OSMOTİK YUMUŞAK DOKU GENİŞLETİCİLERİN YERLEŞTİRİLMESİNDE TÜNEL VE FLEP TEKNİKLERİNİN KARŞILAŞTIRILMASI

Yıl 2019, Cilt: 28 Sayı: 1, 1 - 4, 01.04.2019

Ahmet Emin Demirbaş , Erdem Kılıç , Cihan Topan Alper Alkan

Öz

Amaç: Yumuşak doku genişleticiler; tümör, defekt veya travma sonrası meydana gelen doku kayıplarının tamiri için komşu sağlıklı dokudan faydalanarak defektlerin onarılması amacı ile cerrahi branşlarda yaygın olarak kullanılmaktadır. Yumuşak doku genişleticiler ile ilgili yaşanan problemlerden biri doku genişleticinin doku altına yerleştirilmesinde doğru tekniğin seçimidir. Bu çalışmadaki amacımız osmotik yumuşak doku genişleti-cilerin doku altına yerleştirilmesinde kullanılan tünel ve flep tekniklerini koyun modelinde karşılaştırmaktır.

Gereç ve Yöntem: Bu çalışmada 14 adet erişkin koyun kullanıldı. Her biri 7’ şer adet koyundan oluşan tünel ve flep tekniğinin karşılaştırıldığı iki ayrı çalışma grup oluş-turuldu. Bu iki teknik; yumuşak dokuya ait nekroz, en-feksiyon ve yara bölgesinin açılması sonucu doku geniş-leticinin kaybı gibi komplikasyonlar yönüyle değerlendi-rildi.

Bulgular: Flep tekniği kullanılan ilk gruptaki toplam 14 adet doku genişleticiden 7 tanesi takip döneminde ağız içine yara kenarlarının bütünlüğünün bozulması sonucu ekspoze oldu. Bu grupta geriye kalan toplam 7 adet doku genişleticide iyileşme sorunsuz olarak gerçekleşti ve yumuşak doku genişlemesi sağlandı. Tünel tekniği kulla-nılan ikinci grupta ise iyileşme ve yumuşak doku geniş-lemesi sorunsuz bir şekilde gerçekleşti ve doku genişle-ticilerde herhangi bir kayıp yaşanmadı.

Sonuç: Osmotik yumuşak doku genişleticilerin tünel tekniği ile yerleştirilmesi ameliyat sonrası meydana ge-lebilecek komplikasyonları önlemede flep tekniğine göre daha başarılıdır.

Anahtar Kelimeler

Osmotik yumuşak doku genişletici, tünel tekniği, flep tekniği

COMPARISON OF TUNNEL AND FLAP TECHNIQUES IN THE PLACEMENT OF OSMOTIC SOFT TISSUE EXPANDERS

Öz

Purpose: Soft tissue expanders are widely used in surgical branches by utilizing adjacent healthy tissue near the defect area for the reconstruction of tissue loss after tumor, defect or trauma. One of the problems with soft tissue expanders is the selection of the right technique for placing the tissue expander under the tissue. We aim to compare tunnel and flap techniques which are used to place the osmotic soft tissue expanders in toothless keratinized soft tissue of sheep mandible.

Materials and Methods: 14 adult sheep were used in this study. Two separate study groups each consisting of 7 sheep were created to compare tunnel and flap technique. Flap and tunnel techniques were evaluated in terms of complications such as necrosis, infection of adjacent soft tissue and loss of tissue expander after surgery.

Results: 7 of a total 14 tissue expanders in the first group using flap technique were exposed to oral cavity due to the loss of the integrity of the wound edges during the follow-up period. In remaining 7 tissue expanders in the first group, it was observed that wound healing was uneventful, and soft tissue expansion was achieved without any problem. In the second group using tunnel technique, it was seen that wound healing and soft tissue expansion were uneventful in all the animals.

Conclusion: The use of tunnel technique for soft tissue expansion with osmotic tissue expanders is more successful than flap technique in preventing postoperative complications.

Anahtar Kelimeler

Osmotic soft tissue expander, tunnel technique, flap technique

Kaynakça

• KAYNAKLAR 1. Baker SR. Fundamentals of Expanded Tissue. Head Neck 1991; 13:327-333.
• 2. Neumann CG. The expansion of an area of skin by progressive distension of a subcutaneous balloon; use of the method for securing skin for subtotal reconstruction of the ear. Plast Reconstr Surg 1957; 19:124-130.
• 3. Radovan C. Tissue expansion in soft- tissue reconstruction. Plast Reconstr Surg 1984; 74:482-492.
• 4. Austad ED, Rose GL. A self-inflating tissue expander. Plast Reconstr Surg 1982; 70:588594.
• 5. Wiese KG. Osmotically induced tissue expansion with hydrogels: a new dimension in tissue expansion? A preliminary report. J Craniomaxillofac Surg 1993; 21:309-313.
• 6. Bergé SJ, Wiese KG, Von Lindern JJ, et al. Tissue expansion using osmotically active hydrogel systems for direct closure of the donor defect of the radial forearm flap. Plast Reconstr Surg 2001; 108: 1-5.
• 7. Ronert MA, Hofheinz H, Manassa E, Asgarouladi H, Olbrisch RR. The beginning of a new era in tissue expansion: self-filling osmotic tissue expander: four-year clinical experience. Plast Reconstr Surg 2003; 114:1025-1031.
• 8. Obdeijn MC, J-Phillip N, Werker PMN. The osmotic tissue expander: a three-year clinical experience. J Plast Reconstr Aesthet Surg 2009; 62:1219-1222.
• 9. Chummun S, Addison P, Stewart KJ. The osmotic tissue expander: a 5-year experience. J Plast Reconstr Aesthet Surg 2010; 63:2128-2132.
• 10. Küçükkurt S, Alpaslan G. Soft tissue expanders and their ussage in oral and maxillofacial surgery. J Dent Atatürk Üni 2016; 14:130-137.
• 11. Uijlenbroek HJ, Liu Y, He JF, et al. Expanding soft tissue with Osmed tissue expanders in the goat maxilla. Clin. Oral Impl 2011; 22:121-128.
• 12. Swan MC, Goodacre TE, Czernuszka JT, Bucknall DG. Cleft palate repair with the use of osmotic expanders: a response. J Plast Reconstr Aesthet Surg 2008; 61: 220-221.
• 13. Von See C, Rücker M, Bormann KH, Gellrich NC. Using a novel self-inflating hydrogel expander for intraoral gingival tissue expansion prior to bone augmentation. Br J Oral Maxillofac Surg 2010; 48:5-6.
• 14. Kaner D, Friedmann A. Soft tissue expansion with self-filling osmotic tissue expanders before vertical ridge augmentation: a proof of principle study. J Clin Periodontol 2011; 38:95-101.
• 15. Abrahamsson P, Isaksson S, Gordh M, Andersson G. Onlay bone grafting of the mandible after periosteal expansion with an osmotic tissue expander: an experimental study in rabbits. Clin Oral Impl Res 2010; 21:1404-1410.
• 16. Von See C, Gellrich NC, Jachmann U, et al. Bone augmentation after soft-tissue expansion using hydrogel expanders: effects on microcirculation and osseointegration. Clin Oral Impl Res 2010; 21:842-847.
• 17. Mertens C, Thiele O, Engel M, et al. The use of self inflating soft tissue expanders prior to bone augmentation of atrophied alveolar ridges. Clin Implant Dent Relat Res 2015; 17:44-51.