Experience of 80 cases with Fournier's gangrene and "trauma" as a trigger factor in the etiopathogenesis.

BACKGROUND: The purpose of the present study was to retrospectively analyze the patients' data presented with Fournier's gangrene (FG), to compare obtained data with the literature and to investigate the role of "trauma" in the etiopathogenesis. METHODS: A retrospective study was conducted on 126 patients with FG that consulted to our department. RESULTS: There were 76 male and four female patients. The mean age of the patients was 53.5±13.6 years. The most common presentation of patients was swelling (n=74). The scrotum has been shown to be the most commonly affected area in the patients (n=75). Diabetes mellitus was the leading predisposing factor and trauma was the leading responsible cause for FG. Escherichia coli was the most frequently identified microorganism (n=43, 53.75%). Primary closure was the most common technique used for all patients. Three patients exhibited a mortal course due to sepsis and multi-organ failure. CONCLUSION: FG still has a high mortality rate. Rapid and correct diagnosis of the disease can avoid inappropriate or delayed treatment and even death of the patient. The healthcare professionals should be aware that any trauma in the perineal region could lead to FG.

Multiple intraoral teratoma in a newborn infant: epignathus.

Teratomas originating from the oral cavity are named as epignathus. It is a rare type of teratoma. An 11-day old male newborn was diagnosed with cleft palate and intraoral masses. The mass on the right side was protruding from the mouth. Another one on the left side was extending from the nasopharynx to the oropharynx. The diagnosis of mature teratoma was made based on the histopathological study of surgically excised masses. We desired to report on this case since multiple localized epignatus in a newborn with cleft palate has not been described yet in the literature.

Risk factors for nosocomial infection and mortality in burn patients: 10 years of experience at a university hospital.

To evaluate the risk factors for nosocomial infection (NI) and mortality in a university hospital, 10-year data of burn patients were assessed retrospectively. The study was conducted at Erciyes University's Burn Center during 2000 and 2009. The records of 1190 patients were obtained. Overall, 131 (11%) patients had 206 NIs with an incidence density of 14.7 infections/1000 patient days. Burn wound infection (n = 109, 53%) was the most common NI. High (%TBSA burned) and late excision were found to be the most significant risk factors for the development of NI. Pseudomonas aeruginosa was the most frequent causative microorganism. However, the prevalence of multidrug-resistant Acinetobacter baumannii has increased in recent years with a prevalence of 47% in 2009. The carbapenem resistance of P. aeruginosa has decreased in recent years, whereas that of A. baumannii increased and it had a prevalence of 94% in the last year. Conversely, the most important risk factors for mortality were advanced age, high %TBSA and having an underlying disease. Prevention of NI is an important issue in burn units to reduce mortality rates. Early excision and wound closure are important therapeutic approaches for the prevention of burn wound infection.

The effect of angiotensin (1-7) on survival of random pattern skin flaps with nicotine-induced ischemia in rats.

OBJECTIVE: The purpose of this study was to reveal the effect of angiotensin (1-7) on survival of random pattern, nicotinized, ischemic flap model in rats. MATERIALS AND METHODS: We used female Sprague Dawley rats weighing between 250 and 300 g. The study was performed on 3 groups each of them was consisted of 30 rats (control [C], angiotensin (1-7) [A] and vehicle [V]).While group C was subjected to 1 mL saline subcutaneous injection once daily for 28 days, groups A and V were nicotinized by 2 mg/kg nicotine subcutaneous injection, twice a day. At the end of this period, McFarlane random flap was constructed in all rats. No drug was applied to the flap bed in the group C, whereas for group A angiotensin (1-7) (A [1-7]) was delivered and a vehicle without an active ingredient was applied to the group V.Following surgery, immediately, Na-fluorescein diffusion tests were performed on 10 subjects of every group and necrotic areas were determined by millimetric paper method. After this, for determining angiogenesis, 10 subjects were killed from each group on the second day and fourth day. Finally, on the seventh day, necrotic areas were measured in 10 subjects of each group. They were then killed after photographs were taken. Specimens were collected from distal and critical zones of flaps, in all the groups, for immunohistochemical and histopathologic analyses. RESULTS: Macroscopic measurements revealed equal ischemic areas for groups A and V in 30 minutes which were both larger than those of the group C (P < 0.005). Measurements performed on the seventh day showed a significant decrease of ischemia, which advanced to necrosis in the group A (P < 0.005). Groups V and C showed a direct progress to necrosis without changes in ischemia levels. Microscopic analysis exhibited a statistically significant increase in the number of microvascular structures and diameters of mature vascular structures in the group A compared with those of groups C and V (P < 0.005). CONCLUSION: A (1-7) increased vasodilatation in nicotinized flaps, triggered angiogenesis in the first 2 days, and contributed remarkably to the flap survival.

