Sabri Acartürk

A retrospective analysis of 1083 Turkish patients with serious burns

A total of 1083 burn cases hospitalised at a burn center between August 1988 and the end of 1997 were studied retrospectively to determine the factors and demographic features associated with burn injury in Turkey. The means for patient age and percent total body surface area (TBSA) burned were 18.1 years and 31.2%, respectively (medians were 14.0 years and 25.0%, respectively). Burn injuries were more common in winter and spring, and most occurred in the home. The majority of patients were city dwellers, and had been referred from public hospitals. There was a predominance of male patients (71.9%) in the study population, but the proportions of children and adults were equal. Almost half of the males and the majority of the females were children/students. The vast majority of female adults were housewives, and most of the men were employed outside the home. More than half of the patients suffered second-degree burns, and the others all had deeper burn injuries. The most frequent cause of burn in the study population was flame. Children mainly suffered from scalding, and adults from flame and electrical burns. There were no differences between the sexes regarding depth of burn; whereas percentage total burned surface area was higher in females. Children had a lower mean TBSA and lower rate of third-degree burns. Mortality rate of the study population was 33.5%. The study results identified various risk factors and the groups at high risk for serious burns and indicated some ways that prevention programmes can be improved.

A retrospective analysis of 1083 Turkish patients with serious burns. Part 2: burn care, survival and mortality.

Epidemiological investigations of burn patient series help practitioners to identify factors that affect patient survival. Our aim was to contribute to the body of knowledge in this area by determining how survival related to certain variables in burn cases. The records of 1083 burn patients who were hospitalised between August 1988 and the end of 1997 were retrospectively reviewed. Of this total, 363 (33.5%) died of burn complications, namely, multi-organ injury due to sepsis (47.1% of deaths), renal failure (44.6%), respiratory injury (5.8%) and gastrointestinal bleeding (2.5%). Mortality was higher in children/students, females, retired persons. Extent and depth of burn were important predictors of patient survival. Flame not only was the commonest burn cause but also carried the highest mortality risk. Most of the 1083 patients were referred to our hospital within 3 days of the injury. Deaths commonly occurred within 7 days. The mortality rate for patients who received medical therapy only was higher than that in the group that underwent both medical and surgical treatment (48.4 versus 10.0%, respectively). The study results highlighted various factors that are related to patient survival. These should be considered in the provision of optimal burn care. Training and experience are important elements in burn care and educational meetings should be held regularly for the staff of the burn unit.

Neutrophil gelatinase associated lipocalin as an indicator of acute kidney injury and inflammation in burned children

INTRODUCTION Neutrophil gelatinase associated lipocalin (NGAL) is a novel predictor of acute kidney injury (AKI), which increases with inflammation. We aimed to assess whether serum NGAL (SNGAL) and urine NGAL (UNGAL) can predict AKI in burned children. METHODS Patients were referred within the 12 h of burn to our center. Serum samples for SNGAL, C-reactive protein (CRP), procalcitonin (PCT) and urine for UNGAL, microalbumine (Umalb), creatinine (Ucr) were obtained at both admission and the 5th day after burn. Blood urea nitrogen (BUN) and serum creatinine (Scr) were examined daily. RESULTS Twenty-two subjects were enrolled and six (27.2%) of them developed AKI within the 48 h of injury. Burn size and abbreviated burn severity index (ABSI) were significantly increased in patients with AKI. CRP, PCT, SNGAL and UNGAL levels at admission and day 5 were significantly higher in patients with AKI than in those without AKI and controls. Scr was not significant between AKI and non-AKI groups at hospital days 1 and 5. A SNGAL level of 315 ng/ml and a UNGAL level of 100 ng/ml were determined as predictive cut-off values of AKI at admission (sensitivity and specificity: 71.4%, 83.3% and 93.3%, 93.7%, respectively). SNGAL and UNGAL were positively correlated with CRP, PCT, ABSI and Umalb/Ucr. CONCLUSION SNGAL and UNGAL are good early predictors of AKI in children with severe burn. NGAL might reflect the severity of burn insult and also could be used as an indicator of inflammation in burn children.

The Spreader-Splay Graft Combination: A Treatment Approach for the Osseocartilaginous Vault Deformities Following Rhinoplasty

Deformities following primary rhinoplasty may be located at different anatomical regions related to the primary operation. Osseocartilaginous vault deformities such as open roof deformity, over-resected bony and cartilaginous dorsum, excessive width of the middle vault, inverted-V deformity and middle vault collapse are the most frequent ones. Stair-step deformity combined with middle vault problems is uncommon. Patients with these deformities not only have poor aesthetic results, but also have moderate or severe respiratory problems due to the severity of the deformity. Spreader grafts, onlay grafts and biomaterials can be used to correct these deformities. We preferred to use the spreader-splay graft combination for severe osseocartilaginous vault deformities. In this paper we present 3 cases. Two cases had severe open roof deformity, middle vault collapse and over resection of the osseocartilaginous hump, along with severe respiratory problems. The Spreader-splay graft combination was used, along with lateral osteotomy and medialization of nasal bones to treat these patients. One patient had a very severe stair-step deformity due to over resection of the hump and excessive infracturing of nasal bones along with severe respiratory problems due to collapse of the middle vault. This deformity was corrected with proper outfracturing along the old osteotomy site and the use of spreader-splay graft combination. All patients had good aesthetic and functional outcome after the surgery. In conclusion, the spreader-splay graft combination provides a good anatomical restoration to obtain a better respiratory function and aesthetic outcome on severe osseocartilaginous vault deformities following rhinoplasty.

Mega dose corticosteroid treatment for traumatic superior orbital fissure and orbital apex syndromes.

