Person: SAÇAK, BÜLENT
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SAÇAK
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BÜLENT
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Publication Open Access Optimizing survival of large fibula osteocutaneous flaps for extensive full-thickness oromandibular defects: A two-stage approach with temporary orocutaneous fistula(2019-03-01) SAÇAK, BÜLENT; Ciudad P., Huang T. C., Manrique O. J., Agko M., Adabi K., Nicoli F., Sacak B., Kiranantawat K., Moran S. L., Chen H.Introduction: Composite and large head and neck defects requiring extensive skin-mucosa coverage are often reconstructed by combining flaps. Herein, we present a simple and reliable twostage fibula osteocutaneous (FOC) flap technique to improve the survival of a large skin paddle for oromandibular reconstructions. Methods: From October 2011 to September 2016, 47 patients with through-and-through oromandibular defects were reconstructed using FOC flaps with large skin paddles. To ensure optimum survival of skin paddles, temporary orocutaneous fistula were left in place and closed during the second stage operation via de-epithelialization of the skin paddle and suturing of mucosa. Demographic data, operative details, and postoperative complications were recorded. Results: The skin paddle dimensions ranged from 20 to 31.5 cm in length and 12 to 17 cm in width with an average area of 430.4 cm2 (range 300–504). The average time between the two stages and hospital stay were 10 days and 14 days, respectively. Complications at the donor site included wound dehiscence (n = 3, 6.4%), partial skin graft loss (n = 3, 6.4%) and hematoma (n = 2, 4.3%). Recipient site complications included two (4.3%) early postoperative venous congestions that resolved after elevation and three (6.4%) partial skin flap necrosis (less than 5% surface area). All complications resolved with bedside conservative management. There was only one take-back for evacuation of recipient site hematoma (2.1%) but no flap loss. Conclusion: Two-staged large skin paddle FOC flaps can simplify reconstruction of extensive oromandibular defects by improving the reliability of the sizable skin paddle and negating the need for a second flap.Publication Open Access Potential use of transferred lymph nodes as metastasis detectors after tumor excision(2015-07-01) SAÇAK, BÜLENT; Nicoli F., Ciudad P., Lim S. Y., Lazzeri D., D'Ambrosia C., Kiranantawat K., Chilgar R. M., Sapountzis S., Sacak B., Chen H.Due to the fact that it reliably results in positive outcomes, lymph node flap transfer is becoming an increasingly popular surgical procedure for the prevention and treatment of lymphedema. This technique has been shown to stimulate lymphoangiogenesis and restore lymphatic function, as well as decreasing infection rates, minimizing pain, and preventing the recurrence of lymphedema. In this article, we investigate possible additional benefits of lymph node flap transfer, primarily the possibility that sentinel lymph nodes may be used to detect micrometastasis or in-transit metastasis and may function as an additional lymphatic station after the excision of advanced skin cancer.Publication Metadata only Distribution of plastic, reconstructive and aesthetic surgery professionals in Turkey: According to provinces(2014-01-01) SAÇAK, BÜLENT; SAÇAK B., Tuncer F. B., Numanoglu A.Plastic, Reconstructive and Aesthetic Surgery (PRAS) is a unique surgical specialty because of its broad area of expertise and its tendency for multidisciplinary work. In this study, through the cross-sectional data obtained from Turkish Statistical Institute and the Ministry of Health, ratios of plastic surgery professionals per population in each province in Turkey has been calculated and compared. The overall ratio of PRAS professionals per 100,000 populations is 1.05 in Turkey. In the analysis made according to the provinces, the highest ratio of PRAS professionals has been found in Ankara (1.99/100,000). In the highly populated cities, PRAS professional ratio is 1.2 in average, whereas the same ratio is 0.7 in average in low-population cities (p<0.001). Based on the results of the present study, the distribution of PRAS professionals in Turkey shows a great diversity across the provinces. The results of this cross-sectional, descriptive, original study are very valuable in terms of keeping a light on health and education policies regarding plastic and reconstructive surgery.Publication Open Access Reply to comment on: Ileocecal vascularized lymph node transfer for the treatment of extremity lymphedema: A case report(2018-09-01) SAÇAK, BÜLENT; Ciudad P., Manrique O. J., Agko M., Huang C., Chang W., Delgado B R., Reynaga C., Sacak B., Chen H.Publication Open Access Two-suture fish-mouth end-to-side microvascular anastomosis with fibrin glue(2012-07-01) SAÇAK, BÜLENT; Sacak B., Tosun U., Egemen O., Sucu D. O., Ozcelik I. B., Ugurlu K.The most decisive step during free tissue transfers and replantation