Tavşan kulak kıkırdağında distraksiyon kondroneogenezisi

Kemik dokudaki defektin onarımı için yapılan kemik grefti ya da flebi ameliyatlarına alternatif olarak uygulanan distraksiyon yöntemi ile yeni bir donör alan kullanılmadan kemik hem enine hem boyuna uzatılabilmektedir. Ameliyat süresi kısalmakta ve greft/flep kaybı korkusu olmaksızın ameliyat başarısızlık oranı düşmektedir. Oysa kıkırdak defekti onarımında greft ya da flep uygulamasına alternatif olarak yeni kıkırdak oluşturacak bir distraksiyon yöntemi bilinmemektedir. Distraksiyon yöntemi ile kondroneogenezis oluşturup oluşturulamayacağını araştırmak amacıyla bu deneysel çalışma planlanmıştır. Bu çalışmada toplam 14 adet Yeni Zelanda tavşanı kullanıldı. Önce, karşılaştırma yapabilmek amacıyla 4 adet tavşanda 1 cm eninde kulak kıkırdak segmenti çıkarılıp iyileşmeye bırakılarak yeni kıkırdak oluşup oluşmadığı ve iyileşmenin kalitesi belirlendi. Daha sonra, kıkırdakta ideal distraksiyon hızını belirlemek için bir pilot çalışma planlandı. Ardışık 3 adet tavşanda 0,50 mm/gün, 0,25 mm/gün ve günaşırı 0,25 mm’lik distraksiyonlar yapıldı ve ideal distraksiyon hızının iki günde bir kez 0,25 mm olmasına karar verildi. Distraksiyon grubunda ise, 7 adet tavşan kullanılarak bunların bir kulaklarında yapılan kondrotomiyi takiben eksternal distraktör yerleştirildi. İki ay boyunca gün aşırı 0,25 mm distraksiyon uygulandı ve toplam 7,5 mm yeni kıkırdak oluşması planlandı. İki ay sonunda distraksiyon vektörüne paralel alınan kesitlerde yeni kondrosit oluşup oluşmadığı incelendi. Kıkırdak segmenti çıkarılan 4 adet hayvandan alınan örneklerin histopatolojik incelemesinde kıkırdak iyileşmesinin yetersiz olduğu saptandı. Günlük (0,50 mm/gün ve 0,25 mm/gün) distraksiyon yapılan hayvanlardan alınan örneklerde, yer yer kondrosit kümelerinin oluştuğu, ancak yeterli ve düzenli kondrosit oluşumunun gerçekleşmediği ve fibröz doku ile iyileşme olduğu görüldü. Bunun üzerine distraksiyonun hızlı olduğuna karar verildi. iii Günaşırı 0,25 mm hızda distraksiyon yapılan hayvanlarda ise distraksiyon alanında düzenli yeni kıkırdak dokusu oluşumu izlendi. Bu deneysel çalışmada elde edilen bulgulara göre, avasküler kıkırdak dokusunun metabolizmasının yavaş olması, distraksiyon hızını ve ritmini etkilemektedir. Ancak distraksiyon yöntemiyle, perikondriumun rejenerasyon kapasitesinden de faydalanılarak, yeni ve düzenli kondrosit oluşturmak ve kıkırdağı uzatabilmek mümkündür. ANAHTAR SÖZCÜKLER: Kıkırdak, distraksiyon, tavşan. ABSTRACT The bone can be lengthened transversally and longitudinally with the help of distraction technique, without a necessity of an extra donor area. Beside this, distraction osteogenesis shortens the operative time and operation failure rates decarases withouth fear of the graft or flap failure. However, producing new cartilage cells with distraction method is unknown instead of repairing it with a cartilage graft or flap for the cartilage defects. This experimental study is planned the purpose of whether chondroneoenesis is created or not with the distraction method. Forteen New Zealand rabbits of similar age were used in this study. First, to compere, cartilage segments were removed 1 cm in width on 4 rabbits to observe if any new cartilage formation occurs or not and to examin the quality of the new cartilage. Then, to determine the ideal distraction rate, a pilot study was planned. On sequenced 3 rabbits, distractions were planned as 0,50 mm/day, 0,25 mm/day and 0,25 mm/every other day, and 0,25 mm/every other day was decided for the ideal distraction rate. In the distraction group, 7 rabbits were used, after the chondrotomy external distracters were placed. Distraction was perforemed 0,25 mm/every other day for two months and 7,5 mm new cartilage creation in length was aimed. At the end of the two months, sections were taken parallel to the distraction vector and examined whether any new chondrocytes developed or not. Histological examination of the cartilage-excision samples revealed inadequate cartilage healing. Histopathological examination of the daily distractions (0,50 mm/day, 0,25 mm/day) were showed healing with fibrous tissue, cartilage defects were composed of chondrocyte clusters however there was no regular chondrocyte formation through the distraction vector. Through these findings, disicion was made that distraction rate was rapid. Regular new cartilage tissue was formed in the 0,25 mm/every other day group. v Based upon these findings, slow metabolism of the avascular cartilage affects the rate and the rhythm of distraction. However, taking the advantage of the perichondrium, creating new and regular chondrocyte formation (chondroneogenesis) and extending the cartilage is possible with a distraction method. KEY WORDS: Cartilage, distraction, rabbit

