The effect of external beam irradiation timing on skin graft survival.

BACKGROUND: The purpose of this study was to evaluate skin graft integrity after external beam irradiation in a rat model. METHODS: Forty-eight male Wistar rats were randomly assigned to 8 groups (A, B, C, D, A(c), B(c), C(c) and D(c)). A rectangular full-thickness skin graft was raised and reapplied to its original bed on the dorsum of each rat. Groups A(c), B(c), C(c) and D(c) were the control groups and were not given postoperative irradiation. After grafting, 25 Gy unfractioned cobalt(60) irradiation was administered to groups A, B, C and D on postoperative days 10, 20, 30 and 40, respectively. Histological samples were obtained 8 weeks after grafting. Dermal and epidermal thickness were measured by the KS-400 image analysis program. RESULTS: The difference in the epidermal and/or dermal thickness between the irradiated groups was not found to be significant. Furthermore, when histological features and the image analysis of the irradiated groups were compared with each other, there were no significant differences between the groups. CONCLUSIONS: Although we are aware that experimental results may not directly translate to the clinical setting, the present study indicates that external radiotherapy can be performed to skin-grafted areas as early as 10 days postoperatively.

Distant muscular (rectus femoris) metastasis from laryngeal squamous cell carcinoma.

OBJECTIVE: We report an extremely rare case of distant metastasis to the rectus femoris muscle from a laryngeal squamous cell carcinoma. METHOD: We present a case report and a review of the world literature concerning distant skeletal muscle metastasis from head and neck squamous cell carcinoma. RESULTS: The patient showed no evidence of distant muscular recurrence at follow up after 21 months; however, two years later he died from brain and suprarenal metastases. CONCLUSION: This report describes the first case of haematogenous distant metastasis to the left rectus femoris muscle from a laryngeal squamous cell carcinoma, without evidence of cervical lymph node metastases. To the best of our knowledge, this is the second reported case of muscular distant metastasis without cervical lymph node involvement. Although the prognosis associated with skeletal muscle metastasis is considered to be poor, surgical excision may be indicated for an isolated muscular metastasis.

Analysis of pediatric burns in a tertiary burns center in istanbul, Turkey.

INTRODUCTION: The factors and demographic features of pediatric patients with burns in eastern and western cultures differ from each other. In this retrospective study, our aim was to identify the demographic features of pediatric burns presenting to our tertiary burn center catering to a large population from Istanbul. METHODS: The demographic data and information of 358 children with burns admitted to the GMM HTH burn center in Istanbul over a 7-year period (2001-2008) were retrospectively reviewed. RESULTS: 48 children with burn injuries were hospitalized in our burn center during the study period. Out of the total of 358 patients, 33.79% (121) were infants and toddlers, 39.66% (142) were in early childhood and 26.53% (95) belonged to the late childhood age group. Males were predominantly affected, the total male to female ratio being 1.3:1. 297 (82.9%) of the 358 subjects resided in urban environments and 61 (17.1%) lived in rural areas. Scalds accounted for more than half (88.16%) of all burns, followed by contact (4.96%), flame (3.43%), electrical (1.52%), chemical (1.52%) and sunburn (0.38). Boiling water was the commonest agent, followed by hot tea. The three most frequent areas of burns were the upper limb (126 cases, 31.18%), followed by the lower limb (105 cases, 25.9%), and the trunk (94 cases, 23.26%). The majority (74%) of the patients had burns covering up to 10% of TBSA, and in 98.8% of the patients' the burn size was less than 30% of TBSA. CONCLUSION: This study demonstrates that the epidemiological features of pediatric burn patients, based on a review of such patients admitted to our burn center, differ in many aspects between eastern and western populations. Scalds occurring in a domestic setting, with mild to moderate burns, caused the vast majority of hospital admissions. It is necessary to improve the preventive programs and strategies in order to reduce the incidence of pediatric burn trauma.

Fasciotomy in crush injury resulting from prolonged pressure in an earthquake in Turkey.

