Tolga Turker

Interests

Teaching

Hand Surgery, Orthopedic Surgery, Upper extremity anatomy.

Research

Clinical Interests: Hand, Upper extremity and microsurgery. Reconstructive surgery. Congenital disorders of hand and upper extremity

Courses

Scholarly Contributions

Chapters

• Larson, E. E., Larson, E. E., Turker, T., & Turker, T. (2016). Decision Making in Reconstructive Surgery. In Surgical Decision Making: Beyond Evidence Based Surgery. Springer.
• Breidenbach III, W. C., Becker, G. W., Kaplan, B., Turker, T., Muhlemann, C. A., & Schmahl, D. T. (2015). The Animal and Human Experimental Foundation of Vascularized Composite Tissue Allotransplantation. In Operative Microsurgery(pp 1023-1039). New York: McGraw-Hill Professional.
• Breidenbach, W. C., Becker, G. W., Kaplan, B., Turker, T., & Muhlemann, C. (2015). The Animal and Human Experimental Foundation of Vascularized Composite Tissue Allotransplantation. In Operative Microsurgery. New York: McGraw-Hill Professional.
• Larson, E. E., Larson, E. E., Turker, T., & Turker, T. (2016). Decision Making In Reconstructions for Traumatic Defects in Extremity Surgery. In Surgical Decsion Making: Beyond Evidence Based Surgery. Springer.

Journals/Publications

• Turker, T. (2020). Surgical technique for harvesting ECRL and ECRB concurrently as upper extremity tendon autograft.. Techniques in Hand and Upper Extremity Surgery.
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  Turker T, Gosey GM, Kempton DM. Surgical technique for harvesting ECRL and ECRB concurrently as upper extremity tendon autograft.
• Turker, T., & Ferguson, S. (2020). Ferguson S, Türker T. A Giant Arteriovenous Malformation in the Hand with Compromised Neurologic Status. Annals of Vascular Surgery.
• Turker, T., Latt, D. L., & Reyes, MS3, R. (2019). A cuneiform reformation following gunshot wound to the foot.. Foot & Ankle Orthopaedics Journal.
• Turker, T., Taljanovic, M. S., Sheppard, J. E., Amerongen, H. M., & Johnston, S. S. (2019). "The Radial and Ulnar Collateral Ligaments of the Wrist are True Ligaments.". Diagnostic and Interventional Radiology.
• Turker, T., & Roettges, P. (2017). Manuscript ID HAND-16-0259 - "Ulnar Nerve Injury as result of Galeazzi Fracture - A Case Report and Literature Review". HAND.
• Breidenbach, W. C., Meister, E. A., Becker, G. W., Turker, T., Gorantla, V. S., Hassan, K., & Kaplan, B. (2016). A Statistical Comparative Assessment of Face and Hand Transplantation Outcomes to Determine Whether Either Meets the Standard of Care Threshold. Plastic and reconstructive surgery, 137(1), 214e-22e.
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  Hand and face transplantation has established itself as a clinical option for certain reconstructive problems. The purpose of this study was to carry out a rigorous statistical analysis of all hand and face transplantations to determine whether hand and/or face transplantation is the standard of care.
• Breidenbach, W. C., Meister, E. A., Turker, T., Becker, G. W., Gorantla, V. S., & Levin, L. S. (2016). A Methodology for Determining Standard of Care Status for a New Surgical Procedure: Hand Transplantation. Plastic and reconstructive surgery, 137(1), 367-73.
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  Hand allotransplantation was initially criticized as unethical and unlikely to succeed. The results proved to be better than anticipated, now raising the issue of whether hand transplantation is the standard of care. The purpose of this article is to outline a reasonable methodology for determining whether a surgical procedure is the standard of care, and then to apply that methodology to hand transplantation.
• Larson, E. E., Larson, E. E., Turker, T., Turker, T., Lawson, K., & Lawson, K. (2016). Wrap technique to cover exposed Achilles tendon with the Soleus Muscle. Eur Jour Plas Surg.
• Larson, E. E., Turker, T., & Lawson, K. (2015). Wrap technique to cover exposed Achilles tendon with the Soleus Muscle. Eur Jour Plas Surg.
• Oroglu, B., Turker, T., Aktas, S., Olgac, V., & Alp, M. (2016). Effect of hyperbaric oxygen therapy on tense repair of the peripheral nerves. Undersea & hyperbaric medicine : journal of the Undersea and Hyperbaric Medical Society, Inc, 38(5), 367-73.
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  After a peripheral nerve cut, tense repair of a nerve compromises circulation of the nerve at the injury site, making the site hypoxic. Hyperbaric oxygen might increase tissue oxygenation and therefore diminish the effects of injury. We investigated whether hyperbaric oxygen treatment affects peripheral nerve healing when repaired nerves are under tension.
• Türker, T., Hassan, K., & Capdarest-Arest, N. (2016). Extensor tendon gap reconstruction: a review. Journal of plastic surgery and hand surgery, 50(1), 1-6.
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  The extensor tendons of the hand are located in a superficial position on the dorsal aspect of the hand and are highly susceptible to injury. Laceration, crush and avulsion injuries are common extensor tendon injuries presenting for acute care. Such injuries that involve tendon loss or gaps in the extensor tendons require specialised attention and can be some of the most challenging to repair, as extensor tendons have less excursion than flexor tendons. Reconstructive techniques for such defects may differ according to the location of the defect, especially in Verdan's extensor zones 1-5. Adequate repair of extensor tendon defects in zones 1-5 is especially important because (a) even a 1 mm tendon gap in those zones may cause 20° extension loss, and (b) shortening of the extensor tendon by as little as 1 mm may cause decreased finger flexion.
• Breidenbach, W. C., Meister, E. A., Turker, T., Becker, G. W., Gorantla, V. S., & Levin, L. S. (2016). A Methodology For Determining Standard Of Care Status For A New Surgical Procedure: Hand Transplantation. Plastic Reconstructive Journal, 367-73.
• Breidenbach, W. C., Meister, E. A., Turker, T., Becker, G. W., Gorantla, V. S., & Levin, L. S. (2016). A Statistical Comparative Assessment of Face and Hand Transplantation Outcomes to Determine Whether Either Meets the Standard of Care. Plast. Reconstr. Surg., 137(1), 214e-22e.
• McKee, D., & Turker, T. (2015). Hematoma Evacuation to Improve Closed Reduction of Bennett Fracture. Journal of hand and microsurgery, 7(1), 114-5.
• Oroglu, B., Turker, T., Aktas, S., Olgac, V., & Alp, M. (2015). Effect of hyperbaric oxygen therapy on tense repair of the peripheral nerves. Undersea & hyperbaric medicine : journal of the Undersea and Hyperbaric Medical Society, Inc, 38(5), 367-73.
  More info

