Burn assault with paint thinner ignition: an unexpected burn injury caused by street children addicted to paint thinner.

The frequency of assault by burning among all burn patients varies from country to country. Assault by burning, although uncommon, is a serious form of trauma and a significant source of morbidity and mortality. The aim of this retrospective study was to identify the epidemiologic features, current etiological factors, and the mortality of nine patients admitted to our burn unit between January 1999 and January 2009 after unexpected burn assault by paint thinner ignition caused by street children addicted to paint thinner. The circumstances of this injury and preventive measures are discussed.

Thermal burns associated with the misuse of flammable liquids in stoves: a continuing problem.

Coal stoves that are used for heating purposes are more popular in economically developing and undeveloped countries because of their lower operational costs. Unfortunately, they may cause serious burn injuries when flammable liquids are misused to kindle or to accelerate a fire within them. Every year, particularly in the winter, many citizens in Turkey have suffered burn injuries caused by this dangerous practice. During the period from January 1989 to January 2009, 82 patients sustained burn injuries as a consequence of coal stove fires and were admitted to burn units. Efforts to inform the public about the danger of using flammable liquids with these kinds of stoves are recommended to minimize the incidence, morbidity, mortality, and cost of this relatively common and preventable type of injury.

Skin-reducing subcutaneous mastectomy using a dermal barrier flap and immediate breast reconstruction with an implant: a new surgical design for reconstruction of early-stage breast cancer.

BACKGROUND: The development of skin-sparing mastectomy techniques for early-stage breast cancer has opened a new era in reconstructive breast surgery. Because of improved early diagnoses, the demand for skin-sparing techniques continues to increase more than ever. METHODS: Between March 2006 and April 2008, skin-reducing subcutaneous mastectomy (SRSM) using the dermal barrier flap technique and simultaneous breast reconstruction with silicone implants was performed for 15 patients (a total of 26 breasts) who had either a diagnosis of early-stage breast cancer or indications for prophylactic mastectomy. Of the 15 patients, 11 underwent bilateral reconstruction. The remaining four patients underwent unilateral reconstruction using SRSM with the dermal barrier flap technique. RESULTS: The average age of the patients who underwent SRSM with the dermal barrier flap was 45.7 years. All the patients were discharged from the hospital on postoperative day 1. The mean follow-up period was 12 months, and the recovery time was 35 days. Excellent aesthetic results and uneventful healing were obtained for 23 breasts. Partial nipple-areola necrosis occurred in two breasts. Total skin necrosis in the bilateral nipple-areola and central breast region occurred for one patient who underwent bilateral SRSM. Prosthesis exposure was not observed for any of these patients. CONCLUSIONS: The authors present their early results with SRSM using the dermal barrier flap and silicone implants for early-stage breast cancer. The dermal barrier flap became a reliable procedure by providing a decreased breast envelope, eliminating the risk of implant exposure, and forming a double layer of dermal tissue at the incision line.

The effect of epidural anaesthesia on the reverse-flow fasciocutaneous flap: an experimental study in rabbits.

BACKGROUND: The reverse-flow fasciocutaneous flap has been popularised as a feasible alternative to reconstruction of the post-burn contractures around lower-extremity joints. The effect of epidural anaesthesia (EA) on the haemodynamics of reverse-flow fasciocutaneous flap (RFFF) has not yet been investigated. Therefore, it was our primary objective to determine how EA impacts on vascular haemodynamics and tissue perfusion. MATERIALS AND METHODS: This study included 30 New Zealand white rabbits. The reverse-flow saphenous fasciocutaneous island flap in rabbit model was used. In group I (n=10), epidural catheterisation of the rabbits were performed and they received an epidural infusion of 0.1 ml kg(-1) 0.125% bupivacaine 12-h periods until the 10th day. In group II (n=10), epidural catheterisation of the rabbits was performed and they received an epidural infusion of 0.1 ml kg(-1) isotonic sodium chloride solution. In group III (n=10), epidural catheterisation of the rabbits was not performed. Intra-arterial blood pressure (IABP) and intravenous blood pressure (IVBP) was recorded at time intervals of 5, 15, 30 and 60 min, respectively, after tourniquet release on the first and 10th day. Microcirculatory flow was measured by laser Doppler flowmetry at 2, 4, 6, 8 and 10 days in all the groups. RESULTS: Throughout the experiment, the flaps showed complete survival. A significant difference was noted in the microcirculatory flow measurements in the flap surfaces between group I and groups II-III throughout the experiment (p<0.05). A significant difference was noted in IVBP and IABP between group I and groups II-III (p<0.05). On the first and the 10th day, however, there were no significant differences between groups II and III (p>0.05). CONCLUSION: EA improves blood flow to RFFF and prevents the progression of venous congestion.

