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Öğe Assessment of tissue viability after frostbite injury by technetium-99m-sestamibi scintigraphy in an experimental rabbit model(Springer Verlag, 2000) Sarikaya, I; Aygit, AC; Candan, L; Sarikaya, A; Türkyilmaz, M; Berkarda, SFrostbite causes injury to the tissue by direct ice-crystal formation at the cellular level with cellular dehydration and microvascular occlusion. Muscle that initially appears viable on reperfusion may subsequently become necrotic because of microcirculatory collapse. Since muscle is a sensitive tissue in frostbite injury, we used technetium-99m-sestamibi limb scintigraphy to assess tissue viability in an experimental rabbit model. Twelve rabbits were used for this investigation. The right hind limb of the rabbits was immersed to the ankle joint in a container filled with 90% ethanol at -25 degrees C for 10 min. Frostbitten limbs were allowed to thaw in air at room temperature. Imaging and pathological examination of the affected limbs were performed 2 h, 24 h, 48 h and 72 h after freezing. In 2-h images, initial hypoperfusion was seen that corresponded to circulatory collapse. In 24-h images, there was hyperperfusion (so-called period of temporary reperfusion), corresponding to circulatory restoration. In 48-h images, a second hypoperfusion corresponded to viable but ischaemic tissue. In 72-h images, there was non-perfusion of the limb that correlated with the pathologically determined diagnosis of necrosis. All scintigraphic patterns correlated with pathological findings. We suggest that these scintigraphic patterns in soft tissue may be helpful in distinguishing between frank infarction and reversible ischemia and therefore may be useful in selecting early therapeutic or surgical interventions to salvage bone and soft tissue. Further studies ape needed to show the usefulness of Tc-99m sestamibi scintigraphy in clinical frostbite cases.Öğe Combined 99mTc MDP bone SPELT and 99mTc sestamibi muscle SPELT for assessment of bone regrowth and free muscle flap viability in an electrical burn of scalp(Elsevier Sci Ltd, 2003) Sarikaya, A; Aygit, ACA case of deep high energy electrical burn of the skull is presented. For assessment of bone regrowth and muscle flap viability after application of latissimus dorsi free flap, combined Tc-99m MDP bone SPELT and Tc-99m sestamibi muscle SPELT scintigraphy were used. Whereas Tc-99m MDP bone SPELT showed absent uptake at the beginning, there was good uptake 3 months after flap application. Tc-99m sestamibi SPELT revealed good uptake indicating normal perfusion of flap muscle tissue. (C) 2003 Elsevier Science Ltd and ISBI. All rights reserved.Öğe Comparison of alloplastic implants for facial bones by scintigraphy and histology(Springer Verlag, 1999) Aygit, AC; Sarikaya, A; Candan, L; Ayhan, MS; Çermik, TFReconstruction of bone defects and contour irregularities in the craniofacial region is difficult and often requires complex solutions. This study investigated the tissue response, vascularization and bone ingrowth, in hydroxyapatite, porous polyethylene and silicone elastomer when used as bone graft substitutes. 24 albino rabbits (8 rabbits for each implant) were used in this investigation. Hydroxyapatite 500 particles, silicone rubber and porous high-density polyethylene were placed in the cavities formed with a drill in the rabbit frontal bones. As a part of a prospective study the vascularization rates of all implant materials were analyzed 10 days and 2 months after surgery using (99m)Technetium-MDP (Methylene diphosphonate) scintigraphy of the skull. The scintigraphic studies were performed 2 hours after intravenous injection of 4 mCi (148 MBq) Tc-99m-MDP. The frontal bone was excised on the 10th and 60th days. All tissue specimens were placed first in 10% formalin and then in 10% nitric acid solution for decalcification. The vascularization, connective tissue ingrowth, foreign body reaction and bone regeneration around the implant were evaluated. Results of this study suggested that hydroxyapatite and porous polyethylene were stabilized in bone while as expected silicone was mobile, also hydroxyapatite implants are vascularized better and are more biocompatible than porous polyethylene.Öğe Contralateral rectus abdominis muscle flap coverage for the management of a complicated groin defect(Lippincott-Raven Publ, 1997) Aygit, AC; Onat, R; Aydin, Y; Orak, F[Abstract Not Available]Öğe Distally based sural flap in treatment of chronic venous ulcers(Lippincott Williams & Wilkins, 2005) Top, H; Benlier, E; Aygit, AC; Kiyak, MThe treatment of venous ulcers of the leg often fails to heal because venous ulcers are mostly associated with severe lipo-dermatosclerosis. These complicated ulcers may require correction of local hemodynamics, excision of ulcer with surrounding lipodermatosclerotic skin, and replacement of the defect with healthy tissue. We present our experience with the use of the distally based sural flaps for the reconstruction of soft-tissue defects of the distal region of the lower limb in patients