  After a peripheral nerve cut, tense repair of a nerve compromises circulation of the nerve at the injury site, making the site hypoxic. Hyperbaric oxygen might increase tissue oxygenation and therefore diminish the effects of injury. We investigated whether hyperbaric oxygen treatment affects peripheral nerve healing when repaired nerves are under tension.
• Türker, T., & Sheppard, J. E. (2015). Emergency Open Reduction for an Irreducible Dislocation of the Metacarpophalangeal Joint of the Thumb in a Child. Journal of hand and microsurgery, 7(1), 166-9.
• Türker, T., Gonzalez, J. P., & Capdarest-Arest, N. (2015). Deepithelized posterior interosseous artery flap for 3-dimensional defect coverage in the hand. Techniques in hand & upper extremity surgery, 19(2), 51-4.
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  The posterior interosseous artery (PIA) flap is a pedicle flap that can be harvested at the posterior forearm based on blood supply from the PIA and its concomitant veins. The flap can be used for posttrauma coverage of exposed bones, tendons, and defects; for treatment of a surgical wound; or as a spacer in congenital or burn-related contracture releases. The surgical technique has been reported with limited donor morbidity and few complications to cover exposed structures. In this article, we present our methods and experience using a modification of the posterior interosseous flap that was deepithelized to fill a 3-dimensional cavity in the hand. This method has been successfully used, and the example of the patient shows good outcome, function, and range of motion with no significant complications. The deepithelized PIA flap is a technique that surgeons may add to their toolbox for 3-dimensional defect coverage in the hand. It offers the following advantages: (a) technically uncomplicated; (b) does not create significant donor site morbidity; (c) does not sacrifice any major vessels; and (d) provides good cosmetic appearance, especially in the dorsum of the hand.
• Capdarest-Arest, N., Gonzalez, J. P., & Türker, T. (2014). Hypotheses for ongoing evolution of muscles of the upper extremity. Medical hypotheses, 82(4), 452-6.
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  There are organs and muscles in the human body that may be considered rudimentary in that they have insignificant or undetermined function. Several such muscles are found in the upper extremity. In this review, four muscles that appear to be undergoing evolutionary changes are discussed: flexor digitorum superficialis to the fifth finger, anconeus, palmaris longus, and anconeus epitrochlearis. The present study synthesizes, advances and extends previously described work about these muscles and extends the hypotheses and concludes that: (a) the flexor digitorum superficialis to the fifth finger is currently under adaptive evolution, (b) the anconeus has currently stabilized its evolution and is serving as a transient stability augmenter during a short portion of the human lifespan, and (c) the entire distal upper extremity is currently in the process of undergoing evolutionary change. Understanding of these muscles and their evolutionary context is important for understanding of impact on function, dysfunction, treatment and future research.
• Türker, T., & Capdarest-Arest, N. (2014). Acute hand ischemia after radial artery cannulation resulting in amputation. Chirurgie de la main, 33(4), 299-302.
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  Although radial artery cannulation is a common procedure, in rare cases, it can cause thrombosis leading to severe ischemia of the hand and potentially subsequent gangrene resulting in tissue loss. In this case report, a patient who developed a severely ischemic left hand subsequent to radial artery cannulation is presented. Doppler ultrasound studies showed adequate flow in the patient's hand, however complete thrombosis of the radial artery and significant low flow of the ulnar artery were found using arterial angiogram. The ischemia progressed and surgical intervention to revascularize the hand was unsuccessful, which led to the ultimate amputation of the patient's hand. In cases such as these, where Doppler ultrasound findings show flow but the hand ischemia continues to progress, further diagnostic studies and surgical intervention should be performed as soon as possible to minimize the amount of tissue loss.
• Türker, T., Capdarest-Arest, N., & Schmahl, D. T. (2014). Zone I extensor reconstruction with tendon salvaged from another finger. The Journal of hand surgery, 39(5), 976-80.
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  Laceration, crush, and avulsion injuries are common acute extensor tendon injuries. Simple lacerations may often be repaired in the emergency room, but crush or avulsion injuries may involve tendon loss and gaps in the extensor tendons. Reconstruction can be difficult. The purpose of this article is to present a salvage technique for reconstruction of large extensor tendon gaps in extensor zone I in patients with severe injuries to multiple fingers. This technique, in which a tendon is transplanted from an unsalvageable finger to another with a terminal tendon gap in the same patient, may be a reasonable remedy for reconstruction of tendon loss or gaps and may offer advantages over other traditional reconstructive techniques in certain cases.
