Limb transplantation is emerging as a promising area of surgery and is an indispensable alternati... more Limb transplantation is emerging as a promising area of surgery and is an indispensable alternative for prosthetic rehabilitation of amputees, the severity of which is increasing because of combat-related injuries. Successful unilateral and bilateral limb transplantations have already been performed before this operation. We performed the first ever quadruple limb transplantation in February 2012. The limbs procured from a 40-year-old man heart-beating donor were transplanted to a 27-year-old male patient who was a quadruple amputee for the last 14 years because of an electrical injury. To shorten the ischemic period to a minimum, 3 separate microsurgery teams worked simultaneously. All extremities were reperfused within 8 hours of procurement, and the operation lasted for 12 hours. Metabolic load was managed by hemodialysis. One hour after the completion of the operation, cardiac arrest developed, resuscitation of which necessitated median sternotomy and temporary partial cardiopulmonary support. Despite the removal of the transplanted limbs and all efforts including continuous hemodialysis, plasmapheresis, and extracorporeal membrane oxygenation, the patient died on the fourth day after transplantation in a clinical condition of severe systemic inflammation. The problems we faced were difficulty of vascular access for invasive monitoring and fluid replacement, and the severe systemic inflammation effects of which could not be dealt with, despite aggressive supportive treatment. We hope that our experience will enlighten the surgeons who are willing to extend the limits of limb transplantation and serve the success of future operations.
The application of composite tissue allograft (CTA) transplants in clinical reconstruction is par... more The application of composite tissue allograft (CTA) transplants in clinical reconstruction is parallel with extended knowledge of anatomy, microsurgical skills and development of transplantation immunology. CTAs are composed of multiple tissues, some of which such as skin are highly immunogenic and cause strong immunologic responses. Strong antigenic nature of skin may be related to Langerhans cells, which are powerful antigen-presenting cells. They are leukocytes found in the epidermis as members of immunologic cascade. Large skin components of CTA transplant may cause higher antigenic load as a result of increased surface area of transplanted skin correlating with increased load of Langerhans cells. In clinical abdominal wall transplants, increased rejection episodes were reported compared with other CTA transplant. This complication may correlate to large skin component of these transplants. To evaluate correlation between large skin island flaps and immunologic responses, CTA models with large skin components should be tested in experimental studies. Here we propose a total abdominal wall (TAW) transplant model in rat to test the feasibility of TAW transplantation in two groups: the anatomic study and experimental transplantation group. In anatomic study, TAW flaps were elevated bilaterally on superficial epigastric vessels and replaced. The entire TAW skin islands of all flaps were viable at postoperative day 21. Dye study confirmed that TAW flap was supplied by two vascular pedicles. Data in this group demonstrated that this flap is composed of the largest skin island when compared with other CTA transplant models such as full face, hemiface, limb, and groin flap. In experimental group, isograft transplantations were performed between Lewis rats (RT11) while allograft transplantations were performed Lewis (RT11) donors and LBN (RT11+n) recipients.
Free gracillis muscle transfer is preferred mostly for facial reanimation (Zuker, 2015). Transfer... more Free gracillis muscle transfer is preferred mostly for facial reanimation (Zuker, 2015). Transferring the whole segment of gracillis muscle causes thick mass under the face skin and unaesthetically appearance deterioration when muscle was contracted after re-innervation period. Furthermore, anterior third of the muscle was transplanted to provide thin segment used in the face skin. The branches of obturator nerve and flap vessels are to take part in this muscle segment. Harvesting of flap from main segment may result in ropy edges of muscle segment because detached muscle fibrils contract independently. Ropy muscle edges may tear by stitches during flap insertion between the corner of the mouth and front of the ear. Providing proficient smile needs effective muscle contraction which depends on the fact that the transferred muscle length is to be equal to the distance between the front of the ear and the corner of the mouth. This tearing causes difficulty in the arrangement of muscle...