with chronic venous ulcer. Between 2001 and 2003, 12 patients with venous ulceration were treated with distally based sural flaps. At operation, the ulcer and its surrounding lipodermatosclerotic skin were excised. The defects after excision ranged from 3 X 3 to I I X 17 cm. The distally based sural artery flap was inset within the defect. In all patients, the flap survived completely, and in only I patient, distal venous congestion was seen and was treated successfully with leeches. There was donor site skin graft loss in 2 patients. Two flaps had minor local complications that healed with local wound care. No recur-rent ulcers were identified after average 19.7 months. In conclusion, the distally based sural flaps can be used reliably for treatment of venous ulcers. Our approach in treatment of chronic venous ulcers improves venous hemodynamics and provides local flap alternative that should be considered prior to a free-flap transfer for closure of the defect.Öğe Evaluation of maxillary sinus after treatment of midfacial fractures [Meeting Abstract](Springer, 2004) Top, H; Aygit, AC; Sarikaya, A; Karaman, D; Firat, MF[Abstract Not Available]Öğe The fate of intramuscularly injected fat autografts: An experimental study in rabbits(Springer, 2004) Aygit, AC; Sarikaya, A; Doganay, L; Top, H; Cakir, B; Firat, MFAn experimental study was designed to assess the viability and revascularization of intramuscularly injected fat autografts. For the study, 18 rabbits were divided into two groups. In the first group, fat was injected intramuscularly (12 rabbits). Autologous fat was obtained from the inguinal area and subsequently injected into the thigh muscle. In the second group, physiologic saline was injected intramuscularly to determine the effects of cannulation and pressure on muscle tissue (6 rabbits). Fat autografts were performed on the right side of the animal, and the left side was used as the control. Scintigraphic imaging and histopathologic examination of the limbs were performed after injection of adipose tissue on days 15, 30, 45, 60, 90. and 120. On the technetium-99m (Tc-99m) hexamethylpropylene amine oxime scintigraphy, whereas similar activity distribution was observed between the left and right thigh on days 15, 30, and 45, there was increased uptake at the right thigh on days 60, 90, and 120. This increased uptake indicates that there is viable fat tissue in this region. Histopathologic evaluation showed that microcysts resulting from degeneration of some adipocytes and inflammatory changes on day 15 additionally increased vascularity and fibrosis in some animals on day 30, as well as fibrosis, microcysties, and focal calcification areas in adipose tissue on day 45 and later. It was observed that adipose tissue survived in more than 50% of the graft area in all the animals. These findings show that fat autografts can survive in muscle tissue with less than 50% fibrotic change.Öğe Imaging of frostbite injury by technetium-99m-sestamibi scintigraphy: A case report(Amer Orthopaedic Foot & Ankle Soc, Inc, 2002) Aygit, AC; Sarikaya, AThe appearance of superficial tissue is often an unreliable indicator of deep-tissue viability in cases of frostbite. We present a 34-year-old black man who was brought to the emergency department at fourth post-injury day with frostbite injury involving both lower extremities after prolonged exposure to subzero temperatures. In our previous experimental study, 99mTc sestamibi scintigraphy has been employed for evaluating frostbite injuries in rabbit hindlegs. In the case presented, 99mTc sestamibi scintigraphy, as a new diagnostic tool, was performed for detection of skeletal muscle perfusion on the fourth post-injury day. The scintigraphic images show diffusely reduced uptake in soft tissues of both calves and feet. It was thought that this hypoperfuslon was due to viable but ischemic tissue. Five days after medical therapy, 99mTc sestamibi scan showed prominently increased uptake in both calves and feet and skin necrosis was observed. Debridement of necrotic skin and subcutaneous tissue was performed, and split-thickness skin graft was applied for coverage of the skin defect. Healing was good 15 days after grafting. We think 99mTc sestamibi scan can be used for assessment of soft-tissue perfusion and evaluation of treatment in frostbite injury.Öğe A left transverse facial cleft with a median cleft of the lower jaw(Alliance Communications Group Division Allen Press, 1999) Aygit, AC; Ayhan, MS; Orak, FObjective: A 13-day-old girl with a left transverse facial cleft and a median defect of the lower jaw is reported in detail. Left macrostomia was repaired using a W-plasty technique, and preauricular appendages were excised. The median defect of the mandible demonstrated by computed tomography scan on the first examination had disappeared at 1 year of age. Conclusion: Congenital clefts of the mandible can fuse at a later stage; thus, it is necessary to wait to treat the mandibular defect until the infant is slightly older.