• Türker, T., Capdarest-Arest, N., Bertoch, S. T., Bakken, E. C., Hoover, S. E., & Zou, J. (2014). Hand infections: a retrospective analysis. PeerJ, 2, e513.
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  Purpose. Hand infections are common, usually resulting from an untreated injury. In this retrospective study, we report on hand infection cases needing surgical drainage in order to assess patient demographics, causation of infection, clinical course, and clinical management. Methods. Medical records of patients presenting with hand infections, excluding post-surgical infections, treated with incision and debridement over a one-year period were reviewed. Patient demographics; past medical history; infection site(s) and causation; intervals between onset of infection, hospital admission, surgical intervention and days of hospitalization; gram stains and cultures; choice of antibiotics; complications; and outcomes were reviewed. Results. Most infections were caused by laceration and the most common site of infection was the palm or dorsum of the hand. Mean length of hospitalization was 6 days. Methicillin-resistant Staphylococcus aureus, beta-hemolytic Streptococcus and methicillin-susceptible Staphylococcus aureus were the most commonly cultured microorganisms. Cephalosporins, clindamycin, amoxicillin/clavulanate, penicillin, vancomycin, and trimethoprim/sulfamethoxazole were major antibiotic choices. Amputations and contracture were the primary complications. Conclusions. Surgery along with medical management were key to treatment and most soft tissue infections resolved without further complications. With prompt and appropriate care, most hand infection patients can achieve full resolution of their infection.
• Turker, T., & Capdarest-Arest, N. (2013). Management of gunshot wounds to the hand: a literature review. The Journal of hand surgery, 38(8), 1641-50.
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  Hand trauma resulting from firearms is becoming more common in civilian life. In the past, as in wartime, infection was a main source of concern following firearm-related hand injuries, whereas in current civilian life with modern medical care, infection rates are actually low for such injuries. As infection is now of lesser concern, the focus should shift to improve functional outcomes. This review summarizes available literature regarding the management of gunshot wounds to the hand, with particular focus on functional outcomes. In conducting this review, we found that there is not comprehensive information regarding management of gunshot wounds to the hand, and literature discussing functional recovery of the hand is limited. Given the current evidence related to management of gunshot wounds to the hand, we believe that early debridement, antibiotic treatment, reconstruction, and rehabilitation offer patients the best chance for full functional recovery.
• Turker, T., & Capdarest-Arest, N. (2013). Open isolated extensor carpi radialis brevis avulsion injury: a case report. Hand (New York, N.Y.), 8(3), 354-7.
• Türker, T., Murphy, E., Kaufman, C. L., Kutz, J. E., Meister, E. A., & Hoying, J. B. (2013). Response of dupuytren fibroblasts to different oxygen environments. The Journal of hand surgery, 38(12), 2365-9.
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  It is thought that local ischemia and oxygen radicals are responsible for fibroblast-to-myofibroblast cell transformation and proliferation. We hypothesized that hypoxia could differentially activate the contractility of fibroblasts from normal human palmar fascia and from fibroblasts-myofibroblasts of Dupuytren cords.
• Costas-Chavarri, A., Turker, T., & Kutz, J. E. (2012). Flexor tendon lacerations due to high-pressure water injection injury: a case report. Hand (New York, N.Y.), 7(1), 121-3.
• Fırat, T., & Türker, T. (2012). Is the long sarcomere length responsible for non-traumatic supraspinatus tendinopathy? Potential novel pathophysiology and implications for physiotherapy. Pathophysiology : the official journal of the International Society for Pathophysiology / ISP, 19(3), 179-83.
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  Several theories have been proposed to explain the mechanism of non-traumatic supraspinatus tendinopathy, which causes rotator cuff tendinitis and rotator cuff ruptures. However, these theories have not addressed all potential causes of rotator cuff tendinopathy. We propose that the microanatomy of the supraspinatus muscle and its response to gravity is the mechanism that responsible for non-traumatic supraspinatus tendinopathy and rotator cuff tears. Gravity causes chronic traction to the supraspinatus muscle, which results in elongation in the sarcomere length. Elongated sarcomere length causes compression on the micro vessels in the muscle which compromises internal microcirculation of the muscle and tendon. Poor microcirculation triggers ischemia and ischemia triggers inflammation process in the muscle and the tendon. This results in a higher incidence of tendinopathy. We also propose a new physiotherapeutic approach that may provide improved healing for rotator cuff tendinopathy.
• Ozyurekoglu, T., & Turker, T. (2012). Results of a method of 4-corner arthrodesis using headless compression screws. The Journal of hand surgery, 37(3), 486-92.
