Wound Care in Burn Patients

Wound care in one of the most important prognostic factors in burn victims. Open wound carries risks for infection due to hypothermia, protein and fluid losses. In addition, unhealed wounds are the major risk factors for acute-subacute or chronic complications in burn patients. Although no exact algorithm exists for open wound treatment, early escarectomy or debridement together with grafting is the best option. Ointments together with topical epithelizing agents without dressings are genereally adequate for first-degree burns. However, topical antibacterial agents are usually required for second to third-degree wounds. Standart treatment for the open wound without epithelization is autologous skin grafting. In cases where more than 50% of the skin surface in affected, autologus donor skin may not be enough. For these cases, epidermal cell culture in vitro may be used. Mesenchymal stem cell applications which have immunosupressive effects should be utilized in cases where cells need to be prepared as allografts. (Journal of the Turkish Society intensive Care 2011; 9 Suppl: 51-4

Biri 7 cm çapında üç nodülün eşlik ettiği idiyopatik skrotal kalsinozis

İdiyopatik skrotal kalsinozis, skrotumda asemptomatik, ağrısız kalsifiye nodüllerle karakterize, çok nadir görülen selim bir hastalıktır. Kırk dört yaşında erkek hasta, skrotumda 20 yıldır var olan ve giderek büyüyerek kaşıntı ve hafif ağrıya yol açan nodüllerle başvurdu. Fizik muayenede, skrotumda çapları 4, 5 ve 7 cm olan, çok sert üç nodül görüldü. Nodüller eksize edildi ve hiçbir komplikasyonla karşılaşılmadı. Histopatolojik incelemede epitel hattını veya gerçek kist veya kist kalıntısını düşündüren bir bulguya rastlanmadı; tanı idiyopatik skrotal kalsinozis şeklinde kondu. Bildiğimiz kadarıyla, 7 cm’lik nodül bugüne kadar skrotum nodülleri için bildirilen en büyük nodüldür.Idiopathic scrotal calcinosis is a very rare and benign disease characterized by asymptomatic, painless, and calcified nodules within the scrotal wall. A 44-year-old man presented with a 20-year history of scrotal nodules which had gradually increased in size and number, causing itching and slight pain. Physical examination revealed three very firm scrotal nodules with diameters of 4, 5, and 7 cm, respectively. Nodules were excised without any complication. Histopathological examination showed no epithelial lining or true cysts or cyst remnants and the diagnosis was made as idiopathic scrotal calcinosis. To our knowledge, the size of the biggest nodule also represents the largest nodule hitherto reported in the scrotum

Reconstruction of congenital alar hypoplasia/aplasia by auricular composite graft: Case report

Konjenital alar hipoplazi ender görülen bir anomalidir. Kliniğimize 3 olgu bu şikayet ile başvurdu. Onarım için hipoplastik ala bölgesinde, deri altı planda, diğer nostril ile simetri oluşturacak bir cep hazırlandı. Daha sonra, kulaktan üçgen biçimli kompozit 'auriküler' greft alınarak, donör bölge primer onarıldı. 'Auriküler' kopmozit greft, alar bölgede hazırlanan cep içine implante edildi. Tüm olgularımızda, kopmozit greftin tuttuğu gözlendi. Donör sahada komplikasyon gözlenmedi. Onarılan nostrilin, geç post-operatif dönemde retrakte olması nedeni ile, ala bölgesinde hazırlanan cebin, ve auriküler kompozit greftin, normal nostrile göre biraz daha büyük hazırlanmasının, veya 'nostril retainer' kullanımının, daha iyi bir simetri elde edilmesinde yararlı olacağını düşünmekteyiz.Congenital alar hypoplasia is a rare anomaly. Three case admitted to our clinic with this complain. A subcutaneous pocket that was dimensionally symmetrical to the left nostril was created at the hypoplastic alar region for reconstruction. Then a triangular shaped composite was harvested; and the donor-site was primarily repaired. This composite auricular graft was implanted in the pocket that had been prepared on the alar region. The composite grafts were survived in all cases. No donor-site complication was observed. We think that, preparing a pocket and inserting a composite auricular graft bigger than the normal nostril or using a nostril retainer could yield a better symmetry due to retraction of the reconstructed nostril in late postoperative follow-up

