Fatih Tekin

Phenol intoxication in a child.

Phenol preparations are used in dermatology and plastic surgery for the treatment of acne and during chemical face peeling. At this institution, phenol peeling is used in addition to mechanical dermabrasion for the elimination of subclinical premalignant lesions of patients having xeroderma pigmentosum. As the phenol peel is performed, most surgeons concentrate on skin results, ignoring systemic complications. Local histological changes and systemic toxicity have been seen during applications. Cardiac arrhythmias and even sudden death have been reported. The high incidence of cardiac arrhythmias after topical application of phenol preparations is demonstrated. The case of an 11-year-old boy with a diagnosis of xeroderma pigmentosum who underwent mechanical dermabrasion and chemical peeling with phenol and then developed severe cardiac arrhythmias is reported. A serious systemic toxic effect on cardiac rhythm from cutaneously applied phenol occurred in this case.

Reconstruction of sternal defects with pectoralis major muscle flap

The earliest treatment of the median sternotomy defects was serial debridements and secondary healing. The muscle flaps that can be used in reconstruction of the presternal defects are pectoralis major muscle flap, rectus abdominis muscle flap, vertical rectus abdominis muscle flap, latissimus dorsi muscle flap with or without skin island, bipedicled pectoralis-rectus muscle flap, and external oblique muscle flap. Pectoralis major muscle flap can be used either as bilateral or unilateral rotation advancement flap, island flap, turnover flap, split turnover flap, and segmental muscle flap. Forty-eight patients with median sternotomy defects, who were treated with pectoralis major muscle flap, were included in this study. The complications were mortality, flap loss, flap dehiscence, persistent infection, and hematoma. The patients were evaluated in terms of functional loss after the operation by shoulder movement measurements. Various techniques of flap transfer can be used for the closure of a presternal defect; almost all presternal defects can be covered with the pectoralis major muscle in a single stage operation. In our opinion, the pectoralis major muscle flap should be the first choice of treatment for sternal defects.

Transfer of innervated split latissimus dorsi free musculocutaneous flap for flexion and extension of the fingers

A severe form of Volkmann contracture is associated with loss of flexor and extensor compartment muscles. An 11-year-old boy with Volkmann contracture was admitted to our clinics with flexion contracture of the wrist joint and total loss of flexor and extensor muscle functions. Split latissimus dorsi free flap was used for reconstruction. The muscle was split based on the branching of thoracodorsal nerve and artery within the muscle so that each part of the muscle is nourished and innervated by a branch of thoracodorsal nerve and artery. No complication has occurred, and the patient can now grasp objects, although he cannot achieve full range of motion of the fingers. We performed a single muscle transfer for reconstruction of both the extensor and flexor compartments in severe form of Volkmann contracture and omitted the use of a second muscle transfer, thus greatly decreasing the operative time, cost, and morbidity.

An unusual complication of condylectomy: fracture of the temporal bone and intratemporal facial paralysis.

The incidence of temporomandibular joint (TMJ) ankylosis appears to be decreasing with the increased socioeconomic status of society. The intraoperative complications were reported to be few, the most dangerous of which are facial nerve injury during the extended preauricular incision and maxillary artery injury during condylectomy. The authors report a case of fracture of the temporal bone tearing the intratemporal portion of the facial nerve, resulting in a total facial nerve paralysis.

Tongue flap as a reconstructive option in intraoral defects.

AbstractThe reconstruction of intraoral defects can be challenging due to the different characteristics of the region, importance of preserving the anatomy and function, and shortage of available donor areas. The location and size of the defect guides the reconstructive surgeon through the treatment plan. Among the options available, tongue flaps have been found useful in intraoral defect reconstruction.In this study, we presented the use of tongue flaps in different kinds of intraoral defects, and compared the advantages and disadvantages with other methods. Between 2004 and 2011, tongue flaps were used in intraoral reconstruction of 11 patients (6 male and 5 female) with a mean age of 30.1. Six patients had palatal fistula, 3 had alveolar region and mouth floor defects, and 2 had lower lip defects. All of the tongue flaps planned were anterior based, 6 dorsal and 5 ventral. Second operations were carried out on the 15th or 20th postoperative days.Despite the disadvantages of being an interpolation flap which requires a second session and good patient cooperation, tongue flap is a choice for reconstruction of intraoral defects with its highly vascular structure, good mobility, localization, texture match, and low donor area morbidity.

Management of pulse oximeter probe–induced finger injuries in children: report of two consecutive cases and review of the literature

Pulse oximetry is a standard noninvasive procedure for monitoring arterial oxygen saturation. Finger injuries related to pulse oximeter use have been reported as chemical or thermal burns, sun-tanning, pressure erosion, sensory loss, and gangrene. The mechanisms of these complications have not been definitively explained; but pressure ischemia, prolonged use, overheating of the probe, inappropriate use of the probe, and short circuiting are considered to be the main factors. We describe 2 cases of pulse oximeter probe-induced finger injuries, propose the possible mechanisms and factors related to the injury, and discuss the management.

