Outcomes of elderly burn patients requiring hospitalization.

BACKGROUND: The elderly population is more likely to be affected by accidents, such as burns, compared to younger populations because of their diminished host defense. There is limited data about the outcomes of elderly burn patients requiring hospitalization. METHODS: In this retrospective study, we assessed the epidemiology and outcomes of burn injuries in elderly patients (>60 years old) admitted to a burn unit of a tertiary medical center based on patient characteristics, type and extent of burns, treatment, hospital stay and mortality rates. RESULTS: Forty-eight elderly burn patients among 870 burn patients during the study period were evaluated. Fire was the most common cause of burns (77.1%). Most of the burns involved more than 20% of total body surface area. Twenty-six (54.2%) patients died during hospitalization. Although burn surface area slightly and non-significantly increased in patients over 75 years, there was a significantly increased mortality rate in these patients. Multivariate linear regression analysis revealed burn area and age as independent associates of mortality. CONCLUSION: Our data show a high mortality rate in elderly burn patients. Extensive burns and increased age seem to increase the mortality risk.

Histological evaluation of wound healing performance of electrospun poly(vinyl alcohol)/sodium alginate as wound dressing in vivo.

Poly(vinyl alcohol)/sodium alginate nanofibrous mats were produced by electrospinning method at optimum process parameters. Evaluation of alginate-based electrospun nanofibrous mats as a wound dressing material and their comparison to commercially available wound dressings produced with conventional methods were carried out in vivo. Tissue specimens were examined histopathologically on 4th, 6th, 15th, 21st postoperative days. In contrast to other dressings it was observed that nanofibrous mat could survive on the wound crust in early stages of healing. In terms of epithelization, epidermis characteristics, vascularization and formation of hair follicles, nanofibrous mat showed the best healing performance. This could be explained with presence of nanofibrous mat acting as an artificial skin on the wound region until new tissue regenerated.

Treatment of recurrent temporomandibular joint dislocation.

Temporomandibular joint dislocation is defined as the movement of condyle out of the fossa and the advancement of the posterior surface of the condyle in front of the articular eminence. If this condition becomes chronic, surgical treatment is the only option. The goal of surgical treatment is to reposition the condyle and prevent further recurrences. In this study, a retrospective analysis is presented examining 73 patients and 83 joints that were treated with hook-shaped miniplates and miniscrews fixed to otolog bone grafts. Records were obtained from archives of the Uludag University Medical Faculty, Plastic, Reconstructive and Aesthetic Surgery Department. The duration of postoperative follow-up was 3-30 months. In one case, the miniplate was fractured, and in two cases, abscesses existed. This study aims to emphasize that using miniplates and otolog bone grafts is more cost effective.

The effect of catheter use on vein grafting of a peripheral nerve defect: an experimental study.

BACKGROUND: Since vein grafts have been used in the repair of nerve defects, studies regarding this procedure have accumulated, and after coming into clinical use, it was noticed that there is a problem of collapse in the vein graft. METHODS: Forty Sprague-Dawley rats were used, divided into five groups. No surgical intervention was performed in the first group. The defect was created in the sciatic nerve in Group 2 and left unrepaired. In Group 3, the defect was repaired with a nerve graft. In Group 4, the defect was repaired with a vein graft, while in Group 5, the repair was performed using a vein graft with an inserted catheter. In order to evaluate functional recovery and nerve regeneration, walking track analysis, electrophysiologic and histomorphometric analyses were done at the end of the 12th week. RESULTS: Although there were no functional differences between Groups 5 and 4, comparisons regarding nerve conduction velocity demonstrated that the results obtained in Group 5 were better than those in Group 4. When the number of axons on the distal part of the sciatic nerve and mid-segment of the repaired area was taken into account, no significant difference was found between Groups 3 and 5, whereas there was a significant difference between Groups 4 and 5. CONCLUSION: In our study, it was experimentally shown that the problem of collapse of a vein graft occurring after its use in the reconstruction of a nerve defect can be overcome by placing a catheter into the vein graft. Consequently, this method may eliminate the need for the use of a nerve graft in selected cases.