Facial Nerve Palsy - A Practitioner’s Guide [Working Title]
Gracilis muscle is the most commonly used muscle in facial paralysis. Although the use of the con... more Gracilis muscle is the most commonly used muscle in facial paralysis. Although the use of the contralateral buccal branches with the sural nerve graft as the recipient nerve provides spontaneous smiling, the main disadvantage is the weak contraction due to insufficient muscle innervation. Although the masseter nerve is a chewing muscle, it can be used as a recipient nerve to provide a strong contraction. However, postoperative adaptation of the brain is required to ensure spontaneous smiling. In this article, I will evaluate the results of the postoperative third-year results of 11 patients with partial thickness gracilis muscle. I carried on the masseter recipient nerve for oral corner reanimation in facial paralysis.
SuleymanDemirel Universitesi TIP FAKULTESI DERGISI: 2003 Haziran; 10(2) Serbest Flep sonuclarimiz... more SuleymanDemirel Universitesi TIP FAKULTESI DERGISI: 2003 Haziran; 10(2) Serbest Flep sonuclarimiz Serdar Nasir, M.Asim Aidin Ozet Klinigimizin yapmis oldugumuz serbest flep vakalari ile ilgili hasta kayitlarindan ve klinik izlemden toparlanan;flep secimindeki oncelikler, hasta karakteristikleri, cerrahi teknik, fonksiyonel sonuclar ve komplikasyonlar ile ilgili bilgiler toplanarak sonuclar tartisildi. Sonucta dogru endikasion, dikkatli flep diseksiyonu ve mikrocerrahi teknikleri ile serbest fleplerin rekonstruksiyon secenekleri icinde en uygun tedavi modellerinden biri oldugu dogrulandi. Anahtar kelimeler: Serbest flep, mikrocerrahi, doku defekt rekonstruksiyonu Abstract The outcome of free Flap Reconstruction We reviewed all cases involving free flap reconstructions performed at our department. Data were obtained from a prospectiveli maintained database and the medical record. Patient characteristics, defect size, proce- dural technique, functional outcome , and complications were ...
ABSTRACTFibrosarcoma of the paranasal sinuses is extremely rare pathology and there is limited re... more ABSTRACTFibrosarcoma of the paranasal sinuses is extremely rare pathology and there is limited report in the literature. We report synchronous presentation of maxillary sinus fibrosarcoma and gemistocytic astrocytoma which is, to our knowledge, unique in the literature. Both tumors metastases to other organ rarely and the metastatic spread of gemistocytic astrocytoma to fibrosarcoma or vice versa have also not been reported in the literature yet. This report discusses the clinical course of the disease, outcome of the treatment approach and survival as well as an unusual occurrence of leukocytoclastic vasculitis during the course of radiotherapy in such unusual presentation. (Eur J Dent 2009;3:233-239)
In the literature, drainage to epitrochlear and popliteal sentinel lymph nodes (SLN) are analyzed... more In the literature, drainage to epitrochlear and popliteal sentinel lymph nodes (SLN) are analyzed for whole or distal extremity (below elbow or knee) melanomas that are not topographically homogeneous with respect to tendency of drainage to interval SLNs. We hypothesize that acral (hand and foot) skin has a uniform frequency of drainage to interval SLNs, which is higher than reported for distal extremity melanomas. One hundred healthy subjects were enrolled. Fifty subjects had standard four extremity lymphoscintigraphies by radiocolloid injection into an interdigital web space as in lymphodynamic studies. On another 50 subjects, either targeted upper (n = 25) or lower (n = 25) extremity lymphoscintigraphies were performed utilizing injection sites that likely drain to interval SLNs. Acral skin drainage to interval SLNs was analyzed for interindividual variability and injection site dependence. There was considerable interindividual variability in drainage of each injection site to interval SLNs. Hand skin had a uniform 50% frequency of drainage to epitrochlear-midhumeral SLNs with both injection sites. This frequency was higher than the epitroclear SLN frequencies reported for distal extremity melanomas. Foot skin had 10% and 90% frequencies of drainage to popliteal SLNs from standard and targeted injection sites, respectively. Foot skin largely simulates the tendency of drainage reported for distal extremity melanomas while lateral heel represents a limited zone that almost uniformly drains to popliteal SLNs. Despite dissimilarities between hand and foot, acral skin drainage to interval SLNs is high enough to obligate a thorough interval SLN exploration in acral primaries.
