Background
In this study, we investigated the effect of matrix metalloproteinase-1 (MMP-1) on wound healing on skin in a model produced in rats.
Methods
Sixteen Sprague–Dawley male rats were included ...in the study. The four full-thickness skin wound was created on the dorsal area of each rat with 4.4 mm punch. The rats were randomly divided into two groups. MMP-1 and saline were administered intraperitoneally once daily for 7 days. The biopsies were taken from the separate wounds on the 4th, 7th, 14th and 21st days of the experiment. The lymphocytic response, vascular proliferation, fibroblast proliferation, epithelial hyperplasia, foreign body reaction, ulcer formation, acute inflammation, keloid scar formation and hypertrophic scar formation were compared in each group in histopathologically.
Results
In our study, epithelial hyperplasia on 14th day was significantly higher in the MMP-1 group compared to the control group (
p
< 0.05). The lymphocytic response on 4th and 21th days, the vascular proliferation on 4th day, the fibroblast proliferation on 4th and 7th days, the acute inflammation on 4th day and the hypertrophic scar formation on 7th, 14th, 21st days were significantly lower in the MMP-1 group compared to the control group (
p
< 0.05). No statistically significant difference was found in comparison with other parameters (
p
> 0.05).
Conclusions
MMP-1 improves the wound-healing process of skin with higher epithelial hyperplasia and reduces scar formation in the animal model. Therefore, MMP-1 can potentially be used as an effective anti-fibrogenic agent for preventing or treating the hypertrophic scar.
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Introduction
Soft-tissue mallet finger occurs due to loss of terminal extensor tendon secondary to rupture of distal phalanx. Although using noninvasive splints for 6–8 weeks is the gold standard for ...conservative treatment of closed soft-tissue mallet injuries, patient compliance is an important factor impacting on patient outcomes. In this study, we used a single Kirschner Wire (K-W) to fix the distal interphalangeal (DIP) joint in extension in those patients failed to comply with routine splinting.
Materials and methods
In this prospective study, 190 patients with Doyle type 1 closed soft-tissue mallet finger deformity were included in four groups between 2011 and 2015. These groups were determined according to treatment modalities. Patients in the first group were treated with a finger splint (
n
= 109). Patients in the second group first received a finger splint and then K-W was applied due to lack of adequate compliance (
n
= 23). Patients in the third group were treated with K-W only (
n
= 47), and the fourth group did not accept surgical treatment nor conservative treatment (
n
= 11). After 20 weeks of follow up, we evaluated the results with functional measurements according to Crawford criteria and patient satisfaction. Additionally, the mid-term outcome was assessed with a follow-up at 2 years.
Results
At 20th week postoperatively, average DIP extension lag was 6 degrees (0–30) for the first group, 6.1 degrees (0–30) for the second group, 3.8 degrees (0–25) for the third group, and 17.3 degrees (7–30) for the fourth group. Total patient satisfaction was 85%, which was considered excellent or good. Swan neck deformity was observed in 11% of patients. Osteomyelitis and KW related complications were not observed. There were no statistically significant differences between short-term and mid-term results.
Conclusion
Internal fixation via K-W may be a suitable treatment option compared to splint therapy for management of closed soft-tissue mallet finger in noncompliant patients. Using this treatment approach, the success rate for patients could satisfactorily be improved.
Amaç: Diz ve çevresi yumuşak doku rekonstrüksiyonunda ekspoze yapıların yeterli yumuşak dokuyla örtülmesi gerekliliği yanında diz
fonksiyonunun korunması da önemlidir. Diz çevresi cilt defektleri ...için çok çeşitli flepler tarif edilmiştir. İleri yaşlı, eşlik eden komorbiditeleri
olan ve lokal flep seçenekleri kısıtlı olan olgularda ise çapraz bacak flebi dışında iyi bir alternatif bulak zordur. Distal anteromedial uyluk
flebi klasik tanımlanmış fleplerin dışında diz ve çevresi cilt defektlerinin rekonstrüksiyonu için iyi bir lokal alternatif flep seçeneği
sunmaktadır. Bu çalışmada komplike hastalarda diz bölgesi yumuşak doku defektlerinin distal anteromedial uyluk flebi ile
rekonstrüksiyon sonuçları sunulmuştur.
Materyal ve Metot: 2014-2019 yılları arasında diz ve diz çevresi cilt defektleri için opere ettiğimiz üç kadın üç erkek toplam altı hasta bu
çalışmaya dahil edildi. Bu hastaların dördü yaşlı ve eşlik eden çoklu ek hastalıkları mevcut iken iki hastada geçirilmiş kompartman
sendromu ve nekrotizan fasiite bağlı lokal flep seçenekleri kısıtlıydı.