Duplication of the mandible in Klippel-Feil syndrome

The duplication of the mandible is an extremely rare case, which was first described by McLaughlin in 1948 as a case report of duplication of the mouth, the tongue and the mandible. Betty in 1956 and Davies in 1973 reported similar cases. The duplication of the mandible may be associated with the Klippel-Feil syndrome (KFS). A low hairline, short neck with cervical vertebral fusion and painless limitation of the head movement are the characteristic findings of this syndrome. The incidence of the syndrome varies from 1/30,000 to 1/40,000. Although autosomal recessive inheritance was suggested, no familial inheritance was found in some cases. A very rare case of mandibular duplication in association with KFS, whose duplicated mass was removed following distraction, has been reported. (C) 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved

Management of palatal fistulas and a simple surgical algorithm proposal

Objectives: Despite improved techniques in repair of cleft palate, failure of healing of palatal structures resulting in a palatal fistula is one of the major challenges in the practice of reconstructive surgery. The aim of this study is to evaluate treatment success and failure in patients with palatal fistulas following cleft palate repair. Patients and Methods: Totally 44 patients with a history of cleft palate who underwent surgery for palatal fistula were included in this study undertaken between January 1999 and August 2014. Fistulas were classified as anterior and posterior according to the repair technique and were repaired using one of the following techniques: buccal mucosal flap, tongue flap or mucoperiosteal flap. Results: Success rate for anterior fistulas was 71.42% with tongue flap and 76.92% with mucoperiosteal flap. Success rate for posterior fistulas was 84.62% with mucoperiosteal flap and 75% with buccal mucosal flap. Difference in success rates between the anterior and posterior fistulas was not statistically significant. Conclusion: Our study results suggest the use of mucoperiosteal flaps for both anterior and posterior fistulas smaller than 5mm as the first choice, guided by the principle of replacing absent tissue with similar tissue

Fat graft survival inside pocket for silicone implant

Objective: The aim of this study was to investigate the survival potential of the fat grafts inside the implant capsule in an experimental setting. Materials and Methods: Twenty male Wistar albino rats were used. A two-staged surgical procedure was performed. In the first stage, silicone sheets were placed in the subcutaneous plane on the left side of each rat. On day 60, fat grafts injected into the silicone capsule either by removing the silicone sheaths or leaving the silicone sheaths in their place. In both groups, the same amount of the fat grafts was injected into the right side of the dorsal subcutaneous plane of the rats and they served as their own controls. The findings were evaluated according to the histopathological criteria. Results: There was no statistically significant difference in the inflammatory cell infiltration, fibrosis, and necrotic adipocytes among the groups. Although, the fat viability rate was higher in control groups, there was no statistically significant difference compared to the capsule or silicone groups (p>0.05). Conclusion: Our study results suggest that implant capsule is a hospitable environment and resection of the capsule is unnecessary, if silicone implants are expected to be removed following fat injection

Analysis of Flow Changes to the Foot after Sacrifice of One of the Major Arteries

The objective of this Study was to find out whether a compensatory increase in blood flow to the foot is observed after sacrifice of one of the tibial arteries. Eleven patients who had one of the tibial arteries as the recipient artery of free tissue transfer to their lower extremities were included. The arterial diameter, cross-sectional area, maximum flow velocity, minimum flow velocity, and flow rate were measured by a Doppler ultrasound in the nonrecipient tibial artery and perforating peroneal artery in the operated limb. The same parameters were measured in the anterior and posterior tibial arteries and the perforating peroneal artery in the contralateral limb. The arterial diameter, cross-sectional area, flow velocity, and flow rate were increased significantly in the nonrecipient tibial artery of the operated limb with respect to the same artery on the contralateral limb. The same changes were not demonstrated in the perforating branch of the peroneal artery. Total blood flow to the foot in the operated extremity was not different from that of the nonoperated foot. The results reveal that if a major feeder to the foot is sacrificed, the other tibial artery compensates for it, and resting blood supply to the foot is not altered