Emin Kapi

Current Concepts in the Management of Marjolin's Ulcers: Outcomes From a Standardized Treatment Protocol in 16 Cases

Marjolins ulcer is a malignant lesion observed in chronic wounds and in areas where the integrity of the skin is compromised because of any one of several reasons. The aim of this study was to define etiology, topography, and histopathology for Marjolins ulcer and its surgical management. Sixteen cases were diagnosed and treated as Marjolins ulcers. The mean age was 57.1 years (range, 32–85 years) and 15 of the patients (93.75%) had history of ulcer of 30 years or more. In 10 cases (62.5%), Marjolins ulcer occurred after a flame burn and in 6 cases (37.5%) after a scalding burn injury. In six cases (37.5%), there was history of chronic trauma due to contact with the clothing. Primary lesions were at the leg, gluteal region, thigh, scalp, trunk, and hand in four (25%), three (18.7%), two (12.5%), two (12.5%), three (18.7%), and two (12.5%) cases, respectively. Amputation was carried out to treat two cases, and repair of the defects with partial-thickness skin grafting was performed in 14 cases after tumor resection on the skin. Superficial inguinal lymph node dissections were performed in four cases with tumor in the thigh and a positive inguinal lymph node. Squamous cell carcinoma was diagnosed in 14 cases (87.5%) and basal cell carcinoma in two cases (12.5%) postoperatively. The authors conclude that diagnosis and surgical planning based on the recent literature must be carried out even more intensively to improve the prognosis of Marjolins ulcer.

Burn injuries related to liquefied petroleum gas-powered cars.

Liquefied petroleum gas (LPG), which is used as a type of fuel, is stored as a liquid under high pressure in tanks. Immediate and sudden explosion of these tanks can release a large amount of gas and energy into the environment and can result in serious burns. In this study, the cases of 18 patients injured due to LPG burns in five incidents were examined, along with their epidemiologic features. The authors also investigated the causes of the LPG tank explosions. Inhalation injury was present in 11 cases with varying degrees of severity, and 7 patients subsequently required mechanical ventilation. The explosions resulted from weakening of the tank wall (n = 2), crash impact (n = 2), and gas leakage from the tank (n = 1). LPG-powered cars are becoming more popular because of their lower operational costs. However, LPG tanks can be hazardous in the event of a tank explosion. Burns caused by explosions of the LPG tanks in cars have significant mortality and morbidity. This danger must be taken into account and public awareness must be increased.

Sudden Rupture of the Internal Maxillary Artery Causing Pseudoaneurysm (mandibular Part) Secondary to Subcondylar Mandible Fracture

The mandible is one of the most frequently fractured bones of the face. Condylar fractures are the most common mandibular fractures in adults. The potential complications of mandibular fractures are infection, paresthesia, malunion, nonunion, asymmetry, and long-term functional and growth disturbances. In this article, we report an uncommon case of life-threatening pseudoaneurysm of the internal maxillary artery secondary to subcondylar fracture. We believe that the subcondylar fracture on the vertical vector and oblique direction can damage vital tissues such as the internal maxillary artery, and this injury was, to our knowledge, the first reported acute pseudoaneurysm, which occurred just after the injury at the initial part of the maxillary artery.

A new design for superficial temporal fascial flap for reconstruction of the eyebrow, upper and lower eyelids, and lacrimal system in one-stage procedure: medusa flap.

Reconstruction of the eyebrows, eyelids, and destroyed lacrimal drainage system is a challenging procedure for plastic and reconstructive surgeons. In the case presented, a superficial temporal fascial flap was designed for reconstruction of the eyebrow, upper and lower eyelids, and lacrimal drainage system in a one-stage procedure in facial burn patient.To the authors’ knowledge, this is the first combined reconstruction of the eyebrow, upper and lower eyelids, and lacrimal drainage system in one surgical procedure with pedicled superficial temporal fascial flap including skin island and buccal mucosal graft. During the 1-year follow-up period, no complication was encountered and patient healed uneventfully.

The Management of Pit Viper Envenomation of the Hand

Snakebites are common among the rural population of developing countries. The severity of venomous snakebites depends on several factors, including the location of the bite, the amount of venom injected, and the effectiveness of the initial therapy. Snakebites frequently occur in the extremities with approximately two thirds of envenomations occurring in the upper extremities. In this study, we presented 12 cases of hand reconstruction after Vipera snakebites and discussed how to minimize functional loss and maximize hand rehabilitation. Twelve patients bitten by Vipera between 2001 and 2006 were included in this study. Groin flaps were performed in three cases, full-thickness grafts in two cases, thenar flaps in three cases, and cross finger flaps in three cases. With medical management, spontaneous healing occurred in one case. We prefer to use flaps on the volar site of the hand and, if the bone is not exposed, full-thickness grafts on the dorsal site of the hand. We also recommend starting rehabilitation of the hand early.