Bulgular: Bir hasta hariç tüm hastalarımızda defektler başarılı bir şekilde kapatıldı. Yüzeysel marjinal nekroz gelişen hastamızda kalan
defekt sorunsuz şekilde greftlendi. Parsiyel %40 nekroz gelişen hastamızda patella üzeri defekt kapatılabilirken pretibial bölge üzeri
kapatılamadı ve çapraz bacak flebi planlandı.
Sonuç: Distal anteromedial uyluk perforatör flebi komplike hastalarda diz ve çevresi cilt defektlerinde kullanılabilecek güvenli bir
seçenektir. Patella altına ulaşan defektlerde delay yapılarak kullanılması venöz yetmezliği engellemek için uygun olabilir
Aim:In soft tissue reconstruction of the knee and its surrounding tissue, it is important to cover the exposed structures with sufficient soft tissue and to protect the knee function. In elderly ...patients with multiple comorbidities and in patients with limited local flap options, it is difficult to find a good alternative except for the cross-leg flap. The distal anteromedial thigh flap provides a good local alternative flap option for the reconstruction of knee and peripatellar skin defects other than classical defined flaps. In this study, reconstruction results of complicated soft tissue defects of knee region with distal anteromedial thigh flap are presented.Materials and Methods:Six patients (three females, three males) who were operated for knee and peripatellar skin defects between 2014-2019 were included in this study. Four of these patients were elderly and had multiple comorbidities, whereas two patients had limited local flap options due to previous compartment syndrome and necrotizing fasciitis.Results:The defects were successfully closed in all patients except one. In one of our patient who developed superficial marginal necrosis, the remaining defect was grafted successfully. The other patient who developed partial 40% necrosis, the patellar defect was closed but the pretibial region could not be closed and a cross leg flap was planned.Conclusion:Distal anteromedial thigh perforator flap is a safe option for reconstruction of knee and peripatellar skin defects in complicated cases. It may be appropriate to use the delayed flap for the defects of infrapatellar region to prevent venous insufficiency.
Aim. The classic inguinal lymph node dissection is the main step for the regional control of the lower extremity melanoma, but this surgical procedure is associated with significant postoperative ...morbidity. The permanent lymphedema is the most devastating long-term complication leading to a significant decrease in the patient’s quality of life. In this study we present our experience with modified, saphenous vein sparing, inguinal lymph node dissections for patients with melanoma of the lower extremity. Methods. Twenty one patients (10 women, 11 men) who underwent saphenous vein sparing superficial inguinal lymph node dissection for the melanoma of lower extremity were included in this study. The effects of saphenous vein sparing on postoperative complications were evaluated. Results. We have observed the decreased rate of long-term lymphedema in patients undergoing inguinal lymphadenectomy for the lower extremity melanoma. Conclusion. The inguinal lymphadenectomy with saphenous vein preservation in lower extremity melanoma patients seems to be an oncologically safe procedure and it may offer reduced long-term morbidity.
Aim: Spindle cell lipoma is a rare tumor. Although located subcutaneously, they are localized in the posterior neck, shoulder, and lumbar regions. It can radiologically mimic liposarcoma. It is ...important to differentiate spindle cell lipoma from atypical lipomatous tumors. In this study, we aimed to present our studies on our patients with spindle cell lipoma with histopathological and clinical findings and give brief information about the differential diagnosis of this rare lipomatous lesion. Material and Methods: A total of 29 patients (27 male, 2 female) who underwent surgical treatment for spindle cell lipoma between January 2015 and December 2020 were included in this retrospective study. All patients were presented with mass lesions, and preoperative biopsy was performed in cases with low-fat content mass lesions. Results: The mean age of the patients was 57.0±14.6 (range, 25-79) years and the mean follow-up period was 25.0±8.6 (range, 6-47) months. No additional disease was detected in the patients. Marginal resection was preferred in 5 (17.2%) patients with lesions close to neurovascular structures. Wide resection was performed in the other 24 (82.8%) patients. CD34 was positive in all lesions. In one patient, CDK4 was positive, and the diagnosis was made as atypical spindle cell lipoma. At the last follow-up, there was no complication and recurrence in any of the cases. Conclusion: Spindle cell lipomas should be regarded in the differential diagnosis of lipomatous tumors. Local excision with negative margins may prevent a recurrence. Correct histopathologic differentiation from liposarcoma is of paramount importance for appropriate treatment.