Öğe Lymphangiosarcoma in chronic lymphoedema - Stewart-Treves syndrome(Churchill Livingstone, 1999) Aygit, AC; Yildirim, AM; Dervisoglu, SA case of post-mastectomy lymphangiosarcoma is reported. Lymphangiosarcoma is an extremely rare but highly lethal complication of chronic lymphoedema. Our patient was treated by amputation and died 6 months later. Treatment of post-mastectomy lymphangiosarcoma is still unsatisfactory. Early recognition and radical ablative surgery seem to provide best chance for survival.Öğe Malignant melanoma in association with palmoplantar keratoderma(Springer Verlag, 1999) Aygit, AC; Bayçin, HN; Demiralay, AA case of malignant melanoma arising on the hyperkeratotic little finger of a 46-year-old patient with palmoplantar keratoderma is reported. A pigmented lesion had been present since childhood, over a period of two years it became larger and darker and had occasion ally bled over the past two months. Histopathologic investigation revealed hyperkeratosis, hypergranulosis, and acanthosis on the left palm and malignant melanoma on the macule of the left little finger.Öğe Management of the long nose: Review of techniques for nasal tip supporting structures(Springer, 2006) Benlier, E; Top, H; Aygit, ACThe long nose with a plunging tip is a deformity that involves an inferiorly rotated nasal tip, leading to an increase in the length of the nose. The anatomic basis of the long nose with a plunging tip may be divided into two types. Type 1 presents a normal alar-cartilage complex inferiorly displaced by a long nasal septum and long upper lateral cartilages. Type 2 is caused by a dislocation of the alar cartilages downward from the aponeurotic attachments to the septal angle. During the study period, the authors identified 60 patients with long noses and plunging tips. For 22 patients with type 1 long noses, the high septal incision technique was used in 12 cases and the step technique in 10 cases. The invagination procedure alone was used for 22 of 38 patients with type 2 plunging noses. Also, an extension graft with the invagination procedure was used for 6 patients, and a columellar strut graft was used for 10 patients. A high septal incision increased tip rotation without significantly changing the amount of tip projection. However, the step procedure, the invagination technique alone, septal extension graft with the invagination technique, and columellar strut grafts increased nasal tip rotation and projection. During the study period, 38 patients were identified as having a smiling deformity, which was improved using the authors' modification procedure. On the basis of the results, the authors recommend that the appropriate treatment for each patient with a long nose and a plunging tip must be determined by preoperative and intraoperative examination findings with the patient at rest and while smiling.Öğe Molding the ears after anterior scoring and concha repositioning: A combined approach for protruding ear correction(Springer, 2003) Aygit, ACThe goal of otoplasty for correction of prominent ears is normalization of shape and position of both pinnas with a certain symmetry. Recreating the antihelical fold and lowering the auriculocephalic angle are the basic processes for achieving a normal-looking car. Various methods have been described to recreate the antihelical fold. In addition to anterior scoring or abrasion, many involve placement of permanent or absorbable sutures to reform the cartilage to proper shape to correct the deformity. In this study the use of a custom-made silicone mold was described after anterior scoring to recreate the antihelical fold, without using any suture material. Silicone molds provide good shaping of the antihelical fold, scapha, and helical rim while the tissue is healing. Fourteen patients underwent bilateral otoplasty for prominent ears in our clinic over a four-year period. The anthelical fold was created by anterior scoring and the concha-mastoid angle lowered and sutured. After completing the surgical procedure for both ears custom-made silicone molds were worn by the patient for the first two weeks to maintain proper position. The third week, the patient wore the mold half a day. A head dressing was used for two days and the ears were subsequently supported using a headband. Follow-up ranged from fourteen months to four years. One patient developed a postoperative hematoma in one ear that resorbed spontaneously. Patient satisfaction with the procedure was generally high. Using a shape mold after a combination of anterior scoring and concha repositioning gives predictable results with a natural-looking ear.