Person: ŞİRİN, EVRİM
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ŞİRİN
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EVRİM
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Publication Open Access Surgeons Experience and Consistency to Determine Surgical Procedures for Hallux Valgus(2020) EROL, BÜLENT; Sirin, Evrim; Yılmaz, Barış; Ozdemir, Guzelali; Okay, Erhan; Bildik, Celaleddin; Ak, Dursun; Erol, Bulent; Muratlı, Hasan HilmiPublication Metadata only Mid-term results of osteoarticular reconstructions of paediatric periarticular bone sarcomas with free fibula head flap(2018-10-13) EROL, BÜLENT; ŞİRİN, EVRİM; AKGÜLLE, AHMET HAMDİ; EROL B., ŞİRİN E., AKGÜLLE A. H., İĞREK S., BAYKAN S. E., TETİK C.Publication Metadata only Reconstruction after periacetabular tumor resection with Lumic (R) endoprosthesis: What are the midterm results?(WILEY, 2021) EROL, BÜLENT; Erol, Bulent; Sofulu, Omer; Sirin, Evrim; Saglam, Fevzi; Buyuktopcu, OmerIntroduction This study aimed to analyze the midterm outcomes of LUMiC (R) endoprosthetic reconstruction following periacetabular resection of primary bone sarcomas and carcinoma metastases. Patients and Methods We retrospectively reviewed the charts of 21 patients (11 male [52.3%], 10 female [47.6%]; mean age 47 +/- 16 years) for whom a LUMiC (R) endoprosthesis (Implantcast) was used to reconstruct a periacetabular defect after internal hemipelvectomy. The tumor was pathologically diagnosed as Ewing's sarcoma in six (28.5%), chondrosarcoma in 10 (47.6%), and bone metastasis from carcinoma in five (23.8%) patients. Results The median follow-up of patients was 57.8 months (95% confidence interval: 51.9-63.7). The implant survival rate at 1, 2, and 5 years were 95.2%, 85.7%, and 80.9%, respectively. The overall complication rate was 33.3% (n = 7). Four (19%) complications resulted in reconstruction failure. Total reoperation rate was 28.5% (n = 6). The causes of failure were soft tissue failure/dislocation in two patients, aseptic loosening in one, infection in two, and local recurrence in two. At the time of study, seven patients were alive with no evidence of disease, seven were alive with disease, and seven died of disease. The 5-year overall survival rate and local recurrence-free survival rates were 67% and 76%, respectively. The median Musculoskeletal Tumor Society score at final follow-up was 70% (range: 50%-86.6%). Conclusion We conclude that LUMiC (R) endoprosthesis provides good functional outcomes and a durable reconstruct. Even though this reconstruction method presents some complications, it provides a stable pelvis in the management of periacetabular malignant tumors.Publication Open Access Indications of amputation after limb-salvage surgery of patients with extremity-located bone and soft-tissue sarcomas: A retrospective clinical study(TURKISH ASSOC ORTHOPAEDICS TRAUMATOLOGY, 2021-04-07) EROL, BÜLENT; Baysal, Ozgur; Saglam, Fevzi; Sofulu, Omer; Yigit, Okan; Sirin, Evrim; Erol, BulentObjective: This study aimed to investigate amputation-related factors after limb-salvage surgery (LSS) in patients with extremity-located bone and soft-tissue sarcomas and determine the relationship between these factors and patient survival. Methods: In this retrospective study at our institution, patients in whom LSS was first performed because of an extremity-located musculoskeletal sarcoma, and subsequently amputation was carried out for various indications were included. Patient and tumor characteristics, details of surgical procedures, indications of amputation, number of operations, presence of metastasis before amputation, and post-amputation patient survival rates were analyzed. Results: A total of 25 patients (10 men, 15 women; mean age=41.96 +/- 21.88 years), in whom amputation was performed after LSS as initial resection of an extremity sarcoma or re-resection(s) of a local recurrence, were included in the study. The leading oncological indication for amputation was local recurrence that occurred in 18 (72%) patients. Non-oncological indications included prosthetic infection in 5 (20%), mechanical failure in 1 (4%), and skin necrosis in 1 (4%) patient. The patients underwent a median of 2 (range, 1-4) limb-salvage procedures before amputation. Distant organ metastasis was detected in 22 (88%) patients during follow-up; in 13 (52%) of these patients, metastasis was present before amputation. A total of 11 (44%) patients were alive at the time of study with no