Reconstruction of "Pinocchio" nasal deformity caused by hemangioma by Open-tip plasty technique

'Pinokyo' veya 'Sirano' burun şekil bozukluğu hemanjioma bağlı ender rastlanan bir deformitedir. Hastanın kişilik gelişimi üzerinde olumsuz etkiler yapabilir. Kitle etkisine bağlı olarak nasal kıkırdaklarda şekil bozukluklarına yol açabilir. Bu nedenle burun ucu yerleşimli hemanjiomlara involüsyon beklenmeksizin erken müdahale etmek gerekir. Olgumuz 6 yaşında kız çocuğu sağ infraorbital bölge ve burun ucunda kitle nedeniyle kliniğimize başvurdu. Hasta ve yakınları kitlenin neden olduğu şekil bozukluğundan şikayet etmekteydi. Sağ alt infraorbital bölgedeki kitle eksize edilip primer onarıldı. Burun ucu yerleşimli kitleye 'open-tip' plasti tekniği ile eksizyon yapıldı. 'Open-tip' plasti tekniği, burun derisinde herhangi bir insizyon nedbesi oluşmamasını sağladı.'Pinocchio' or 'Cyrano' nasal deformities are rare deformities caused by hemangioma. The presence of this mass may have negative effects on personality and may cause nasal cartilage deformity. Due to these problems nasal tip hemangiomas deserve early treatment without expectation of involution. Our case is a six-year-old girl. She is admitted to our clinic because of right infraorbital and nasal tip masses. The main complain was the aesthetic deformity caused by the masses. The right infraorbital mass was excised and repaired primarily. The nasal tip mass was excised by open-tip plasty technique. With this technique the lesion is excised without a visible incisional scar on the nasal skin

Unusual complication of septoplasty: Oronasal fistula and reconstruction: Case report

Oronazal perforasyon, septoplasti ameliyatının çok nadir karşılaşılan bir komplikasyonudur. Semptomatik fistüller, hipernazal konuşmaya ve besinlerin nazal pasajdan kaçağına yol açar¬lar. Bu yazıda daha önce septoplasti ameliyatı olan ve katı yiyeceklerin burundan gelmesi şi¬kayetiyle başvuran hastanın değerlendirilmesini ve oronazal fistülünün onarımını sunuyoruz.Unusual complication of septoplasty: Oronasal fistula and reconstruction. Case report. Oro-nasal fistula is a rare complication of septoplasty operation. Symptomatic fistulas may contri¬bute to hypernasality and the patient complains of liquid or food getting into the nose. Here, we present a patient who was operated for septum deviation and had nasal escape of food and descrihe surgical closure of her fistula

Mandibular giant cell reparative granuloma due to chronic renal failure

Reperâtif granülom yavaş gelişen, ağrılı ve kanamalı selim bir lezyondur. Tedavisi eksizyon küretaj koterizasyondur. '"i Olgumuz kronik böbrek yetersizliği olan 22 yaşında bayandır. Âğız içinde bir buçuk ayda bü¬yüyen, vital fonksiyonlarını olumsuz etkileyen kitle nedeniyle kliniğimize başvurmuştur. Has¬taya kitle eksizyonu, ekspoze olan mandibulanın marjinal rezeksiyonu yapılmış ekspanse ol¬muş dudak normal boyutlarına uygun olarak küçültülüp artan yumuşak dokular ağız içi defek-tin onarımında kullanılmıştır. Hastanın postoperatif 1,5 yıllık takibinde herhangi bir kompli-kasyon, ve nüks gözlenmemiştir.Mandibular giant cell reparative granuloma due to chronic renal failure. Reparative granulo-ma is a progressively growing, painful, and bleeding benign lesion. The treatment is excisional curettage and cauterization. Our case was a twenty-two-years-old female with chronic renal failure. She presented to our clinic due to an intraoral lesion that had grown in 1.5 months and adversely affected her vital functions. After excision of the mass and marginal resection of exposed mandible, expanded lower lip reduced to its normal size and the excess soft tissues were used for reconstruction of the intraoral defect. Complication and recurrence was not observed in 1.5-year follow-up