OBJECTIVES: The authors report on the patients treated in a clinic who were injured in the earthquake that took place in north western part of Turkey in 1999 and was reported to be measured at 7.4 on the Richter scale. This catastrophe killed over 16 000 people while injuring more than 23 000 people. The type of housing was varied and entrapment occurred in single, two or more storey buildings. METHODS: 35 patients were admitted to the plastic surgery department after the earthquake. The hospital is about 400 km from the disaster site. Although all the transported victims had intravenous lines, few had adequate volume replacement. Sixteen had an urgent fasciotomy at the time of admission. The procedures were performed between 8 and 21 hours after extrication. After fasciotomy, all non-viable muscle content was removed but an attempt was made to retain as much viable muscle as possible. RESULTS: Amputation was required on four patients (25%). Fasciotomy incisions were closed with skin grafting in eight cases, and with primary closure in four cases. CONCLUSION: Prompt fasciotomy in earthquake victims will be both life saving and can prevent some of the severe and dangerous complications after crush syndrome.

Cross-foot island instep flap: a new use of instep skin flap for management of persistent wounds after complex plantar foot reconstruction.

When presented with an extensive soft-tissue defect involving the sole of the foot, reconstruction with free muscle flaps covered by a split-thickness skin graft is the proposed method of treatment. However, persistent graft breakdown and a chronic wound of the weight-bearing flap is a challenging problem during the late postoperative period, as experienced by the authors in their patients with high-energy-induced lower extremity injuries. The authors used the instep flap as an island cross-foot flap to manage persistent graft breakdown that involved skin-grafted muscle flaps transferred previously to the heel in 3 patients and to treat a chronic wound involving an amputation stump in 1 patient. The vascular pathology of the injured extremities indicated a cross-leg procedure instead of a free flap transfer. Pedicles were wrapped with split-thickness skin grafts and flaps were harvested superficial to the plantar fascia. Pedicles were divided during postoperative week 3, and no complications related to the operation or to immobilization have been encountered during the postoperative follow-up. During the 1-year follow-up, durable coverage, free from development of open wounds, has been achieved, and patients have expressed their satisfaction. In the case of complicated, high-velocity foot injuries, the authors suggest that this procedure be kept in mind as an alternative treatment option because it has some advantages over conventional cross-leg procedures.

Recontruction of facial defects and burn scars using large size freehand full-thickness skin graft from lateral thoracic region.

Reconstruction of facial defects due to trauma, burn scar and congenital deformities is very challenging for reconstructive surgeons. Although many alternative techniques have been suggested, the ideal technique has not been described yet. Full-thickness skin grafting procedures are one of the options, but when larger grafts are needed, donor site morbidity is problematic. Full-thickness skin graft harvested from lateral thoracic region has some advantages for face reconstruction with its larger size, similar colour, thickness, skin quality and texture.

Lower extremity salvage using a free flap associated with the Ilizarov method in patients with massive combat injuries.

Nine patients with massive combat injuries of the lower extremities were treated with Ilizarov bone transport in conjunction with free muscle flap coverage. In 4 patients soft-tissue coverage was applied first, and distraction osteogenesis was initiated 4 to 6 weeks later. In 3 patients both methods were applied simultaneously, and in 2 patients soft-tissue coverage occurred after distraction. The bones healed well, and all flaps survived. The segmental defects ranged from 8 to 16.5 cm in greatest dimension. The total disability time from initial injury ranged from 16 to 25.5 months. In all patients, full union of the tibia was achieved, and no osteomyelitis occurred. However, in 2 patients the applied flap became depressed, necessitating another flap operation. Despite late treatment in all 9 patients, successful results were obtained. Maintaining the original length of the tibia and providing timely, definitive treatment offer the best outcome for repair of massive injuries of the lower extremities. The Ilizarov transport method, used in combination with muscle flap coverage, represents an effective therapy for repair of massive injury of the lower extremities.

A new bisabolene derivative from the essential oil of Prangos uechtritzii fruits.

