Mustafa Nişancı

The last 10 years in a burn centre in Ankara, Turkey: an analysis of 5264 cases

This is a retrospective study analysing 5264 patients treated in the burn centre at Gülhane Military Medical Academy from 1 January 1986 to 31 December 1995. Our burn centre is not only the first, but one of the best established and supported in Turkey. Our present study has the largest patient group of other previously published studies from Turkey. Of the total patients studied, 4464 patients had minor burns and were treated on an outpatient basis and 800 patients had moderate to major burns. Although our centre is in a military area in Ankara, only 1047 (20 per cent) patients were military personnel and the military-related burn causes comprised only 6 per cent of the total. The remaining 4217 (80 per cent of the total patients) were civilians. Flame injuries were also more frequent in military patients than civilians. Minor burns were most common in the age group 0-10 years old (40 per cent) and moderate to major burns in the age group 21-30 years (54 per cent). Scalds were the main cause of paediatric burns. Male patients were dominant. The overall mortality among inpatients was 18.2 per cent and mean total body surface area (TBSA) was 57.6 per cent in patients who died. 134 patients demonstrated inhalation injury and 82 per cent of these patients died. The epidemiological pattern of our patients is similar to that in other studies from developed countries, although some ethnic causative factors could be found. Our study indicates that emergency measures should be taken to prevent flame injuries at military barracks and industrial workplaces and scalding accidents to children at home and throughout the country.

Treatment modalities for post-burn axillary contractures and the versatility of the scapular flap

Inappropriate treatment of axillary burns frequently results in adduction contractures. In this clinical study we have reviewed 32 patients with different types of axillary post-burn adduction contractures. We have used a variety of surgical treatments for reconstruction of axillary contracture releasing defects such as simple grafting, Z-plasties and locally pedicled flaps. Among these alternatives, we preferred to use scapular island flap most frequently. In addition to conventional harvest of this flap, extension of its pedicle up to the subscapular ramification by passing it through the triangular space allowed its transfer even to the anterior axillary line defects in a vertical orientation without pedicle kinking. In conclusion, the island scapular flap is a good choice for reconstruction of all types of axillary contracture, releasing defects with satisfactory results in terms of function and cosmesis.

Burn scar carcinoma with longer lag period arising in previously grafted area

A case of Marjolins ulcer that arose in previously grafted area of right ankle 55 years after initial burn injury was managed by below knee amputation and right inguinal lymph node dissection. The characteristics of this malignancy were reviewed, and rarely seen features particular to this case, which are a longer lag period and rapid growth in a previously grafted area, were discussed.

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.)

Treatment with cerium nitrate bathing modulate systemic leukocyte activation following burn injury: an experimental study in rat cremaster muscle flap

It is suggested that burn toxin known as lipid protein complex (LPC) stimulates phagocytic cells that cause the release of a variety of inflammatory mediators which induce the activation of leukocytes. It is reported that cerium nitrate (CN) might fix LPC in eschar tissue and prevent LPC from entering the circulation. In this study, we tested the hypothesis that prevention or modulation of LPC initiated cell activation by fixing LPC in eschar tissue with CN treatment, would reduce the number of activated leukocytes, which is an important indicator of inflammation, in rat cremaster muscle flap model. Twenty-eight animals were studied in four groups--group I (control), only cremaster muscle flap was dissected; group II (burn injury), burn injury was performed and flap was dissected; group III (saline); and group IV (CN), following burn injury rats treated with saline and CN, respectively, and than flaps were dissected. Blood vessels were observed in vivo under an intravital microscopy system and the number of rolling, sticking, and transmigrating leukocytes were measured in each group. Burn injury significantly increased the number of activated leukocytes (P<0.001). We observed that CN treatment significantly reduced the number of activated leukocytes following burn injury (P<0.001). In conclusion, we demonstrated that CN treatment significantly decreased the activation of leukocytes, which plays an important role in systemic inflammation. Decreased leukocyte activation is interpreted as prevention or modulation of systemic inflammatory response following burn injury.