The impact of lidocaine on flap survival following reperfusion injury.

BACKGROUND: Inflammatory events triggered by the mediators released from free oxygen radicals and infiltrated leukocytes play a direct role in formation of the ischemia-reperfusion (IR) injury. The aim of this study was to investigate the impact of lidocaine on IR injury due to its anti-inflammatory properties. MATERIALS AND METHODS: Following delivery of lidocaine to the ischemic flaps in two different doses prior to the reperfusion, flap survival, malondialdehyde (MDA) level, myeloperoxidase (MPO) level, neutrophil count, and measurement of vascular diameters were studied. Twelve hours after reperfusion, tissue specimens were collected for measurement of MDA level, MPO level, neutrophil count, and vascular diameters. Flap survival was evaluated on the fifth day. RESULTS: Flap survival rate was 15.54% ± 8.23% in the control group, whereas the groups treated wtih lidocaine showed remarkable elevations in survival rates as follows: 70.83% ± 33.53% and 67.42% ± 30.81%, respectively. MDA levels in sham and lidocaine treatment groups were significantly lower than those observed in control group. CONCLUSION: Lidocaine inhibited the increase in MDA level associated with IR injury while showing no influence over increases in number of neutrophils and tissue MPO level, and it elevated the flap survival rate.

Retrospective analysis of two hundred thirty-five pediatric mandibular fracture cases.

Maxillofacial fractures are encountered less commonly during childhood period due to anatomic, social, cultural, and environmental factors. Although the incidence of all maxillofacial fractures is 1% to 15% among pediatric and adolescent patients, this rate drops to less than 1% in children below 5 years age. Two hundred thirty-five cases (

An undescribed scalding, "cökelek" burns in Turkish children: is acidic effect the reason of high mortality and double-hit injury?

This retrospective review was aimed to evaluate for the first time the risk factors in addition to the demographic and epidemiological features of immersion scalds by hot çökelek in 23 preschool-aged Turkish children younger than 7 years of age, who were admitted to the burn unit of Erciyes University Medical Faculty between January 1996 and August 2006. This retrospective study consisted of 23 hospitalized scalded children by hot çökelek. Hot çökelek burns were studied in terms of age, sex, length of hospital stay, seasonal variation, regions of involvement, the time between burn and admission to our burn unit, extent of burn injury, mortality, morbidity, and treatment modalities. The study consisted of 17 male (74%) and 6 female (26%) pediatric burns with a male-to-female ratio of 2.83:1, which was more frequent in boys. The mean age distribution, extent of burn injury, length of hospital stay, and mean transport time were 3.47 +/- 1.41 (range, 2-6 years), 36.60 +/- 16.60% (range, 12-79%), 26.00 +/- 10.88 (range, 13-38 days), and 8.69 +/- 3.73 (range, 2-15 hours), respectively. The overall mortality rate of the study population was 47.8% (11 of 23 children died). All patients suffered deep partial and full thickness burn injuries and received surgical treatment. Hot çökelek burns with acidic component should be considered important because of its high morbidity and mortality. We emphasize the admittance criteria of patients into burn units need to be reviewed in countries where çökelek is being widely consumed.

