressure (MAP), and heart rate (HR) were recorded.ResultsThe phenomenon of 'no reflow' was encountered in 35 digits of 22 patients who underwent salvage surgery due to vascular compromise. The survival rate in the revascularization group was 75%, while it was 42.1% in the replanted digits. Metaphysis level of proximal phalanx was the most common localization for 'no reflow' phenomenon. The least values of CI, MAP and HR to obtain sufficient perfusion in salvaged digits were as follows: 4.2 l.min(-1).m(-2), 76 mm Hg, and 83 beat & BULL;min(-1), respectively.ConclusionsIt was demonstrated that dobutamine infusion at a rate of 4 & mu;g & BULL;kg(-1)& BULL;min(-1) intraoperatively and at 2 & mu;g & BULL;kg(-1)& BULL;min(-1) postoperatively has favorable effects on the vascular compromise derived from no reflow of proximal artery.Öğe Gracilis Muscle Interposition to Fill the Perianal Dead Space May Decrease Hospital Length of Stay in Fournier's Gangrene(Lippincott Williams & Wilkins, 2023) Ismayilzade, Majid; Dadaci, Mehmet; Kendir, Munur Selcuk; Ince, BilsevPurposeThe treatment of Fournier's gangrene (FG) includes aggressive debridement of the affected necrotic area, broad-spectrum antibiotic therapy, and reconstructive procedures, respectively. One of the main reasons of unfavorable outcomes in FG surgery is that the dead space occurs in the perianal region because of destruction of fascias and soft tissues. In this study, we aimed to evaluate the results of gracilis muscle flap transposition to fill the FG-associated perianal dead spaces.MethodsPatients treated for FG-associated dead spaces in their perianal region between the years 2017 and 2021 were included in the study. The patients who underwent the pedicled gracilis muscle flap surgery were included in group 1, whereas group 2 consisted of the patients with no additional surgical procedure for dead spaces but only the reconstruction of the soft tissue defects. Demographic data (age, sex), comorbid diseases, localization and length of perianal dead space, and management method for the soft tissue defects and complications were noted. The length of hospital stay and discharge day after surgery were also recorded.ResultsIn group 1, the mean duration of hospital stay was 23.5 +/- 5.0 (range, 14-48) days, whereas the mean period between the surgery and discharge was 5.1 +/- 2.2 (range, 3-12) days. These numbers were 31 +/- 8.3 (range, 19-58) days and 12.7 +/- 6.1 (range, 7-22) days in group 2, respectively. Statistical comparison of the periods between the surgery and discharge was found to be significantly different (P = 0.022). The duration of hospital stay was also shorter in the patients with gracilis muscle flap (P = 0.039).ConclusionsPerianal dead spaces accompanying many of the patients with FG provide appropriate conditions for bacterial colonization. Filling these pouches by the gracilis muscle flap prevented the progression of infection and enabled the patients to return to their normal life earlier.Öğe The Impact of Age on Anthropometric Changes Following Rhinoplasty(Mary Ann Liebert, Inc, 2023) Ince, Bilsev; Ismayilzade, Majid; Dadaci, MehmetBackground: There are several factors affecting the results of rhinoplasty, and the predictability of outcomes still remains insufficient.Objective: To associate the rhinoplasty results with patients' age by anthropometric measurements.Methods: Retrospective chart review of patients undergoing rhinoplasty who were divided into decades of age. Anthropometric measurements were carried out using Rhinobase(& REG;) Software. Wilcoxon t test was used for the postoperative 3 months and 2 years analysis. p values of Results: A total of 243 patients (median age: 37.1; M:F = 68:175) were included in the study: group I (19-29 years) n: 80; group II (30-39 years) n:71; group III (40-49 years) n: 48; and group IV (50-61 years) n: 44. In group IV, the highest value of difference (& UDelta;) was seen in the midfacial height with the number of 5.5 & PLUSMN; 1.1 (mm) (<0.001). The values of nasal length, tip projection, and midfacial height parameters showed significant differences in both group III and group IV.Conclusions: Unfavorable age-related changes in long-term postoperative period following rhinoplasty can occur in patients above 40 years of age.Öğe Original Location of Congenital Nasal Sinus Midcolumella: A Modified Inverted V Incision Technique(Springer India, 2023) Ismayilzade, Majid; Tekecik, Mahmut; Soylu, Arda; Nursen, Hayri Ahmet Burak; Ince, Bilsev; Dadaci, MehmetAmong the rare congenital malformations, congenital nasal sinuses with blind end are extremely unusual. To the best of our knowledge, a sinus located in the midcolumellar region has not been reported yet. Since there is no consensus about the treatment of midcolumellar sinus, to manage the case as individually as possible was our priority. Considering the patient's age, aesthetic concerns, and requirement of septorhinoplasty in the future, the known inverted V incision was modified to provide surgical excision without any extra scar in the midcolumellar line. This report emphasizes a patient-specific treatment of a 15-year-old female patient presented for congenital sinus in the midcolumellar area.