Aim: Although most defects can close by primary suturing after radical surgery of gynecological malignancies, different reconstruction options are available when large defects that require ...reconstruction occur. In this study, we present the treatment strategy and results for patients who underwent reconstruction after resection for gynecological cancer in the vulva and perineum. Material and Methods: A total of 18 patients who underwent reconstruction between May 2018 and July 2020 were included in this retrospective study. Demographics and clinical data, the resection operation, characteristics of the defect, and the reconstruction methods applied were evaluated. Postoperative treatment strategy and complication rates were evaluated. Results: The mean age was 62.3±13.2 (42-83) years. 88.9% of the patients had additional diseases. Pelvic exentration was performed in 5 (27.8%) patients, anterior resection in 2 (11.1%) patients and vulvectomy in 11 (61.1%) patients. The most common malignancy was squamous cell carcinoma, and mean defect size was 106±97 (12-476) cm2. Reconstruction was performed with a local fasciocutaneous flap in 16 (88.9%) patients, pedicled rectus myocutaneous flap in one (5.6%) patient, and skin graft in one (5.6%) patient. Wound complications occurred in 5 (27.8%) patients, partial flap necrosis in one (5.6%) patient, and recurrence in one (5.6%) patient in the long term. Conclusion: It is possible to reconstruction most of the vulva and perineal defects with local flaps after oncological resections, Considering the characteristics of the area and patient comorbidities, it should be kept in mind that prolonged wound problems may be seen, especially in vulvectomy patients.
Amaç: Nicolau sendromu (NS), bazı ilaçların enjeksiyonlarını takiben gelişen ve yaklaşık bir perforazomu kaplayan boyutlara ulaşan yumuşak doku ve ciltte nekroz gelişmesi durumudur. Bu çalışmada ...klinikte sık karşılaşılmayan diklofenak sodyum enjeksiyonu sonrası gelişmiş bu nadir patolojiye yönelik klinik yaklaşımımız ve tedavi alternatiflerinin sunulması amaçlanmıştır. Gereç ve Yöntemler: Bu geriye dönük çalışmada diklofenak sodyum enjeksiyonu sonrası enjeksiyon yerinde NS gelişen 16 hastaya yaklaşımımız değerlendirildi. Hastaların demografik verileri, eşlik eden hastalıkları, nekrozun yerleşimi ve boyutları ve cerrahi teknikler tarandı. Postoperatif komplikasyonlar, hastanede kalış süresi ve sonuçlar değerlendirildi. Bulgular: Toplam 16 hasta mevcut olup bunların 14'ü kadın 2'si erkek idi. Ortalama yaş 60±14,4 yıl ve ortalama vücut kitle indeksi (VKİ) 33±1,4 kg/m2 idi. En sık eşlik eden hastalık diyabetes mellitus, daha sonra primer hipertansiyon olarak gözlendi. Ortalama nekroz boyutu 8x8x5 cm olarak saptandı. Tüm 16 nekroza da cerrahi debridman uygulandı. Nekrozun cerrahi debridmanı sonrası 8 hastanın defekti primer kapatılırken 6 hastada fasyokutan flep yapıldı ve 2 hasta ise bir hafta sonra gecikmiş primer olarak onarıldı. Hastaların tümü sorunsuz olarak tamamen iyileşti. Sonuç: Yüksek VKİ, diyabetes mellitus ve primer hipertansiyon gibi komorbid özellikler taşıyan hastalara diklofenak sodyum enjeksiyonu yapılırken çok dikkatli olunmalıdır. İşlem sırasında, iğnenin kas tabakasına kadar ulaştığından ve perforatör bir damara denk gelmediğinden emin olunmalıdır. Enjeksiyon sonrası nekroz gelişmesi durumunda erken dönemde cerrahi debridmanı takiben rekonstrüksiyon etkili bir tedavidir.
Amaç: Jinekomasti erkeklerde görülen iyi huylu meme büyümesidir. Cerrahi tedavi seçenekleri arasında liposakşın, glandüler eksizyon ve liposakşın ve glandüler eksizyon kombinasyonu yer almaktadır. Bu ...çalışmada farklı teknikler kullanılarak ameliyat edilen ardışık 65 jinekomasti hastasının değerlendirilmesi, tedavi yaklaşımının ve cerrahi tekniklerle ilgili sonuçların ve komplikasyonların sunulması amaçlanmıştır.Gereç ve Yöntemler: Bu çalışmaya Haziran 2016 ve Ocak 2019 arasında kliniğimizde jinekomasti ameliyatı yapılan 65 hasta dahil edildi. Demografik veriler, preoperatif ve postoperatif fotoğraflar, klinik sınıflandırma, perioperatif detaylar, postoperatif sonuçlar ve komplikasyonlar retrospektif olarak değerlendirildi.Bulgular: Elli beş (%84,6) hastada iki taraflı jinekomasti ve 10 hastada (%15,3) tek taraflı jinekomasti vardı. Simon sınıflamasına göre, ameliyat edilen toplam 120 memenin 91 (%75,8)’i Evre II, 20 (%16,7)’si Evre III ve 9 (%7,5)’u Evre I idi. Yirmi sekiz (%43,1) hastaya liposakşın ve glandüler eksizyon uygulandı, 35 (%53,8) hastaya sadece liposakşın yapıldı ve 2 (%3,1) hastaya sadece glandüler eksizyon uygulandı. İlk ameliyatta iki hastaya deri eksizyonu yapıldı. Biri yetersiz küçültme ve diğeri ciltte fazlalığı için olmak üzere sadece iki hasta revizyon cerrahisi talep etti.Sonuç: Jinekomasti hastalarında meme dokusunun klinik değerlendirilmesine ve cilt fazlalığı derecesine göre cerrahi tedavi seçeneği belirlenebilir. Genç hastalarda deri kalitesi iyi ise cilt fazlalığı olsa dahi cilt ekzisyonu ikinci bir seansa bırakılabilir. Bu çalışmada kullanılan yöntemler arasında anlamlı bir fark olmamasına rağmen, eksizyonel teknikte daha fazla sayıda komplikasyon görülmüştür.
