Socio-demographic and economic indicators in gender structure in the middle Taurus mountainous villages of Turkey / Indicadores sócio-demográficos e econômicos em termos de estrutura de gênero nas aldeias Taurus Mountainous Villages da Turquia

ABSTRACT: Socio-demographic and economic indicators are very important clues to scientists and institutions to direct development programs for the empowerment of rural women. The goal of this study is to determine the status of rural women living in the Taurus mountainous villages of Turkey according to socio-demographic and economic indicators as related to gender structure. In this research area, there is not enough official data related to socio-demographic and economic indicators about mountainous rural women, like in most developing countries. For this study, the authors collected data from 146 women and 133 men using questionnaires and face-to-face interviews. In this research area, we found that women occupy positions of low power compared to men when taking socio-demographic and economic indicators into account. Women tend to define themselves as housewives instead of farmers, and their tendency to migrate to cities were higher than men's.

RESUMO: Os indicadores sócio-demográficos e econômicos são muito importantes, não só para o cientista, para o empoderamento das mulheres rurais, mas também para que as instituições direcionem os programas de desenvolvimento relacionados com as mulheres rurais. O objetivo deste estudo foi determinar o status de mulheres rurais com indicadores sócio-demográficos e econômicos em termos de estrutura de gênero que vivem em aldeias Taurus Mountainous Villages da Turquia. Na área de pesquisa, dados oficiais relacionados a indicadores sociodemográficos e econômicos sobre estas mulheres não são suficientes, como na maioria dos países em desenvolvimento. Os dados foram coletados de 146 mulheres e 133 homens, por meio de questionário e entrevista presencial dos autores. Na área de pesquisa, as mulheres estão atrás de indicadores sócio-demográficos e econômicos relacionados aos homens e têm posição secundária de acordo com os dados obtidos. As mulheres se definem como uma dona de casa em vez de agricultoras e a tendência de migração das mulheres para as cidades são maiores do que a dos homens.

Is the transposition of the nipple-areolar complex necessary in Simon grade 2b gynecomastia operations using suction-assisted liposuction?

OBJECTIVE: The aim of this study was to assess the efficacy of suction-assisted liposuction (SAL) in Simon grade 2b gynecomastia and its effect on sternal notch to nipple areola (SNN) distance. METHODS: A retrospective analysis was performed on 21 patients with grade 2b gynecomastia who underwent SAL. Preoperative and postoperative SNN distances of the patients were measured, the results were analysed using a Mann-Whitney U test and a p-value <.05 was accepted as statistically significant. Aesthetic results were evaluated by the surgical team considering five criteria: breast size, breast shape, nipple-areolar complex positioning, scarring, and skin tightness of the breast envelope. A 10-point Likert scale was used to assess patient satisfaction with SAL surgery. RESULTS: All of the patients were followed up for an average period of 17.8 months (range = 12-28 months). The mean amount of lipoaspirate was 232 mL per breast (range = 190-310 mL). The mean preoperative SNN distance was 22.3 cm (range = 20-23.5 cm), whereas postoperative was 21.3 cm (range = 19.2-22.8 cm); the difference was statistically significant (p < .05). There was one case of nipple areola necrosis, three hypoesthesia, five persistent pains, and four slight buttonhole deformities. The aesthetic result was evaluated as very good by the surgical team, and the overall patient satisfaction rate in terms of breast shape and volume was 92%. CONCLUSIONS: It was concluded that SAL provides a good aesthetic outcome in patients with Simon grade 2b gynecomastia and shortens the SNN distance by 1 cm, but further clinical studies are required to support this conclusion.

The Effect of Smoking on Facial Fat Grafting Surgery.

