Biomedical Engineering, Drexel UniversityAug.16, 2011

Reconstructive & Restorative Procedure in Plastic Surgery: from Microsurgery toward Tissue Engineering

Gürsel TURGUT MDPlastic Reconstructive and Esthetic SurgeryCranio-Maxillofacial Surgery

Promedart Co Genkord Cord Blood Bank and Stem Cell Tech.

RECONSTRUCTIVE MICROSURGERY

Surgery Cases esthetic cases cancer surgery congenital deformities Restorative Procedures epitheses custom implants

Researches biomaterials stemcells

published in 2010, American Soc. of Plastic Surgery

Dorsal cartilage hump resection and preparing for septal extension graft

Supratype break point

•The cartilage graft was split into half.

• For creating supratype break point, caudal part of incised graft was used to whom it was necessary.

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Case: allergic rhinitis

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Personal Approach for Reconstruction Cases

44 y44 y- female, - female, maxillamaxillarry sinus y sinus caca

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Maxillectomy+iliac osteocutaneousMaxillectomy+iliac osteocutaneous(bone-(bone-skin)skin) flap flap

bone

skin

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Po 2.year

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20y 20y ,, ameloblastoma ameloblastoma

Segmentary mand. resec.Segmentary mand. resec.fibua osseos flap recfibua osseos flap rec

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Planning of vascular pedicle of flap

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*External fixator should be screwed before resection of tumor

*It provides us with keeping upper lower tooth relationship (Centric occlusion)

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Fibular bone should be attached to upper borderline of mandible … otherwise we would use to additional bone graft for elevating of upper border of flap for improving esthetic result of dental restoration and supporting implants.

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70y ,70y , mandibulary fixated met mandibulary fixated metastatiastaticc cancer cancer

Segmentary mand. Eksc.+fibula Segmentary mand. Eksc.+fibula bone-skinbone-skin flap rec.flap rec.

Po 2. yearPo 2. yearss

Restorations of Face Restorations of Face DefectsDefects

62 y, 62 y, 44 years ago ear upper half years ago ear upper half amputation was performed foramputation was performed for SSquamous quamous CCell ell CCaa

Patient condition has Patient condition has cardiogenically cardiogenically ASA 3 rASA 3 risk for a isk for a recostructive operationrecostructive operation

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37y, Patient with

deformities from a major burn

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Olgu

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41y In

1999 ,exenteration and TRAM flap reconstruction was performed to left eye for mycotic infection at another center.

Type II DM (8 years).

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Reconstruction of Reconstruction of Cranial defects with Cranial defects with

custom made implantscustom made implants

www.promedart.comwww.promedart.com

36y , traffic accident , frontal bone defect

2005:Reconstruction of bone defect with implant

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21 y,hemifacial atrophy

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Breast reconstruction with perforator flap

Clinical Applications

Detecting perforator vessels and fashioning the flap

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Making the Implants

OUR RESEARCHESOUR RESEARCHES

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Materials that will be used instead of bone Materials that will be used instead of bone grafting must mimic the physical,mechanical grafting must mimic the physical,mechanical and biological properties of bone .and biological properties of bone . Comparison of Comparison of Basic properties of boneBasic properties of bone and and carbon foamscarbon foams::

Integrated, anisotrophic poreous structure-%60-90

Carbon- %60-82

Osteons:Smallest bone unit 200µ--

Carbon 350-400

Microhardness

Elasticity(elasticity modulus: 7-30 GpaCarbon-58.6 GPa

Anizotropik –open structure pores

Rough surfaceRough surface

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density: 0.79/cm³-carbon 0.57-70/cm³

tensile strength: 500-1500 kPa

carbon-810kPa %1-3 elongation

remodeling and repair function

crack resistance

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Study was performed in Study was performed in 2 2 stepssteps::

Design of pDesign of pororeous foamy ceous foamy carbon materarbon materiial al and productionand production

Cytotoxicity and tissue compatability tests and rat Cytotoxicity and tissue compatability tests and rat experiments of materialexperiments of material

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I. CaI. Carbon rbon MMateraterial Productionial Production