The fruits of endemic Prangos uechtritzii Boiss. & Hausskn. (Umbelliferae) were subjected to hydrodistillation and microdistillation. The resulting volatiles were investigated by GC-MS to determine the composition of the essential oils. 109 compounds representing 86.7% and thirty-two compounds representing 90.0% were identified and isolated by two different techniques, respectively. Column chromatography of the essential oil yielded a new bisabolene ether (7-epi-1,2-dehydrosesquicineole), which was characterized by spectral methods (GC-FTIR, 1D-, 2D NMR and HRESIMS).

Brachytherapy: reconstructive options and the role of plastic surgery.

The objectives of this study were to evaluate reconstructive methods for patients receiving brachytherapy after cancer ablation. This retrospective review evaluated 19 patients who received brachytherapy and reconstruction between 1991 and 1998. The average age of the patient was 61.9 years and the average follow-up was 2.9 years. Lesions were located in the upper extremity (N = 6), trunk (N = 2), and lower extremity (N = 11). In all patients, early postoperative brachytherapy was initiated 5 days after wound closure. The average radiation dose was 47 Gy (range, 45-50 Gy) and was delivered over a 3 to 5-day period. In each case, varying numbers of catheters were employed (average, 8 +/- 5 catheters). Free flap coverage was performed in 8 patients, and the latissimus dorsi was used most often. Pedicled regional flaps were employed in 11 patients (58%). Sixteen patients (84%) had additional external beam irradiation, and 10 patients (52%) underwent preoperative chemotherapy. All flaps survived with a demonstrated low complication rate (10%). In 2 patients, partial flap necrosis and infection occurred. Three donor site complications were observed and included wound dehiscence in 2 patients and hematoma in 1 patient. Cumulative effects of external beam radiation and brachytherapy did not affect the complication rate. Location of the defect did not alter the incidence of complications. Wound complications did not delay functional rehabilitation in these patients; however, hospital stay was longer. In 8 patients local recurrence occurred (42%) between 6 and 36 months after surgery whereas in 6 patients (32%) distant metastasis was observed. Ten patients are currently alive without evidence of disease. One of the most important concerns about early postoperative brachytherapy is wound healing. With careful planning and precise reconstructive techniques, the use of brachytherapy as a part of salvage or primary surgery does not lead to increased wound morbidity. Reconstructive procedures and a multidisciplinary approach have allowed the delivery of brachytherapy in these complicated patients with low morbidity.

Supratrochlear artery flap for the repair of lower eyelid defects.

An island pattern flap in the treatment of lower eyelid cicatricial ectropion is described. The flap is based on the supratrochlear artery and its associated veins. The donor site can be closed easily primarily. The very thin thickness of the pedicle increases the rotational arc of the flap. However, this procedure requires two stages and there is a slight bulkiness of the flap, both of which are major drawbacks of this method. This flap was used to restore missing supporting soft tissue of the lower eyelid in the clinical cases described herein.

Reconstruction of contour and anterior wall defects of frontal bone with a porous polyethylene implant.

Frontal bone contour defects cause marked facial deformity, which is instantly obvious to the observer. The aetiology is usually post-traumatic either following a traffic accident or a gunshot injury. The contour deformity of the frontal bone was reconstructed using Medpor porous polyethylene in 12 consecutive patients during a period of 2 years. In four of the patients, we used a coronal approach, whilst using the old incision scar and laceration for access in the remainder. In two of the patients it was not necessary to fix the implant at all, but the remainder were fixed with lag screws because of implant mobility. The aetiology, the technique used, and the results obtained are presented.

Multiple meningiomas and intracranial aneurysms: a case report and review of the literature.

An extremely rare case with multiple meningiomas and multiple aneurysms is reported. This 48 year-old female had her meningiomas at the convexity and along the sphenoid wing, and intracranial aneurysms at the basilar tip, left middle cerebral artery bifurcation, and left pericallosal artery. All of them were shown by preoperative radiological evaluation. During the operation, two more meningiomas, again at the sphenoid wing and at the tentorium, were found. There was no evidence of either a connective tissue disease or neurofibromatosis.

Common fragile site expression and genetic predisposition to breast cancer.

