Rahmi Evinc

Comparison of efficacy of silicone gel, silicone gel sheeting, and topical onion extract including heparin and allantoin for the treatment of postburn hypertrophic scars

We compared the efficacy of silicone gel (Scarfade), silicone gel sheet (Epi-Derm), and topical onion extract including heparin and allantoin (Contractubex) for the treatment of hypertrophic scars. Forty-five postburn scars were included in the study. Patients with scars less than 6 months from injury were assigned at random to three groups each containing 15 scars, and their treatment was continued for 6 months. Scars were treated with Scarfade, Epiderm and Contractubex. Scar assessment was performed at the beginning of the treatment, and at the end of the sixth month when the treatment was completed by using the Vancouver scar scale. The difference between before and after treatment scores for each three groups was statistically significant. The difference between Scarfade group and Epi-Derm group was not significant; however, the differences of the other groups (Scarfade-Contractubex, Epiderm-Contractubex) were significant. Silicone products, either in gel or sheet, are superior to Contractubex in the treatment of the hypertrophic scar. The therapist should select the most appropriate agent according to the patients need and guidelines of these signs.

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.

Severe burn injury associated with misuse of forced-air warming device

To the Editor:A 64-year-old male was admitted to our department witha third-degree burn on his left ankle. His medical historyrevealed type 2 diabetes of 12 years’ duration and coronarybypass surgery 3 weeks previously. The patient claimedthat he had noticed large blisters on his left ankle when heawoke from anesthesia after coronary bypass surgery. Afterdetailed questioning it became evident that because thepatient began complaining of cold after surgery, he washeated with a forced-air warming system. The nozzle of thedevice was not connected to the blanket, however, and hotair at 40–43 C was blown directly on to the patient’s legsfor nearly 2 h. On examination, a third-degree burn of12 9 5 cm in size and surrounding hyperemia was docu-mented (Fig. 1). His pedal pulses were absent bilaterally.The 10-g-Semmes–Weinstein monofilament test revealedreduced sensation suggestive of diabetic peripheral neu-ropathy. The patient required 3 months of wound care andhyperbaric oxygen therapy to heal the wound.Forced-air warming is one of the most frequently usedmethods of patient warming in the operating room [1]. Thisdevice comprises an electrical heater unit, a hose, and ablanket. Hot air generated by the electrical heater istransferred to the blanket via the hose. Burn injuriesassociated with forced-air warming systems are extremelyrare when the device is used according to the manufac-turer’s instruction [2]. However, improper use of thedevices exposes patients to a considerable risk of burninjury [3]. Moreover, even if the device had been usedadequately, the connection could have come off acciden-tally. General misuse of this system is detaching the hosefrom the blanket and blowing hot air directly on to thepatient’s skin. This practice is called ‘‘hosing’’. Hosingcauses concentration of hot air at a single spot for anextended time period. Although a few cases including asevere burn injury of lower extremities have been reported[4], the dangers of ‘‘hosing’’ are not known by everyone.The Food and Drug Administration has issued a warningand requested submission of hosing-associated hazards [5].In addition, one of the manufacturers has started a cam-paign by posting a website (http://stophosing.com)toinform clinicians about the dangers of the use of forced-airwarming units without blankets [4].Our patient had both diabetic angiopathy and sensoryneuropathy. We think that diabetes also increased the riskof burn injury in our patient. Diabetic angiopathy andneuropathy makes skin more vulnerable to injuries.Because of diabetic sensory neuropathy in his lowerextremities, the patient did not perceive the temperature ofthe hot air correctly and hence could not warn the techni-cian to stop hosing.

Comparison of octenidine dihydrochloride (Octenisept®), polihexanide (Prontosan®) and povidon iodine (Betadine®) for topical antibacterial effects in Pseudomonas aeruginosa-contaminated, full-skin thickness burn wounds in rats

Pseudomonas aeruginosa is one of the most frequently isolated organisms from infected burn wounds and a significant cause of nosocomial infection and septic mortality among burn patients. In this animal study, three antiseptic agents which were Octenidine dihydrochloride (Octenisept®, Schülke & Mayr, Norderstedt, Germany), polyhexanide (Prontosan®, B. Braun, Melsungen AG, Germany) and povidon iodine (Betadine, Purdue Pharma L.P, Stamford, USA) were compared to assess the antiseptic effect of their applications on experimental burn wounds in in rats contaiminated with P. aeruginosa. All treatment modalities were effective against P. aeruginosa because there were significant differences between treatment groups and control groups. The mean eschar concentrations were not different between polyhexanide and povidon iodine groups, but there were significant differences between the octenidine dihydrochloride group and the other treatment groups, indicating that the Octenidine dihydrochloride significantly eliminated P. aeruginosa more effectively in the tissues compared to the to other agents. All treatment modalities were sufficient to prevent the P. aeruginosa invasion into the muscle and to cause systemic infection. In conclusion, Octenidine dihydrochloride is the most effective antiseptic agent in the treatment of the P. aeruginosa-contaminated burn wounds; Octenidine dihydrochloride can be considered as a treatment choice because of its peculiar ability of limit the frequency of replacing wound dressings.

Salvaging the zone of stasis by simvastatin: an experimental study in rats.

Salvaging the zone of stasis is important for burn researchers because this can prevent an increase in the depth and width of the injured area. Statin analogues have many pleiotropic effects on the vessel walls and the coagulation and fibrinolytic systems. In this study, we investigated the effects of simvastatin, a statin analogue, administered to rats burned with a metal comb. No treatment was given to the control group (n = 10). Simvastatin was given at a dose of 5 mg/kg/d by intraperitoneal injection in treatment group (n = 10) for 7 days. Phosphate-buffered saline was given 1 mg/kg/d by intraperitoneal injection in sham group (n = 10). The groups were randomly divided into two subgroups (n = 5) for evaluation at 24 hours and 7 days. It was observed that there were necrotic areas and viable interspaces in both the experimental and control groups at 24 hours. The interspaces progressed to necrotic areas in the control and sham groups at 7 days. However, viable interspaces were separated from necrotic areas clearly in the treatment group at 7 days. In the samples taken from interspaces at 24 hours, positive staining for thrombomodulin (TM) for all groups was noted. In the samples taken from the control and phosphate-buffered saline groups at 7 days, there was negative staining for TM. However, in the samples taken from interspaces of the treatment group, positive staining for TM was observed. The conclusion of this study was that simvastatin potently increased endothelial TM expression in the zone of stasis and preserved the zone.

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.

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.