Serkan Erbatur

β-Glucan treatment prevents progressive burn ischaemia in the zone of stasis and improves burn healing: An experimental study in rats

Saving the zone of stasis is one of the major goals of burn specialists. Increasing the tissue tolerance to ischaemia and inhibiting inflammation have been proposed to enable salvage of this zone. After a burn, excessive inflammation, including increased vascular permeability, local tissue oedema and neutrophil activation, causes local tissue damage by triggering vascular thrombosis and blocking capillaries, resulting in tissue ischaemia and necrosis. Oxygen radicals also contribute to tissue damage after a burn. However, macrophages play a pivotal role in the response to burn. We studied β-glucan because of its many positive systemic effects that are beneficial to burn healing, including immunomodulatory effects, antioxidant effects (free-radical scavenging activity) and effects associated with the reduction of the inflammatory response. There were four test groups in this study with eight rats in each group. Group 1 was the control group, group 2 was administered a local pomade (bacitracin+neomycin sulphate), group 3 received β-glucan (50 mg kg(-1), orally) + the local pomade and group 4 received β-glucan. Burns were created using a brass comb model. Macroscopic, histopathological and statistical assessments were performed. Samples were harvested on the 3rd, 7th and 21 days for analysis. The neutrophilic infiltration into the zone of stasis was analysed on day 3. Macrophage infiltration, fibroblast proliferation, angiogenesis and re-epithelialisation ratios in the zone of stasis were analysed on days 7 and 21. The β-glucan groups (groups 3 and 4) exhibited lower neutrophil counts on the 3rd day, and macrophage infiltration, fibroblast proliferation, angiogenesis and re-epithelialisation were very high in these groups on the 7th day. In particular, re-epithelialisation on the 21st day was significantly better in the β-glucan groups. This study demonstrated that β-glucan may prevent neutrophil-dependent tissue damage and burn-induced oxidative injury through its anti-inflammatory and antioxidant properties. We speculate that the inhibition of neutrophil activation preserves vascular patency by preventing capillary blockage. β-Glucan is also a powerful macrophage stimulator, and is therefore very effective in saving the zone of stasis.

Management of extravasation injuries: A retrospective study

Abstract The extravasation of many agents during administration by way of the peripheral veins can produce severe necrosis of the skin and subcutaneous tissue. The incidence of an extravasation injury is elevated in the populations prone to complications, including the younger age groups. The severity of the necrosis depends on properties of the extravasated agent (vinca alkaloids, antracyclines, catecholamines, cationic solutions, osmotically active chemicals) including the type, concentration, and the quantity injected. In general, the primary diseases were chronic diseases such as hepatic or ischaemic encephalopathies, cardiac or pulmonary diseases, diabetes mellitus, and oncological diseases. The aim of this article was to explore the prevention, diagnosis, and treatment of extravasation injuries with a review of the literature. From January 2009 to August 2011, 22 patients were reviewed. Ten patients were children, and the others were adults. The surgical interventions were delayed until the development of the necrosis. A topical boric acid 3% solution was applied to all wounds with repetitive debridement. Debridement was performed once every 2 days and was continued until healthy tissue was obtained. The wounds of eight patients were repaired with split-thickness skin grafts, the wounds of six patients were reconstructed with randomised fasciocutaneous flaps, and the wounds of five patients healed by secondary intention. The wounds of three patients with massive swelling of the forearms were treated with only conservative modalities and limb elevation for 24–48 hours. Boric acid was found to promote granulation tissue in the wounds. The extravasation injuries can be prevented by using appropriate measures, such as the avoidance of perfusion under pressure, patient participation in pain follow-up, wound management by experienced health professionals, and preference for large and suitable veins.

Effectiveness of early fasciotomy in the management of snakebites

BACKGROUND The purpose of this study was to emphasize that early fasciotomy performed in the treatment of snakebites in the absence of the classic compartment syndrome criteria accelerates the clinical recovery and reduces the progressive tissue damage. METHODS Fourteen patients with snakebite were examined retrospectively. Five of them healed with routine treatments. Six patients who did not respond to the treatment underwent early fasciotomy procedure in 48 hours. All of the patients had edema, pain, ecchymosis, bulla formation, and progressive skin necrosis over the extremity. Fasciotomy was performed in three patients who were referred in the late period with compartment syndrome. Fasciotomy incisions were closed after 4-6 days. RESULTS After the early fasciotomy, edema diminished rapidly, the skin became more viable and local necrosis did not progress. Further, the toxic symptoms like local temperature increase and fever also diminished. The healing process in the three patients who underwent late fasciotomy was much slower compared with the early fasciotomy group. In particular, necrosis on the muscle and skin had deteriorated. CONCLUSION Fasciotomy has a special place in snakebites. In cases of compartment syndrome, all necessary treatments including early fasciotomy should be performed before the full clinical symptoms develop or the compartment pressure reaches the threshold value.

Isolated Congenital Hypoplasia of Nasal Lower Lateral Cartilages and Its Correction With Helical Rim and Conchal Cartilage Composite Grafts

Isolated congenital absence of the alar cartilages and nasal septum is rarely reported. We report here an example for the phenotype of carbamazepine embryopathy with lower lateral cartilage hypoplasia and our surgical approach to solve the nasal problems. This unusual presentation and the literature surrounding infant nasal surgery are discussed.