The effect of simvastatin on the survival of ischaemic skin flap: an experimental study in rats.

Thrombomodulin (TM) is down-regulated from the vascular endothelial surfaces and corresponds to disturbed dermal blood flow and microthrombus formation in the ischaemic skin flap. We examined the therapeutic potential of simvastatin which up-regulates endothelial cell TM expression and activity in the dorsal ischaemic skin flap model. The study was carried out on 30 rats, divided into three groups. Group 1 was treated with simvastatin at a dose of 5mgkg(-1) day(-1) by intraperitoneal injection. Group 2 was treated with 1mgkg(-1) day(-1) with a phosphate-buffered saline for 7 days. Group 3 was the control group. Tissue blood flow, vascularisation and the survival rate of the skin flaps from each group were compared. The mean surviving area of group 1 was higher than groups 2 and 3 (p<0.05). The blood flow change rate did not decrease in the treatment group in contrast to the control groups at 3cm and 5cm (p<0.05). Microangiography demonstrated decreased flap vascularity in groups 2 and 3. There was no evidence of necrosis or positive peroxidase staining for TM in group 1 at 3cm and 5cm., although it was negative in groups 2 and 3. In this study, it was demonstrated that simvastatin prevented shedding of endothelial TM and contributed to flap survival.

Thermal crush injury of the hand caused by roller type ironing press machine.

Industrial garment machines may cause occupational hand injuries. However, combined thermal and crush injuries are uncommon, and their etiologies are varied. We present a case of thermal crush injury of the hand caused by laundry roller type ironing press machine. The circumstances of this injury and preventive measures are discussed.

Should we hesitate to use subcutaneous tunneling for fear of damaging the sural flap pedicle?

BACKGROUND: The distally based sural nerve flap is a preferable option for covering defects of the lower third of the leg. However, many authors noted that in particular pressure exerted by tunneling of the flap pedicle could be harmful. Thus, they either inset the pedicle or exteriorize the pedicle to decrease complications. METHODS: We used distally based superficial sural artery island flaps for the reconstruction of defects of the lower leg, the ankle, and malleolus in 12 patients between 2004 and 2008 without tunelization. The defects were covered with no major complications. RESULTS: In 3 flaps, there was a small amount of distal marginal necrosis, which was excised and closed spontaneously or skin grafted. CONCLUSION: We concluded that unless there are certain risk factors such as arterial hypertension, diabetes, peripheral vascular disease, and vasculitis, avoiding a subcutaneous tunneling is not necessary.

Expression of the endothelial thrombomodulin (TM) on the ischemic rat flap model: preliminary study.