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2008
Several vascular carriers for different tissues were used for the purpose of fat tissue prefabric... more Several vascular carriers for different tissues were used for the purpose of fat tissue prefabrication. However, the inguinal fat pad in rats can be elevated with a vascular pedicle and considered as a vascular carrier. To the best of our knowledge, the fat tissue in rats as a vascular carrier has not been reported in any experimental studies to date. In our study, we aimed to describe a new prefabrication model in rats in which skin prefabrication was accomplished using the inguinal fat pad as a vascular carrier. Inguinal fat pads in rats were elevated over a superficial epigastric vessel pedicle in the pilot study. The contralateral inguinal fat pads were prepared as grafts. After 1 week, we compared the histopathological findings of the inguinal fat pad flaps and grafts and determined that the inguinal fat pad can be safely elevated over the vascular pedicle. In the experimental group, bilateral vascularised inguinal fat pads were transferred to the lower abdomen for skin prefabrication. After 3 weeks, bilateral fat-skin composite flaps including prefabricated lower abdomen skin were elevated over the vascular pedicles. One side was used as a composite flap while pedicle of the other side was transected at its origin at the femoral vessels to create the composite graft. Composite flap and graft were inserted at their original positions. One week later, the composite flaps were stained with India ink, perfused by fluorescein, and filled with contrast material for microangiographic study. In the histological examination, fat and skin tissues of the composite flaps were viable while those of the composite grafts were necrotic. Based on these findings, we can conclude that the fat tissue as a vascular carrier can be successfully used for tissue prefabrication in plastic surgery.
The effect of power frequency electric field (EF) on nerve regeneration was investigated on a rat... more The effect of power frequency electric field (EF) on nerve regeneration was investigated on a rat peroneal nerve crush injury model. The animals were assigned to three groups: 50 Hz EF and Static EF groups were exposed at 10 kV/m. The sham group was kept in the same setting without any EF applications. EF was uninterruptedly applied for 21 days postoperatively. Repeated measures analysis of daily walking tracks during EF exposure demonstrated lower toe spread recovery (TSR) in the 50 Hz EF group. Significant difference across the groups was found only at days 7, 8, 12, 16, 17, 20, and 21 when TSR was analyzed for each measurement time. Print length recovery and peroneal function index did not differ across the groups. Walking track parameters were found to recover to their baseline values by day 28 in all groups. Day 14 but not day 21 measurements revealed smaller nerve cross-sectional area, lower total regenerating axon area, and higher mean myelin debris area in 50 Hz EF group. Both day 14 and 21 measurements revealed higher total myelin debris area, lower EDL muscle weight, and lack of significant enlargement in nerve cross-section distal to the injury, compared to the normal counterpart in 50 Hz EF group. All differences were in keeping with lower rates of Wallerian degeneration and nerve regeneration in 50 Hz EF group. When walking track, histomorphometry and muscle weight are considered individually, their differences across the groups may appear to be subtle to derive a conclusion for a 50 Hz EF effect. However, their concordance with each other in direction of effect suggests that continuous 50 Hz EF exposure has a weak effect that is detrimental mostly to the rate of early nerve regeneration in this axonotmetic injury model. Recovery of walking tracks was not different between Static EF and Sham groups. This suggests that the surface charges that may indirectly affect walking behaviors of the rats, do not account for the lower recovery of TSR in 50 Hz EF group. Differences in nerve regeneration between 50 Hz EF and Static EF groups suggests that electric induction may be required for pure EF effects even though the estimated density of induced fields is not above the endogenous background level for the 50 Hz EF exposure in this study.
