Burhan Özalp

Comparison of the antibacterial effect of silver sulfadiazine 1%, mupirocin 2%, Acticoat and octenidine dihydrochloride in a full-thickness rat burn model contaminated with multi drug resistant Acinetobacter baumannii.

In this study, our aim is to compare the efficacy of different topical antibacterial agents in a rat model contaminated with a multi drug resistant (MDR) standard Acinetobacter baumannii strain. The study was carried out on 40 Sprague-Dawley rats of 250-300 g each. For the purposes of this study, the rats were divided into 5 groups, with 8 rats in each group: Group 1 control; Group 2 silver sulfadiazine; Group 3 mupirocin; Group 4 Acticoat group; and Group 5 octenidine dihydrochloride group. Following to the formation of the full-thickness burn areas in rats, the MDR A. baumannii standard strain was inoculated into the burned area. The rats in all the groups were sacrificed at the end of the 10th day and subjected to histopathological and microbiological evaluation. In the histopathological evaluation, the lowest inflammatory cell response and bacterial density in the eschar and muscle tissues were observed in the Acticoat group. While these results were found to be statistically significant compared to the silver sulfadiazine group, only the bacterial density in the muscle tissue was found as significant in comparison to the mupirocin and octenidine groups. In the microbiological evaluation, the lowest growth in the muscle tissue culture among all the groups was observed in the Acticoat group. The growth in the eschar tissue culture was significantly lower in the Acticoat and octenidine groups in comparison to the silver sulfadiazine group. At the end of the study, it has been observed that Acticoat was effective both in eschar and muscle, while octenidine was effective in eschar tissues in a rat burn model contaminated with MDR A. baumannii.

The effect of hyperbaric oxygen therapy on the survival of random pattern skin flaps in nicotine-treated rats

Previous studies have shown that nicotine increases the risk of necrosis in skin flaps. We investigated the effect of hyperbaric oxygen (HBO(2)) treatment on the survival of random skin flaps in nicotine-treated rats. Thirty-two Sprague-Dawley rats were divided into four groups with eight rats in each group. Group 1 (n=8) was the control, group 2 (n=8) received HBO(2) treatment without being exposed to nicotine, group 3 (n=8) received nicotine and group 4 (n=8) received HBO(2) treatment with exposure to nicotine. The rats in the nicotine-treated groups were prepared by treating them with nicotine for 28 days. At the end of the 28th day, standard McFarlane-type random skin flaps were lifted from the backs of all the rats. In groups 2 and 4, HBO(2) treatment started at the 30th min following the surgery and continued once a day for 7 days. The flap survival rates and histopathological evaluation results related to neovascularisation and granulation tissue formation were significantly better in the HBO(2)-treated groups (groups 2 and 4) than in the groups that did not receive HBO(2) treatment (groups 1 and 3) (p < 0.05). The flap survival rates, neovascularisation and granulation tissue formation were highest in group 2 and lowest in group 3 (p ≤ 0.001). No significant difference was observed between group 4, which received HBO(2) treatment with nicotine exposure, and the control group (group 1) (p > 0.05). In conclusion, our study demonstrates that HBO(2) treatment has a positive effect on flap survival in nicotine-treated rats.

The effect of hyperbaric oxygen treatment on the healing of burn wounds in nicotinized and nonnicotinized rats.

The importance of oxygen in wound healing and the negative effects of cigarette smoking have been demonstrated in various studies. In this study, our aim was to investigate the effect of hyperbaric oxygen (HBO2) treatment on wound healing in nicotinized and nonnicotinized rats. The study was conducted on 32 Sprague Dawley rats. The rats were divided into four groups, with eight rats in each: group 1, nonnicotinized rats; group 2, nonnicotinized rats treated with HBO2; group 3, nicotinized rats; and group 4, nicotinized rats treated with HBO2. To prepare the nicotinized groups, the rats were given nicotine for 28 days. At the end of day 28, standard, deep, second-degree to third-degree burns were created on the rats. The HBO2-treated groups underwent HBO2 treatment once a day for 7 days after the creation of the burn damage. All rats were killed 21 days after injury, and the burns were subjected to macroscopic, histopathological, and microbiological evaluation. During this evaluation, the smallest necrotic areas and the lowest rate of fibrosis were observed in group 2. The largest necrotic areas and the highest inflammation and fibrosis rates were observed in the nicotine-treated group 3. When the nicotinized and nonnicotinized groups were compared separately, there was a significant difference in favor of the groups treated with HBO2. Bacterial growth was the highest in the nicotinized group 3, whereas no statistically significant difference was observed among the other groups. We conclude that HBO treatment accelerates the recovery of burn wounds and provides more effective healing by reducing the development of scars both in nicotinized and nonnicotinized rats.

