Fatih Uygur

Nosocomial infection characteristics in a burn intensive care unit: Analysis of an eleven-year active surveillance

AIMS The objective of this study was to describe nosocomial infection (NI) rates, risk factors, etiologic agents, antibiotic susceptibility, invasive device utilization and invasive device associated infection rates in a burn intensive care unit (ICU) in Turkey. METHODS Prospective surveillance of nosocomial infections was performed according to Centers for Disease Control and Prevention (CDC) and National Healthcare Safety Network (NHSN) criteria between 2001 and 2012. The data was analyzed retrospectively. RESULTS During the study period 658 burn patients were admitted to our burn ICU. 469 cases acquired 602 NI for an overall NI rate of 23.1 per 1000 patient days. 109 of all the cases (16.5%) died. Pseudomonas aeruginosa (241), Acinetobacter baumannii (186) and Staphylococcus aureus (69) were the most common identified bacteria in 547 strains. CONCLUSION Total burn surface area, full thickness burn, older age, presence of inhalation injury were determined to be the significant risk factors for acquisition of NI. Determining the NI profile at a certain burn ICU can lead the medical staff apply the appropriate treatment regimen and limit the drug resistance. Eleven years surveillance report presented here provides a recent data about the risk factors of NI in a Turkish burn ICU.

Effects of three different topical antibacterial dressings on Acinetobacter baumannii-contaminated full-thickness burns in rats.

In this animal study, three topical antibacterial dressings, Acticoat, chlorhexidine acetate 0.5% and silver sulfadiazine 1%, were compared in the treatment of Acinetobacter baumannii contamination of burns. All treatments were effective and prevented the organism invading the muscle and causing systemic infection, so there were significant differences between the results of the treatment groups and the control group. Mean eschar concentrations did not differ significantly between the silver sulfadiazine and chlorhexidine acetate groups, but there were significant differences between these and the Acticoat group, indicating that Acticoat eliminated A. baumannii from the tissues more effectively.

Comparison of silver-coated dressing (Acticoat®), chlorhexidine acetate 0.5% (Bactigrass®) and nystatin for topical antifungal effect in Candida albicans-contaminated, full-skin-thickness rat burn wounds

BACKGROUND In this experimental animal study, the effects of three different topical antimicrobial dressings on Candida albicans contaminated full-thickness burn in rats were analyzed. METHODS In total 32 adult Wistar rats (body weight 200-220 g) were used. Silver-coated dressing (Acticoat™®), chlorhexidine acetate 0.5% (Bactigrass®) and Mycostatine (Nystatin®) were compared to assess the antifungal effect of a once-daily application on experimental rat 15% full-skin thickness burn wound seeded 24h earlier with a 10(8) CFU/mL standard strain of C. albicans ATCC 90028. All the animals were sacrificed at post burn day 7. The quantitative counts of seeded organism in burn eschar and subjacent muscle were determined, in addition to the cultures of left ventricle blood and lung biopsies. RESULTS While there were significant differences between Acticoat™® group (4 ± 10 × 10(4)) and control group (5 ± 6 × 10(6)), and between Nystatin group (4 ± 4 × 10(4)) and control group (P=0.01, P=0.01), there were no significant differences between chlorhexidine acetate 0.5% group (2 ± 3 × 10(4)) and control group (P=0.7) respectively. Acticoat™® and Nystatin were sufficient to prevent to C. albicans from invading to the muscle and from causing systemic infection. CONCLUSIONS The animal data suggest that nystatin is the most effective agents in the treatment of C. albicans-contaminated burn wounds, and Acticoat™® is a choice of treatment on fungal burn wound infection with antibacterial effect and the particular advantage of limiting the frequency of replacement of the dressing.

The role of the vacuum-assisted closure therapy in the salvage of venous congestion of the free flap: case report

Indications for vacuum‐assisted closure (VAC) therapy described generally include acute, chronic, traumatic wounds and ulcers. Recent studies related to investigating new applications of VAC therapy have begun to be reported at literature in many aspects. We used this technique in a novel area. A 21‐year‐old man presented who suffered venous congestion in anterolateral thigh fasciocutaneous flap at the postoperative second day. Following two cycles of VAC therapy, 72 hours later, venous congestion disappeared. Application of VAC therapy to the flap helps removal of excess interstitial fluid because of increased pressure gradients. It seems that VAC therapy is an option in venous congestion when the interstitial pressure rises above capillary pressure.

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.

