Carcinomas with the Appearance of Chronic Wounds

Amaç Kutanöz maligniteler sıklıkla travmatize, degeneratif ve kronik inflame cilt veya skar dokusundan gelişir. Yapılan incelemelerde kutanöz malignitelerin sıklıkla yanık skarları (Marjolin ülser), venöz ülserler, bası yaraları, sistostomi alanları, kronik pilonidal sinüs, hidradenitis süpürativa, lupus skarları, kronik lenfödem, travmatik yaralar, kronik osteomiyelit alanlarında geliştiği gösterilmiştir. Bu çalışmamızda kronik yara görünümü nedeniyle yara bakımı tedavisi almasına rağmen iyileşme göstermeyen, biyopsi sonucunda malignite tespit edilen hastalarda ayırıcı tanı ve uygulanan tedavi yaklaşımlarımız sunulmaktadır. Materyal ve Metot 2008-2012 yılları arasında kliniğimize kronik yara nedeniyle başvurup biyopsi sonucu karsinom çıkan beş hasta çalışmaya alındı. Hastalar daha önce aldıkları tedavi, patolojik tanıları, predispozan faktörler, malign dejenerasyon süresi, rekonstrüksiyon teknikleri, komplikasyon ve nüks açısından retrospektif incelendi. Bulgular: Patolojik inceleme sonucunda 3 hastada verrüköz karsinom, 2 hastada skuamoz hücreli karsinom belirlendi. Malign dejenerasyon süresi ortalama 8 yıl (5- 12) idi. Sonuç Ciltteki kronik irritasyonun veya yumuşak dokunun farklı büyüme faktörlerine maruz kalmasının, aynı zamanda inflamasyona bağlı olarak bu bölgede ortaya çıkan sitotoksik faktörlerin malign transformasyonda önemli rol oynadığı düşünülmektedir Kronik yaralı hastalarda karsinom gelişimini engellemede, iyi yara bakımı, travmadan kaçınmak, iyileşmeyen ülserlerden biyopsi alarak erken tanı konulması önemlidir. En yaygın rastlanan histolojik tümör tipi squamoz hücreli karsinomdur. Uzun süreli iyileşmeyen açık yarası olan ve risk faktörleri bulunan hastalarda kutanöz malignite gelişebileceği akılda tutulmalıdır.Aim Cutaneous malignancies often develop in traumatized, degenerative, and chronically inflamed skin or scar tissues. The observations indicated that cutaneous malignancies often arise in burn scars (Marjolin's ulcer), venous ulcers, compression wounds, cystostomy sites, chronic pilonidal sinus, hidradenitis suppurativa, lupus scars, chronic lymphedema, traumatic wounds, and sites of chronic osteomyelitis. The current study presents a differential diagnosis and treatment approach in patients who received wound care and treatment due to the presence of chronic wounds and in whom biopsy revealed malignancy. Material and Methods Five patients who presented to the clinic due to chronic wounds between 2008 and 2012 and in whom biopsy revealed carcinomas were included in the study. The patients were retrospectively reviewed in terms of previously administered therapies, pathological diagnosis, predisposing factors, time to malignant degeneration, reconstruction techniques, complications, and recurrence. Results The pathological examination revealed verrucous carcinoma in three patients and squamous cell carcinoma in two patients. The mean of malignant degeneration time was 8 years (5- 12). Conclusion Chronic skin irritation and exposure of the soft tissues to different growth factors, and cytotoxic factors arising due to inflammation are thought to play an important role in malignant transformation. Providing good wound care, avoiding traumas, and obtaining biopsy from non-healing wounds to establish early diagnosis are very important in patients with chronic wounds. Squamous cell carcinoma was the most commonly encountered histological tumor type. Moreover, it must also be remembered that cutaneous malignancies can develop in patients with sustained open wounds and risk factors

Use of a Pedinculated Groin Flap in Penile Reconstruction Secondary to Fournier Gangrene: A Case Report

Fournier gangrene is a progressive clinical picture of necrotizing fasciitis with a high rate of morbidity and mortality, involving external genital organs and the perineal region, and may rapidly spread to other areas such as the abdomen, lower extremities and chest. It is a polymicrobial infection caused most frequently by aerobic and anaerobic bacteria. Treatment is achieved through the removal of dead tissues by serial debridement and broad spectrum parenteral antibiotic administration. In this case report, we present a successful penis reconstruction achieved by pedicled inguinal flap and urethra reconstruction in a patient with approximately 6x3 cm wide full-thickness skin and urethra defect secondary to Fournier gangrene.

Use of a Pedinculated Groin Flap in Penile Reconstruction Secondary to Fournier Gangrene: A Case Report

Fournier gangreni, eksternal geni¬tal organları ve perineal bölgeyi tutan, hızla ilerleyerek karın, alt ekstremitelere ve göğüs bölgesine de yayılabi¬len, yüksek morbidite ve mortalite ile seyreden ilerleyici nekrotizan fasiit tablosudur. Sıklıkla aerob ve anaerob bakteriler tarafından oluşturulan polimikrobiyal bir enfeksiyondur. Tedavide ölü dokuların seri debridmanlarla uzaklaştırılması ve geniş spektrumlu parenteral antibiyotik uygulaması yer almaktadır. Bu olgu sunumunda Fournier gangreni nedeni ile penis sirkumferensiyel subglanüler alanda yaklaşık 6x3 cm’lik tam kat deri ve üretra defekti bulunan hastaya pediküllü kasık flebi ve üretra rekonstrüksiyonu ile sağlanan başarılı penis rekonstrüksiyonu sunulacaktır.Fournier gangrene is a progressive clinical picture of necrotizing fasciitis with a high rate of morbidity and mortality, involving external genital organs and the perineal region, and may rapidly spread to other areas such as the abdomen, lower extremities and chest. It is a polymicrobial infection caused most frequently by aerobic and anaerobic bacteria. Treatment is achieved through the removal of dead tissues by serial debridement and broad spectrum parenteral antibiotic administration. In this case report, we present a successful penis reconstruction achieved by pedicled inguinal flap and urethra reconstruction in a patient with approximately 6x3 cm wide full-thickness skin and urethra defect secondary to Fournier gangrene