Reactive oxygen species in experimental ischemic flow-through venous flaps and effects of antioxidants on reactive oxygen species and flap survival.

We made an experimental study on rabbit ears using an ischemic flow-through venous flap model to determine the changes in levels of reactive oxygen species (ROS) in venous flaps and effects of exogenous antioxidants on endogenous antioxidant superoxide dismutase (SOD) and ROS indicator malonyldialdehyde (MDA) levels and on flap survival. Mean SOD level significantly decreased and the MDA level significantly increased after the flap elevation according to basal levels of untreated flaps. The mean flap survival rates in the exogenous SOD or glutathione (GSH)-treated groups were significantly increased with respect to the untreated group. The SOD level was increased significantly and the MDA level was decreased significantly in the SOD- or GSH-treated groups relative to the control group after the flap elevation. These results have suggested that ROS may have an important role in ischemic flow-through venous flap pathogenesis and additionally, antioxidants could enhance the rate of flap survival.

A new proposal of classification of zygomatic arch fractures.

PURPOSE: Among facial fractures, zygomatic arch fractures occur rather frequently. Facial fractures have recently been classified in fine detail according to computed tomographic findings. Nevertheless, there exists no classification of the zygomatic arch fracture, which has a physiognomically important place, to provide guidance for treatment. We aimed to make a detailed classification of zygomatic fractures in various shapes, which does not exist in the literature, and to form an algorithm for treatment. PATIENTS AND METHODS: A total of 451 patients with zygomatic arch fractures treated in our clinic from 1987 through 2004 were assessed retrospectively from the treatment viewpoint together with radiological and clinical findings. RESULTS: At the end of this assessment, arch fractures were divided into 2 groups: 1) isolated fractures in which the zygomatic arch alone broke, and 2) combined fractures in which the zygomatic arch broke together with the other facial bones. Isolated fractures were also divided into 2 subgroups as A) 2 fractures in the arch, and B) more than 2. Isolated arch fractures with more than 2 fracture lines were also classified as V-shaped fractures where fragments are partially reduced and those where fragments are displaced. As for combined fractures, they were subgrouped as A) single fracture in the arch, and B) plural. Plural fractures were further classified within their own group, also according to whether fragments were displaced or not. CONCLUSION: In the 2 fractures and V-shaped fracture subgroups of isolated fractures, preservation of fragments in reduced position was satisfactory during the closed reduction and afterwards. As for those with more than 2 fractures of isolated arch fractures, they required open reduction and internal rigid fixation. The same treatment was used in combined zygomatic arch fractures where there were more than one displaced fractures. In addition to classification, we formed an algorithm to guide us in treatment based on our series.

A seven-year burn unit experience in Kayseri, Turkey: 1996 to 2002.

A retrospective multifactorial epidemiological study of 742 patients admitted to Erciyes University Medical Faculty Burn Unit during a 7-year period between 1996 and 2002 is presented. The overall male-to-female ratio was 1.88:1. The highest-risk age group of burn injuries was 0 to 6 years (48.6%), with the greatest number of injuries occurring to children who were 2 to 3 years of age. Seasonal variations had no influence on the increased number of admissions to the burn unit. Scalding was the major cause of pediatric burns. Flame burns were the most frequent cause of burns in adults and the second-leading cause in children. Seventy-eight of the 742 patients died, with a mortality rate of 7.8 % in children and 12.6% and 19.23% in adult males and females, respectively. The overall mortality rate was 10.5%.

A surgical conundrum: Tessier number 4 cleft.

OBJECTIVE: Among the rarest of the craniofacial clefts is the Tessier no. 4 cleft; and hence little has been published about its management and treatment. Complete forms of the cleft yield poor surgical results because of the shortened oculoalar and oculo-oral distance and inadequate soft and bony tissue. Multiple sequential corrective operations are required. A primary early concern is the protection of the eye, particularly in severe forms in which corneal exposure occurs. This article presents two cases of Tessier no. 4 clefts, one unilateral and the other bilateral, and discusses the problems encountered during their surgical and postoperative managements.