Ceyhun Cesur

Finger injury from over-exposure to an industrial gamma radiation source

The aim of this paper was to report a rare cause of radionecrosis and its long-term results. Iridium-192 ((192)Ir) is commonly used for radiography as a gamma ray source to locate flaws in welds and metal components in gas and oil industry. A 38-year-old man was subjected to radiation unintentionally. One month after the exposure wounds were appeared on the second and third fingers, and they were treated by conventional wound care and hyperbaric oxygen therapy. However wounds were relapsed one year later that brought the patient to us. The wounds were treated by wound care and hyperbaric oxygen therapy. When the patient was brought to us one year later the result was interesting. The third fingers pulp (there was not any wound one year before) was contracted and one third of the distal phalanx was exposed.

Three-layer primary closure of the bipedicled TRAM flap donor site for unilateralbreast reconstruction: a 15-year experience with 124 consecutive patients

BACKGROUND/AIM The pedicled transverse rectus abdominis myocutaneous (TRAM) flap remains widely used as a breast reconstruction technique. The bipedicled TRAM flap is not as preferable as it was formerly, mainly because of its donor site complications. However, in a number of situations, a bipedicled TRAM flap may be the only alternative. Therefore, a three-layer primary closure technique used with bipedicled TRAM flap breast reconstructions that can avoid donor site complications without using a mesh is presented. MATERIALS AND METHODS A retrospective study was performed that included patients who underwent bipedicled TRAM flap breast reconstruction with the three-layer primary closure technique. Between 2000 and 2015, 124 breast reconstruction patients were reviewed for donor site morbidity. RESULTS During the 15-year study period, 106 patients had conventional bipedicled TRAM flaps and 18 had bipedicled TRAM flaps with a surgical delay procedure. For all groups, none of the patients developed abdominal wall hernia, but three patients had bulging. Partial flap loss was the most common flap complication, present in 6 flaps (4.8%). CONCLUSION The suturing technique studied provided abdominal wall closure without the use of a mesh even when utilizing a bilateral pedicle with very low complication rates.

An interesting trichloracetic acid injury in a patient with psychiatric disorder

Dear Editors, Trichloracetic acid (TCA) is a topically used and a corrosive medicine, and is used for some dermatological disorders such as epidermodysplasia verruciformis as in our patient. Epidermodysplasia verruciformis consists of benign, diffuse and usually self-limiting lesions, aetiology is viral and related with human papillomavirus (1–3). A 22-year-old male patient admitted to our burn unit with a third-degree chemical burn on his forearm due to acute exposure to high dose of TCA. The patient narrated us that he could not show patience and poured a full bottle of TCA on the lesion. On physical examination, there was a 4× 16 cm2 sized third-degree burn on his left forearm dorsal surface (Figure 1). TCA was prescribed for epidermodysplasia verruciformis on his left forearm by a dermatology clinic. Moreover, the patient had a history of psychiatric disorder and he had been given a treatment for this. There are few reports of burns with TCA in the English literature. Not only systemic effects and skin injuries after experimental dermal exposure (4) to TCA, but also full-thickness chemical burns in different ages of paediatric group are reported (1,5). To the best of our knowledge, there is no report for psychiatric group with burns due to improper use of TCA. Epidermodysplasia verruciformis is more common in paediatric age group. Therefore, prevention from those types of chemical burns with patient education and family education for paediatric group is widely known as a preventive precaution. Another patient group and their families that must be educated are patients with psychiatric disorders. We would like to advice our colleagues to warn patients and their families or relatives if they have psychiatric diseases that TCA has corrosive effects on skin, especially if used improperly. Also, the treatment time and detailed use of the TCA must be clearly described . Besides TCA, many other therapy modalities such as salicylic acid, cryotherapy, pulsed dye laser, imiquimod, bleomycin, retinoids, intralesional immunotherapy are used for the treatment of this kind of lesions (6). Hence, in psychiatric patients choosing one of these treatment modalities could be a better option. Figure 1 Third-degree burn injury caused by improper use of trichloracetic acid.

Loop Nerve Graft Prefabrication in Peripheral Nerve Defect Reconstruction.

MATERIALS AND METHODS: Two minipigs were each implanted with tissue expanders under tattooed skin grids, with unexpanded patches as internal controls. One pig was expanded maximally over 35 days (slow protocol), and the second over 15 days (rapid protocol). Multiview stereo was used to create 3-dimensional models of skin patches in vivo and ex vivo. Isogeometric analysis was performed to calculate skin growth due to expansion and purely elastic deformation (stretch). Epidermal/dermal thickness was evaluated by histology. Immunohistochemistry was performed to assess cellular proliferation (Ki-67), vascularity (CD31), and activation of ERK1/2, a biomarker implicated in mechanotransduction.

A reliable method for the treatment of lower third soft tissue defects of the leg: Use of a posterior tibial artery perforator flap -

Management of lower third limb defects is a common challenge for the reconstructive surgeon due to a lack of soft tissue in that anatomic area. Traditionally, lower third of the limb defects were usually reconstructed with free flaps. The evolution of reconstructive surgery enabled thinner and pliable flaps to be harvested for the purpose of minimizing morbidity from muscle inclusion into the flap. With the introduction of perforator flaps, repairing of small and medium size defects of the distal lower third of leg and ankle region is possible with minimal donor site morbidity. Perforator flaps are based on cutaneous, small diameter vessels that arise from a main pedicle that adjacently perforates the fascia to reach the skin. In this article, we present our experience with two cases involving the repair of these defects by using posterior tibial artery perforator flaps.

Modulation of AQP-3 in burn wound: Comment on “Epidermal aquaporin-3 is increased in the cutaneous burn wound”

I read with interest the article by Sebastian et al. titled ‘‘Epidermal aquaporin-3 is increased in the cutaneous burn wound’’ [1] but I have a few comments regarding it. The authors state that Aquaporin 3 (AQP-3) protein shows a significant expression along the burn wound edge compared to unburned skin. Also they state that they report for the first time the effect of cutaneous burns on AQP-3 expression. Finally they conclude that AQP-3 modulating therapies can play role to improve burn wound healing. However AQP-3 modulation can be either upregulation or down-regulation. As they stated in their work decreased expression of AQP-3 cause delayed wound healing with decreased keratinocyte proliferation and migration. Consequently, we estimated that implicated meaning of ‘‘modulation’’ is up-regulation. AQP3 is the predominant aquaporin in the epidermis and is overexpressed in many hyperplastic skin disorders. After a skin trauma wound edge epidermis show increased expression of AQP-3 as well as in hyperplastic skin disorders. This over expression can be considered as physiologic response. However any interference to epidermis to overexpress AQP-3 may promote cancer. Recent studies on AQP-3 clearly state that AQP-3 overexpression is associated with skin squamous cell carcinoma [2]. AQP-3 overexpression is also associated with non-skin cancer such as prostate cancer, gastric cancer and hepatocellular carcinoma [3–5]. Authors may elaborate the modulation of AQP-3 in order to shed light on how the modulation of AQP-3 help burn wound healing.