Haluk Duman

Reconstruction of the orbital floor with lyophilized tensor fascia lata

PURPOSE This article describes the results of using lyophilized tensor fascia lata for the repair of orbital floor defects. PATIENTS AND METHODS During a 2-year period, orbital floor reconstruction was performed in 12 patients using lyophilized tensor fascia lata. A Foley catheter was placed into maxillary sinus and left in place for 10 days to provide temporary support for the fascia. RESULTS Patients were followed for 12 months to 2 years. No cases of infection, exposure, extrusion, or graft removal were encountered, and enophthalmus, symmetry changes, or restricted movement were not observed during the follow-up period. CONCLUSION Lyophilized fascia lata is easy to shape and place in the defect. It provides an excellent material for repair of small to moderate-sized orbital floor defects.

Versatility of the medial plantar flap: our clinical experience.

&NA; The medial plantar flap presents an ideal tissue reserve, particularly for the reconstruction of the plantar and palmar areas, which require a sensate and unique form of skin. In the past 5 years, the authors performed 16 free flaps, 10 locally pedicled flaps, and five cross‐leg flaps on 31 patients for the reconstruction of palmar and plantar defects. All flaps transferred to the palmar area survived, providing good color match and sufficient bulkiness. The overall results were satisfactory in terms of function and sensation, and no complications related to flap survival in the plantar area were observed. All flaps used to cover defects in the heel and ankle region adapted well to their recipient areas, and all lower extremities remained functional. Because the medial plantar flap presents glabrous, sensate skin with proper bulkiness and permits the movement of underlying structures, the authors advocate its use and view this procedure as an excellent alternative in the reconstruction of palmar and plantar weight‐bearing areas. (Plast. Reconstr. Surg. 109: 1007, 2002.)

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.

Recontruction of facial defects and burn scars using large size freehand full-thickness skin graft from lateral thoracic region.

Reconstruction of facial defects due to trauma, burn scar and congenital deformities is very challenging for reconstructive surgeons. Although many alternative techniques have been suggested, the ideal technique has not been described yet. Full-thickness skin grafting procedures are one of the options, but when larger grafts are needed, donor site morbidity is problematic. Full-thickness skin graft harvested from lateral thoracic region has some advantages for face reconstruction with its larger size, similar colour, thickness, skin quality and texture.

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.

Electrical burn caused by contact of radio receiver antenna with overhead cables

Two soldiers suffering from electrical burns due to contact of radio receiver antenna with overhead cables are presented. The necessary preventive measures for such injuries are discussed.

Bilateral free myocutaneous latissimus dorsi flap repair of the upper limb amputation stumps due to electrical injury

High-voltage electrical injuries of the extremities result in necrosis of deep structures as well as skin and subcutaneous tissues. This necrosis may contribute to the decreased function or loss of the affected limb and even life-threatening complications such as renal failure and sepsis. A delay in debridement and reconstruction can lead to increased morbidity and mortality rates. Currently accepted methods in the management of these patients is early thorough debridement and flap coverage [1,2]. This article reports the successful free flap coverage of defects of both upper limbs in a patient with high-voltage electrical burns of both upper extremities and one lower extremity.

The Effect of External Beam Irradiation Timing on Skin Graft Survival

Background: The purpose of this study was to evaluate skin graft integrity after external beam irradiation in a rat model. Methods: Forty-eight male Wistar rats were randomly assigned to 8 groups (A, B, C, D, Ac, Bc, Cc and Dc). A rectangular full-thickness skin graft was raised and reapplied to its original bed on the dorsum of each rat. Groups Ac, Bc, Cc and Dc were the control groups and were not given postoperative irradiation. After grafting, 25 Gy unfractioned cobalt60 irradiation was administered to groups A, B, C and D on postoperative days 10, 20, 30 and 40, respectively. Histological samples were obtained 8 weeks after grafting. Dermal and epidermal thickness were measured by the KS-400 image analysis program. Results: The difference in the epidermal and/or dermal thickness between the irradiated groups was not found to be significant. Furthermore, when histological features and the image analysis of the irradiated groups were compared with each other, there were no significant differences between the groups. Conclusions: Although we are aware that experimental results may not directly translate to the clinical setting, the present study indicates that external radiotherapy can be performed to skin-grafted areas as early as 10 days postoperatively.

Fatal Burn Injury Related to Liquefied Petroleum Gas

Liquefied petroleum gas (LPG) is a term describing a group of hydrocarbon-based gases derived from crude oil or natural gas. LPG is mostly propane, butane, or a mix of the two. It has been widely used for domestic, agricultural, and industrial purposes. In recent years, LPG-powered cars are becoming more popular. LPG is promoted by the government as being environmentally cleaner, because it burns easily and completely. Moreover, LPG is cheaper than petrol. Although LPG offers many advantages, this technology is not risk free. To our knowledge, up to now, despite its widespread use, only a few fatal burn cases have been reported in the literature. We would like to report a case of a 42-year-old man who suffered third-degree burn and inhalation injury. The burn injury was caused by the explosion of automotive LPG tank when the patient was in the car. On arrival at our burn unit, mechanical ventilation was performed, and subsequently, the patient was immediately taken to a cleaning tank. Burn areas were dressed every day. The patient was followed up in our intensive burn care unit. Unfortunately, postburn day 7, the patient died because of acute respiratory distress syndrome. LPG is supplied as a liquid under pressure and subsequently vaporized for use as a fuel. In some countries, it has been used since the 1940s as an alternative fuel for spark-ignition engines. However, LPG tanks may be hazardous in the event of a tank explosion. The main hazards associated with LPG are leakage followed by ignition (when mixed with air it is highly flammable and potentially explosive). Burns caused by explosions of the LPG tanks in cars have significant mortality and morbidity. These burns are preventable, and, therefore, some basic measures may reduce the incidence of accidental burn injury because of LPG-powered cars.