Squamous cell carcinoma arising from chronic dermatoses

Kronik güneş hasarı, ve çevresel karsinojenlere ek olarak sifiliz, lupus vulgaris, lepra gibi kro¬nik granülomatöz hastalıklar ve lupus eritematozus, kronik ülserler, yanık nedbeleri zeminin¬den de yassı epitel hücreli karsinom gelişebilir. Bu sunuda tedavisiz bırakılan diskoid lupus eritematozus (DLE) ve lupus vulgaris zemininde gelişen iki yassı epitel hücreli karsinom vakası sunulmakta ve sikatris zemininde kanser gelişi¬mine karşı yakın takibin yararı tartışılmaktadır.Squamous cell carsinoma arising from chronic dermatoses. In addition to chronic sun damage and environmental carcinogens, granulomatous diseases such as syphilis, lupus vulgaris, lep¬rosy and lupus erythematosus, chronic ulcers, burn scars may predispose squamous cell carci¬noma. In this case report, two untreated cases, a discoid lupus erythematosus and a lupus vulgaris gi¬ving rise to squamous cell carcinoma are presented. The importance of close follow- up of the patients even after appropriate treatment is noted

Reconstruction of penile and perineal by means of scrotal flap: Two cases

Genital bölge ve perine bölgesindeki defektler pek çok nedene bağlı olarak oluşabilir. Penis ve perine bölgesinde yaralanma sonucu bize başvuran iki olgumuzda defektler, skrotal flep ile onarıldı. Skrotal flep, kolay hazırlanabilir olması, geniş defektleri dolaşım problemleri olmadan örtebilmesi, elastisitesinin iyi olması nedeniyle, seçilmiş vakalardaki, penis ve perineal bölge defektlerinin onarımında alternatif bir yöntem olarak kullanılabilir.Reconstruction of penile and perineal region by means of scrotal flap: two cases. Defects of genital and perineal regions are caused by various reasons. In two of our cases with penile and perineal injuries, scrotal flap was used for reconstruction of defects. Scrotal flap which is relatively easy to prepare, covering large defects without circulatory trouble, having good elasticity, could be an alternative reconstructive method in selective cases with penile and perineal injuries

Sirküler trakeal rekonstrüksiyonda farklı yöntemlerin karşılaştırılması: Deneysel çalışma