The expression of common fragile sites induced by aphidicolin and caffeine was evaluated on prometaphase obtained from the peripheral blood lymphocytes of 35 women with breast cancer, their 35 clinically healthy female family members, and 20 sex- and age-matched normal controls. As a result of the cytogenetic and statistical evaluation, the number of damaged cells, chromosomal aberrations, and expression frequencies of fragile sites detected in patients with breast cancer and their first-degree relatives were found to be significantly higher than those in the control group. Our findings indicate an increased genetic instability in women with breast carcinomas and their relatives. Therefore, fragile sites may be used as a reliable marker for defining genetic susceptibility to cancer in general.

Total thyroidectomy or lobectomy in benign nodular disease of the thyroid: changing trends in surgery.

METHODS: Over a 23-month period (January 1994-December 1995) in the era of fine needle aspiration (FNA), 344 thyroid surgery operations were performed for benign diseases of the thyroid. Of these 55 total thyroidectomies or lobectomies were evaluated. Mean age was 43.6 + 9.7 and the female/male ratio was 47/8 (5.8). All cases were operated on with the consensus of the surgery + endocrinology + pathology council according to a protocol based on FNA, thyroid function tests, scintigraphy and ultrasound. Suspected FNA or suspected nodules during the surgery were verified by frozen section also. Of these 55 benign nodules, 7 (12.7%) had total bilateral, 48 (87.3%) unilateral lobectomies. RESULTS: Postoperatively 3 cases (5.8%) of seroma, one transient hypoparathyroidism (1.8%) and one unilateral vocal cord paralysis (1.8%) were seen as complications. CONCLUSIONS: In our center, FNA cytology has been a routine procedure since 1992. Surgery for benign thyroid disease has been reduced 50% since than. This study was started after two years of the FNA procedure. Resident nodules are the most common cause of recurrence in nodular thyroid disease, so some cases need radical surgery when it is decided to operate. Morbidity of surgery for recurrent disease is unacceptably high and is comparable to lifelong supplement therapy.

Reconstruction of the orbital floor with lyophilized tensor fascia lata.

PURPOSE: This article describes the results of using lyophilized tensor fascia lata for the repair of orbital floor defects. PATIENTS AND METHODS: During a 2-year period, orbital floor reconstruction was performed in 12 patients using lyophilized tensor fascia lata. A Foley catheter was placed into maxillary sinus and left in place for 10 days to provide temporary support for the fascia. RESULTS: Patients were followed for 12 months to 2 years. No cases of infection, exposure, extrusion, or graft removal were encountered, and enophthalmus, symmetry changes, or restricted movement were not observed during the follow-up period. CONCLUSION: Lyophilized fascia lata is easy to shape and place in the defect. It provides an excellent material for repair of small to moderate-sized orbital floor defects.

Electrical burn caused by contact of radio receiver antenna with overhead cables.

Two soldiers suffering from electrical burns due to contact of radio receiver antenna with overhead cables are presented. The necessary preventive measures for such injuries are discussed.

Colorectal cancer in young adults.

The study was carried out to promote a greater awareness of the potential for colorectal cancer in young adults under 40 years of age. During the 8 years between 1986 and 1993, 237 patients with adenocarcinoma of the colon and rectum were operated at the Uludag University Hospital. Of these 237 cases, 46 patients under 40 years old were reviewed retrospectively. They accounted for 19.4% of the total number of patients with carcinoma of the colon and rectum operated during the same period. Rectal bleeding was the most common presenting symptom. The mean duration of time from the onset of symptoms to diagnosis was 5.8 months. The rectosigmoid area was the most frequently involved site (80%). Seventy-six percent of the patients had Dukes' stage C or D tumors. Forty-eight percent of the tumors were either poorly differentiated or mucinous. The cumulative survival rate at 5 years was 43.4%. Patients under 40 years old with carcinoma of the colon and rectum are usually symptomatic and have advanced disease at the time of presentation. Although colorectal cancer is usually a disease of older patients it is becoming more common in younger populations.