Thrombomodulin (TM), a cell surface-expressed glycoprotein predominantly synthesized by vascular endothelial cells, is a critical cofactor for thrombin-medicated activation of protein C. TM thus has an impact on coagulation, inflammation, and fibrinolysis. In this study, we investigated expression of endothelial TM in the dorsal skin of the rat as an ischemic flap model. Twenty male Wistar rats weighing between 250 and 350 g were used in the study. Nine by 3-cm, full-thickness, caudally based random pattern dorsal skin flaps were elevated. The rats were randomized into 2 subgroups according to the evaluation time. Tissue blood flow of the skin flaps was measured 4 times (before the operation and on days 1, 3, and 7) at 1, 3, and 5 cm distal to the baseline of the skin flap. Skin flap samples including subcutaneous tissue were taken from killed rats at day 3 (n = 10) and 7 (n = 10) for histologic assessment. These samples were also taken from the midline at 1, 3, and 5 cm distal to the baseline of the skin flaps. The survival rate of the skin flaps was measured on day 7. According to the blood flow rate change, we found that there were significant differences between the 1-, 3-, and 5-cm samples throughout the experiment. The most profound change was that it was at 5 cm in which there was an initial pattern of reduced perfusion followed by cessation of perfusion. On the third day, positive immunoperoxidase staining specific for TM was detected in all the specimens of the skin biopsies taken from 1 and 3 cm. The 5-cm samples demonstrated very little evidence of necrosis and had negative immunoperoxidase staining for TM. The 1-cm samples were found to have preserved morphologic features present on days 3 and 7. The 3-cm samples showed no evidence of necrosis, though some of the capillary vessels were filled with aggregated blood cells. The vascular wall had negative peroxidase staining for endothelial TM. At 5 cm, there was clear evidence of necrosis, some found within the capillary vessels, which were filled with aggregated blood cells. These samples also had negative peroxidase staining for TM. On day 7, the survival rate of skin flaps was 45.35%. In this study, we demonstrate that tissue ischemia is an important factor, particularly in down-regulating TM transcription. TM depletion from the vascular cells and microthrombus formation occurred in the ischemic areas, playing an important role in secondary aggravation of tissue ischemia.

Frostbite burns caused by liquid oxygen.

Frostbite burns are uncommon and they have various etiologies. We will present a case of rapid frostbite burn caused by liquid oxygen. The patient injured both hands from contact with liquid oxygen. The circumstances of this injury and preventive measures are discussed in this case report.

Posterior auricular muscle flap as an adjunct to otoplasty.

Prominent ear deformity is a common congenital ear deformity. Prominent ear deformity includes components such as valgus of concha, failure of scaphal folding, conchal hypertrophy, and prominent lobule. The deformity and the elastic properties of the ear cartilage determine the method of surgical correction in each case. Concha-mastoid suture, conchal excision, and posterior auricular muscle excision are different treatment options for mild to severe cases of conchal hypertrophy and valgus deformity. In this article we present a method of conchal excision, combined with a posterior auricular muscle flap, to repair severe conchal hypertrophy or valgus deformity. Six patients (11 ears) were operated on using this method. The results obtained were satisfactory. Postoperative results at 6 months were satisfactory in all patients. The smoothness and the natural appearance of the conchal bowls were notable in all patients. In contrast to the early methods of utilizing the posterior auricular muscle by transposing to the scapha or excising, its usage as a muscle flap for conchal hypertrophy and valgus deformity may be a promising option for the future.

Reconstruction of distal forefoot burn defect with retrograde medial plantar flap.

Burn reconstruction of forefoot remains as a difficult challenge, because the local flap alternatives are limited. We evaluated the efficiency of distally based medial plantar fasciocutaneous island flap in the coverage of forefoot defects resulting from release of toe contracture and burn debridement. Four patients with toe contractures and two patients with third degree burn in forefoot were treated between June 2004 and February 2006. The mean follow-up period was 10.4 months. The flaps were elevated as with a fasciocutaneous base on the distal medial plantar artery. The dimensions of the flaps ranged from 4cmx3cm to 5cmx4cm. The skin over the pedicle was included as a part of flap in three cases. Concomitant vein of the pedicle was anastomosed with the first plantar digital vein in four cases. In the early postoperative period, one flap used to cover third degree burn due to high-voltage electric injury was lost completely. We concluded that this flap was an appropriate alternative reconstructive option for the forefoot defect. Including skin and subcutaneous tissue over the pedicle to flap protects the pedicle against kinking and compression. Venous supercharging of the flap improves venous drainage.