Doğan Alhan

Cerium nitrate treatment prevents progressive tissue necrosis in the zone of stasis following burn

Cerium nitrate (CN) was used as a topical antiseptic agent for the treatment of burn wounds and found to reduce the number of anticipated death in burn. This decreased burn related mortality cannot be explained by the control of wound infection alone. In the studies performed to elucidate the unexplained effects of CN treatment, it was shown that CN treatment reduced the alarm cytokine levels, decreased leukocyte activation, reduced macromolecular leakage and finally burn edema formation. We hypothesized that CN treatment prevents the conversion of the zone of stasis to progressive tissue necrosis by decreasing leukocyte activation and reducing macromolecular leakage and burn edema. This was investigated on a well-described burn comb model in the rats. Fifty-four rats were randomly divided into control and CN treatment groups. Each rat in CN treatment group received 0.04 M CN bathing 30 min after burn whereas rats in control group received 0.09% saline bathing. Viability of zone of stasis is assessed with (99 m)Tc-sestamibi scintigraphy. Nine rats in each group were scintigraphically evaluated at the 3rd and 7th day after burn and remaining 9 rats had macroscopic and histological examination at the 21st day after burn to confirm the scintigraphic results. In CN treatment groups, the scintigraphic uptake ratios were higher both at post burn day 3rd and 7th when compared to that of control groups. This was statistically significant (p≤0.05). In the CN treatment group, the results of the average percentage of the re-epithelialization in the zone of stasis were higher than that of control groups. The difference between the groups was also statistically significant (p≤0.05). These results were accepted that CN treatment prevents progressive tissue necrosis in the zone of stasis. This study further elucidates the unexplained effects of CN treatment on burn.

The effect of combined use of platelet-rich plasma and adipose-derived stem cells on fat graft survival.

BackgroundFree fat grafts have an unpredictable survival rate that limits their successful use. To increase the viability of fat grafts, it is important to minimize the reabsorption rate. ObjectiveOur aim was to investigate whether the combined use of platelet-rich plasma (PRP) and adipose derived stem cells (ADSCs) would contribute an improvement in lower resorption rates of fat grafts. MethodsInbred Fischer 344 rats were randomized into 4 groups (n = 10). Fat grafts were mixed with Dulbecco modified Eagle medium in group A, with PRP in group B, with ADSC in group C, and with PRP + ADSC in group D and were injected to the scalp.In vitro growth factor (vascular endothelial growth factor, transforming growth factor-&bgr;, and fibroblast growth factor) levels were compared using enzyme-linked immunoassay method. After 12 weeks weight, volume and histology of the transplants were evaluated. ResultsThe mean weight and volume of the fat grafts were highest in group D. Histopathological investigations revealed that the number of viable adipocytes and blood vessels were highest in group D. The level of growth factors was significantly higher in stem cell plus PRP group. ConclusionAdipose-derived stem cells combined with PRP can enhance the survival of transplanted fat tissue.

Our experiences on the reconstruction of lateral scalp burn alopecia with tissue expanders

INTRODUCTION Cicatricial alopecia is a form of hair loss that causes both cosmetic and psychological concerns. Although tissue expanders are the common approach to reconstruction, no algorithm exists in the literature for this process. In this study, it was aimed to create an algorithm for the reconstruction of lateral scalp alopecias with the goal to achieve better and standardized results. MATERIALS AND METHODS Lateral scalp alopecias were divided into three groups: total lateral alopecia (type I), temporal and sideburn alopecia (type II), and sideburn alopecia (type III). Tissue expanders were placed at the parieto-occipital area in type I defects, parietal area in type II defects, and the temporal region in type III defects. Tissue expanders were used to create flaps that were advanced with 60° rotation, 90° rotation, and no rotation for type I, II, and III defects, respectively. RESULTS Fifteen patients were treated with this algorithm. Using this simple approach, we achieved natural, standardized aesthetic results for each patient, all of whom were satisfied with the final results. CONCLUSION Although the number of case were limited, the ideal and standardized cosmetic results could be obtained by this approach.

Total lower eyelid reconstruction with superficial temporal fascia flap and porous polyethylene implant: A case report

Total reconstruction of the eyelid after serious periorbital injury is a challenging procedure for plastic and reconstructive surgery. Although several methods have been used for reconstructing the eyelids, such as advancement flap with fascia lata sling, island mucochrondrocutaneous flap, prefabricated temporal island flap, porous polyethylene and superficial temporal fascia flap, creating a supportive eyelid for housing an artificial eye without complication is still an ongoing problem. In the case presented, superficial temporal fascia flap with porous polyethylene was used for the reconstruction of total lower eyelid.

A new flap alternative for trochanteric pressure sore coverage: distal gluteus maximus musculocutaneous advancement flap.

