Vacuum-assisted closure therapy in newborn gangrene.

Gangrene of the newborn or neonatal gangrene is very uncommon, and it usually involves the extremities. Neonatal gangrene seems to be more frequent in pregnancies related with spontaneous rupture of the amniotic sac leading to delayed delivery or dry labour. However, in most of the cases, no aetiological factor can be found. Foetal pressure necrosis and amniotic band sequence are two of the most common causes of this condition.Thrombosis, emboli, congenital heart disease, coagulopathy, sepsis and polycythaemia are some of the other aetiologic factors. Treatment of this condition is usually conservative and supportive. Conservative treatment includes adequate hydration, prevention from infections and allowing the involved area to demarcate in an aseptic environment. In some cases, surgical debridement and further reconstruction can be necessary. In order to prepare the wound bed for surgical closure after surgical debridement, vacuum-assisted closure (VAC) therapy can be a new, highly effective method in the treatment of newborn gangrene. In this article, a case of a neonatal gangrene treated with the application of VAC therapy is presented.

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.

Milking technique for reimplanted digits with insufficient venous drainage.

The most common problem after finger replantation is congestion because of insufficient venous drainage. A simple method--milking technique--is described as an additional method for the treatment of venous congestion.

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.

A single tensor fasciae latae musculocutaneous and fascia flap for composite reconstruction of urogenital and groin defect.

The tensor fasciae latae flap is a well known musculocutaneous flap used for many indications in the field of plastic surgery. The flap has some modifications to fit different reconstructive requirements of the defects. Osseous-muscle flap, osseous musculocutaneous flap, muscle flap, muscle-fascial flap and musculocutaneous-fasciocutaneous flap are some known alternatives. We used a modification of this well-known flap as musculocutaneous and fascia flap for a composite reconstruction of groin and urogenital defect. We reconstructed the groin defect with musculocutaneous part of the flap, and the defect over neourethra with the fascial extension and grafting. The aim of this modification was to reconstruct a genital defect with a thin and more pliable tissue to overcome the problem of distortion, kinking and thickness of the flap.

Osteocutaneous posterior interosseous flap for reconstruction of the metacarpal bone and soft-tissue defects in the hand.

A vascularized bone segment of the ulna together with a posterior interosseous fasciocutaneous flap is harvested, including a cuff of the extensor pollicis longus muscle. The authors treated five male patients with metacarpal bone and soft-tissue defects of the hand using a distally based island osteocutaneous posterior interosseous flap. Their ages at the time of surgery ranged from 15 to 37 years (mean, 24 years). The bone defects were in the first metacarpal in three cases, the fourth metacarpal in one, and the fifth metacarpal in one. The length of the donated ulna ranged from 3 to 7 cm (mean, 5 cm). The follow-up period ranged from 5 to 92 months (mean, 39 months). All flaps survived completely. The posterior interosseous flap provides thin skin of good texture, together with vascularized bone, for a one-stage reconstruction of the metacarpal bone and soft-tissue defects in the hand.