Facial fat grafting has been increasingly performed to create a more youthful face. Cigarette smoking might have potential harmful effects on fat graft survival. The aim of this study was to evaluate the effects of cigarette smoking on facial lipofilling.Eighteen smoker patients (13 females and 5 males) with a mean age of 37.4 years (range: 21-53 years) who underwent facial lipofilling were enrolled in this retrospective study. The patients were followed up for an average of 19.3 months (range: 14-32 months). The fat-graft survival rate, degree of skin improvement, and presence and severity of surgical complications (fat necrosis, oil cysts, and infection) were evaluated. A 10-point Likert scale was used to assess patient satisfaction with facial fat grafting surgery.The mean injected fat volume was 42 mL (range: 30-80 mL). Clinical and photographic evaluation by the surgical team led to an estimation of 40% for the mean fat survival rate. Four instances of fat necrosis, 2 oil cysts, and 1 infection were diagnosed and treated conservatively. Five patients underwent a second fat grafting surgical procedure; 3 of these had a third fat grafting surgery to obtain the desired facial fullness. Improvement of skin quality was better during the first months after surgery, but not long standing. Overall patient satisfaction in terms of aesthetic appearance, facial fullness, and rejuvenation was 74%.Although cigarette smoking causes low fat survival rates and impairs the improvement of skin quality, successful results can be obtained with facial lipofilling in the smokers.

The effects of limited adventitiectomy on vascular anastomosis: An experimental study in rats.

OBJECTIVE: Blockages in anastomotic vessels cause complete loss of free tissue transfer and replanted limb. Many studies have been conducted in the last 30 years to solve this problem. There are insufficient studies dealing with the effects of the limited adventitiectomy done before surgery for sympathetic overactivity leading situations. The aim of this experimental study is to reveal the effects of limited adventitiectomy. METHODS: In this study, limited adventitiectomy was performed in a wide area before surgery, and the effect of this practice on the vessel diameter and anastomosis was investigated. RESULTS: Rapidly growing dilatation and increase in vessel diameter was observed, and dilatation continued in the limited adventitiectomy group. CONCLUSIONS: The preoperative performed limited adventitiectomy is a useful preparation for super microsurgery. Especially in clinical practice before the free flap surgery, limited adventitiectomy can be applied if the recipient site is expected to have vascular problems.

Breast Augmentation Combining Fat Injection and Breast Implants in Patients With Atrophied Breasts.

Breast augmentation is a challenging issue in atrophied breasts related to breastfeeding. Here, we describe a modification combining breast implants and fat grafting to obtain a successful outcome without implant edge visibility and palpability.Thirty-four women with atrophied breasts underwent breast augmentation over a 6-year period. The breast implants were placed in the subglandular plane to obtain optimal filling and expansion of atrophied breast tissue. Autologous fat grafting was performed above the inframammary sulcus to prevent implant visibility and palpability due to insufficient soft tissue coverage. Rippling, implant visibility, palpability, and capsular contracture were examined in the follow-up controls.Twenty anatomical and 48 round-shaped breast implants were placed with an average size of 321 cc (range, 200-415 cc). The mean injected fat volume was 114 cc (range, 98-142 cc) per breast. The mean follow-up period was 22 months (range, 19-31 months). The implants were palpable in only 1 breast; however, there was no implant visibility or rippling. Of the 68 breasts, 2 presented with cyst formations, and 4 with Becker Grade 2 capsular contracture, but no fat necrosis was observed. Overall, patient satisfaction in terms of breast shape, size, and coverage of the breast implant was 90%.A breast implant placed in the subglandular plane with fat injection throughout the lower quadrants of the breast may provide the desired increase in size and expansion of atrophied tissue while preventing implant visibility and palpability.

The effect of coenzyme Q10 on venous ischemia reperfusion injury.

BACKGROUND: Coenzyme Q10 (CoQ10) is a lipid-soluble benzoquinone with antioxidant features that make it important in the treatment of ischemia reperfusion injury. In this study, we aimed to investigate the beneficial effect of CoQ10 in the treatment of venous ischemia/reperfusion injury. METHODS: Eighteen Sprague-Dawley male rats were randomly divided into two equal groups: the control group and an experimental group (n = 9 rats). The experimental group received CoQ10 orally, and the control group received a control diet for 8 wk. An inferior epigastric island flap was raised, and the inferior epigastric vein was clamped for 9 h; the flap was then reperfused. All rats were sacrificed on postoperative day 5. The flap survival rate and levels of CoQ10, malondialdehyde, glutathione, and superoxide dismutase were assessed, and flap tissues were examined under a light microscope (×200 magnification) after being stained with Hematoxylin & Eosin. RESULTS: The flap survival rate and levels of CoQ10, glutathione, and superoxide dismutase were significantly higher, but level of malondialdehyde was lower in the experimental group. The mean flap survival rates and plasma levels of CoQ10 were 51% ± 24% and 251 ± 11 ng/mL in the control group, whereas they were 88% ± 7% and 692.8 ± 79.7 ng/mL in the experimental group with statistically significant differences (P < 0.001). Polymorphonuclear leukocyte infiltration was higher, and surface epithelial integrity was more impaired in the control group. CONCLUSIONS: We concluded that CoQ10 supplementation has a beneficial effect on venous ischemia and/or reperfusion injury and improves flap survival rate.