AbstractManagement of long-term bedridden patients experiencing pressure sores still represents a surgical challenge due to limited flap alternatives and high recurrence rates after the treatment. Fasciocutaneous, musculocutaneous, local perforator-based flaps, and free flaps have all been used for treatment of trochanteric pressure sores. This study presents a new use of distal gluteus maximus (GM) muscle as an advancement musculocutaneous flap for coverage of trochanteric pressure sores in 7 patients. The technique involves design of a long V-shaped skin island over the distal fibers of the GM muscle, beginning from the inferoposterior wound edge and extending inferomedially, almost parallel to the gluteal crease. After its harvest as an island flap on the distal fibers of the GM muscle, the skin paddle can be advanced onto the trochanteric defect, whereas the muscle itself is rotated after severing its insertion to femur. If a second triangular skin island is designed on the proximal fibers of GM muscle to cover an associated sacral defect, 2 coexisting pressure sores can be reconstructed concomitantly with 2 skin paddles on a single muscle belly at 1 surgical setting. Of the 7 patients, 3 had 3 (bilateral trochanteric and sacral), 2 had 2 (sacral and trochanteric), and 2 had 1 (only trochanteric) pressure sores. All ulcers were closed successfully and all of the flaps survived totally without any complication except the one in which we experienced minimal wound dehiscence in the early postoperative period. Conclusively, our current surgical method provided a reliable coverage for trochanteric pressure sores although it was technically straightforward and fast. Additionally, it offers simultaneous closure of 2 pressure ulcers with 2 skin islands on a single muscle flap.

A New Approach to Objective Evaluation of the Success of Nasal Septum Perforation

Background Perforations in the nasal septum (NSP) give rise not only to disintegration of the septum anatomy but also impairment in normal nasal physiology. The successes of these surgical techniques are usually equated to anatomical closure of the perforation. The goal of this study is to evaluate the subjective and objective results of our surgical technique for septal perforation surgery. Methods All NSPs in the six patients were closed by inferior turbinate flap. The Nasal Obstruction Symptom Evaluation (NOSE) instrument was used to evaluate the preoperative and postoperative subjective sensation of nasal obstruction. Measurement of preoperative and postoperative nasal airway resistance was performed using active anterior rhinomanometry which is an objective test. Wilcoxson signed rank test and Spearman correlation test were used to analyze correlation between NOSE scores and rhinomanometric measurements. Results The full closure of the septal perforations was noted in 100% of patients. The total NOSE score was 14 preoperatively and one postoperatively. The improvement in NOSE scores was statistically significant (P≤0.002). The mean preoperative total resistance (ResT150) value was 0.13 Pa/cm3s-1, which is below the normal range (0.16-0.31 Pa/cm3s-1), while the mean postoperative ResT150 value was 0.27 Pa/cm3s-1. The correlation between the improvement in NOSE scores and improvements in ResT150 values was statistically significant. Conclusions Surgical approaches should aim to solve both the anatomical and physiological problems of NSP. The application of subjective and objective tests in the postoperative period will help surgeons assess the applied techniques.

Sutureless microvascular anastomosis with the aid of heparin loaded poloxamer 407

BACKGROUND Anastomosis with tissue adhesives is an alternative method for conventional anastomosis. However, this method has several technical challenges. It requires the use of suture to prevent leakage into lumen and precise application onto all surfaces of the anastomosis site. To solve these problems, poloxamer 407 (P 407) was previously used as a stent. In this study, we made heparinized P 407 (h-P 407) as a new formula. We aimed to successfully use h-P 407 as a stent in sutureless anastomosis in a rat abdominal aorta model. METHODS Sixty Sprague-Dawley rats were used. In the first group, end-to-end anastomoses were performed with suture; in the second and third groups, sutureless anastomoses were performed with 2-octyl cyanoacrylate. As an intraluminal stent, P 407 was used in the second group, and h-P 407 was used in the third group. Anastomosis time was measured. Lumen width, intimal hyperplasia, and foreign body reaction were assessed histologically. Velocity flow rates and vessel diameters were measured radiologically. Burst strength was measured, and the results were statistically evaluated. RESULTS Sutureless anastomosis was more rapid than conventional anastomosis. Lumen width was narrower in the suture group. İnflammation and foreign body reaction were more severe in the suture group. There was no radiologic and biomechanical difference between the groups. We found that intimal hyperplasia was less in h-P 407 than in P 407. CONCLUSION h-P407 can be successfully used as an intraluminal stent for sutureless microvascular anastomosis with tissue adhesives.

Auto-/homografting can work well even if both autograft and allograft are meshed in 4:1 ratio.

BACKGROUND Patients suffering major burns of more than 50% total burn surface area lack an adequate skin graft donor site to resurface extensive burn wounds and usually need widely meshed autografting and allografting. Anything over the 3:1 expansion ratio is strongly associated with low graft take, poor or delayed epithelialization, and hypertrophic scarring. METHODS In this study, both autografts and allografts were expanded at a 4:1 ratio. We aimed to use skin grafts effectively and to decrease the morbidity due to graft harvesting. Nine patients with major burns were treated with this method. Graft gain ratio and percentage of actual expansion to predicted expansion were calculated. RESULTS Ten auto-allografting procedures were performed on a mean of day 16. Graft take was over 95% successful. Five patients survived, and four patients died. The mean total burn surface area was 58.8% in patients who recovered, and 77.5% in the patients who died. The graft gain ratio was 74.8%. The actual expansion rate was 43.7% of the predicted expansion rate. CONCLUSION In this study, we demonstrated that the donor site morbidities were reduced and successful epithelialization was completed on the eighth day after using both autograft and allograft meshed with a 4:1 ratio.

One Staged Silicone Implant Breast Reconstruction Following Bilateral Nipple-Sparing Prophylactic Mastectomy In High-Risk Breast Patients

IntroductIon: Diverse opinions are encountered in the literature regarding the indications, incisions to be chosen or reconstruction method following prophylactic mastectomy. In addition, the biggest handicap in most studies concerning either patient’s satisfaction or operation results is the lack of group homogeneity. The purpose of the study was to evaluate the patient satisfaction rate and the operation technique used in homogeneous group of patient for prophylactic mastectomy.