Saime Irkoren

Penile strangulation and necrosis due to condom catheter

Condom catheters are often used in the management of male urinary incontinence, and are considered to be safe. As condom catheters are placed on the male genitalia, sometimes adequate care is not taken after placement owing to poor medical care of debilitated patients and feelings of embarrassment and shame. Similarly, sometimes the correct size of penile sheath is not used. Strangulation of penis due to condom catheter is a rare condition; only few such cases have been reported in the literature. Proper application and routine care of condom catheters are important in preventing this devastating complication especially in a neurologically debilitated population. We present a case of penile necrosis due to condom catheter. We will also discuss proper catheter care and treatment of possible complications.

A Clinical Comparison of EMLA Cream and Ethyl Chloride Spray Application for Pain Relief of Forehead Botulinum Toxin Injection.

ObjectivesThis study aims to analyze the efficiency of EMLA cream and ethyl chloride spray application for pain alleviation before botulinum toxin injection. MethodsForty-five patients were divided into 3 treatment groups. Skin cooling with ethyl chloride spray (in group 1), topical anesthetic cream (EMLA) (in group 2), was used on the forehead area on one side previous to injection; the opposite side served as the control. In the third group (n = 15), cold was applied using ethyl chloride spray to one side, and to the other side topical anesthetic cream (EMLA) was applied. A visual analog scale was used for pain intensity. ResultsIn the first group, the average pain score was 3.20 ± 1.20 on the side where ethyl chloride spray was applied and 7.26 ± 1.94 on the control side (P < 0.05). It was 4.20 ± 1.37 on the side receiving EMLA and 7.66 ± 1.54 (P < 0.05) on the control side in the second group. In the third group, the average score was 6.80 ± 1.37 for the EMLA side and 2.93 ± 1.03 for the ethyl chloride sprayed side (P < 0.05). ConclusionsSkin cooling with ethyl chloride spray significantly decreases the pain associated during forehead botulinum toxin injections.

Versajet hydrosurgery system in the debridement of skin necrosis after Ca gluconate extravasation: report of 9 infantile cases

OBJECTIVE The aim of the study was to evaluate the results of debridement with Versajet hydrosurgery system in patients with skin necrosis after ca gluconate extravasation. METHODS We evaluated nine infants (mean age: 26 days; range: 1 day to 3 months) with calcium gluconate extravasation injury. Site of injury was the foot in 3 cases, the hand and wrist in 5 and the scalp in one. In all patients the skin necrosis was debrided with Versajet hydrosurgery system under general anesthesia without damaging the dermis layer. RESULTS Following debridement all wounds healed spontaneously by re-epithelization and the mean time of full epithelization was fourteen days. No patient required a second debridement. At a minimum follow-up of 1 year minimal scar formation was noted and there was no hypertrophic scar. CONCLUSION Versajet hydrosurgery system appears to be effective in the debridement of skin necrosis due to ca gluconate extravasation in pediatric population.

The effects of botulinum toxin A on the wound and skin graft contraction.

Objective In the current study, we investigated the efficiency of botulinum toxin–A (BTX-A) on wound and skin graft contractions. Methods Thirty adult female Wistar rats weighing 150 to 200 g were used. The rats were divided into 2 groups. As each rat in these groups underwent 2 different procedures, those groups also were divided into 2 subgroups. Group 1 (n = 15) was assigned as the control group. Pair of full-thickness skin grafts of 40 × 20 mm was harvested from the 2 sides of the dorsal regions of the rats. The full-thickness skin graft harvested from the left side was readapted (Group 1A), and the right side was left as an open wound (Group 1B). The rats in the second group (n = 15) underwent the same procedures and botulinum toxin–A (BTX-A) 0.5-international unit injection to the graft area (Group 2A) and open wound area (Group 2B). Results A decrease in the amount of the contraction was observed in the groups, which underwent BTX-A injection. In the histologic examination, it was observed that inflammation and collagen amount was higher, and the arrangement of the collagen was different in the groups, which underwent BTX-A injection. Conclusions It has been determined that BTX-A injection reduces wound and graft contraction, and also, it is effective on reducing the amount of sebaceous cells and hair follicles.

Repairing peripheral nerve defects by vein grafts filled with adipose tissue derived stromal vascular fraction: an experimental study in rats

BACKGROUND There are many studies in the literature combining vein grafts with cell cultures, muscle, tendon, and nerve tissues, but none of them could replace isolated nerve grafts for nerve repair in clinical settings. There are studies in the literature indicating that adipose tissue derived stromal vascular fraction (SVF) enhances peripheral nerve healing. Considering these facts, an experimental study was performed in rats based on combining SVF with vein grafts for peripheral nerve defect repairs. METHODS The study included 30 rats which were divided in three groups. In the first stage, an 8 mm nerve defect was created in tibial nerve of each rat. In Group 1, the defect was reconstructed with nerve graft, in Group 2, the defect was reconstructed with vein graft, and in Group 3, the defect was reconstructed with vein graft filled with SVF solution. After 3 months, the second surgical stage was performed and nerve biopsies were taken. Tissue samples were observed histopathologically. RESULTS There were no statistically meaningful difference between nerve grafts, vein grafts and adipose tissue derived SVF- vein grafts combination groups considering myelin diameter and axonal diameter. Axon count was statistically superior in the nerve graft and study groups when compared to empty vein groups. CONCLUSION In conclusion, our results support the usage of stromal vascular fraction-vein graft combination for peripheral nerve defect repairs.