... Ulnar sinir distale doğru izlendi. Arter askıya alındı ve yana çekilerek posterior kordondan ... more ... Ulnar sinir distale doğru izlendi. Arter askıya alındı ve yana çekilerek posterior kordondan radial sinirin humerus posterioruna gidişi izlendi. Median ve ulnar sinir epinöriyumları çıkışlarından 8-10 cm distalde uzunlamasına insize edilerek skar yapısı görüldü. ...
Limb transplantation is emerging as a promising area of surgery and is an indispensable alternati... more Limb transplantation is emerging as a promising area of surgery and is an indispensable alternative for prosthetic rehabilitation of amputees, the severity of which is increasing because of combat-related injuries. Successful unilateral and bilateral limb transplantations have already been performed before this operation. We performed the first ever quadruple limb transplantation in February 2012. The limbs procured from a 40-year-old man heart-beating donor were transplanted to a 27-year-old male patient who was a quadruple amputee for the last 14 years because of an electrical injury. To shorten the ischemic period to a minimum, 3 separate microsurgery teams worked simultaneously. All extremities were reperfused within 8 hours of procurement, and the operation lasted for 12 hours. Metabolic load was managed by hemodialysis. One hour after the completion of the operation, cardiac arrest developed, resuscitation of which necessitated median sternotomy and temporary partial cardiopulmonary support. Despite the removal of the transplanted limbs and all efforts including continuous hemodialysis, plasmapheresis, and extracorporeal membrane oxygenation, the patient died on the fourth day after transplantation in a clinical condition of severe systemic inflammation. The problems we faced were difficulty of vascular access for invasive monitoring and fluid replacement, and the severe systemic inflammation effects of which could not be dealt with, despite aggressive supportive treatment. We hope that our experience will enlighten the surgeons who are willing to extend the limits of limb transplantation and serve the success of future operations.
Limb transplantation is emerging as a promising area of surgery and is an indispensable alternati... more Limb transplantation is emerging as a promising area of surgery and is an indispensable alternative for prosthetic rehabilitation of amputees, the severity of which is increasing because of combat-related injuries. Successful unilateral and bilateral limb transplantations have already been performed before this operation. We performed the first ever quadruple limb transplantation in February 2012. The limbs procured from a 40-year-old man heart-beating donor were transplanted to a 27-year-old male patient who was a quadruple amputee for the last 14 years because of an electrical injury. To shorten the ischemic period to a minimum, 3 separate microsurgery teams worked simultaneously. All extremities were reperfused within 8 hours of procurement, and the operation lasted for 12 hours. Metabolic load was managed by hemodialysis. One hour after the completion of the operation, cardiac arrest developed, resuscitation of which necessitated median sternotomy and temporary partial cardiopulmonary support. Despite the removal of the transplanted limbs and all efforts including continuous hemodialysis, plasmapheresis, and extracorporeal membrane oxygenation, the patient died on the fourth day after transplantation in a clinical condition of severe systemic inflammation. The problems we faced were difficulty of vascular access for invasive monitoring and fluid replacement, and the severe systemic inflammation effects of which could not be dealt with, despite aggressive supportive treatment. We hope that our experience will enlighten the surgeons who are willing to extend the limits of limb transplantation and serve the success of future operations.
