Nurettin Noyan

Frostbite Burns Caused by Liquid Oxygen

Frostbite burns are uncommon and they have various etiologies. We will present a case of rapid frostbite burn caused by liquid oxygen. The patient injured both hands from contact with liquid oxygen. The circumstances of this injury and preventive measures are discussed in this case report.

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.

The current analysis of the effect of hyperbaric oxygen therapy on the frostbitten tissue: Experimental study in rabbits

Many experimental studies have been performed and the mechanism of hyperbaric oxygen therapy on the frostbitten tissue has not been elucidated. In this study, we evaluated the effect of hyperbaric oxygen therapy on the frostbitten ears of rabbits in an experimental animal model by examining the concentrations of thromboxane A2 (as thromboxane B2-Tx B2) and of prostaglandin I2 (PG I2) (as 6-keto-prostaglandin F1α-PG F1α) in tissues, and by counting the numbers of inflammatory cells (neutrophils and mast cells-MC) Hyperbaric oxygen therapy (HBO) at 2.5 ATA for 90 minutes twice daily for fourteen days to rabbits, the ears of which were subjected to frostbite, decreased presence of inflammatory cells (mast cells −75%; neutrophils −40%) and increased prostaglandin I2 (PG I2) (as 6-Keto-PGF1α) in the involved skin. Thromboxane A2 (TxA2) (as Tx B2) was unaffected. Our results revealed that an inflammatory process was the underlying cause of frostbite injury and that hyperbaric oxygen therapy was active in pathological situations involving an inflammatory process in frostbite.

Should we hesitate to use subcutaneous tunneling for fear of damaging the sural flap pedicle

Background:The distally based sural nerve flap is a preferable option for covering defects of the lower third of the leg. However, many authors noted that in particular pressure exerted by tunneling of the flap pedicle could be harmful. Thus, they either inset the pedicle or exteriorize the pedicle to decrease complications. Methods:We used distally based superficial sural artery island flaps for the reconstruction of defects of the lower leg, the ankle, and malleolus in 12 patients between 2004 and 2008 without tunelization. The defects were covered with no major complications. Results:In 3 flaps, there was a small amount of distal marginal necrosis, which was excised and closed spontaneously or skin grafted. Conclusion:We concluded that unless there are certain risk factors such as arterial hypertension, diabetes, peripheral vascular disease, and vasculitis, avoiding a subcutaneous tunneling is not necessary.

Burn Assault With Paint Thinner Ignition: An Unexpected Burn Injury Caused by Street Children Addicted to Paint Thinner

The frequency of assault by burning among all burn patients varies from country to country. Assault by burning, although uncommon, is a serious form of trauma and a significant source of morbidity and mortality. The aim of this retrospective study was to identify the epidemiologic features, current etiological factors, and the mortality of nine patients admitted to our burn unit between January 1999 and January 2009 after unexpected burn assault by paint thinner ignition caused by street children addicted to paint thinner. The circumstances of this injury and preventive measures are discussed.

Thermal Burns Associated With the Misuse of Flammable Liquids in Stoves: A Continuing Problem

Coal stoves that are used for heating purposes are more popular in economically developing and undeveloped countries because of their lower operational costs. Unfortunately, they may cause serious burn injuries when flammable liquids are misused to kindle or to accelerate a fire within them. Every year, particularly in the winter, many citizens in Turkey have suffered burn injuries caused by this dangerous practice. During the period from January 1989 to January 2009, 82 patients sustained burn injuries as a consequence of coal stove fires and were admitted to burn units. Efforts to inform the public about the danger of using flammable liquids with these kinds of stoves are recommended to minimize the incidence, morbidity, mortality, and cost of this relatively common and preventable type of injury.

The effect of epidural anaesthesia on the reverse-flow fasciocutaneous flap: an experimental study in rabbits.

BACKGROUND The reverse-flow fasciocutaneous flap has been popularised as a feasible alternative to reconstruction of the post-burn contractures around lower-extremity joints. The effect of epidural anaesthesia (EA) on the haemodynamics of reverse-flow fasciocutaneous flap (RFFF) has not yet been investigated. Therefore, it was our primary objective to determine how EA impacts on vascular haemodynamics and tissue perfusion. MATERIALS AND METHODS This study included 30 New Zealand white rabbits. The reverse-flow saphenous fasciocutaneous island flap in rabbit model was used. In group I (n=10), epidural catheterisation of the rabbits were performed and they received an epidural infusion of 0.1 ml kg(-1) 0.125% bupivacaine 12-h periods until the 10th day. In group II (n=10), epidural catheterisation of the rabbits was performed and they received an epidural infusion of 0.1 ml kg(-1) isotonic sodium chloride solution. In group III (n=10), epidural catheterisation of the rabbits was not performed. Intra-arterial blood pressure (IABP) and intravenous blood pressure (IVBP) was recorded at time intervals of 5, 15, 30 and 60 min, respectively, after tourniquet release on the first and 10th day. Microcirculatory flow was measured by laser Doppler flowmetry at 2, 4, 6, 8 and 10 days in all the groups. RESULTS Throughout the experiment, the flaps showed complete survival. A significant difference was noted in the microcirculatory flow measurements in the flap surfaces between group I and groups II-III throughout the experiment (p<0.05). A significant difference was noted in IVBP and IABP between group I and groups II-III (p<0.05). On the first and the 10th day, however, there were no significant differences between groups II and III (p>0.05). CONCLUSION EA improves blood flow to RFFF and prevents the progression of venous congestion.