Our treatment approaches in head-neck injuries caused by animal bites

Several approaches exist for the treatment of animal attacks targeting the head and neck region. The treatment options and timing vary depending on the animal species, the nature of the defect, and the experience of the surgeon. In this study, early surgical treatment options used in head-neck injuries caused by domesticated or wild animal attacks are presented.We consider 12 patients who were admitted to our clinic between June 2006 and May 2010 with head-neck injuries caused by animal attacks. Tissue defect had developed in 10 patients due to half-wild dog bite and in 2 patients due to wolf bite. The ages of the patients ranged from 3 to 45 years (mean, 21.3 years). Among the patients included in the study, 4 had facial injury, 3 had ear, 3 had scalp, 1 had eye, and 2 had nose injuries. In all patients, early surgical reconstruction was performed after irrigation, antisepsis, and debridement. Concurrent rabies and tetanus prophylactic antibiotherapy program was started.Infection or surgical complications were not observed in any of the patients. Rabies symptoms were determined in one of the quarantined dogs under surveillance. There were no positive findings in the patient bitten by the dog. The surgical treatment results from all patients were at satisfactory levels.As a result, it is observed that, in the treatment of head and neck injuries resulting from animal bites, early acute approach has replaced the traditional long-term treatment. We believe that debridement and early surgical reconstruction used in combination with medical support and prophylactic treatment are the best treatment method.

Reconstruction of the Lower Lip in Van der Woude Syndrome

Van der Woude syndrome (VWS) is a congenital disease characterized by labial cysts, accessory salivary glands, congenital lower lip pits, fistula, and paramedian sinuses, and is often accompanied by cleft lip and palate. VWS is an autosomal dominant craniofacial syndrome, which represents only lower lip pits due to variable gene expression. The principles of VWS surgery include excision of lower lip pits and accessory glands, reconstruction of the lip and nose, and correction of accompanying anomalies. In this article, we present a technique with dermal allograft reconstruction to prevent deformities after excision of the accessory gland in the lower lip pit.

Comparison of Effects of Pulsed Electromagnetic Field Stimulation on Platelet-Rich Plasma and Bone Marrow Stromal Stem Cell Using Rat Zygomatic Bone Defect Model.

BackgroundReconstruction of bone defects that occur because of certain reasons has an important place in plastic and reconstructive surgery. The objective of the treatments of these defects was to reinstate the continuity of tissues placed in the area in which the defect has occurred. In this experimental study, the effect of pulsed electromagnetic field stimulation on platelet-rich plasma (PRP) and bone marrow stromal cell, which propounded that they have positive impact on bone regeneration, was evaluated with the bone healing rate in the zygomatic bone defect model enwrapped with superficial temporal fascia. MethodsAfter creating a 4-mm defect on the zygomatic bone of the experiments, the defect was encompassed with a superficial temporal fascial flap and a nonunion model was created. After surgery, different combinations of the PRP, bone marrow stromal cell, and electromagnetic field applications were implemented on the defective area. All the experiments were subjected to bone density measurement. ResultsThe result revealed that the PRP and pulsed electromagnetic field implementation were rather a beneficial and an effective combination in terms of bone regeneration. ConclusionsIt was observed that the superficial temporal fascial flap used in the experiment was a good scaffold choice, providing an ideal bone regeneration area because of its autogenous, vascular, and 3-dimensional structures. As a result, it is presumed that this combination in the nonhealing bone defects is a rather useful treatment choice and can be used in a reliable way in clinical applications.

Y-to-V setback for prominent lobule correction in otoplasty.

Prominent ears may be very distressing for the patient and they need to be corrected. The situation is especially important for school children or the teenagers as it may cause peer criticism and psychological issues. Various techniques have been suggested, and it is possible to obtain a successful result with one of these techniques chosen according to the patients specific needs and the surgeons preference. However, there are not many publications regarding the finer details of this operation such as the correction of the prominent lobule. There are few techniques available with limited success. In this study, we humbly present our Y-to-V setback technique for correction of the prominent lobule, as an individual operation or as an adjunct to a successful otoplasty. A total of 22 cases in which prominent lobule correction had to be performed during otoplasty were included in our study. Mean age of the patients was 21.3 years. Of the 22 patients, 14 were female and 8 were male. All cases underwent bilateral lobule transposition together with bilateral otoplasty. All cases have been followed up for at least 12 months. Mean follow-up was 20 months. The lobule incisions were inconspicuous, and they were well hidden in the postauricular sulcus. Hypertrophic scars or keloid were not seen in any cases. No relapse of lobule prominence was seen during the follow-up period. All patients were satisfied with their results. One of the reasons the ears may look unnatural or “operated” after an otoplasty is the disharmony of the lobule with the corrected parts. Even normal lobules may become relatively prominent after medialization of the helix. It is suggested that the use of a “v”-shaped advancement flap elevated from the posterior surface of the lobule may be a very useful technique to set the lobule back to the desired extent.

Reconstruction of large meningomyelocele defects with rotation-transposition fasciocutaneous flaps.

AbstractMeningomyelocele is one of the most common congenital defects of the central nervous system. Reconstruction of these defects must be performed immediately after delivery to prevent complications such as primary meningitis and to protect the neural tissues. The most important factors in the surgical treatment of meningomyelocele defects are the size of the defect, its location, the presence of kyphosis, and the quality of the surrounding tissue. The chosen method must be a simple one that causes minimal blood loss, requires a short duration of surgery, and covers the surface of the neural defect with a soft-tissue mass enabling closure without tension. In our study, satisfactory results have been obtained using 1 or 2 fasciocutaneous flaps based on the midline in 20 patients with large meningomyelocele defects where primary closure was not possible. A single flap based superiorly on the midline was sufficient to close the defects in patients without kyphosis. In patients with concurrent kyphosis, a second flap based inferiorly on the midline has been used. All flaps survived, except for a distal partial necrosis observed in 1 patient. In the method we used, we adopted a defect reconstruction that is similar to the normal anatomic structures and resistant to trauma and infections, and does not sacrifice any muscle tissue. According to our clinical experiences, this method is useful for large meningomyelocele defects that are unsuitable for primary closure.