The Effect of Botox on the Implant Stabilization and Capsular Formation: An Experimental Study.

BackgroundBreast augmentation is one of the most common esthetic procedures with increasing frequency throughout the past years. The most demanding complications involving esthetic and reconstructive breast surgery are the malpositioning of the implant and capsular contracture. The etiology, prevention, and management remain to be fully explained. Botulinum toxin (BTX) administration has anti-inflammatory effects that can possibly decrease capsular contracture, and chemical denervation of the pectoral muscle theoretically may decrease incidence of malrotation. In our literature search, we found only 1 clinical study using BTX A for capsular contraction, and there were no experimental studies about the implant stabilization and capsular contracture. Therefore, we have studied the effect of BTX A on the prevention of breast implant malrotation and capsular contracture in a rabbit model. MethodsSixteen smooth-surfaced cohesive gel implants were implanted in 8 New Zealand white rabbits. The backs of the rabbits were divided into 2 groups. After skin incision, the exposed latissimus dorsi muscle was elevated, and a submuscular pocket was made. In the experimental group, Botox was injected in the muscle overlying the implant. In the control group, the implants were placed under the muscle, and saline was injected into the muscle. At the end of 3 months, the rabbits were imaged and evaluated by ultrasonography and x-ray to examine capsule formations and the movement of the implants. The animals were killed, and the implants with peri-implant capsule were excised. We evaluated collagen pattern and capsule thickness on ventral, lateral, and dorsal aspects. ResultsThe Botox group showed less infiltration of inflammatory cells at the third month (P < 0.05). Statistically significant differences in capsular thickness were observed on histopathological examination and ultrasonographic imaging. The capsule was thinner on all aspects and the collagen pattern had a more parallel alignment at low density in the experimental group compared with the control group. With x-ray, we observed an increased lateral movement of the implants in the control group. ConclusionsThe use of Botox effectively decreased implant movement and capsular formation at 12 weeks. More experimental and clinical studies will be required to determine whether this is a durable result that can be reproduced in humans.

A hydrosurgery system (Versajet) with and without hydrogen peroxide solutions for the debridement of subacute and chronic wounds: a comparative study with hydrodebridement.

OBJECTIVE: The aim of this study was to evaluate the efficacy of hydrosurgery prepared with or without hydrogen peroxide for the management of subacute and chronic wounds. METHODS: This is a retrospective study on patients with infected subacute and chronic wounds. The wounds were debrided using hydrosurgery prepared with (the study group) or without hydrogen peroxide before grafting the wound (the control group). RESULTS: There were 60 patients in the study group and 70 patients in the control group. The hospital stay (mean, 7.83 [SD, 2.16] vs 9.86 [SD, 3.41] days; P < .001) and graft viability (mean, 3 [2–3] vs 2 [2–3]; P = .001) were significantly better in the study group than in the control group. The difference of hemoglobin levels after surgery was also significantly lower in the study group (0.1 [0–0.48] vs 0.45 [0–1]; P = .004). CONCLUSIONS: Encouraging results were obtained with the use of the hydrosurgery system prepared with hydrogen peroxide for infected subacute and chronic wounds. This method decreased hospital stay and bleeding, thus providing better contact of the skin graft with the wound bed, allowing early rehabilitation. The findings of the authors’ study need to be substantiated in large-scale randomized controlled trials.

2 octyl-cyanoacrylate glue for Fixation of STSG in genitourinary tissue defects due to Fournier gangrene: A Preliminary Trial

BACKGROUND In these reported cases, we observed the outcomes of skin take and wound healing using 2-octyl-cyanoacrylate glue, which was used as tissue glue in the reconstruction of complex genital skin loss due to fournier gangrene. METHODS Fifteen patients with Fourniers gangrene were treated in this study. After initial surgical debridement, all defects were repaired using STSG. In this method a thin layer of 2-octyl-cyanoacrylate was dripped on the recipient site immediately before graft application. All wounds were followed up postoperatively and observed for evidence of graft take, seroma or hematoma formation, drainage, and infection. Patient and physician satisfaction were also determined. RESULTS Grafts were completely accepted in all fifteen patients. None of the patients had wound infection, seroma, hematoma, or other complications. CONCLUSION Use of 2-octyl-cyanoacrylate glue (Glueseal) for STSG fixation in complex genital skin defects after Fournier gangrene may be an acceptable alternative to conventional surgical closure with a good cosmetic outcome. Further studies are needed to confirm our initial success with this approach.

Using surgical drapes to facilitate pedicle deepithelialization in reduction mammoplasty

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Unusual burn injury due to application of white vinegar and aspirin mixture

Traditional medicine remedies are believed to provide relief from pain; nevertheless, it can be a risky procedure if these remedies are prepared inappropriately. Here, we describe a patient who suffered from a split‐thickness leg burn after applying a self‐inflicted mixture consisting of white vinegar and aspirin prepared for knee pain. This case report highlights a rare cause of a chemical burn that could become more common with increasing use of traditional remedies worldwide.