Amaç: Bu çalışmada sirküler trakeal rekonstrüksiyon için farklı prefabrike modellerin karşılaştırılması amaçlandı. Gereç ve Yöntem: Otuz adet erişkin dişi Yeni Zelanda tavşanı, farklı doku kombinasyonuyla sirküler trakeal rekonstrüksiyon için altı gruba ayrıldı. Prefabrike edilmiş trakealarda anastomoz yapılmadı. Vasküler kaynak olarak lateral torasik fasya veya pektoralis majör kası; iskeletsel çatı olarak polipropilen mesh, politetrafloroetilen (Gore-Tex) veya yüzük kartilajlar kullanıldı. İç yüzey tüysüz epitelyal deri greftinden sağlandı. Gruplar tüysüz epitel greftinin canlılığı, longitüdinal esneklik, dayanıklılık, flep duvar kalınlığı, iç çap ve flep canlılığı açısından karşılaştırıldı. Bulgular: Polipropilen mesh gruplarında tama yakın epitelyal deri grefti canlılığı görülürken (%95-%99), Gore-Tex gruplarında tama yakın nekroz gözlendi (%74-%71). Longitüdinal esneklik ve dayanıklılık Gore-Tex ve polipropilen mesh gruplarında normal trakeaya yakın ölçülerde bulundu. Kartilaj greftleri ile prefabrikasyon yapılan gruplar normalden fazla longitüdinal esneklik ve kolayca kollaps gösterdi. Sonuç: İskeletsel çatı olarak polipropilen mesh, vasküler kaynak olarak lateral torasik fasyanın kullanıldığı prefabrike model, sirküler trakea defektlerinin rekonstrüksiyonunda en iyi seçenek olarak görünmektedir.Objectives: This study was designed to compare different préfabrication models for circumferential tracheal reconstruction. Materials and Methods: Thirty adult female New Zealand rabbits were divided into six groups for circumferential tracheal reconstruction with a different tissue combination. Préfabrication of neotrachea was performed without anastomosis. Lateral thoracic fascia or pectoralis major muscle were used for vascular supply. Polypropylene mesh, polytetrafluoroethylene (Gore-Tex), or cartilage rings were used for skeletal framework. Hairless epithelial skin graft was used for inner lining. The groups were compared in terms of viability of hairless epithelial graft, longitudinal flexibility, rigidity, flap wall thickness, internal diameter, and flap viability. Results: Epithelial skin graft was almost totally viable (95%-99%) in the polypropylene mesh groups.. Gore-Tex groups exhibited almost total necrosis (74%-71%). Longitudinal flexibility and rigidity were similar to the native trachea in Gore-Tex and polypropylene mesh groups. Neotrachea prefabricated with cartilage grafts showed more than normal longitudinal flexibility and collapsed easily, Conclusion: The prefabricated model with the use of polypropylene mesh for skeletal framework and lateral thoracic fascia for vascular supply seems to be the best alternative in the reconstruction of circumferential tracheal defects

Comparison of the early and late postoperative results in cases with pedicled transverse rectus abdominis musculocutaneous flap breast reconstruction: Twenty-year follow-up

Background: The TRAM flap has proven to be the autogenous tissue of choice for breast reconstruction. The progressive improvement of the aesthetic results in long-term follow-up of patients with well-executed TRAM flap breast reconstructions is observed to be highly satisfactory for both patients and the surgeon. Aims and Objectives: In this article, I aimed to present long term results of cases with pedicles TRAM flap reconstruction. Material and Methods: Between January 1999 and July 2001 period, 22 pedicled TRAM flap breast reconstructions were performed to 21 patients with breast carcinoma. The mean age of the patients was 42 (28-53) years. In this study, the contralateral rectus abdominis muscle was preferred as a pedicle in patients who had received adjuvant radiotherapy- (10 patients) and vertical or oblique flap inset was applied in most of them- (9 patients). In patients without adjuvant radiotherapy but with infraclavicular tissue losses, or with small opposite breast, again vertical or oblique flap inset was preferred- (4 patients). In all patients with vertical or oblique flap inset, the contralateral rectus abdominis muscle was used as a pedicle- (13 patients). In patients with full and attractive opposite breast, horizontal flap inset was preferred- (7 patients). In patients with horizontal flap inset, ipsilateral rectus abdominis muscle was used as a pedicle unless the patient had received adjuvant radiotherapy- (6 patients); contralateral rectus abdominis muscle was used as a pedicle if the patient had received adjuvant radiotherapy- (1 patient). Results: The follow-up period is 18-20 years for this series. During the early postoperative days, highly satisfactory results have been obtained. Eighteen of the cases were totally satisfied. Three of the cases had dissatisfactions mostly related to complications. During 18 to 20 years period follow-up of 12 patients has been performed regularly. Oncologic tracing, the degree of maintenance of the breast shape of the flap and symmetry, softness, and naturality of the reconstructed breast, maturational changes in surgical scars, abdominal strength, sensational changes over the flap skin, color and shape changes over nipple areola complex have all been periodically observed. Conclusion: TRAM flap is still the gold standard among all breast reconstruction modalities. Progressive improvement in all measures such as breast, symmetry, softness, and naturality of the reconstructed breast, maturational changes in surgical scars, abdominal strength, sensational changes over the flap skin are very satisfactory for patients and the surgeon