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  To evaluate the functional and radiographic results of a scaphoid excision and four-corner arthrodesis technique using percutaneous headless compression screws.
• Turker, T., Tsai, T., & Thirkannad, S. (2012). Size discrepancy in vessels during microvascular anastomosis: two techniques to overcome this problem. Hand surgery : an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand, 17(3), 413-7.
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  The problem of size discrepancy between vessels during microvascular procedures is well known. Inability to successfully overcome this problem can lead to turbulent flow at the anastomotic site with consequent thrombosis. Various techniques have been described to overcome this problem. We describe two techniques that have been used for over two decades in our institution. Both these techniques enable the surgeon to overcome far more significant size mismatches than other available techniques while still allowing for end-to-end anastomosis.
• Turker, T., & Kutz, J. E. (2011). Can oral levofloxacin cause of flexor digitorum profundus rupture?. Medical hypotheses, 77(4), 696-7.
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  Fluoroquinolones are broad-spectrum antibacterial agents. Reports of Achilles tendon rupture as a possible side effect of the quinolones have been previously presented but mechanism of the side effect of the medication is still unknown. Tendon rupture in the forearm associated with fluoroquinolone use has not been reported. We present a patient who underwent levofloxacin treatment for skin infections and subsequently developed left small finger flexor digitorum profundus rupture. We propose that this rupture may be related to the side effect of the medication. If it is, clinicians have to be aware of possible tendon ruptures in the upper extremity due to side effects of quinolones and patients have to be informed about it.
• Turker, T., & Thirkannad, S. (2011). Trapezio-metacarpal arthritis: The price of an opposable thumb!. Indian journal of plastic surgery : official publication of the Association of Plastic Surgeons of India, 44(2), 308-16.
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  Trapezio-metacarpal arthritis is the most common arthritic problem of the hand for which patients seek surgical treatment. The current article reviews the etio-pathogenesis, epidemiology, classification and management of this widespread problem. The anatomy and unique biomechanics of this joint are also reviewed. In addition, the article provides a detailed description of our preferred method of trapezio-metacarpal arthroplasty.
• Türker, T., Robertson, G. A., & Thirkannad, S. M. (2010). A classification system for anomalies of the extensor pollicis longus. Hand (New York, N.Y.), 5(4), 403-7.
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  Variations of the long extensor tendon to the thumb are very rare.
• Ogüt, T., Akgün, I., Kesmezacar, H., Türker, T., Uzün, I., Demirci, S., Marur, T., Can, G., & Akkin, S. M. (2004). Navigation for ankle arthroscopy: anatomical study of the anterolateral portal with reference to the superficial peroneal nerve. Surgical and radiologic anatomy : SRA, 26(4), 268-74.
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  We aimed to navigate the surgeon regarding the localization of the main anatomical structures at the anterior part of the ankle joint, in order to find easily the safest anatomical points with reference to the superficial peroneal nerve (SPN), in particular for anterolateral portal placement in ankle arthroscopy. Sixty-three ankles in 36 fresh cadavers were dissected. In all specimens we examined (1) the distance between the SPN bifurcation and the most distal point of the lateral malleolus; and at the level of ankle joint, (2) the number of SPN, (3) the distance between the medial and intermediate dorsal cutaneous nerves, which are branches of the SPN, (4) the localization of the peroneus tertius (PT) tendon in relation to the lateral malleolus, (5) the width of the extensor digitorum longus (EDL) tendon, (6) the relationship of the PT tendon and (7) the relationship of the extensor hallucis longus (EHL) tendon with the SPN. The results were as follows: (1) In 41 ankles with bifurcation (65%) the average distance was 71.8+/-35.3 mm. (2) There were two SPN branches in 39 (62%), three branches in seven (11%) and one branch in 17 (27%) cases. (3) In 39 ankles with two branches of the SPN, the mean distance was 15.2+/-7.1 mm. (4) The lateral border of the PT tendon was positioned a mean distance of 20.8+/-3.3 mm proximal and 25.2+/-5.8 mm medial to the reference points. (5) The mean width was 10.1+/-2.9 mm. (6) In 42 ankles (67%) the distance between the lateral border of the PT tendon and the SPN was a mean of 6.2+/-6.6 mm, median of 3 mm (range 0-22 mm lateral to the tendon). (7) In 56 cases (89%) a branch of the SPN was found a mean of 6.6+/-4 mm and a median of 6 mm lateral to the EHL tendon, and in seven cases (11%) on the tendon. According to our study, in ankle arthroscopy the risk of the SPN injury is maximal in the 0-3 mm lateral to the PT tendon. To avoid injury to the SPN, the safest placement of the anterolateral portal is 4 mm lateral to the PT tendon.