Foreign Body Penetrations of Hand and Wrist; a Retrospective Study

BACKGROUND Despite significant practical knowledge and experience on foreign body penetration injuries to the hand and/or wrist, deficient management and complications can still be encountered, and ignorance of its causative and eventual social aspects unfortunately is a substantial fact. This study aims to cover the clinical and social properties and the management of these kinds of injuries. METHODS A retrospective analysis of 86 patients requiring evaluation and treatment in a Hand Surgery Division of a university hospital was performed. RESULTS The median age was 32 (min: 4, max: 63). Industrial workers constituted the largest occupational group (n=22, 25.6%). Twenty-three (26.7%) of the cases were elective admissions. Thirteen (15.1%) patients had various comorbidities, and five (5.8%) had psychiatric diagnoses at the time of the injury. The index finger was the most frequent site of injury (n=29, 33.7%). General anesthesia was not necessary for the management of 94.2% of the cases. In 26 (30%) of the patients, neural, tendinous or osseous damage was observed. Twenty-four (30%) patients were included in a postoperative hand physiotherapy program. CONCLUSION The practically well-known general features of the issue and those aspects that may still be overlooked currently are reevaluated herein, in light of our observational data.

Reconstruction of full-thickness nasal alar defects using cartilage-supported nonfolded nasolabial flaps.

Abstract The difficulties faced in the reconstruction of the nasal alar defects are still continuing because of their unique anatomy, free margin, and triple-layered complex structure. In this study, we would like to present the results of the cartilage-supported nonfolded nasolabial flap reconstruction method that we applied to full-thickness alar defects involving the alar rim. Between March 2009 and October 2011, 5 patients with full-thickness alar defects underwent cartilage graft-supported nasolabial flap reconstructions. Three of the patients were men, whereas 2 patients were women. Their median age was 54.2 years (range, 43–62 y). The defects were caused by either tumor excision or trauma. According to the method we applied, cartilage grafts were placed into the pouches formed between the skin and the adipose tissue to provide cartilaginous support to the nasolabial flaps to be adapted to the defect areas. The deep surfaces that were going to form the nasal mucosa were grafted using postauricular full-thickness skin grafts. Patients were followed up for a median period of 7.3 months (range, 3–21 mo). In all patients, the flaps fully fitted the defect areas and provided enough coverage over the defects. Although minimal graft contractions were observed in the later phase because of the cartilage support placed within the pouches formed in the flaps, no nasal airway constrictions were observed. The technique we applied is a simple and reliable method providing adequate framework support, full color and texture harmony, an open nasal passage, and a single-session reconstruction in most cases.

Subgaleal-subperiosteal flap for forehead and scalp reconstruction.

Abstract Forehead soft tissue defects are most usually associated with motor vehicle accident and less commonly with physically assault, trauma resulting from falls, malignant tumor resection, and burn injury. These kinds of defects incorporate only the soft tissue in general but sometimes there are accompanying bone defects. Different reconstruction alternatives can be preferred depending on the defect type and the amount of tissue loss. In this report, a patient who underwent surgery for tumor excision is presented. After surgical excision, denuded frontal bones were covered with subgaleal–subperiosteal flap. Split thickness skin graft harvested from the medial upper arm was used for skin resurfacing. Optimal healing and cosmetic outcome were obtained using 1-step surgical procedure.

Conservative treatment of displacement mandibular third molar.