Öğe A new approach to smiling deformity: Cutting of the superior part of the orbicularis oris(Springer, 2005) Benlier, E; Top, H; Aygit, ACA diagnosis of an aesthetic smiling deformity, which is functional rather than anatomic, is essential for provision of the best treatment in rhinoplasty. Smiling deformity consists of three elements: (a) the nasal tip tending to retrodisplace and rotate inferiorly; (b) the lower part of the upper lip moving superiorly; and (c) a horizontal groove occurring in the midphiltral area. An active depressor septi and orbicularis muscle can accentuate a drooping nasal tip and shorten the upper lip during smiling. Downward movement of the nasal tip and a sharper nasolabial angle usually are aesthetically unpleasant. During the study period (January 2000 to January 2004), the authors identified 38 patients with smiling deformities, 16 of whom underwent dissection and transposition of the paired depressor septi during rhinoplasty. The remaining 22 patients experienced hyperactivity of both the depressor septi and orbicularis muscles, as diagnosed by a descending nasal tip and a shortened upper lip at animation. These patients underwent a modification of the depressor septi and orbicularis muscles. No relapse was evident up to 2 years postoperatively. Repositioning of the depressor septi nasi muscle improved only mild cases. However, modification of the orbicularis and depressor septi muscles was a valuable adjunct to rhinoplasty for moderate and severe forms of smiling deformity. The new approach for smiling deformity provided an aesthetically pleasant appearance for the patient both at rest and when smiling.Öğe Review of monitoring free muscle flap transfers in reconstructive surgery(Lippincott Williams & Wilkins, 2006) Top, H; Sarikaya, A; Aygit, AC; Benlier, E; Kiyak, MBackground Free tissue transfer is a method of moving any tissue from a donor area of the body to a recipient site and re-attaching the arteries and veins to the blood vessels at the recipient site by microvascular surgery. Improved microsurgical techniques have resulted in a high percentage of successful free tissue transfers. Post-operative monitoring of tissue viability can detect early problems in free tissue transfer which may allow early intervention and salvage. Although many flap monitoring methods have been described, there is still no consensus on which of these techniques will become the standard accepted method for monitoring free muscle flaps. Objective In present study, we investigated the use of Tc-99m sestamibi scintigraphy in determining free muscle flap viability and complications, and also in directing treatment. Methods Thirteen patients were examined prospectively during the post-operative period after free tissue transfer for foot defects. The cause of the defect was diabetic foot ulcer in 10 patients, dermatofibrosarcoma in one patient, squamous cell carcinoma in one patient and gunshot wound in one patient. Foot defect covering was carried out with a free latissimus dorsi muscle flap and skin graft (n=12) and a free gracilis muscle flap (n=1). All patients were examined with a monitoring system that consisted of visual inspection, hand-held Doppler ultrasonography and scintigraphic examinations. Scintigraphic imaging of all cases was performed routinely within the first 48 h post-operatively, and also on days 10 and 91 in two patients. Results There were four flap failures during the study. One of these patients had viable findings upon visual inspection and no evidence of vascular compromise on Doppler at the first examination. In the other patient, visual inspection of the flap showed that it was ischaemic in one region, but there was no vascular compromise on Doppler examination. Scintigraphic images of each of these patients showed a partial hypoperfused area in the flap region. Later, these two flaps showed positive clinical indications of hypoperfusion (colour of muscle and appearance of skin graft) and Doppler abnormalities. The remaining two patients had non-viable scintigraphic images as well as positive clinical indicators of hypoperfusion and evidence of vascular compromise on Doppler. Nine patients each had a viable flap. In these patients, all three examination tools demonstrated that the flaps were totally viable and there were no vascular complications. Conclusion According to the results of this study, Tc-99m sestamibi scintigraphy appears to be a feasible and promising method in the evaluation of free muscle flap viability and complications. On the other hand, to demonstrate any impact on management or patient outcome, further evaluation of 99mTc sestamibi imaging, including comparative studies with different established methods in a larger patient population, is highly recommended.Öğe Salivary duct carcinoma of the parotid gland metastasizing to the skin - A case report and review of the literature(Lippincott Williams & Wilkins, 2005) Aygit, AC; Top, H; Cakir, B; Yalcin, OSalivary duct carcinomas of parotid gland are rare, as are the skin metastases from them. Four cases are reported with metastases to the skin. We present an additional case, with Subcutaneous metastases of the back and leg. To our knowledge, this is the first case reported in the literature in which the nodule on an extremity was the metastasis of a salivary duct carcinoma of parotid gland.