Complicated Diagnosis; Glomus Tumor of Finger

AimTo evaluate the clinical properties and treatment results of patients with glomus tumor which is one of the rare tumors of the hand originating from the neuromyoarterial glomus body.Materials and MethodsBetween years 2012-2014, a total of 9 patients (6 women and 3 men) diagnosed with glomus tumor of the hand were included in this retrospective study. Age, sex, localization of the lesion, symptoms and the initiation time of the symptoms, time of first clinical evaluation and diagnosis, radiological imaging methods, the treatment applied, pathological diagnosis, follow-up results and the presence of complications were evaluated for each patient.ResultsThe mean age of the patients were 39.6 years. Glomus tumor was observed to be subungual in all patients. Two of the lesions were in the thumb, 3 were in the index finger, 3 were in the middle finger, and 1 was in the fourth finger. The common complaint in all patients was pain in the finger and the nail and tenderness. Cold intolerance was prominent in 4 patients. There was blue discoloration in 2 patients and protuberance and deformation of the nail was observed in 3 patients. The average time between the initiation of the symptoms and the diagnosis was 10.7 months. No erosion in the bony segment of the distal phalanx was present in plain radiography except 1 patient. The masses were observed in the Magnetic Resonance imaging. In 8 of the 9 patients the diagnosis was made clinically and radiologically, and only one patient was diagnosed clinically. All patients received surgical treatment. No recurrence was observed in the 12 month follow-up period. Minimal nail deformities were observed in 4 patients postoperatively.ConclusionIn cases of severe pain localized in the finger, especially fingertip, of unknown cause, glomus tumor should be suspected as a prediagnosis. MRI is the most important step in the diagnosis of the mass

Temel Mikrocerrahi Uygulamaları

KitapMikrocerrahi uygulamaları için temel kabul edilebilinecek mikroskop kullanımı, cerrahi aletlerin bakım ve kullanımı, arter, ven ve sinir onarımları yanısıra ven greftiyle onarım, uç-yan anatamoz gibi ileri mikrocerrahi tekniklerinin de anlatımını bulacaksınız. Temel mikrocerrahi tekniklerini adım adım anlatırken mikrocerrahi uygulamalarında yaptığımız, mikrocerrahiyle yeni tanışan meslektaşlarımızın da faydalanabileceğini düşündüğümüz farklı tekniklerimizi de göstermeye çalıştık. Tabii ki mikrocerrahi yazdıklarımız kadar kısa ve basit değil ancak temeli özümsemek adına bu kitabın meslektaşlarımıza faydalı olacağını düşünüyoruz

Extensor mechanism variation of the index finger

WOS:000377227900022PubMed ID: 27130399The extensor indicis proprius (EIP) tendon and extensor digitorum communis (EDC) tendons are the main extensor tendons of the second finger. Different variations of extensor tendons are frequently reported. In our report, we describe a variation of the index finger extensor mechanism in a healthy subject

Comparison between knot and Winograd techniques on ingrown nail treatment

Objective: The aim of this study was to compare the Winograd and knot techniques based on efficiency, complication rate, surgery time, and amount of local anesthetic required. This study also aimed to determine the etiology of ingrown nails, whether due to involvement of the nail or soft tissue.Methods: Seventy-five patients with a total of 90 ingrown nails (stages 2 and 3) who presented at our clinic between 2012-2014 were included in this study. Patients were divided into 2 groups: those treated with the knot technique and those treated with the Winograd technique. Patients in both groups were evaluated for the amount of local anesthetic required, intraoperative pain, effectiveness of preventing/stopping hemorrhage, surgery time, complications, postoperative nail size, recurrence, nail deformities, and secondary surgery rates.Results: The mean surgical time, relapse rate, number of additional surgeries required, and amount of local anesthetic were significantly greater in the Winograd group than in the knot group. The mean nail diameter was significantly decreased, with a mean of 3 mm in the Winograd group. No statistically significant differences were found between the groups in the incidence of infection, intraoperative pain, hematoma, or nail deformity.Conclusion: This study demonstrated that the knot technique, consisting of wedge excision of soft tissue without affecting the nail itself, is a simple technique to treat ingrown nails with a lower complication rate and shorter surgical time. We believe that successful treatment of ingrown nails depends only on excision of soft tissue, with no need to operate on the nail be

A Salvage Operation for Total Penis Amputation Due to Circumcision

Circumcision is one of the most common rituals in Jewish and Islamic cultures. It may also be performed for phimosis correction or the treatment of recurrent balanitis. Although circumcision is considered to be a technically easy and safe surgical procedure with no significant risk, it may lead to severe complications such as necrotizing fasciitis or total penis amputation. In this report, we present a case of penis amputation at two levels occurring with third-degree burns due to electrocautery during circumcision. Although penile replantation was attempted, it was unsuccessful due to burn damage to the veins. After restoration of the functional structures, the penis was buried in the inguinal area by reepithelization to maintain blood circulation. The recovery of the penis was successful. This case is presented as a novel example of groin flap surgery to achieve a functionally and aesthetically acceptable outcome in a salvage operation for a penis with significant traumatic injury, which has not been previously reported in the literature