Aim: Spindle cell lipoma is a rare tumor. Although located subcutaneously, they are localized in the posterior neck, shoulder, and lumbar regions. It can radiologically mimic liposarcoma. It is ...important to differentiate spindle cell lipoma from atypical lipomatous tumors. In this study, we aimed to present our studies on our patients with spindle cell lipoma with histopathological and clinical findings and give brief information about the differential diagnosis of this rare lipomatous lesion.
Material and Methods: A total of 29 patients (27 male, 2 female) who underwent surgical treatment for spindle cell lipoma between January 2015 and December 2020 were included in this retrospective study. All patients were presented with mass lesions, and preoperative biopsy was performed in cases with low-fat content mass lesions.
Results: The mean age of the patients was 57.0±14.6 (range, 25-79) years and the mean follow-up period was 25.0±8.6 (range, 6-47) months. No additional disease was detected in the patients. Marginal resection was preferred in 5 (17.2%) patients with lesions close to neurovascular structures. Wide resection was performed in the other 24 (82.8%) patients. CD34 was positive in all lesions. In one patient, CDK4 was positive, and the diagnosis was made as atypical spindle cell lipoma. At the last follow-up, there was no complication and recurrence in any of the cases.
Conclusion: Spindle cell lipomas should be regarded in the differential diagnosis of lipomatous tumors. Local excision with negative margins may prevent a recurrence. Correct histopathologic differentiation from liposarcoma is of paramount importance for appropriate treatment.
Amaç: İğsi hücreli lipom nadir görülen bir tümördür. Cilt altı yerleşimli olmakla birlikte arka boyun, omuz ve bel bölgesinde de yerleşim göstermektedirler. Radyolojik olarak liposarkomu taklit edebilmektedir. İğsi hücreli lipomanın atipik lipomatöz tümörlerden ayırımı önemlidir. Bu çalışmada, histopatolojik ve klinik bulguları olan iğsi hücreli lipomlu hastalarımıza ilişkin çalışmalarımızı sunmayı ve bu nadir gözlenen lipomatöz lezyonun ayırıcı tanıları hakkında kısaca bilgi vermeyi amaçladık.
Gereç ve Yöntemler: Bu geriye dönük çalışmaya Ocak 2015 ve Aralık 2020 tarihleri arasında iğsi hücreli lipom nedeniyle cerrahi tedavi uygulanmış olan toplam 29 hasta (27 erkek, 2 kadın) dahil edildi. Tüm hastalar kitle lezyonu ile başvurdular ve düşük yağ içerikli kitle lezyonu olan olgularda ameliyat öncesi biyopsi uygulandı.
Bulgular: Hastaların ortalama yaşı 57,0±14,6 (aralık, 25-79) yıl ve ortalama takip süresi ise 25,0±8,6 (aralık, 6-47) ay idi. Hastalarda başka herhangi bir ek hastalık saptanmadı. Nörovasküler yapılara yakın lezyonu olan 5 (%17,2) hastada marjinal rezeksiyon tercih edildi. Diğer 24 (%82,8) hastaya ise geniş rezeksiyon uygulandı. CD34 tüm lezyonlarda pozitifti. Bir hastada CDK4 pozitifti ve bu hastaya atipik iğsi hücreli lipom tanısı konuldu. Son kontrollerinde hiçbir vakada komplikasyon veya nüks saptanmadı.
Sonuç: Lipomatöz tümörlerin ayırıcı tanısında iğsi hücreli lipomlar düşünülmelidir. Negatif sınırlar ile lokal eksizyon nüksü önleyebilir. Uygun tedavi için liposarkomdan doğru histopatolojik ayrım oldukça önemlidir.
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