Perforator-based propeller flaps for leg reconstruction in pediatric patients.

BACKGROUND: Perforator-based propeller flaps provide adequate soft tissue coverage for leg reconstruction. The aim of this study was to assess the versatility and reliability of the use of propeller flaps for leg reconstruction in pediatric patients. METHOD: Seven male pediatric patients ranging in age from 2 to 13 years with a mean age of 6.7 underwent perforator-based propeller flap surgery over a four-year period. The defects resulted from burn injuries (n = 4) and traffic accidents (n = 3). The injuries were located on the ankles of four patients and on the knee, anterior lower tibia, and foot dorsum of the other three patients, respectively. RESULTS: The flap sizes ranged from 5 × 3 to 10 × 6 cm with a mean flap size of 7.6 × 4.3 cm. Flap harvesting time ranged from 38 to 56 m with a mean of 46 m. The rotation degree range of the flaps was from 90° to 180°. The propeller flaps were based on the posterior tibial artery (n = 4), anterior tibial artery (n = 2), and the descending branch of the lateral circumflex femoral artery (n = 1). All flaps survived completely without surgical complication; however, one patient developed disseminated intravascular coagulation syndrome two days post-surgery and died within four days. CONCLUSION: Perforator-based propeller flap reconstruction is a safe, reliable, and versatile method for lower extremities in pediatric patients; however, it requires meticulous surgical dissection and extreme patience during the surgical procedure.

Distally based subcutaneous veins for venous insufficiency of the reverse posterior interosseous artery flap.

BACKGROUND: The reverse posterior interosseous artery flap (PIAF) provides soft, thin, and pliable tissue for upper extremity reconstruction without sacrificing any major arteries of the hand. The authors performed a new technique that included one extra distally based subcutaneous vein within the pedicle to diminish venous insufficiency and they aimed to present the results of reconstruction with this technique. PATIENTS AND METHODS: Twelve patients with a mean age of 30 years (range 5-52 years) underwent reverse PIAF surgery. The defects were located on the hand and wrist, with a mean area of 57.8 cm2 (range 20-99 cm2) . After the skin between the distal edge and the pivot point of the flap was elevated, the most reliable subcutaneous vein was chosen, chased, and included within the flap. RESULTS: The average size of the PIAF was 6 × 5 cm to 12 × 9 cm (mean area: 64.4 cm2 ) and the median follow-up time was 13 months (range 4-16 months). The mean quick Disabilities of the Arm, Shoulder and Hand (DASH) score was 21.4, indicating a low degree of disability. Of the 12 patients, ten were very satisfied and two were satisfied with the result of the reconstruction. All but one flap survived completely. One flap was nearly totally lost due to arterial insufficiency after hemodialysis. We observed no venous congestion or insufficiency in the patients. CONCLUSIONS: Subcutaneous veins may be reliable and useful for overcoming major drawbacks associated with reverse flow posterior interosseous artery flap and for diminishing flap loss due to venous insufficiency. © 2016 Wiley Periodicals, Inc. Microsurgery 36:384-390, 2016.

Toe Amputation After Minor Surgery in a Patient with Behçet's Disease: A Case Report.

Behçet's disease is a systemic autoimmune vasculitis. Although various clinical findings can be observed depending on the pathologic features caused by the blood vessels involved, the classic triad of the disease includes oral aphthae, genital ulcers, and uveitis. Although complications involving the aorta or the vena cava inferior can prove fatal, thrombophlebitis in the superficial veins of the lower extremities are more commonly observed. Some patients can remain asymptomatic for a long period after the diagnosis. In patients with positive pathergy test findings, trauma can trigger the inflammatory cascade. This case report presents a patient with vasculitis that occurred subsequent to minor surgery and led to amputation of the great toe in a female patient with a 14-year old history of Behçet's disease.