ITU Faculty of ITU Faculty of ChemistryChemistry (Prf. Ekinci (Prf. Ekinci s group)s group)

Designed carbon Designed carbon material was exposed material was exposed to various heat and to various heat and pressure degrees to pressure degrees to determine the determine the changes of total changes of total porosity,break point porosity,break point and densityand density

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2nd step:Tissue and bone 2nd step:Tissue and bone compatability tests of materialcompatability tests of material

This part of study was performed atThis part of study was performed at Clinics of PClinics of Plastilastic Surgery c Surgery and Pathologyand Pathology..Sisli Etfal Research HospitalSisli Etfal Research Hospital Tissue compatability tests were studied on 30 ratsTissue compatability tests were studied on 30 rats

II grII grooupupss ::

11st group:st group: Carbon foam was inserted under the skin of Carbon foam was inserted under the skin of dorsum of 15 rats and cytotoxicity and tissue compatability dorsum of 15 rats and cytotoxicity and tissue compatability was studiedwas studied..

22nd group:nd group: Carbon foam was inserted to the left femoral bony Carbon foam was inserted to the left femoral bony defects of 15 rats.3 months later carbon foam material was defects of 15 rats.3 months later carbon foam material was resected with normal tissue and bone for histopathologic resected with normal tissue and bone for histopathologic analysisanalysis

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*3 months later material was extirpated from the same incision line

*No substance rejection or no infection sign

*Thin capsule formation around the carbon

* Successful adaptation of carbon to the bone

J Biomed Mater Res A. 2008 Jun 1;85(3):588-96.Pore structure engineering for carbon foams as possible bone implant material.Turgut G, Ekinci E.

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OUR RESEARCHES

CD34+ STEM CELL TREATMENTS FOR DIABETIC FOOT CASES

Where we are obtaining Adult Stem Where we are obtaining Adult Stem Cells. Cells.

Adult Stem Cells are mostly derived from Bone Marrow and Fat tissue.

Bone Marrow aspirates include:1. Hematopoietic Stem

Cells2. Endothelial Cell

Progenitors3. Mezenchymal Stem

Cells

CasesCases

We can not reconstruct or treat the cases who has any disease affecting vessels.

53 53 yy,6 y,6 years ofears of T Tyyppee II DM II DM and and 22 years of chronic leg ulcer years of chronic leg ulcer

After 1After 1stst month month

•33-5 th -5 th finger finger amputation amputation was was performed performed • %60%60 stenostenosis in sis in left common left common ilia iliacc arter artery y andand local local occlusal occlusal plaques of plaques of left left superficial superficial femoral femoral ateryatery..

40 y,Peri40 y,Peripheral arterial diseasepheral arterial disease

67y67y,,15 y15 years ofears of Type II Type II DM DM historyhistory

Surgical debridement and 3Surgical debridement and 3rdrd finger amputation was finger amputation was performed at another center for necrotising leg ulcer performed at another center for necrotising leg ulcer before 2 months.before 2 months.

Before applicationBefore application 4 weeks after application4 weeks after application

58y,3 y58y,3 yeaearrss of of TTypeype II DM II DM and leg ulcer and leg ulcer

Management with wet dressing Management with wet dressing and stem cell applicationand stem cell application

After After 3 3 weeks of weeks of applicationapplication

56 y, 2 y56 y, 2 years ofears of T Typeype II DM II DM and and 1 y 1 yeaear r of chronic leg of chronic leg ulcer historyulcer history

66y,6 y66y,6 years ofears of T Typeype II D II DMM,, and rapidly growing and rapidly growing hee Occlusion greater then 80% in femoral artery , hee Occlusion greater then 80% in femoral artery , No response to treatment No response to treatment

AmputaAmputation was suggested to the patient tion was suggested to the patient

62y,6 y62y,6 yeaearrss of of TType IIype II DM DM and and 3 3 months of leg ulcer months of leg ulcer historyhistory 1-5 digits were amputated at another center1-5 digits were amputated at another centerAfter application no response was seen and After application no response was seen and amputation was suggested.amputation was suggested.

Before treatmentBefore treatment

After treatmentAfter treatment

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