To the Editor: Impacted third molar surgery is performed frequently all around the world. It is very important to assess the patient’s general condition, age, oral hygiene, premedication, and the presence of alveolar bone loss and to choose the proper method for each individual patient for reasonable results. The surgery is performed under local or general anesthesia. During surgery, to prevent displacement of impacted molar, the lingual cortex is supported by the finger or by free elevator while the tooth is elevated and taken off. Inadequate surgical technique can cause displacement of the inferior third molar into the lateral pharyngeal space (LPS) and recurrent oral infections. A 28-year-old man who had been operated on to extract the right mandibular third molar was referred to our clinic. The patient was operated on under local anesthesia 3 months ago. The information reported that the tooth was not visible and could not be found while the dentist was elevating it. After the operation, the dentist requested a panoramic radiograph, and the tooth was diagnosed near the upper mandibular ramus. The patient had no complaints, and conservative treatment was preferred. Clindamycin 600 mg/d was given to the patient for 7 days after the surgery. Initially, the patient’s health was normal, and he had no complaints regarding the remnant tooth. Twenty days after the surgery, the patient had fever, and his main complaint was difficulty in swallowing with pain, but the patient did not return to the dentist and took the same antibiotics. The infection regressed gradually, but according to the patient, similar periods repeated with different intervals in the 3 months after surgery. On examination, the patient had pain with palpation, swelling on his face and upper neck, temperature of 38.2-C, and discomfort with swallowing, and there was a hyperemia on his oropharyngeal mucosa. The tooth was not palpable. The lingual cortex would be thick because of long-term alveolitis, and it had to be supported during the surgery to prevent displacement of the tooth. The imaging techniques showed that the third molar was broken, and it was in the perimandibular region (Figs. 1 and 2). There was no abscess in the deeper neck space and near the tooth. Surgical operation was strongly

Breast Augmentation Combining Fat Injection and Breast Implants in Patients With Atrophied Breasts.

Abstract Breast augmentation is a challenging issue in atrophied breasts related to breastfeeding. Here, we describe a modification combining breast implants and fat grafting to obtain a successful outcome without implant edge visibility and palpability. Thirty-four women with atrophied breasts underwent breast augmentation over a 6-year period. The breast implants were placed in the subglandular plane to obtain optimal filling and expansion of atrophied breast tissue. Autologous fat grafting was performed above the inframammary sulcus to prevent implant visibility and palpability due to insufficient soft tissue coverage. Rippling, implant visibility, palpability, and capsular contracture were examined in the follow-up controls. Twenty anatomical and 48 round-shaped breast implants were placed with an average size of 321 cc (range, 200–415 cc). The mean injected fat volume was 114 cc (range, 98–142 cc) per breast. The mean follow-up period was 22 months (range, 19–31 months). The implants were palpable in only 1 breast; however, there was no implant visibility or rippling. Of the 68 breasts, 2 presented with cyst formations, and 4 with Becker Grade 2 capsular contracture, but no fat necrosis was observed. Overall, patient satisfaction in terms of breast shape, size, and coverage of the breast implant was 90%. A breast implant placed in the subglandular plane with fat injection throughout the lower quadrants of the breast may provide the desired increase in size and expansion of atrophied tissue while preventing implant visibility and palpability.

An alternative surgical procedure for anterosuperior dislocation of intact mandibular condyle.

Superolateral and anterolateral dislocations of the intact mandibular condyle can be easily overlooked because of their rarity among maxillofacial injuries. In this report, we present the surgery of delayed anterosuperior dislocation of intact mandibular condyle into the temporal fossa. A 17-year-old adolescent girl with anterosuperior dislocation of left intact condyle and associated mandible and zygomatic body fracture underwent surgery 33 days after trauma because of priority accompanied life-threatening intracranial and intra-abdominal injuries. Temporalis muscle shortening with soft tissue attachment prevented closed reduction of the temporomandibular joint; therefore, the temporalis muscle was divided from its insertion on coronoid in a process that, to our knowledge, has never before been described. Although good occlusion was achieved at operation, open bite deformity and laterognathism were observed at the sixth month of follow-up.

Reconstruction of vaginal agenesis with pudendal thigh flaps thinned with liposuction

AIM The aim of this study is to describe a technique for and data from vaginoplasty surgeries performed using a pudendal thigh flap (PTF) thinned with liposuction. METHOD A total of six patients diagnosed with Müllerian agenesis underwent vaginoplasty procedures using this technique between January 2009 and April 2012. The age range of the patients was 19-24 years. In the first stage, the subcutaneous fat tissue under the planned skin flap islands was thinned with liposuction. After 3 months, the second stage of the procedure was carried out and the PTFs were elevated. RESULTS Complications such as infection, dehiscence of the suture line and haematoma were not observed in any of the patients. Although a partial flap loss was observed at the distal aspect of a flap in one patient, total healing was achieved through debridement and local wound care. Mean tissue flap thickness was found to be thinner, and adequate vaginal depth was achieved in all patients on average 13 months following surgery. CONCLUSION We are of the opinion that PTFs thinned with liposuction enable both a thinner tissue flap and a vaginal reconstruction that more closely resembles natural anatomy.