Atypical Presentation of Skull Metastasis from Rectal Adenocarcinoma as an Initial Symptom of Recurrence

Most malignant rectal tumors are histopathologically characterized as adenocarcinoma and generally metastasize to distant organs such as the lungs or the liver. Metastasis of rectal carcinomas to the skull is extremely rare. This study reports the initial diagnosis of rectal adenocarcinoma recurrence in a 65-year-old female with scalp metastasis. The patients history indicated a colorectal adenocarcinoma that was resected five years earlier. A skull metastasis from a rectal adenocarcinoma has not yet been reported in the literature as an initial symptom for recurrence. This paper suggests that skull metastasis from any part of the body must be considered in the differential diagnosis of soft tissue tumors in the skull even in the absence of intestinal symptoms.

Repairs of Large Defects of the Lower Lid and the Infraorbital Region With Suspended Cheek Flaps With a Dermofat Flap.

AbstractAfter the repair of large defects of the lower lid and the infraorbital region using larger flaps without adequate support, retractions of the lower lid may be observed due to the weight of the flap. In this study, the authors’ aim is to present the outcome of the repairs they performed on large defect areas in the lower lid and the infraorbital region using cheek flaps suspended by a dermofat flap.The method was performed on 7 patients between 2011 and 2015. Among the patients, 4 were female, while 3 were male. The mean age of the patients was 61.3 (54–69) years. In all the patients, the defects were secondary to tumor excisions. The mean size of the defects was 4.4 × 5 cm (4 × 4 cm to 6 × 5 cm). In all the patients, the repair of the defect was performed using the Mustarde flaps prepared in the subcutaneous plane. After the flap was advanced to the defect area, a dermofat flap was prepared from the part at the lateral canthal area and was sutured to the periosteum superiorly to the lateral canthus.Patient satisfaction and functionality was high during the long-term follow-up. While minimal scleral show occurred in 1 patient, the lid position was normal in the other patients.The authors are of the opinion that the method they used may reduce the risk of lid deformities that may develop with the cheek flaps used to repair large lid defects.

Depressive and Anxious Temperaments in Patients with Complex Regional Pain Syndrome Secondary to Tendon Injury

Abstract Objective: To determine the affective temperaments and somatoform amplification of the symptoms and its relation with the complex regional pain syndrome [CRPS] in patients who had tendon injuries of the forearm and hand. Methods: Sixty-seven patients [60 males, 7 females] with a forearm or hand tendon injury were enrolled in the present study. The patients were divided into two groups: CRPS and non-CRPS. The patients’ pain levels within the last 48 hours were assessed using the visual analog scale [VAS]. The temperament of the patients was evaluated using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto questionnaire [TEMPS-A]. Their anxiety levels were evaluated with the help of the State-Trait Anxiety Inventory [STAI]. The depression assessment was performed using the Beck Depression Inventory [BDI]. The Somato sensory Amplification Scale [SSAS] was employed for the evaluation of the somatoform disorders. Results: The mean age of the patients was 26.21 ± 8.01 years [age range: 18 to 57 years]. Among the patients 24 [35.8%] had developed CRPS. When the patients with and without CRPS were compared in terms of their psychological scores, the STAI-II and BDI scores were observed to be significantly deteriorated in the CRPS group in comparison to the non-CRPS group [p < 0.05]. Among the TEMPS-A subtypes, anxious [16.7%] and depressive [41.7%] temperaments were more dominant in the CRPS group and the ratio was significantly more deteriorated than the non-CRPS group [p < 0.05]. No significant difference was observed between the groups regarding the SSAS scores [p > 0.05]. Conclusion: The present study is the first one evaluating the affective temperaments of CRPS patients with tendon injury, and the main findings point out that depressive and anxious temperaments are the most common dominant affective temperaments among our patients.

A novel flap for the reconstruction of midcheek defects: "rabbit ear flap".

Abstract Cheek defects generally occur because of reasons such as trauma, burn, and tumor excisions. In the reconstruction of cheek defects, it is essential to cover the defects using the tissues with compatible color and similar texture. Although many techniques have been described for this purpose, local flaps are more likely to be used. In this study, we describe a new technique named “rabbit ear flap,” which we used for the reconstruction of a 4.5 × 7-cm cheek defect due to basal cell carcinoma excision in a 71-year-old male patient. Two separate flaps on the extension of right facial artery with an inferior pedicle on the nasolabial region (hairless skin) and a superior pedicle flap that extended from right oral commissure to the submandibular region (hairy skin) were used. The hairy skin part of the defect was closed via the hairy skin flap, whereas the hairless region was closed with the hairless skin flap. The donor sites were closed primarily. No complication was encountered in the early or long-term follow-ups. In the 28-month follow-up of the patient, it was observed that the color and texture compatibility was fine, the natural beard integrity was obtained, the donor site scarring was minimal, and the scarring was camouflaged well in the anatomical lines. This technique is supposed to be an alternative method for reconstruction of medium-sized cheek defects because it is a simple, reliable, and single-session procedure, and because of its similar color and texture, it offers satisfactory aesthetic and functional outcomes due to natural beard restoration.