Celalettin Sever

Reconstruction of Postburn Antebrachial Contractures Using Pedicled Thoracodorsal Artery Perforator Flaps

Background: Full-thickness burns involving the antecubital area result in severe contractures. Functional impairment is inevitable if the affected areas are not managed properly. Proper treatment requires complete release and radical excision of the scar tissue, followed by reconstruction using durable tissue that will not contract during long-term follow-up. Methods: Nine patients with flexion contractures were reconstructed with pedicled thoracodorsal artery perforator flaps between 2004 and 2008. All of the patients were male, and their ages ranged from 20 to 23 years (mean, 21.4 years). The size and orientation of the skin islands were planned according to the defect size and orientation. The size of the flaps varied from 6.5 to 9.0 cm in width (mean, 8.0 cm) and 16.0 to 21.0 cm in length (mean, 20.0 cm). All of the patients were followed up for 6 to 12 months (mean, 9.3 months). Results: All of the flaps used on the postburn antecubital contractures survived completely. Minimal transient venous congestion occurred in two flaps during the early postoperative period. A complete range of motion at the elbow joint was achieved in all patients by the end of the reconstruction period. Conclusions: This study revealed that the pedicled thoracodorsal artery perforator flap is a suitable alternative for postburn elbow contractures. A very long pedicle can be obtained to transfer the flap to the antecubital area without tension. With its thin, pliable texture and large size, it adapts well to forearm skin and the donor-site scar is considered cosmetically acceptable.

Hand burn caused by Freon gas

Freon is a trade name for a group of chlorofluorocarbons (CFCs) used primarily as refrigerants in industry in the form of clear, colourless, non-flammable gas or liquid. Several different types of refrigeration equipment contain Freon gas, such as refrigerators, air conditioners, freezers and water coolers. CFCs are also occasionally used as dry-cleaning solvents, aerosol propellants, blowing agents, chemical excipients and topical anaesthetics. When CFCs were first developed in the 1930s, it was thought that they were useful and non-toxic to human health. Decades later, it was discovered that CFCs harm the environment and human health. Freon gas has low toxicity, but exposure to relatively high concentrations may have adverse effects on health. Despite its widespread use, few reports of injuries involving Freon gas have been published. Freon gas produces rapid and profound cooling of the surrounding air, thus causing localised cold injury and cellular destruction in human tissue, and subsequent inactivation of sensory nerves results in numbness. Moreover, skin contact with Freon gas can lead to drying of the skin, contact dermatitis and mild skin irritation with discomfort or rash. The gas may also cause severe frostbite. Frostbite following exposure to cold gases is a recognised occupational hazard. Prevention is the best strategy for reducing the morbidity and mortality of frostbite. The first step is to increase the awareness of the public and of healthcare professionals of the risks of these injuries, most of which can be prevented by education and by adequate precautions. Language: en

Frostbite Burns Caused by Liquid Oxygen

Frostbite burns are uncommon and they have various etiologies. We will present a case of rapid frostbite burn caused by liquid oxygen. The patient injured both hands from contact with liquid oxygen. The circumstances of this injury and preventive measures are discussed in this case report.

Thoracodorsal artery perforator fasciocutaneous flap: A versatile alternative for coverage of various soft tissue defects.

Objective: The thoracodorsal artery perforator (TDAP) flap has contributed to the efficient reconstruction of tissue defects that require a large amount of cutaneous tissue. The optimal reconstruction method should provide thin, and well-vascularized tissue with minimal donor-site morbidity. The indications for the use of this particular flap with other flaps are discussed in this article. Materials and Methods: Thirteen patients underwent soft tissue reconstruction using TDAP flaps between 2009 and 2011. Of those, there were four cases of antecubital burn contracture, three cases of axillary burn contracture, two cases of giant hair cell nevus of upper extremity, two cases of axillary reconstruction following severe recurrent hidradenitis, and two cases of crush injury. All patients were male and their ages ranged from 20 to 23 (average, 21 years). The mean follow-up period was 8 months (range, 4-22 months). Results: All reconstructive procedures were completed without any major complications. Minor complications related to transfered flaps were wound dehiscence in one case, transient venous congestion in two cases. Minor complication related to the donor site was seroma in one case. The success rate was 100%, with satisfactory cosmetic results. Conclusions: The TDAP flap is a safe and extremely versatile flap that offers significant advantages in acute and delayed reconstruction. Although the vascular anatomy may be variable, free and pedicled TDAP flap is a versatile alternative for soft tissue defects. It adapts very well to the soft tissue defects with acceptable donor site scar.

Profile of Self-Inflicted Burn Patients Treated at a Tertiary Burn Center in Istanbul

The factors and demographic features of self-inflicted burns in Eastern and Western cultures differ from each other. In this retrospective study, the authors’ aim is to identify the epidemiologic features of self-inflicted burn patients treated at their Tertiary Burn Centre. The Burn Centre provides health care to a large population from Istanbul, which is located at the crossroads between Asia and Europe. The demographic data and information of 32 patients who were admitted to the GATA HEH Burn Center in Istanbul for attempted suicide were retrospectively reviewed over a 7-year period (2001–2008). Twenty-eight of the 32 patients were men, whereas the remaining four patients were women. The average age was 25.9 years. Seventeen patients had a previous history of self-harming and 22 patients were unemployed. History of a psychiatric illness was found in 20 patients. Mean total body burn surface area was 70%. The mortality rate was 43.4%. This study demonstrates that suicide attempts by burning differ from Eastern and Western cultures by factors and demographic features. It has been concluded that the solution to preventing self-inflicted burns calls for the joint efforts of physicians, psychologists, and sociologists. Furthermore, it is necessary to reinstate prevention programs and revise strategies for prevention based on the country and its culture.