evidence of the disease (n=3) or with disease (n=8), and 14 (56%) patients died of disease. The mean overall and post-amputation survival were 47 +/- 20.519 (range, 11-204) months and 22 +/- 4.303 (range, 2-78) months, respectively. The median follow-up was 27 (range, 6-125) months. Conclusion: The most common causes of amputation after LSS were local recurrence and prosthetic infection. Patients who underwent amputation after LSS developed a high rate of distant organ metastasis during follow-up and had reduced survival.Publication Metadata only Staged management of infection with adjustable spacers after megaprosthesis implantation in primary sarcoma patients(2023-03-01) ŞİRİN, EVRİM; AKGÜLLE, AHMET HAMDİ; EROL, BÜLENT; ŞİRİN E., Sofulu O., Baysal O., AKGÜLLE A. H., EROL B.BackgroundWhile periprosthetic joint infection has always been a significant concern for orthopaedic surgeons, the rate of infection is five to ten times higher after tumor prosthesis implantation. With the growing use of mega-implants, the number of these infections has also increased. We aimed to investigate the results of our patients with a primary malignant musculoskeletal tumor, who underwent two-stage revision surgery for an infected mega-prosthesis. We also presented the emerging complicatons and required soft tissue reconstruction procedures.MethodsThe study included 32 primary bone and soft tissue sarcoma patients who underwent a two-stage revision procedure for infection. After a rigorous bone and soft tissue debridement procedure at the first stage, antibiotic-loaded bone cement was wrapped around a cloverleaf type intramedullary nail and inserted into the forming gap. After a minimum of 6 weeks of antibiotic therapy, depending on patients\" clinical signs and serum infection markers, the reimplantation stage was undertaken.ResultsThe mean oncologic follow-up period was 28 months (range 5-96 months). During this period, 11 patients died because of non-infection related causes, 12 patients were alive with their disease, whereas 9 patients were totally free of their oncologic condition. The infection was eradicated in all survivors except one patient, where a high-level transfemoral amputation became necessary.ConclusionPeriprosthetic infection after tumor proshesis implantation in cancer patients can be managed with same principles as conventional arthroplaty procedures, taking care that they are immunocompromised and vulnerable patients and their bone stock loss is significant which makes surgical options more challenging.Publication Metadata only Tümör cerrahisi sonrası yara problemlerinin vakum tedavisi ile tedavisinde süreci etkileyen faktörler önceden tahmin edilebilir mi?(2020-11-08) ŞİRİN, EVRİM; EROL, BÜLENT; YİĞİT, OKAN; AKGÜLLE, AHMET HAMDİ; Baysal Ö., SAĞLAM F., AKGÜLLE A. H., Sofulu Ö., YİĞİT O., ŞİRİN E., EROL B.Amaç: Tümör cerrahisi sonrası yara problemi olan ve vakum tedavisi gören hastalardan bir kısmı birkaç seans negatif basınçlı vakum tedavisi (NBVT) ile iyileşirken, diğer kısmında ise 10 seans ve üzerinde NBVT tedavisine ihtiyaç duymuştur. Buna bağlı olarak literatürde saptanan risk faktörlerinden hangilerinin daha uzun süreli NBVT tedavisiyle ilişkili olduğunu araştırmaktır. Yöntem: Çalışmamız hastanemiz etik kurul onayı (09.2019.585) alındıktan sonra retrospektif olarak yapıldı. Kliniğimizde 2012-2018 yılları arasında kemik veya yumuşak doku sarkomu nedeniyle opere olan, postoperatif lokal yara problemleri gelişmiş, NBVT uygulanmış ve en az 6 aylık takibe sahip hastalar çalışmaya dahil edildi. Hastaların demografik özellikleri, komorbidite durumu, nutrisyonel durumu (albumin değeri), patolojik tanısı, patolojik tümör volümü, kitlenin grade’ı, kitlenin cildi infiltre edip etmediği, implant ya da megaprotez uygulanıp- uygulanmadığı, cilt kapama yöntemi (primer, cilt grefti, rotasyonel flap, serbest flap), operasyon süresi, kanama miktarı, transfüzyon miktarı, yara problemi çeşidi (enfeksiyon, yara açılması), kültür pozitifliği-negatifliği, adjuvan tedavi (Kemoterapi, Radyoterapi) alıp almadığı, NBVT uygulama sayısı, hastaların takip süresi ve NPWT tedavisi sonrası nüks olup olmadığı bilgilerine hastaların arşiv dosyalarından ve hastane bilgisayar kayıtlarından erişildi Bulgular: Kliniğimizde 2012-2018 yılları arasında kemik veya yumuşak doku sarkomu nedeniyle opere olan 436 hastanın 46’sında postoperatif lokal yara problemleri gelişmiş, NBVT uygulanmış ve en az 6 aylık takibe sahip 42 hasta çalışmaya dahil