surgery may be respected as microvascular anastomosis. The conventional end-to-side anastomosis technique with simple interrupted sutures is well established and proven to be successful. On the other hand, conventional technique can be time consuming and can cause vascular thrombosis, vessel narrowing, and foreign-body reactions. Search for a more rapid and secure alternative to conventional technique is carried on. In this study, we defined a new technique for end-to-side anastomosis with fish-mouth incisions and application of fibrin glue and compared our results with those we obtained with conventional end-to-side anastomosis. We evaluated end-to-side anastomosis of carotid arteries of a total number of 64 Wistar-Albino rats. In control group (n = 32), conventional anastomoses with 8 to 10 sutures were performed. In experimental group (n = 32), fish-mouth incisions were applied first on the recipient artery, followed by performing anastomosis with only 2 corner sutures and applying commercially available fibrin glue. Time taken to perform the anastomosis was significantly shorter with the experimental group (P = 0.001), whereas early and late patency and aneurysm rates were comparable to those achieved with control group. Histological evaluation did not point out any significant differences between the groups. We have defined a rapid and safe alternative technique of end-to-side anastomosis with the use of fibrin glue. This method may be an alternative especially where multiple anastomoses are required or where it is difficult to approach anastomotic line, as it is easily performed, rapid, safe, and not involving any complex equipments.Publication Open Access Absence of the ileocolic artery: Microsurgical implications in reconstruction of the esophagus with the free ileocolon flap(2016-02-01) SAÇAK, BÜLENT; Orfaniotis G., Sacak B., Nicoli F., Ciudad P., Gesakis K., Lee C. Y., Chen H. C.Publication Open Access Expanding the applications of “Y-shaped” vein grafts in microsurgery(2015-09-01) SAÇAK, BÜLENT; Orfaniotis G., Maruccia M., Sacak B., Ciudad P., Lima A., Chen H.Publication Open Access A head-to-head comparison among donor site morbidity after vascularized lymph node transfer: Pearls and pitfalls of a 6-year single center experience(2017-01-01) SAÇAK, BÜLENT; Ciudad P., Manrique O. J., Date S., Sacak B., Chang W., Kiranantawat K., Lim S. Y., Chen H.Between 2010 and 2016, 110 patients with extremity lymphedema underwent vascularized lymph node (VLN) transfer: groin (G-VLN = 20), supraclavicular (SC-VLN = 54), and right gastroepiploic (RGE-VLN = 36) open and laparoscopic approach. Herein, we discuss the pearls and pitfalls for VLN harvest and compare donor site morbidity and complications. Lymphatic leakage: G-VLN (n = 1) and SC-VLN (n = 1) and one hematoma: SC-VLN were found. Laparoscopic harvest of the RGE-VLN reduces donor site morbidity. However, surgeons experience is imperative to minimize donor site morbidity and complications. (C) 2016 Wiley Periodicals, Inc.Publication Open Access Keyhole anterolateral thigh flap: A special way of partition for reconstruction around a protruding structure or cavity/tunnel(2015-07-01) SAÇAK, BÜLENT; Sirimahachaiyakul P., Orfaniotis G., Gesakis K., Kiranantawat K., Ciudad P., Nicoli F., Maruccia M., Sacak B., Chen H.Background: Anterolateral thigh (ALT) flap is now a workhorse flap for reconstruction of skin and soft tissue defects. However, there are some drawbacks in its application, and revisions are often needed after surgery. Here, we present the results of the use of a special type of partition for ALT flap based on the concept of perforator flap vascular anatomy for reconstruction around a protruding structure, a cavity or a canal, in patients. Patients and methods: We used the keyhole design for reconstruction with ALT flaps in five patients. Wounds involved circumferential soft tissue defects around the following structures: thumb (two cases), penis, ear canal, and anus. Defects arose following excision of scar contracture, arterio-venous malformation, Paget\"s disease, squamous cell carcinoma, and Fournier\"s gangrene, respectively. The ALT flap was raised based on perforators. The flap was partitioned with a keyhole incision performed in a zone between two perforators or distal to them, avoiding complete split of the flap and minimizing disruption of its vascular crossover. The circulation of the flap was well preserved. The closure of the flap had no tension. Results: All the flaps had 100% viability without partial loss. Mean follow-up was of 7.4 months (range 4-11 months). Significant functional improvement was achieved in the two thumb cases. Adequate patency of the ear and anal canals was obtained. No contracture around the penis was observed. Conclusion: The keyhole design may be a valuable method of partition of the ALT flap for specific reconstructions around protruding organs, cavities, or canals. (c) 2015 Wiley Periodicals, Inc. Microsurgery 35:356-363, 2015.