Treatment of facial burn scars with CO2 laser resurfacing and thin skin grafting.

Background: Facial burns are very common and have significant clinical impact. Facial scars are easily recognized in the community and become a source of lifelong guilt, shame, and regret for the patients. In the presented clinical study, we aimed to investigate the effectiveness of CO2 laser resurfacing and thin skin grafting for burn scars of face. Methods: Sixteen white men, whose ages ranged from 20 to 26 years (mean, 22 y), were operated on for elimination of facial burn scars. Burn areas were de-epithelialized by CO2 laser. Each area was grafted with a split-thickness skin graft. The follow-up period for these patients ranged from 3 to 15 months, with a mean follow-up period of 9 months. Results: The scars were successfully treated and converted to a socially acceptable appearance. The color match was good or excellent in all patients. No new hypertrophic scar developed. Conclusions: Facial burn scars may be dermabraded in a short time, and a bloodless and smooth raw surface may be created by a flashed-scanned CO2 laser. The CO2 laser resurfacing and thin skin grafting method is effective in treating facial burn scars.

The current analysis of the effect of hyperbaric oxygen therapy on the frostbitten tissue: Experimental study in rabbits

Many experimental studies have been performed and the mechanism of hyperbaric oxygen therapy on the frostbitten tissue has not been elucidated. In this study, we evaluated the effect of hyperbaric oxygen therapy on the frostbitten ears of rabbits in an experimental animal model by examining the concentrations of thromboxane A2 (as thromboxane B2-Tx B2) and of prostaglandin I2 (PG I2) (as 6-keto-prostaglandin F1α-PG F1α) in tissues, and by counting the numbers of inflammatory cells (neutrophils and mast cells-MC) Hyperbaric oxygen therapy (HBO) at 2.5 ATA for 90 minutes twice daily for fourteen days to rabbits, the ears of which were subjected to frostbite, decreased presence of inflammatory cells (mast cells −75%; neutrophils −40%) and increased prostaglandin I2 (PG I2) (as 6-Keto-PGF1α) in the involved skin. Thromboxane A2 (TxA2) (as Tx B2) was unaffected. Our results revealed that an inflammatory process was the underlying cause of frostbite injury and that hyperbaric oxygen therapy was active in pathological situations involving an inflammatory process in frostbite.

Reverse flow flap use in upper extremity burn contractures

Upper extremity contractures still happen and constitute one of the most trying challenges in burn patients. This series comprised of 4 radial forearm flaps, 14 dorsoulnar artery flaps, and 4 medial arm flaps, all of which were used in a reverse pattern for upper extremity postburn contractures. The reverse flow radial forearm flap (RRFF) was chosen for reconstruction of extensive palmar contractures after burn. The reverse flow dorsoulnar flap (RDUF) was used particularly for reconstruction of the hypothenar aspect of the hand which requires moderate size tissue transfer. The reverse medial arm flap (RMAF) was used for elbow contractures after burn. In the first RMAF, venous congestion occurred and was finaly resolved with minimal flap loss, which was managed with STSG later. In the following 3 cases the flap was supercharged with anastomosis of the brachial vein into the antebrachial vein. Both RRFF and RDUF may provide a smooth and efficient solution. However, RMAF has a significant venous problem, which may result in flap loss, therefore, this flap should not be considered as a first option in the elbow area.

Reconstruction of postburn cervical contractures using expanded supraclavicular artery flap.

Postburn cervical contractures involving the anterior neck represent a serious social, public, and medical problem. The expanded supraclavicular artery flap is a good reconstructive option for these defects to improve functional and aesthetic appearance. Its main vascular supply is the supraclavicular artery, and it may be harvested as either a skin pedicled flap or an island flap. In our clinic, 10 patients with severe cervical burn contractures were reconstructed with preexpanded supraclavicular artery flaps between 2005 and 2012. All the flaps primarily healed with good functional and cosmetic results, and the donor sites primarily closed without any tension. A complete range of motion at the cervical region was obtained in all patients by the end of the reconstruction period. The preexpanded supraclavicular artery flap is a suitable alternative for coverage of the cervical defects after the release of the burn contractures. It is a thin tissue of both good color and texture, and is easy to harvest.

Two-stage surgical approach with dermofat graft and lipofilling for the treatment of established Frey syndrome and facial depression deformity.

Abstract Frey syndrome and facial contour deformity commonly occur after parotid surgery. Although the treatment of established Frey syndrome has focused on medical solutions, surgical solutions to established Frey syndrome have been less reported. Moreover, these methods may not resolve the facial depression. In the presented case here, we used 2-stage surgical approach with dermofat graft and lipofilling for the treatment of established Frey syndrome and facial depression deformity. We considered that this technique provides the easiest, most practical, satisfying, and effective solution for Frey syndrome that develops in the late follow-up period after superficial parotidectomy.