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    Evaluation of Surgical Techniques in Gynecomastia Treatment: Analysis of 65 Cases
    (2020) Tezcan, Mustafa; Öztürk, Muhammed Beşir; Ertekin, Cengiz; Aksan, Tolga; Kalem, Uğur Kaan
    Aim: Gynecomastia is a benign enlargement of the breast in males. Surgical treatment optionsinclude liposuction, glandular excision and the combination of liposuction and glandularexcision. In this study, it was aimed to evaluate 65 consecutive gynecomastia patients whowere operated using different techniques and to present the treatment approach, and results andcomplications related to surgical techniques.Material and Methods: Sixty five patients who underwent gynecomastia operation in ourclinic between June 2016 and January 2019 were included in this study. Demographic data,preoperative and postoperative photographs, clinical classification, perioperative details,postoperative results and complications were evaluated retrospectively.Results: Fifty five (84.6%) patients had bilateral gynecomastia and 10 (15.4%) patients hadunilateral gynecomastia. Of the 120 breasts operated, 91 (75.8%) were Grade II, 20 (16.7%)were Grade III and 9 (7.5%) were Grade I, according to the Simon classification. Twenty-eight(43.1%) patients underwent liposuction and glandular excision, 35 (53.8%) patients underwentliposuction alone, and two (3.1%) patients underwent glandular excision only. Skin excisionwas performed for two patients at the first operation. Only two patients, one for inadequatereduction and the other for skin excess, were demanded revision surgery.Conclusion: Surgical treatment options for gynecomastia patients can be determinedaccording to clinical evaluation of breast tissue and skin excess. In young patients with goodskin quality, skin excision can be left for a second session. Although there was no significantdifference between the methods used in this study, more complications were found with theexcisional technique.
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    Reconstruction of Vulva and Perineal Defects After Gynecological Oncological Surgery and Effectiveness of Local Flaps
    (2021) Karateke, Ateş; Uzuneyüpoğlu, Orkun; Öztürk, Muhammed Beşir; Aksan, Tolga; Küçükbaş, Mehmet
    Aim: Although most defects can close by primary suturing after radical surgery of gynecological malignancies, different reconstruction options are available when large defects that require reconstruction occur. In this study, we present the treatment strategy and results for patients who underwent reconstruction after resection for gynecological cancer in the vulva and perineum. Material and Methods: A total of 18 patients who underwent reconstruction between May 2018 and July 2020 were included in this retrospective study. Demographics and clinical data, the resection operation, characteristics of the defect, and the reconstruction methods applied were evaluated. Postoperative treatment strategy and complication rates were evaluated. Results: The mean age was 62.3±13.2 (42-83) years. 88.9% of the patients had additional diseases. Pelvic exentration was performed in 5 (27.8%) patients, anterior resection in 2 (11.1%) patients and vulvectomy in 11 (61.1%) patients. The most common malignancy was squamous cell carcinoma, and mean defect size was 106±97 (12-476) cm2. Reconstruction was performed with a local fasciocutaneous flap in 16 (88.9%) patients, pedicled rectus myocutaneous flap in one (5.6%) patient, and skin graft in one (5.6%) patient. Wound complications occurred in 5 (27.8%) patients, partial flap necrosis in one (5.6%) patient, and recurrence in one (5.6%) patient in the long term. Conclusion: It is possible to reconstruction most of the vulva and perineal defects with local flaps after oncological resections, Considering the characteristics of the area and patient comorbidities, it should be kept in mind that prolonged wound problems may be seen, especially in vulvectomy patients.
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    The Surgical Treatment of Tissue Necrosis due to Diclofenac Sodium Injection (Nicolau Syndrome)
    (2020) Özkan, Korhan; Kalem, Uğur Kaan; Öztürk, Muhammed Beşir; Ertekin, Cengiz; Aksan, Tolga
    Aim: Nicolau syndrome (NS) is the necrosis of skin and subcuticular tissue, followinginjection of many drugs, which covers nearly a perforasome. This study aims to unveil ourclinical approach and treatment alternatives against this rare pathology subsequent todiclofenac sodium.Material and Methods: In this retrospective study, our approach to 16 patients who developedNS at the injection site after diclofenac sodium injection was evaluated. Patients’ demographicdata, concomitant diseases, location and size of necrosis, and surgical techniques werecollected. Post-operative complications, hospitalization period and results were evaluated.Results: There were total of 16 patients, 2 of which were male and 14 were female. The meanage was 60±14.4 years, and the mean body mass index (BMI) was 33±1.4 kg/m2. The majorconcomitant comorbidity was diabetes mellitus, followed by primary hypertension. The meandefect size was 8x8x5 cm. Surgical debridement was applied to all 16 necrosis. Following thesurgical debridement of necrosis, 8 patients were reconstructed with primary closure, 6 patientswith fasciocutaneous flaps and 2 patients with delayed primary closure after a week. Allpatients heal completely without complications.Conclusion: Utmost care must be given when performing diclofenac sodium injections to thepatients with comorbidities, such as high BMI, diabetes mellitus, and primary hypertension.The caregiver must be certain that the needle is in the muscular plane and no perforator vesselto be harmed during this procedure. In case of a post-injection necrosis, an early interventionwith surgical debridement and reconstruction is an efficient treatment.