Presentations

• Turker, T. (2019, February). (Presentation x 2) 1) Adipose-derived stem cells for CMC arthritis; 2) Investigation effectiveness of vibratory stimulus in trigger finger injections.. UA Research Day Data BlitzUniversity of Arizona.
• Gimber, L. H., Krupinski, E., Turker, T., Becker, G. W., Sheppard, J. E., Chadaz, T., Desilva, G. L., & Taljanovic, M. (2018, March). Diffusion Tensor Imaging of the median nerve with ultrasound correlation in patients with carpal tunnel syndrome before and after flexor retinacular release. Society of Skeletal Radiology Annual Meeting. Austin, Texas: SSR.
• Turker, T., Capdarest-Arest, N., Obukowica, S., Hassan, K., & Jarrouj, A. (2016, June). Abstract A-0279 - Oral Presentation "Transforming Finger Trauma Care: Considering Cultural Preferences". XXI FESSH 2016 Conference. Santander, Spain.

Poster Presentations

• Gimber, L. H., Krupinski, E. A., Turker, T., Becker, G. W., Sheppard, J. E., Chadaz, T., Desilva, G. L., & Taljanovic, M. (2018, March). Diffusion Tensor Imaging of the Median Nerve with Ultrasound Correlation in Patients with Carpal Tunnel Syndrome Before and After Flexor Retinacular Release. 41st Annual Meeting of the Society of Skeletal Radiology (SSR). Austin, TX.
• Taljanovic, M., Desilva, G. L., Chadaz, T., Sheppard, J. E., Becker, G. W., Turker, T., Krupinski, E. A., & Gimber, L. H. (2017, November). Diffusion Tensor Imaging of the Median Nerve with Ultrasound Correlation in Patients with Carpal Tunnel Syndrome Before and After Flexor Retinacular Release. Radiological Society of North America (RSNA). Chicago.