Öğe Significance of arginase and ornithine in malignant tumors of the human skin(Mosby-Elsevier, 2001) Gökmen, SS; Aygit, AC; Ayhan, MS; Yorulmaz, F; Gülen, SDuring neoplastic development, several aspects of the regulation of polyamine synthesis undergo profound changes. In extrahepatic mammalian tissues in which the urea cycle is not functioning, arginase is believed to supply the cell with ornithine, a non-protein amino acid that is a precursor for biosynthesis of polyamines. Because the activity of ornithine decarboxylase and polyamine levels have been shown to be elevated during carcinogenesis, we decided to investigate the role of arginase in the development of malignant tumors of the human skin and to examine whether arginase activity and ornithine level can be used as biologic markers for distinguishing patients with squamous cell cancer from patients with basal cell cancer. For this purpose, we studied tissue arginase activity and ornithine level in tumor and adjacent normal tissues in 16 patients (55 +/- 10 years of age) with malignant skin tumors (8 of which were squamous cell cancers and 8 of which were basal cell cancers). The mean arginase activity and ornithine levels in tumor tissues (total) were 17.75 +/- 8.54 U/mg protein and 40.89 +/- 14.88 nmol/mg protein, respectively, versus 3.69 +/- 1.71 U/mg protein and 12.98 +/- 6.21 nmol/mg protein, respectively, for normal tissues. The mean specific arginase activity levels in squamous cell and basal cell cancers of the human skin were 18.49 +/- 10.47 U/mg protein and 16.63 +/- 6.00 U/mg protein, respectively. The mean ornithine levels in squamous cell and basal cell cancers of the human skin were 42.45 +/- 9.10 nmol/mg protein and 39.33 +/- 10.19 nmol/mg protein, respectively. Our results indicated that (1) arginase activity and ornithine levels are elevated in squamous cell and basal cell cancers of the human skin (2) the increased activity of arginase and hence the elevated levels of ornithine may be important in the development of malignant tumors of the human skin; and (3) although arginase activity and ornithine level may be useful for distinguishing patients with malignant skin tumors from healthy subjects they cannot be used as biologic markers for distinguishing patients with squamous cell cancer from patients with basal cell cancer.Öğe Spitzoid melanoma in childhood(John Libbey Eurotext Ltd, 2006) Top, H; Aygit, AC; Bas, S; Yalcin, OSpitzoid melanoma is a rare variant of melanoma. It has morphological features similar to those of Spitz's nevus. In this study, the histologic and immunohistochemical features of both Spitzoid melanoma and Spitz's nevus are emphasized. We report two cases of melanoma with spitzoid features occurring in the extremities of 9 and 8-year-old girls. Histologically both lesions had typical features of Spitzoid melanoma. We conclude that the differential diagnosis of Spitzoid melanoma and Spitz's nevus is at times problematic in childhood, in that distant metastasis may be the only diagnostic criteria for some cases to be distinguished from Spitz's nevus if strict criteria are followed. Spitzoid melanoma must be treated as other types of melanoma.Öğe Technetium 99m sestamibi scintigraphy for noninvasive assessment of muscle flap viability(Lippincott Williams & Wilkins, 1999) Aygit, AC; Sarikaya, A[Abstract Not Available]Öğe Utility of 99mTc dextran scintigraphy in diabetic patients with suspected osteomyelitis of the foot(Springer, 2003) Sarikaya, A; Aygit, AC; Pekindil, GPurpose: Osteomyelitis of the foot is a frequent complication of diabetes mellitus and its diagnosis is often difficult. The goal of this study was to demonstrate the utility of Tc-99m dextran scintigraphy in suspected diabetic foot infections. Materials and Methods: Twenty-six patients (20 males, 6 females, age range 18-80 years) with diabetes mellitus who had a total of 36 foot ulcers or necrosis were studied. All the patients underwent both three phase bone scan and Tc-99m dextran scintigraphy. Final diagnosis was based upon either pathologic examination or clinical follow-up at least four months. Results: On bone scan increased uptake was seen in 55 sites, and among these there were 11 lesions of proven osteomyelitis. There were 11 true-positive, 0 false negative, 0 true negative and 44 false positive results for bone scan. The sensitivity, specificity and accuracy of bone scan were 100%, 0% and 20%, respectively. With regard to Tc-99m dextran scan, nine lesions produced true-positive results with two lesions indicating false negatives resulting in a sensitivity of 82%. Thirty-six true negative and eight false positive results produced a specificity of 82%, and an accuracy 82% from Tc-99m dextran studies was obtained. Eight false-positive results were possibly due to neuroarthropathy, pressure points and deep penetrating ulcers. A patient with one false-negative result had angiopathy while other had neither neuropathy nor angiopathy. Conclusions: According to these results, Tc-99m dextran scintigraphy seems to be a sensitive and specific diagnostic method, and because of its advantages over other radiopharmaceuticals (shorter preparation time, highly stability in vivolin vitro, early diagnostic imaging and low cost), it may be a radiopharmaceutical of choice for diagnosing in diabetic foot infections.