Delayed removal of a primary incisor embedded in the upper lip after dental trauma: a case report about the importance of soft tissue examination.

This article describes a child patient who initially had inadequate treatment and suffered concomitant soft tissue trauma involving complete displacement of a primary central incisor into the lip tissue. The primary tooth was subsequently removed by surgery under general anesthesia. Despite the delay in diagnosis, there was an excellent outcome following removal of the embedded tooth. This paper again emphasizes the importance of an accurate history, physical, and radiographic evaluation of these patients in the acute phase. The importance of soft tissue inspection even in cases that are presented late for dental trauma management is also highlighted. This case shows that educated emergency room staff preferably including an oral and maxillofacial surgeon is required for a proper emergency management in orofacial traumas.

Custom subatmospheric dressing for fingertip injuries.

Fingertip injuries are difficult to treat. Although the best way is to cover the wound with flap or graft without finger shortening, coverage of the wound with flap or graft cannot be suitable in each case. For some cases, secondary wound healing can be an alternative treatment. In the secondary healing process, to promote the granulation tissue and to reduce wound-healing time, subatmospheric dressing (vacuum dressing) can be a useful method. In this study, a new custom-made subatmospheric dressing method designed for fingertip injuries has been described.

Severe hand injuries in children related to farm tractors: a report of 70 cases.

BACKGROUND: The purpose of this study was to review tractor-related childhood hand injuries. METHODS: Seventy children (53 males, 17 females; range 1 to 11 years) were admitted to our unit. Patients were analyzed according to sex, age, pattern of injury, type of treatment and functional results. The first step of the treatment included extensive debridement and irrigation. Patients with complex tissue defects were treated with multi-stage reconstruction procedures. Patients with amputations or partial amputations were treated with amputation of the devascularized digits. RESULTS: The most common injuries were amputations and complex tissue defects. Other types of injuries were fractures, partial amputations and skin defects. In 20 cases, skin defects were covered with split-thickness skin grafts and the functional results were good. In 40 cases with complex soft tissue injuries, skin defects were covered with flaps. The functional results were good in 30 and fair in 10. In 50 digits with complete amputations, attempts at revascularization immediately after injury failed in all patients. The functional results were good in 40, fair in 5 and poor in 5. All fractures healed in 6 weeks and no complications related with bone healing were observed. CONCLUSION: The concepts of aggressive debridement, fracture reduction, and early soft tissue coverage are central to the care of these hand injuries.

Reconstruction of sphincteric function after dysfunctional total lower lip reconstruction using free muscle graft technique.

Many techniques can be used in primary reconstruction of total lower lip defects and most of them are functional. If a total lower lip defect is reconstructed with a static, dysfunctional technique, then the patient is prone to some problems such as drooling and gingival show. In order to restore sphincteric function in a previously reconstructed lower lip, we used the free muscle graft technique, which has been firstly used by Thompson for the treatment of facial paralysis. We obtained a satisfactory result, such that symptoms of drooling and gingival show have disappeared, and a minimal purse-stringing movement has been restored. To our knowledge, this is the first time of a free muscle graft application in this type of an indication. According to our result, the use of free muscle graft technique can be a good alternative method in patients, who suffer from drooling and gingival show following dysfunctional total lower lip reconstruction.

Use of an intact sensory nerve to bridge a motor nerve defect: an experimental study.

OBJECT: End-to-side neurorrhaphy has recently became popular for peripheral nerve repair. Although this method is mainly indicated in nerve defects in which there is an absent proximal nerve stump, bridging a motor nerve defect by coapting the proximal and distal ends of the defect to a neighboring mixed nerve in an end-to-side fashion has been another experimental use of this method. In this situation, however, the source of the regenerating axons is unclear because the axons in both the proximal end of the defect and the bridging intact nerve have the capacity for regeneration. The goal of this study was to identify the source of the regenerating axons. METHODS: In this experimental study, the authors used a sensory nerve to bridge a motor nerve defect so that they could elucidate the source of the regenerating motor axons in the distal part of the motor nerve. One advantage of using a sensory nerve was that it eradicated the risk of damaging another motor nerve. Tests used in the analysis included gait evaluation, electrophysiological tests, and histological assessment. CONCLUSIONS: Results of this study showed that, in the rat model, a sensory nerve can be used to bridge a motor nerve defect, thereby eliminating the need for nerve grafting.