The superior orbital fissure syndrome and orbital apex syndrome are rare complications of craniomaxillofacial traumas. The neurologic symptoms are generally due to reversible neuropathy caused by edema, contusion, and compression of the nerves. Much has been written but no firm conclusions have been reached on the best mode of treatment. Whereas some authors advocate emergency optic nerve decompression, others recommend mega dose corticosteroids alone. We have treated 11 patients with traumatic superior orbital fissure or orbital apex syndromes with mega dose corticosteroids in the last 10 years. No complications attributable to the very high dose of corticosteroids were observed. The long-term follow-up of the patients showed complete recovery. These satisfactory results have led to our recommendation of the mega dose corticosteroid treatment in the management of these patients.

Callotasis in nonvascularized periosteal bone grafts and the role of periosteum : a new contribution to the concept of distraction osteogenesis

Bone lengthening by slow, progressive distraction has gained widespread acceptance. In this study we investigated the possibility of distraction osteogenesis in nonvascularized periosteal bone grafts, and assessed callus formation and callotasis by means of radiological and histological examination with the aim of determining the role of the periosteum. The process of distraction osteogenesis in nonvascularized bone grafts was studied histologically and radiotegically in 22 growing rabbits. The metatarsal bone grafts taken from the rabbits were divided into two groups. Group 1 contained 15 bone grafts covered with periosteum and group 2 (the control group) contained 7 bone grafts without periosteum. These grafts were subjected to osteotomy and then placed in the lumbar pocket. After 10 days, distraction was started and continued at 0.5 mm per day for 10 days. Thus an elongation of 4 to 6 mm was achieved in both groups. Radiological examination was performed postoperatively and after 10, 15, 20, and 30 days of starting the distraction. Histological examination was performed after 15, 20, and 30 days. Radiologically, progressive calcification and, histologically, both intramembranous and endochondral ossification were detected in group 1. However, in the control group (group 2), bone lengthening failed. Our study demonstrated the possibility of distraction osteogenesis in periosteal bone grafts, and provides information regarding the importance of periosteum as well as its osteogenic capacity.

An Uncommon Complication of Secondary Augmentation Mammoplasty:Bilaterally Massive Engorgement of Breasts After Pregnancy Attributable to Postinfection and Blockage of Mammary Ducts

Augmentation mammoplasty is one of the most frequently performed aesthetic operations. Galactorrhea and galactocele formation after augmentation mammoplasty, while the patient is experiencing the hormonal effects, is rarely seen. The cause remains unknown. However, postoperative fibrosis and blockage of the mammary ducts after augmentation mammoplasty is a probable cause of this formation in some patients. In the reported case, the patient described painful massive engorgement of both breasts during the last month of pregnancy and inability to breast-feed after delivery. In her history, she had undergone breast augmentation via the semicircular periareolar transglandular approach. She had experienced an infection at an early stage of her postoperative period and had needed to have both prostheses removed. A second breast augmentation mammoplasty was performed 1 year after the first operation via the same incision. She was content with the result of her second augmentation mammoplasty, up until her third pregnancy, at which time she reported inability to breast-feed after her delivery. At our examination, it was determined that there was massive painful breast engorgement, hyperemia, and inflammation of both breasts attributable to a bilateral galactocele formation. She refused to take any medication (bromocriptine), but approved antibiotic treatment. The patient responded to the antibiotics, and the prostheses therefore were left in place without further complications.

Upper extremity salvage with a flow-through free flap.

In complex extremity injuries, which include composite tissue lost with devascularization caused by segmental vascular damage, simultaneous coverage of the defects with revascularizations should be required. One-stage reconstruction of both soft tissue coverage and vascular damage can be performed by a flow-through-type free flap. In this series, 5 patients between 13 and 36 years of age with wide composite tissue defects in the cubital region and segmental defects in brachial arteries were operated at our clinic between 1996 and 2003. With the aim of reconstructing the wide tissue defects in the cubital region as well as that of the brachial artery, a radial arterial flow-through flap was applied. The radial artery of the flow-through flap was anastomosed to the proximal ends of the brachial and ulnar arteries in an end-to-end fashion. In 4 of the patients, the radial arterial flow-through flap was prepared from the distal aspect of the wounded forearm and in 1 patient from the contralateral forearm. In the postoperative period, no complications related to the anastomosis were encountered in the flap with all anastomoses found to be patent, and distal circulation was restored. The radial arterial flow-through flap is very useful in the clinical field of major trauma of the cubital region with brachial artery damage with numerous advantages that include the opportunity to work in one single surgical area, shorter dissection times resulting from simple and fixed anatomy, perfect color and tissue adaptation, and the suitability of the vessel caliber and length.

The reversed-flow temporoparietal fascial flap.

A patient is reported whose forehead soft-tissue defect was reconstructed by a reversed-flow temporoparietal fascial flap. This procedure can shorten the operating time. The blood circulation of the flap is satisfactory. The only drawback is the resulting scar of the skin-grafted area.

Orbital apex syndrome associated with fractures of the zygoma and orbital floor

SummaryThe orbital apex syndrome can be caused by trauma. The patient presented was hit by an elbow in the right periorbital area with resulting fractures to the right zygoma and orbital floor. Examination revealed visual loss, total ophthalmoplegia, and ptosis of the right upper eyelid with hypoesthesia in the ophthalmic division of the trigeminal nerve. After a week of supportive therapy and observation, the orbital floor fracture was repaired by reducing the bone fragments, and the zygomatic fracture was reduced through a Gillies incision. Over the next six months, there was complete resolution of the ophthalmoplegia, the ptosis, the loss of sensation in the ophthalmic division of the trigeminal nerve, and the vision.