An alternative surgical procedure for anterosuperior dislocation of intact mandibular condyle.

Superolateral and anterolateral dislocations of the intact mandibular condyle can be easily overlooked because of their rarity among maxillofacial injuries. In this report, we present the surgery of delayed anterosuperior dislocation of intact mandibular condyle into the temporal fossa. A 17-year-old adolescent girl with anterosuperior dislocation of left intact condyle and associated mandible and zygomatic body fracture underwent surgery 33 days after trauma because of priority accompanied life-threatening intracranial and intra-abdominal injuries. Temporalis muscle shortening with soft tissue attachment prevented closed reduction of the temporomandibular joint; therefore, the temporalis muscle was divided from its insertion on coronoid in a process that, to our knowledge, has never before been described. Although good occlusion was achieved at operation, open bite deformity and laterognathism were observed at the sixth month of follow-up.

Multiple disseminated pyogenic granuloma after second degree scald burn: a rare two case.

Pyogenic granuloma is a benign lesion and usually occurs after trauma. Disseminated pyogenic granuloma, is a rare form of pyogenic granuloma. There are 9 cases of disseminated pyogenic granuloma in literature and most of them are hot milk burns. First case describes an 18- month-old girl who developed disseminated pyogenic granulomas on her right cheek, neck, and right nasal ala. Lesions on her right cheek and neck were excised and sutured primarily. Lesion on right nasal ala was excised and repaired with full thickness skin graft. Second case describes a 7-years- old boy who developed pyogenic granulomas on his left forearm. These lesions were excised and sutured primarily. In both cases lesions were developed after scald burn. During 6-month follow-up, no recurrence was observed in both cases.

Reconstruction of vaginal agenesis with pudendal thigh flaps thinned with liposuction.

AIM: The aim of this study is to describe a technique for and data from vaginoplasty surgeries performed using a pudendal thigh flap (PTF) thinned with liposuction. METHOD: A total of six patients diagnosed with Müllerian agenesis underwent vaginoplasty procedures using this technique between January 2009 and April 2012. The age range of the patients was 19-24 years. In the first stage, the subcutaneous fat tissue under the planned skin flap islands was thinned with liposuction. After 3 months, the second stage of the procedure was carried out and the PTFs were elevated. RESULTS: Complications such as infection, dehiscence of the suture line and haematoma were not observed in any of the patients. Although a partial flap loss was observed at the distal aspect of a flap in one patient, total healing was achieved through debridement and local wound care. Mean tissue flap thickness was found to be thinner, and adequate vaginal depth was achieved in all patients on average 13 months following surgery. CONCLUSION: We are of the opinion that PTFs thinned with liposuction enable both a thinner tissue flap and a vaginal reconstruction that more closely resembles natural anatomy.

Foreign body penetrations of hand and wrist: a retrospective study.

BACKGROUND: Despite significant practical knowledge and experience on foreign body penetration injuries to the hand and/or wrist, deficient management and complications can still be encountered, and ignorance of its causative and eventual social aspects unfortunately is a substantial fact. This study aims to cover the clinical and social properties and the management of these kinds of injuries. METHODS: A retrospective analysis of 86 patients requiring evaluation and treatment in a Hand Surgery Division of a university hospital was performed. RESULTS: The median age was 32 (min: 4, max: 63). Industrial workers constituted the largest occupational group (n=22, 25.6%). Twenty-three (26.7%) of the cases were elective admissions. Thirteen (15.1%) patients had various comorbidities, and five (5.8%) had psychiatric diagnoses at the time of the injury. The index finger was the most frequent site of injury (n=29, 33.7%). General anesthesia was not necessary for the management of 94.2% of the cases. In 26 (30%) of the patients, neural, tendinous or osseous damage was observed. Twenty-four (30%) patients were included in a postoperative hand physiotherapy program. CONCLUSION: The practically well-known general features of the issue and those aspects that may still be overlooked currently are reevaluated herein, in light of our observational data.