The application of composite tissue allograft (CTA) transplants in clinical reconstruction is par... more The application of composite tissue allograft (CTA) transplants in clinical reconstruction is parallel with extended knowledge of anatomy, microsurgical skills and development of transplantation immunology. CTAs are composed of multiple tissues, some of which such as skin are highly immunogenic and cause strong immunologic responses. Strong antigenic nature of skin may be related to Langerhans cells, which are powerful antigen-presenting cells. They are leukocytes found in the epidermis as members of immunologic cascade. Large skin components of CTA transplant may cause higher antigenic load as a result of increased surface area of transplanted skin correlating with increased load of Langerhans cells. In clinical abdominal wall transplants, increased rejection episodes were reported compared with other CTA transplant. This complication may correlate to large skin component of these transplants. To evaluate correlation between large skin island flaps and immunologic responses, CTA models with large skin components should be tested in experimental studies. Here we propose a total abdominal wall (TAW) transplant model in rat to test the feasibility of TAW transplantation in two groups: the anatomic study and experimental transplantation group. In anatomic study, TAW flaps were elevated bilaterally on superficial epigastric vessels and replaced. The entire TAW skin islands of all flaps were viable at postoperative day 21. Dye study confirmed that TAW flap was supplied by two vascular pedicles. Data in this group demonstrated that this flap is composed of the largest skin island when compared with other CTA transplant models such as full face, hemiface, limb, and groin flap. In experimental group, isograft transplantations were performed between Lewis rats (RT11) while allograft transplantations were performed Lewis (RT11) donors and LBN (RT11+n) recipients.
Free gracillis muscle transfer is preferred mostly for facial reanimation (Zuker, 2015). Transfer... more Free gracillis muscle transfer is preferred mostly for facial reanimation (Zuker, 2015). Transferring the whole segment of gracillis muscle causes thick mass under the face skin and unaesthetically appearance deterioration when muscle was contracted after re-innervation period. Furthermore, anterior third of the muscle was transplanted to provide thin segment used in the face skin. The branches of obturator nerve and flap vessels are to take part in this muscle segment. Harvesting of flap from main segment may result in ropy edges of muscle segment because detached muscle fibrils contract independently. Ropy muscle edges may tear by stitches during flap insertion between the corner of the mouth and front of the ear. Providing proficient smile needs effective muscle contraction which depends on the fact that the transferred muscle length is to be equal to the distance between the front of the ear and the corner of the mouth. This tearing causes difficulty in the arrangement of muscle...
Facial Nerve Palsy - A Practitioner’s Guide [Working Title]
Gracilis muscle is the most commonly used muscle in facial paralysis. Although the use of the con... more Gracilis muscle is the most commonly used muscle in facial paralysis. Although the use of the contralateral buccal branches with the sural nerve graft as the recipient nerve provides spontaneous smiling, the main disadvantage is the weak contraction due to insufficient muscle innervation. Although the masseter nerve is a chewing muscle, it can be used as a recipient nerve to provide a strong contraction. However, postoperative adaptation of the brain is required to ensure spontaneous smiling. In this article, I will evaluate the results of the postoperative third-year results of 11 patients with partial thickness gracilis muscle. I carried on the masseter recipient nerve for oral corner reanimation in facial paralysis.
SuleymanDemirel Universitesi TIP FAKULTESI DERGISI: 2003 Haziran; 10(2) Serbest Flep sonuclarimiz... more SuleymanDemirel Universitesi TIP FAKULTESI DERGISI: 2003 Haziran; 10(2) Serbest Flep sonuclarimiz Serdar Nasir, M.Asim Aidin Ozet Klinigimizin yapmis oldugumuz serbest flep vakalari ile ilgili hasta kayitlarindan ve klinik izlemden toparlanan;flep secimindeki oncelikler, hasta karakteristikleri, cerrahi teknik, fonksiyonel sonuclar ve komplikasyonlar ile ilgili bilgiler toplanarak sonuclar tartisildi. Sonucta dogru endikasion, dikkatli flep diseksiyonu ve mikrocerrahi teknikleri ile serbest fleplerin rekonstruksiyon secenekleri icinde en uygun tedavi modellerinden biri oldugu dogrulandi. Anahtar kelimeler: Serbest flep, mikrocerrahi, doku defekt rekonstruksiyonu Abstract The outcome of free Flap Reconstruction We reviewed all cases involving free flap reconstructions performed at our department. Data were obtained from a prospectiveli maintained database and the medical record. Patient characteristics, defect size, proce- dural technique, functional outcome , and complications were ...