A 2-Year-Old Girl with Stevens–Johnson Syndrome/Toxic Epidermal Necrolysis Treated with Intravenous Immunoglobulin

Abstract:  Toxic epidermal necrolysis and Stevens–Johnson syndrome are severe skin reactions, usually to drugs, associated with a widespread destruction of the epidermis. Widespread purpuric macules and epidermal detachment of less than 10% of the body surface is indicative of Stevens–Johnson syndrome, whereas epidermal detachment between 10% and 30% is called Stevens–Johnson‐toxic epidermal necrolysis overlap. Epidermal detachment involving more than 30% of the total body surface is designated as toxic epidermal necrolysis. These generalized reactions are known to occur in association with various drugs. Treatment is primarily supportive care, and there are no specific therapy regimens. Therapeutic modalities such as corticosteroids, cyclosporin, thalidomide, cyclophosphamide, and plasmapheresis, usually based on a symptomatic approach, have been tried in single patients or in small series. Intravenous immunoglobulin has recently been shown to provide rapid improvement in all three of these skin reactions. We report a 2‐year‐old girl who developed Stevens–Johnson syndrome‐toxic epidermal necrolysis overlap after receiving ampicillin‐sulbactam for an upper respiratory tract infection. She was treated successfully with a 4‐day course of intravenous immunoglobulin.

An extraordinary cause of scalding injury in childhood

In an attempt to statistically evaluate burn injuries in childhood in terms of incidence, aetiology, mortality and morbidity, a surprising aetiological cause was noticed, not only as having a high mortality rate, but also as being preventable in most cases if simple precautions are taken. Fifteen preschool children had been severely scalded in kitchens by hot milk which was heated in a cauldron to produce cheese, a traditional custom. The clinical data relating to this aetiology and the probable underlying factors pertaining to the social characteristics are given and discussed.

Cross-foot island instep flap: a new use of instep skin flap for management of persistent wounds after complex plantar foot reconstruction.

When presented with an extensive soft-tissue defect involving the sole of the foot, reconstruction with free muscle flaps covered by a split-thickness skin graft is the proposed method of treatment. However, persistent graft breakdown and a chronic wound of the weight-bearing flap is a challenging problem during the late postoperative period, as experienced by the authors in their patients with high-energy-induced lower extremity injuries. The authors used the instep flap as an island cross-foot flap to manage persistent graft breakdown that involved skin-grafted muscle flaps transferred previously to the heel in 3 patients and to treat a chronic wound involving an amputation stump in 1 patient. The vascular pathology of the injured extremities indicated a cross-leg procedure instead of a free flap transfer. Pedicles were wrapped with split-thickness skin grafts and flaps were harvested superficial to the plantar fascia. Pedicles were divided during postoperative week 3, and no complications related to the operation or to immobilization have been encountered during the postoperative follow-up. During the 1-year follow-up, durable coverage, free from development of open wounds, has been achieved, and patients have expressed their satisfaction. In the case of complicated, high-velocity foot injuries, the authors suggest that this procedure be kept in mind as an alternative treatment option because it has some advantages over conventional cross-leg procedures.

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.

Repair of thumb abduction contracture by microsurgical transfer of partial toe.

Unfortunately, patients suffering from major burns frequently have hand involvement, it having been reported that over 85% of burn victims have burns of the hand [1]. The reconstruction of hand deformities due to burn injury is a challenging problem [2]. Inappropriate acute phase care of a burned hand almost always results in postburn deformity that impairs hand functions. The overriding goal should be to maximize and restore function which restoration of the thumb constitutes the most critical point. The thumb is the most important digit that which fulfils 40–50% of hand function. Therefore, diminished thumb function is a severe handicap for an individual especially if the remaining portion of the hand was involved as it usually happens in burn victims. Adequate length, mobility, stability and sensation are the goals of functional thumb reconstruction [3]. Despite there being a lot of reconstructive options, advances in microsurgery have provided transfer of partial toe elements which seems to be the best choice that meets the needs of a functional reconstruction [4]. In this current clinical study, the cases who had postburn thumb deformities treated by microsurgical transfer of partial toe elements are discussed.