Simultaneous end-to-side coaptations of two severed nerves to a single healthy nerve in rats.

OBJECT: This experimental study was designed to evaluate functional and sensory outcomes and morphological features observed after simultaneous end-to-side coaptations of distal stumps of two nerves to a single neighboring nerve. Studies were performed using both parallel and end-to-side coaptation (PEC) and serial end-to-side coaptation (SEC) methods in a rat model. METHODS: In the PEC group, distal stumps of the sural and common fibular nerves were coapted to the intact tibial nerve 1 cm apart from each other in an end-to-side fashion. In the SEC group, identical surgical procedures apart from the coaptation method were conducted. For the coaptation method in this group, the distal stump of the common fibular nerve was first coapted to the side of the intact tibial nerve, and then the distal stump of the sural nerve was coapted to the side of the common fibular nerve 1 cm apart from the first coaptation site. Nonoperated contralateral sides were used as controls. Nerve regeneration in both groups was evaluated functionally, electrophysiologically, and histomorphometrically. CONCLUSIONS: When there is a need for two end-to-side coaptations of two severed nerves, PEC is the recommended method of choice to obtain better axonal regeneration into both nerves.

Titanium mesh fracture in mandibular reconstruction.

Mandibular reconstruction is important for providing good functional and cosmetic results after the resection of a mandibulary segment. Reconstruction plates and titanium meshes are usually used to reconstruct the bony defects in mandible. Although their complications are well known there is not a report on the fractures of a titanium mesh after mandible reconstruction in the literature. We reported a case of a broken titanium mesh after mandible reconstruction.

End-to-side nerve coaptation: is an additional proximal coaptation useful when available?

The aim of this experimental study was to evaluate the effects of end-to-side coaptation of the proximal end of a severed nerve to the same intact nerve, in addition to traditional end-to-side coaptation of the distal end, with an aim to use the intact nerve as a nerve conduit in a rat model and to compare the functional and histologic results of this modality to those obtained after nerve grafting and traditional end-to-side nerve coaptation. In group A, a peroneal nerve defect measuring 1 cm was created in the left hind limb, and a nerve graft 1 cm long was used to bridge the defect. In group B, only the distal stump of the peroneal nerve was coapted to the intact tibial nerve. In group C, both ends of the peroneal nerve defect were coapted to the intact tibial nerve in an end-to-side fashion 1.5 cm apart from each other, and in group D, the peroneal nerve defect was left unrepaired. Group E was consisted of nonoperated peroneal nerves that were used to obtain normative data. Although significantly higher myelinated axon densities were observed in groups B and C compared with group A and group E, total number of the myelinated axons was significantly higher only in group C. Peroneal functional index assessments demonstrated that nerve recovery in the peroneal nerve was similar in groups A and C, and both were better than those observed in groups B and D. Collectively, these results suggest that end-to-side coaptation of both ends of a severed nerve to an intact nerve, in case of a nerve defect in this length, may serve as an alternative for nerve grafting.

The effect of delayed admission in burn centers on wound contamination and infection rates.

BACKGROUND: Since wound infection rates in patients with delayed admission seemed to be significantly higher, a retrospective study of bacteriology in 320 burn patients, over a 5-year period was carried out in order to analyze the relation between delayed admission and wound infection rates in our Burn unit of Uludag University, Faculty of Medicine. METHODS: The patients were separated into moderate or major burn groups according to burn severity. Wound infection and contamination frequencies were analyzed according to time-delay between burn injury and hospitalization time. RESULTS: Delayed admission was found to be an important factor that causes an increase in wound infection and contamination frequency. This increase was significant especially among patients with moderate burn wounds. In patients with severe burns, wound infection and contamination frequencies were found to be higher for all admission time points. CONCLUSION: Systemic antibiotic prophylaxis should be discussed in patients with moderate burns whose admission-delay is more than 78 hours. Wound infection and contamination rates were high in patients with major burns independent of the admission time. Therefore, systemic antibiotic prophylaxis should also be discussed in this group of patients, although it results in elimination of the normal skin flora.