ABSTRACTFibrosarcoma of the paranasal sinuses is extremely rare pathology and there is limited re... more ABSTRACTFibrosarcoma of the paranasal sinuses is extremely rare pathology and there is limited report in the literature. We report synchronous presentation of maxillary sinus fibrosarcoma and gemistocytic astrocytoma which is, to our knowledge, unique in the literature. Both tumors metastases to other organ rarely and the metastatic spread of gemistocytic astrocytoma to fibrosarcoma or vice versa have also not been reported in the literature yet. This report discusses the clinical course of the disease, outcome of the treatment approach and survival as well as an unusual occurrence of leukocytoclastic vasculitis during the course of radiotherapy in such unusual presentation. (Eur J Dent 2009;3:233-239)
In the literature, drainage to epitrochlear and popliteal sentinel lymph nodes (SLN) are analyzed... more In the literature, drainage to epitrochlear and popliteal sentinel lymph nodes (SLN) are analyzed for whole or distal extremity (below elbow or knee) melanomas that are not topographically homogeneous with respect to tendency of drainage to interval SLNs. We hypothesize that acral (hand and foot) skin has a uniform frequency of drainage to interval SLNs, which is higher than reported for distal extremity melanomas. One hundred healthy subjects were enrolled. Fifty subjects had standard four extremity lymphoscintigraphies by radiocolloid injection into an interdigital web space as in lymphodynamic studies. On another 50 subjects, either targeted upper (n = 25) or lower (n = 25) extremity lymphoscintigraphies were performed utilizing injection sites that likely drain to interval SLNs. Acral skin drainage to interval SLNs was analyzed for interindividual variability and injection site dependence. There was considerable interindividual variability in drainage of each injection site to interval SLNs. Hand skin had a uniform 50% frequency of drainage to epitrochlear-midhumeral SLNs with both injection sites. This frequency was higher than the epitroclear SLN frequencies reported for distal extremity melanomas. Foot skin had 10% and 90% frequencies of drainage to popliteal SLNs from standard and targeted injection sites, respectively. Foot skin largely simulates the tendency of drainage reported for distal extremity melanomas while lateral heel represents a limited zone that almost uniformly drains to popliteal SLNs. Despite dissimilarities between hand and foot, acral skin drainage to interval SLNs is high enough to obligate a thorough interval SLN exploration in acral primaries.
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2008
Several vascular carriers for different tissues were used for the purpose of fat tissue prefabric... more Several vascular carriers for different tissues were used for the purpose of fat tissue prefabrication. However, the inguinal fat pad in rats can be elevated with a vascular pedicle and considered as a vascular carrier. To the best of our knowledge, the fat tissue in rats as a vascular carrier has not been reported in any experimental studies to date. In our study, we aimed to describe a new prefabrication model in rats in which skin prefabrication was accomplished using the inguinal fat pad as a vascular carrier. Inguinal fat pads in rats were elevated over a superficial epigastric vessel pedicle in the pilot study. The contralateral inguinal fat pads were prepared as grafts. After 1 week, we compared the histopathological findings of the inguinal fat pad flaps and grafts and determined that the inguinal fat pad can be safely elevated over the vascular pedicle. In the experimental group, bilateral vascularised inguinal fat pads were transferred to the lower abdomen for skin prefabrication. After 3 weeks, bilateral fat-skin composite flaps including prefabricated lower abdomen skin were elevated over the vascular pedicles. One side was used as a composite flap while pedicle of the other side was transected at its origin at the femoral vessels to create the composite graft. Composite flap and graft were inserted at their original positions. One week later, the composite flaps were stained with India ink, perfused by fluorescein, and filled with contrast material for microangiographic study. In the histological examination, fat and skin tissues of the composite flaps were viable while those of the composite grafts were necrotic. Based on these findings, we can conclude that the fat tissue as a vascular carrier can be successfully used for tissue prefabrication in plastic surgery.
