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    Application of Mechanical Negative Pressure Drainage (Cupping Method) for Venous Compromise in Flap Surgery
    (Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi, 07.10.2024) İsmayılzade, Majid; Dadaci, Mehmet; Kendir, Münür Selçuk; Nurşen, Hayri Ahmet Burak
    ABSTRACT Background: Venous insufficiency after flap surgery is an unpredictable complication that can lead to flap loss. Several approaches have been described to eliminate the venous problems after flap surgery, but it still remains unsolved. In this study, we aimed to demonstrate the application of the cupping method to treat the venous compromise in the flaps. Patients and Methods: Patients with flaps undergoing mechanical negative pressure drainage due to venous compromise were included in the study. Only procedures with pedicled island flaps were included to exclude cases of venous insufficiency due to thrombosis or anastomotic problems. Patients with free flaps, perforator flaps and skin-connected flaps were also excluded. Demographic data (age, sex), mean duration and frequency of application, complications were recorded. Results: Eight patients were included in the study with a mean age of 40.3 years. A parascapular flap was performed in four patients, a transverse rectus abdominis flap in three patients and a medial gastrocnemius musculocutaneous flap in one patient. The mean duration of mechanical negative pressure drainage was 2.8 days and the mean frequency of application was 4.6 times per day. The mean duration of the procedure was 2.25 minutes. Two patients underwent revision surgery on postoperative day 5 under local anaesthesia due to marginal necrosis of the flap. There were no complications in the other patients. Conclusion: Compared to other approaches described in the literature, the cupping method may provide a more practical and faster solution for venous congestion. Although the limited number of patients seems to be a limitation of the study, the main priority of the study was to demonstrate the applicability of the method. A large population study with a controlled randomised methodology will make a positive contribution to the literature.
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    Effect of vascularized jejunal conduit flap on peripheral nerve regeneration in rats
    (TÜBİTAK, 23.10.2024) İsmayılzade, Majid; İnce, Bilsev; Oltulu, Pembe; Baycar, Zikrullah; Kendir, Münür Selçuk; Dadaci, Mehmet
    Background/aim: In the literature, almost all of the nerve conduits proposed for obtaining better nerve recovery were applied as graft materials. In this study, we aimed to propose a new nerve conduit model with a flap pattern and evaluate the effect of a pedicled vascularized jejunal flap on nerve regeneration after wrapping it around a sciatic nerve. Materials and methods: A total of 90 Wistar albino rats were randomly divided into nine groups with 10 rats in each. The first three groups constituted the control groups, whereas Groups 4–6 were the jejunum conduit (JC)-applied groups. A mucosa-resected JC (MRJC) was applied in Groups 7 and 8. Epineurial neurorrhaphy was performed in Groups 1, 4, and 7; repair with a nerve graft was applied in Groups 2, 5, and 8; and a 1-cm-long nerve defect was created in Groups 3, 6, and 9. After 2 months of follow-up, nerve regeneration was assessed by statistical analyses of the Sciatic Functional Index (SFI) and histopathological evaluation. Results: The MRJC groups had significantly better results in terms of SFI (p = 0.005). Statistical differences in axonal degeneration, axonal density, myelination, and disorganization were found between all control groups and MRJC groups (p = 0.022, p = 0.001, p = 0.001, and p = 0.039, respectively). Conclusion: In this study, the feasibility of wrapping around the nerve repair zones of pedicled autologous flaps designed in a tubular fashion was observed in a small rat model. The findings must be further validated with larger animals before clinical testing.
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    Evaluation of the effects of ectopic replantation on amputate survival in the management of crush traumatic amputations in rats: An experimental study
    (Turkish Association of Trauma and Emergency Surgery, 2024) Kendir, Münür Selçuk; İnce, Bilsev; İsmayılzade, Majid; Baycar, Zikrullah; Nurşen, Hayri Ahmet Burak; Dadacı, Mehmet
    BACKGROUND: This controlled experimental study aimed to compare ectopic replantation with other replantation techniques in a rat model of crush amputations. It also assessed the impact of different replantation methods on the viability of amputates. METHODS: Forty male Wistar albino rats were divided into four groups. Groin flaps served as the amputation model. Group 1 underwent guillotine-style amputation followed by orthotopic replantation, Group 2 experienced crush-type amputation and orthotopic replantation, Group 3 had crush-type amputation and orthotopic replantation with a vein graft, and Group 4 underwent crush-type amputation followed by ectopic replantation. Flap viability and perfusion rates were assessed on day 3 using an infrared perfusion assessment system. The ratio of viable area to total flap area and thrombus formation in the pedicle vessels were evaluated on day 7. RESULTS: Infrared evaluations on day 3 post-replantation revealed flap perfusion percentages of 73.5% in Group 1, 11.1% in Group 2, 65% in Group 3, and 64.1% in Group 4. Statistical analysis indicated that Group 1 exhibited the highest perfusion rates, while Group 2 showed the lowest. No differences were observed between Groups 3 and 4. On the seventh day, the average surviving flap areas were found to be 74.6% in Group 1, 2.5% in Group 2, 64.5% in Group 3, and 64% in Group 4. Statistically, Group 1 exhibited the best outcomes, while Group 2 had the poorest, with no differences between Groups 3 and 4. Additionally, thrombus formation was observed in the vessels of two animals in Group 1, nine in Group 2, and three each in Groups 3 and 4. Significant statistical differences were noted among the groups. CONCLUSION: The results indicate that ectopic replantation and replantation with a vein graft are equally effective. The preferred method for crush-type replantations may depend on the patient’s and the amputated limb’s conditions. In crush-type amputations, we recommend vein graft repair if the patient’s overall condition supports replantation and if crushed segments can be debrided without excessive shortening of the amputated part. If these conditions are not met, temporary ectopic replantation is advised to preserve the amputated limb. © 2024, Turkish Association of Trauma and Emergency Surgery. All rights reserved.