Kimura disease: a brief clinical report

Kimura disease (KD) is an uncommon idiopathic inflammatory disease (Khoo and Chan, Cutis 70(1):57–61, 2002). This chronic inflammatory soft tissue disease is characterized by lymphoid and angiomatous tissue proliferation with lymphadenopathy, eosinophilia, and elevated serum IgE levels (Khoo and Chan, Cutis 70(1):57–61, 2002). Lesions are usually located on the head and neck area (Kung et al., Pathology 16:39–44, 1984), and the disease is more common among Asians. In this study, we present a patient with a diffuse mass on his left side of the face from the parotid area to the temporal fossa, who is also suffering from nephrotic syndrome. A review of the literature is presented.

Is there any difference in tetanus IgG levels of diabetic patientswith respect to the presence of foot ulcers

BACKGROUND/AIM The aim of this study was to reveal the tetanus immunization status of diabetic patients and to determine whether diabetic patients with foot ulcers have different TIG levels. MATERIALS AND METHODS A cross-sectional study was designed that included diabetic patients with foot ulcers (n = 30) and diabetic patients without ulcers (n = 30). The groups were compared for serum TIG levels along with total serum protein, albumin, C-reactive protein (CRP), and total immunoglobulin G (Ig G). RESULTS For diabetic patients without foot ulcers, 17 of 30 (56.6%) patients were found to have nonprotective TIG levels whereas for diabetic patients with foot ulcers, 28 of 30 (93.3%) patients were found to have nonprotective TIG levels. The mean value of TIG for diabetic patients without foot ulcers was 0.345 ± 0.281 IU/mL and for diabetic patients with foot ulcers the mean TIG value was 0.055 ± 0.033 IU/mL. Statistically significant differences were observed in TIG (P = 0.008), total protein (P < 0.001), albumin (P < 0.001), and CRP levels (P < 0.001) between the two groups. CONCLUSION The majority of the diabetic patients had low TIG levels and they were significantly lower in diabetic patients with ulcers. A booster dose of tetanus vaccine should be considered for diabetic patients with and without diabetic foot ulcers.

Microbiological Evaluation of Wagner Grade III and IV Diabetic Foot Ulcers

Özet GİRİŞ ve AMAÇ: Bu çalışmanın amacı patojen mikroorganizma popülasyonları ve antibiyotik dirençleri açısından kritik klinik ve cerrahi müdahale ihtiyacı duyulan Wagner evre III ve IV diyabetik ayak ülserli olguları incelemektir. YÖNTEM ve GEREÇLER: Gereç ve Yöntemler: Wagner sınıflamasına göre evre 48 evre III ve 42 evre IV olmak üzere toplam 90 diyabetik ayak ülserli olgu çalışmaya dahil edildi. Hasta kayıtları gözden geçirildi ve hasta bilgileri ile mikrobiyoloji kültür sonuçları analiz için kaydedildi. BULGULAR: Gram (-) mikroorganizmalar 124 örnekte ve Gram (+) mikroorganizmalar 37 örnekte izole edildi. E. Coli, P. aeruginosa, Staphylococcus aureus ve Proteus mirabilis en sık görülen enfeksiyon ajanları olarak tespit edildi. Kültür antibiyogram sonuçlarında Enterococcus türleri % 80, Staphylococcus % 42,8, pseudomonas aeruginosa % 38,4, E.coli ise % 64,5 antibiyotik direnci gösterdi. İzole edilen bakterilerin % 31,6’sı ise birden çok ilaca direnç gösterdi. TARTIŞMA ve SONUÇ: Cerrahlar, cerrahi müdahale gerektiren Wagner Evre III ve IV ülserli diyabetik ayak olgularında yaygın antibiyotik direncinin farkında olmalıdırlar. Abstract INTRODUCTION: The aim of the study to investigate the cases of Wagner grade III and IV diabetic foot ulcers which need critical clinical and surgical intervention, regarding to the pathogen microorganism populations and their antibiotic resistances. METHODS: A total 90 cases consist of 48 grade III and 42 grade IV ulcers according to the Wagner classification were included to the study. The carts are reviewed retrospectively, and patients’ demographics and microbiological culture results were recorded for analysis. RESULTS: Results: Gram (-) microorganisms were isolated in 124 samples, Gram (+) microorganisms were isolated in 37 samples. E. Coli, P. aeruginosa, Staphylococcus aureus and Proteus mirabilis were the most frequently detected infectious agents. Enterococcus species showed 80%, staphylococcus showed as much as 42.8%, pseudomonas aeruginosa showed as much as 38.4%, E.coli showed as much as 64.5% drug resistance in the culture antibiogram studies. 31.6% of the isolated bacteria showed a multidrug resistance. DISCUSSION AND CONCLUSION: Surgeons should be aware of common antibiotic resistance in diabetic foot cases had Wangner grade III and IV ulcer which require surgical intervention. Anahtar Kelimeler: Diyabetik ayak enfeksiyonu, Wagner, Antibiyotik direnci

An Important Complication in Augmentation Mammoplasty: Striae Distensea

Striae distensae (SD) is a common linear atrophic depression in dermatology practice presenting with epidermal atrophy and dermal injury. Generally it does not cause a medical problem for the patients but an aesthetically unpleasing condition. Etiological factors could be physiologic like height and weight gaining and iatrogenic like hypercortisolism. In this case report, a female case of SD formation following breast augmentation surgery was presented. Its presentation after aesthetic breast augmentation could be devastating for both patient and plastic surgeon. Preoperative evaluation of risk factors together with dermatology department and proper treatment in case of occurrence would be beneficial in both medical and legal aspects for patients with risk factors.