The effect of simvastatin on the survival of ischaemic skin flap: An experimental study in rats

Thrombomodulin (TM) is down-regulated from the vascular endothelial surfaces and corresponds to disturbed dermal blood flow and microthrombus formation in the ischaemic skin flap. We examined the therapeutic potential of simvastatin which up-regulates endothelial cell TM expression and activity in the dorsal ischaemic skin flap model. The study was carried out on 30 rats, divided into three groups. Group 1 was treated with simvastatin at a dose of 5mgkg(-1) day(-1) by intraperitoneal injection. Group 2 was treated with 1mgkg(-1) day(-1) with a phosphate-buffered saline for 7 days. Group 3 was the control group. Tissue blood flow, vascularisation and the survival rate of the skin flaps from each group were compared. The mean surviving area of group 1 was higher than groups 2 and 3 (p<0.05). The blood flow change rate did not decrease in the treatment group in contrast to the control groups at 3cm and 5cm (p<0.05). Microangiography demonstrated decreased flap vascularity in groups 2 and 3. There was no evidence of necrosis or positive peroxidase staining for TM in group 1 at 3cm and 5cm., although it was negative in groups 2 and 3. In this study, it was demonstrated that simvastatin prevented shedding of endothelial TM and contributed to flap survival.

Use of lyophilized bovine collagen for split-thickness skin graft donor site management

Donor site management after split-thickness skin graft applications can have problems such as late healing and pain. Many dressing methods and medical applications are reported to solve these problems but none of them were ideal. In this study we aimed to promote epithelisation and remove pain earlier with using lyophilized bovine collagen (gelfix spray). According to our results, epithelisation time for the gelfix group was earlier than control group (9.09 days mean and 11.2 days mean for control group (p<0.05)). Pain relief was determined by visual analogue pain scale. In the gelfix group, there was pain relief up to 40 h from the operation. There were no differences between groups for scarring 30 and 90 days after surgery.

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.

Is phosphatidylcholine harmful to the peripheral neural tissue? An experimental study in rats.

BACKGROUND Subcutaneous phosphatidylcholine (PC) injection has become a popular technique for treating localized fat accumulation. Some clinical studies reported minor local soft tissue complications, such as ecchymosis, edema, and pain. However, there are no data on how PC affects the peripheral nervous tissue. OBJECTIVE To investigate the local effect of PC on the peripheral nervous tissue of rats. METHODS Twenty adult Lewis rats weighing between 200 and 300 g were divided into 2 experimental groups (n=10). In group 1, animals received an intrafascicular injection of 0.1 mL PC (Lipostabil 250 mg/5 mL) with a 30-gauge needle into the left posterior tibial nerve. In group 2, as a negative control group, 0.1 mL normal saline was injected intrafascicularly respectively. After the operation, rats were evaluated on days 7, 14, and 21 with walking track analysis. On day 21, all the animals were sacrificed and the left tibial nerves were taken for histologic study. Light and electron microscopic studies, along with morphometric analysis, were performed. RESULTS According to the tibial nerve indices, there were no signs of nerve damage observed in either of the groups, and there was no statistical difference between the groups (P> .05). The nerves that received PC and saline injections could not be distinguished grossly and appeared similar to segments of the nerve that did not come in contact with either solution. The number and diameter of fibers, the thickness of the myelin, and the percentage of neural tissue were comparable with normal controls. According to these analyses, there were no statistical differences between the 2 groups (P> .05). CONCLUSIONS This study demonstrates that in a rat model, even direct intraneural injection of PC causes no damage. This information should encourage people to consider broader applications of PC.

Comparison of membranous bone healing characteristics in fetal and postnatal periods: an experimental study.

In this experimental study, the postnatal and fetal membranous bone healing were investigated radiologically, histologically and levels of growth factors. Sixteen sheep fetuses and 16 sheep were included in this study. In the fetal group, 5 mm diameter ostectomy, and a 10 mm osteotomy were created in 90th gestational day. In the postnatal group, similar ostectomy and osteotomies were created. In the early period, radiologically similar radiolucencies in the ostectomy areas were seen in both groups. Histologically, fetal bone healing was decreased in the early postoperative period. However, it was accelerated in further time points. Histomorphometric analyses revealed accelerated fetal bone healing. TGF-&bgr;1 levels were higher and then lower in early and late postoperative periods respectively in the fetal group. In the postnatal group, the levels of TGF-&bgr;1 were lower and the differences between two groups were statistically significant in all time points (p < 0.05). The FGF and PDGF levels in both areas were higher in early postoperative period whereas lower in the late period in both groups. However, the fetal FGF levels were higher compared to the postnatal group (p < 0.05). The fetal PDGF levels were lower compared to the postnatal ones (p < 0.05). In conclusion, the calvarial bone gap model at the end of the second trimester of gestation in the fetal sheep model proved useful in examining the membranous bone healing. Histologically, the process of fetal bone healing seems similar to that of postnatal healing, albeit at an accelerated rate. Histomorphometric evaluation is a valuable tool in the evaluation of bone formation and gives more objective information about the ratio of bone formation.