The effect of power frequency electric field (EF) on nerve regeneration was investigated on a rat... more The effect of power frequency electric field (EF) on nerve regeneration was investigated on a rat peroneal nerve crush injury model. The animals were assigned to three groups: 50 Hz EF and Static EF groups were exposed at 10 kV/m. The sham group was kept in the same setting without any EF applications. EF was uninterruptedly applied for 21 days postoperatively. Repeated measures analysis of daily walking tracks during EF exposure demonstrated lower toe spread recovery (TSR) in the 50 Hz EF group. Significant difference across the groups was found only at days 7, 8, 12, 16, 17, 20, and 21 when TSR was analyzed for each measurement time. Print length recovery and peroneal function index did not differ across the groups. Walking track parameters were found to recover to their baseline values by day 28 in all groups. Day 14 but not day 21 measurements revealed smaller nerve cross-sectional area, lower total regenerating axon area, and higher mean myelin debris area in 50 Hz EF group. Both day 14 and 21 measurements revealed higher total myelin debris area, lower EDL muscle weight, and lack of significant enlargement in nerve cross-section distal to the injury, compared to the normal counterpart in 50 Hz EF group. All differences were in keeping with lower rates of Wallerian degeneration and nerve regeneration in 50 Hz EF group. When walking track, histomorphometry and muscle weight are considered individually, their differences across the groups may appear to be subtle to derive a conclusion for a 50 Hz EF effect. However, their concordance with each other in direction of effect suggests that continuous 50 Hz EF exposure has a weak effect that is detrimental mostly to the rate of early nerve regeneration in this axonotmetic injury model. Recovery of walking tracks was not different between Static EF and Sham groups. This suggests that the surface charges that may indirectly affect walking behaviors of the rats, do not account for the lower recovery of TSR in 50 Hz EF group. Differences in nerve regeneration between 50 Hz EF and Static EF groups suggests that electric induction may be required for pure EF effects even though the estimated density of induced fields is not above the endogenous background level for the 50 Hz EF exposure in this study.
... Ulnar sinir distale doğru izlendi. Arter askıya alındı ve yana çekilerek posterior kordondan ... more ... Ulnar sinir distale doğru izlendi. Arter askıya alındı ve yana çekilerek posterior kordondan radial sinirin humerus posterioruna gidişi izlendi. Median ve ulnar sinir epinöriyumları çıkışlarından 8-10 cm distalde uzunlamasına insize edilerek skar yapısı görüldü. ...
Limb transplantation is emerging as a promising area of surgery and is an indispensable alternati... more Limb transplantation is emerging as a promising area of surgery and is an indispensable alternative for prosthetic rehabilitation of amputees, the severity of which is increasing because of combat-related injuries. Successful unilateral and bilateral limb transplantations have already been performed before this operation. We performed the first ever quadruple limb transplantation in February 2012. The limbs procured from a 40-year-old man heart-beating donor were transplanted to a 27-year-old male patient who was a quadruple amputee for the last 14 years because of an electrical injury. To shorten the ischemic period to a minimum, 3 separate microsurgery teams worked simultaneously. All extremities were reperfused within 8 hours of procurement, and the operation lasted for 12 hours. Metabolic load was managed by hemodialysis. One hour after the completion of the operation, cardiac arrest developed, resuscitation of which necessitated median sternotomy and temporary partial cardiopulmonary support. Despite the removal of the transplanted limbs and all efforts including continuous hemodialysis, plasmapheresis, and extracorporeal membrane oxygenation, the patient died on the fourth day after transplantation in a clinical condition of severe systemic inflammation. The problems we faced were difficulty of vascular access for invasive monitoring and fluid replacement, and the severe systemic inflammation effects of which could not be dealt with, despite aggressive supportive treatment. We hope that our experience will enlighten the surgeons who are willing to extend the limits of limb transplantation and serve the success of future operations.
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Papers by Serdar Nasir