edilmiştir. Tümör cerrahisi sonrası yara problemi olan ve vakum tedavisi uygulanan hastalarda kadın cinsiyet, Albumin düzeyi <3,5 g/dl olması, tümörün cildi infiltre etmemesi durumu, ameliyat sonrası yoğun bakım ünitesinde hastanın takip edilmesi ve intraoperatif kan kaybı >1200 cc vakum tedavisinin 10 seanstan fazla süreceğini işaret eder. Çıkarımlar: Preoperatif dönemde nutrisyonel durumu bozuk olan hastalarda, intraoperatif kan kaybı fazla olan hastalarda, postoperatif yoğun bakım ünitesinde kalan hastalarda ve yara yeri problemine neden olan faktör enfeksiyon ise tedavinin daha uzun süreçli olabileceğini ve buna bağlı olarak önlemlerin alınabileceğini düşünmekteyiz.Publication Metadata only Karpal ve metakarpal kemiklerde intraosseöz kemik kistleri(2004-05-19) EROL, BÜLENT; ŞİRİN, EVRİM; EROL B., TETİK C., ŞİRİN E.Publication Open Access The mid-term results of minimal medial epicondylectomy and decompression for cubital tunnel syndrome(2004-01-01) EROL, BÜLENT; ŞİRİN, EVRİM; EROL B., TETİK C., ŞİRİN E.Objectives: We evaluated the mid-term follow-up results of patients who were treated by minimal epicondylectomy and decompression for cubital tunnel syndrome. Methods: The study included 17 elbows of 15 patients (9 females, 6 males; mean age 45 years; range 35 to 63 years) who underwent minimal medial epicondylectomy and in situ decompression for cubital tunnel syndrome, which was diagnosed through history, physical examination, and electrodiagnostic tests. Before surgery, all the patients received various conservative treatments for at least six months, with no beneficial effect. Thirteen patients had unilateral, two patients had bilateral involvement, with 11 elbows on the dominant side. The mean duration of symptoms was 14 months (range 8 to 36 months). Preoperative grading of nerve compression according to the McGowan system was as follows: three patients (20%) grade I, 11 patients (73.3%) grade II, and one patient (6.7%) grade III. The results of surgical treatment was evaluated according to the Wilson-Krout criteria. The mean follow-up was 32 months (range 25 to 64 months). Results: Symptomatic improvement was achieved in all the patients. The results were excellent in 11 elbows (64.7%), good in five elbows (29.4%), and fair in one elbow (5.9%). None of the patients developed ulnar nerve palsy or subluxation, medial elbow instability, or weakness of the flexor-pronator origin. Pain and tenderness detected at the osteotomy site in four elbows disappeared after a mean of three months. Conclusion: Minimal medial epicondylectomy and decompression was found to be a safe and effective method with a low complication rate in the treatment of cubital tunnel syndrome.Publication Open Access Immobilization after pediatric supracondylar humerus fracture surgery: Cast or splint(2022-01-01) ŞİRİN, EVRİM; POLAT, MURAT; ŞAHBAT, YAVUZ; EROL, BÜLENT; AKGÜLLE, AHMET HAMDİ; AKGÜLLE A. H., ŞİRİN E., Baysalo O., POLAT M., Sahbat Y., EROL B.Objective: While surgical treatment is the most accepted treatment method for displaced supracondylar humerus fractures in children, there is little data about immobilization method after surgery. The aim of the study is to determine whether there is any difference in preventing loss of reduction between long-arm cast and long-arm splint following pediatric supracondylar humerus fracture surgery. Patients and Methods: We conducted a retrospective analysis of pediatric patients with supracondylar humerus fractures treated operatively between 2012 and 2019 at a university hospital. According to Skaggs criteria, early postoperative and 3rd-week follow-up X-rays were evaluated for the loss of reduction (LOR). Postoperative immobilization method; splint or cast was compared in the context of LOR. Results: Cast immobilization was found to be superior in preventing LOR in the first three weeks postoperatively (p˂0.05). There was no significant difference for other factors like fracture configuration, patient age and surgical technique. Conclusion: Cast immobilization is superior to splint immobilization in preventing radiologic LOR after pediatric supracondylar humerus fracture surgery however, clinical relevance of this conclusion is yet to be proved.Publication Metadata only Clinical and functional results of endoprosthesis after bone sarcoma resection of the lower extremity in children and adolescents(2021-04-16) ŞİRİN, EVRİM; EROL, BÜLENT; EROL B., SOFULU Ö., ŞİRİN E., SAĞLAM F., BAYKAN S. E.