Thermal crush injury of the hand caused by roller type ironing press machine

Industrial garment machines may cause occupational hand injuries. However, combined thermal and crush injuries are uncommon, and their etiologies are varied. We present a case of thermal crush injury of the hand caused by laundry roller type ironing press machine. The circumstances of this injury and preventive measures are discussed.

Expression of the Endothelial Thrombomodulin (TM) on the Ischemic Rat Flap Model: Preliminary Study

Thrombomodulin (TM), a cell surface-expressed glycoprotein predominantly synthesized by vascular endothelial cells, is a critical cofactor for thrombin-medicated activation of protein C. TM thus has an impact on coagulation, inflammation, and fibrinolysis. In this study, we investigated expression of endothelial TM in the dorsal skin of the rat as an ischemic flap model. Twenty male Wistar rats weighing between 250 and 350 g were used in the study. Nine by 3-cm, full-thickness, caudally based random pattern dorsal skin flaps were elevated. The rats were randomized into 2 subgroups according to the evaluation time. Tissue blood flow of the skin flaps was measured 4 times (before the operation and on days 1, 3, and 7) at 1, 3, and 5 cm distal to the baseline of the skin flap. Skin flap samples including subcutaneous tissue were taken from killed rats at day 3 (n = 10) and 7 (n = 10) for histologic assessment. These samples were also taken from the midline at 1, 3, and 5 cm distal to the baseline of the skin flaps. The survival rate of the skin flaps was measured on day 7. According to the blood flow rate change, we found that there were significant differences between the 1-, 3-, and 5-cm samples throughout the experiment. The most profound change was that it was at 5 cm in which there was an initial pattern of reduced perfusion followed by cessation of perfusion. On the third day, positive immunoperoxidase staining specific for TM was detected in all the specimens of the skin biopsies taken from 1 and 3 cm. The 5-cm samples demonstrated very little evidence of necrosis and had negative immunoperoxidase staining for TM. The 1-cm samples were found to have preserved morphologic features present on days 3 and 7. The 3-cm samples showed no evidence of necrosis, though some of the capillary vessels were filled with aggregated blood cells. The vascular wall had negative peroxidase staining for endothelial TM. At 5 cm, there was clear evidence of necrosis, some found within the capillary vessels, which were filled with aggregated blood cells. These samples also had negative peroxidase staining for TM. On day 7, the survival rate of skin flaps was 45.35%. In this study, we demonstrate that tissue ischemia is an important factor, particulary in down-regulating TM transcription. TM depletion from the vascular cells and microthrombus formation occurred in the ischemic areas, playing an important role in secondary aggravation of tissue ischemia.

Unusual Contact Burn due to Argon Gas

Argon is a monatomic, colorless, odorless, nonflammable, and nontoxic gas present in the atmosphere. Argon is used in critical industrial processes such as the manufacturing of high-quality stainless steels and production of impurity-free silicon crystals for semiconductor manufacture. Till now, despite its widespread use, no frostbite case due to argon gases has been reported in the literature. We would like to report a case of a 22-year-old man who suffered frostbite to the left hand. He told us that the frostbite injury due to a contact with argon gas occurred while he was filling light bulbs with gas. His hand had sustained contact with the argon gas for a period of 45 to 60 seconds. The patient was hospitalized immediately for close monitoring of the perfusion. After 72 hours, the capillary circulation of fingers was poor. Antiedema treatment, extremity elevation, the high-molecular-weight dextran in saline medication and heparin infusion were started. In addition, we decided to perform hyperbaric oxygen therapy (HBOT), which improves microcirculation. Remarkable improvement of the frostbite area was seen in daily consultation. The frostbite healed gradually over 4 weeks. HBOT may be used successfully in frostbite therapy. Increasing local tissue oxygen tension improves and maintains the viability of the adjacent tissue. Therefore, vascular and cellular regeneration occurs faster and more efficiently. Prevention is the best strategy for reducing the morbidity and mortality of frostbite. The first step is increasing employees’ and health care professionals’ awareness of the risk of these injuries. In conclusion, adjunctive HBOT is an alternative treatment for frostbite injuries. To see the favorable effects of HBOT, it is better to start the treatment within the first 48 hours after injury. Controlled studies on the treatment of frostbite with HBOT are necessary to further establish the effectiveness of this treatment modality.