Cartilage-supported paramedian forehead flaps for reconstruction of full-thickness nasal defects.

The nose is an important esthetic structure of the human face, and its defects may lead to serious esthetic and functional losses. In the current study, our aim was to present the results of the repairs that we performed using cartilage-supported forehead flaps in patients with full-thickness nasal defects in various locations.Between March 2009 and March 2012, a total of 6 patients with full-thickness nasal defects underwent repairs using cartilage-supported forehead flaps. Among the patients, 4 were women, whereas 2 were male. The median age of the patients was 60.3 (38-67) years. The defects were caused by either tumor excision or burn wounds. Defect areas were at the dorsum of the nose, the medial canthal area, and the distal half of the nose. The repairs in all patients were performed using cartilage-supported median forehead flaps. In the method we applied, to provide framework support, a cartilage graft was placed into the pouch formed between the frontal muscle and the subcutaneous tissue within the flaps to be adapted to the defect area. The patients were followed up for a median period of 11 (4-27) months. In the long-term follow-up of all patients, satisfactory results in terms of the functional and cosmetic outcomes were obtained.Through the technique we applied, a simple and safe repair with adequate framework support and full color and texture harmony is achieved.

The effect of hyperbaric oxygen treatment on the healing of burn wounds in nicotinized and nonnicotinized rats.

The importance of oxygen in wound healing and the negative effects of cigarette smoking have been demonstrated in various studies. In this study, our aim was to investigate the effect of hyperbaric oxygen (HBO2) treatment on wound healing in nicotinized and nonnicotinized rats. The study was conducted on 32 Sprague Dawley rats. The rats were divided into four groups, with eight rats in each: group 1, nonnicotinized rats; group 2, nonnicotinized rats treated with HBO2; group 3, nicotinized rats; and group 4, nicotinized rats treated with HBO2. To prepare the nicotinized groups, the rats were given nicotine for 28 days. At the end of day 28, standard, deep, second-degree to third-degree burns were created on the rats. The HBO2-treated groups underwent HBO2 treatment once a day for 7 days after the creation of the burn damage. All rats were killed 21 days after injury, and the burns were subjected to macroscopic, histopathological, and microbiological evaluation. During this evaluation, the smallest necrotic areas and the lowest rate of fibrosis were observed in group 2. The largest necrotic areas and the highest inflammation and fibrosis rates were observed in the nicotine-treated group 3. When the nicotinized and nonnicotinized groups were compared separately, there was a significant difference in favor of the groups treated with HBO2. Bacterial growth was the highest in the nicotinized group 3, whereas no statistically significant difference was observed among the other groups. We conclude that HBO treatment accelerates the recovery of burn wounds and provides more effective healing by reducing the development of scars both in nicotinized and nonnicotinized rats.

Reconstruction of full-thickness nasal alar defects using cartilage-supported nonfolded nasolabial flaps.

The difficulties faced in the reconstruction of the nasal alar defects are still continuing because of their unique anatomy, free margin, and triple-layered complex structure. In this study, we would like to present the results of the cartilage-supported nonfolded nasolabial flap reconstruction method that we applied to full-thickness alar defects involving the alar rim. Between March 2009 and October 2011, 5 patients with full-thickness alar defects underwent cartilage graft-supported nasolabial flap reconstructions. Three of the patients were men, whereas 2 patients were women. Their median age was 54.2 years (range, 43-62 y). The defects were caused by either tumor excision or trauma. According to the method we applied, cartilage grafts were placed into the pouches formed between the skin and the adipose tissue to provide cartilaginous support to the nasolabial flaps to be adapted to the defect areas. The deep surfaces that were going to form the nasal mucosa were grafted using postauricular full-thickness skin grafts. Patients were followed up for a median period of 7.3 months (range, 3-21 mo). In all patients, the flaps fully fitted the defect areas and provided enough coverage over the defects. Although minimal graft contractions were observed in the later phase because of the cartilage support placed within the pouches formed in the flaps, no nasal airway constrictions were observed.The technique we applied is a simple and reliable method providing adequate framework support, full color and texture harmony, an open nasal passage, and a single-session reconstruction in most cases.