Umbilicus reconstruction with modified 'unfolded cylinder' technique.

Many techniques have previously been reported for reconstruction of the umbilicus. The common goal of reconstruction is to obtain a stable and aesthetically pleasing umbilicus with sufficient depth. Presented here is the reverse application of an 'unfolded cylinder' design, which has previously been reported for nipple reconstruction. The procedure can be applied with local anaesthesia on an outpatient basis and the drawing of the design is simple. Since the walls of the neoumbilicus are consisted of flaps, which are brought together without any twisting or tension, long-term use of a stent is unnecessary and the result is mostly stable and lasting. Moreover, the depth of the neoumbilicus is adjustable by widening the top rectangle in its design, which can increase it. Therefore, the procedure is suitable for thin as far patients.

Free rectus abdominis muscle flap with plantar skingraft--a combined method of aesthetic and functional reconstruction of the heel.

A 16-year-old girl presented with a contusion of the left calcaneus that was treated by combined free rectus abdominis muscle flap and plantar skin graft. The main advantages of this procedure are that it replaces weight-bearing skin of the heel with histologically similar skin from the instep, and the fibrofatty pad of the heel with muscle; it provides a good cosmetic result in the heel, and the scars of the donor site are well-hidden.

[The prognostic value of the Hand Injury Severity Score in industrial hand injuries]. / El Yaralanmasi Ciddiyet Skoru'nun endüstriyel el yaralanmalarinda prognozu belirlemedeki rolü.

BACKGROUND: We evaluated the value of the "Hand Injury Severity Score" (HISS) in determining the prognosis of industrial hand injuries. METHODS: Hand injury severity scores of 112 patients (17 females, 95 males; mean age 31 years; range 15 to 54 years) were calculated following surgery for industrial hand injuries. During the course of rehabilitation program, the patients were followed-up regularly. Pearson correlation coefficients were used to determine the relationship between the HISS scores and the time intervals from injury to healing and return to work. RESULTS: The mean HISS score was 37.1+/-27 (range 6 to 116). The time to healing ranged from 12 to 210 days (mean 73.7+/-40.7 days). All the patients returned to work after a mean of 80.4+/-52.9 days (range 7 to 300 days), mainly to previous working places with (12%) or without (79%) changing job activities. Nine per cent of the workers had to change their jobs. The HISS scores were found to be correlated with the healing period and the time to work (p<0.05 and p<0.000, respectively). CONCLUSION: The results of this study indicated that HISS was a useful system in predicting the prognosis in the early stages of industrial hand injuries.

[Clinical evaluation and treatment results of 30 patients with necrotizing fasciitis]. / Nekrotizan fasiitli 30 hastanin klinik degerlendirilmesi ve tedavi sonuçlari.

BACKGROUND: We retrospectively evaluated patients who underwent treatment for necrotizing fasciitis within a five-year period. METHODS: Thirty patients (4 females, 26 males; mean age 55 years; range 19 to 78 years) with necrotizing fasciitis were evaluated with respect to age, sex, etiology, predisposing factors, localization of infections, culture results, and treatment methods and results. RESULTS: The most common etiologic and predisposing factors were anorectal lesions (36.7%) and diabetes (53.3%), respectively. Wound cultures yielded Pseudomonas aeruginosa in 50% of the patients. Two strains of aerobic bacteria were isolated in three patients. All patients underwent extensive surgical debridement and received antibiotic therapy. Twenty-nine patients (96.6%) required more than one debridement, with a mean of 4.5 debridements. The ensuing skin defects following debridement were reconstructed with grafts or local flaps. No complications were encountered in the postoperative period. CONCLUSION: Early diagnosis and treatment result in decreased morbidity and prevent mortality in necrotizing fasciitis.