Sinan Oksuz

Nosocomial infection characteristics in a burn intensive care unit: Analysis of an eleven-year active surveillance

AIMS The objective of this study was to describe nosocomial infection (NI) rates, risk factors, etiologic agents, antibiotic susceptibility, invasive device utilization and invasive device associated infection rates in a burn intensive care unit (ICU) in Turkey. METHODS Prospective surveillance of nosocomial infections was performed according to Centers for Disease Control and Prevention (CDC) and National Healthcare Safety Network (NHSN) criteria between 2001 and 2012. The data was analyzed retrospectively. RESULTS During the study period 658 burn patients were admitted to our burn ICU. 469 cases acquired 602 NI for an overall NI rate of 23.1 per 1000 patient days. 109 of all the cases (16.5%) died. Pseudomonas aeruginosa (241), Acinetobacter baumannii (186) and Staphylococcus aureus (69) were the most common identified bacteria in 547 strains. CONCLUSION Total burn surface area, full thickness burn, older age, presence of inhalation injury were determined to be the significant risk factors for acquisition of NI. Determining the NI profile at a certain burn ICU can lead the medical staff apply the appropriate treatment regimen and limit the drug resistance. Eleven years surveillance report presented here provides a recent data about the risk factors of NI in a Turkish burn ICU.

The effect of subcutaneous mesenchymal stem cell injection on statis zone and apoptosis in an experimental burn model.

Background: In an acute burn injury the zone of stasis is initially vital but may progress to coagulation necrosis with time. In this study, salvage of the zone of stasis was aimed at by subcutaneous mesenchymal stem cell injection. Methods: Mesenchymal stem cells were obtained from the bone marrow of Sprague-Dawley rats (n = 10). Twenty Sprague-Dawley rats received thermal injury on the back according to the previously described “comb burn” model. Thirty minutes after the burn injury, mesenchymal stem cells were injected subcutaneously to the stasis zone of the experimental group (n = 10). Animals in the control group (n = 10) were given the same amount of saline without mesenchymal stem cells. Animals in the sham group (n = 6) did not receive any thermal trauma. Seventy-two hours after the burn injury, scintigraphic examination was applied to determine average vital tissue at the stasis zone. Thereafter, skin samples were assessed by immunohistochemistry assay for apoptosis count. The blood samples drawn before and 72 hours after the burn injury were analyzed to determine systemic cytokine levels. Results: The apoptosis count of the control group was found to be significantly higher than that of the experimental group. Vital tissue percentage of the stasis zone was significantly higher for the experimental group than for the control group. The cytokine levels did not reveal any statistically significant difference between the groups. Conclusion: Apoptosis count and scintigraphic results of this study confirm that mesenchymal stem cell treatment has a statistically significant benefit for the survival of the stasis zone in acute burn.

Profile of Self-Inflicted Burn Patients Treated at a Tertiary Burn Center in Istanbul

The factors and demographic features of self-inflicted burns in Eastern and Western cultures differ from each other. In this retrospective study, the authors’ aim is to identify the epidemiologic features of self-inflicted burn patients treated at their Tertiary Burn Centre. The Burn Centre provides health care to a large population from Istanbul, which is located at the crossroads between Asia and Europe. The demographic data and information of 32 patients who were admitted to the GATA HEH Burn Center in Istanbul for attempted suicide were retrospectively reviewed over a 7-year period (2001–2008). Twenty-eight of the 32 patients were men, whereas the remaining four patients were women. The average age was 25.9 years. Seventeen patients had a previous history of self-harming and 22 patients were unemployed. History of a psychiatric illness was found in 20 patients. Mean total body burn surface area was 70%. The mortality rate was 43.4%. This study demonstrates that suicide attempts by burning differ from Eastern and Western cultures by factors and demographic features. It has been concluded that the solution to preventing self-inflicted burns calls for the joint efforts of physicians, psychologists, and sociologists. Furthermore, it is necessary to reinstate prevention programs and revise strategies for prevention based on the country and its culture.

Treatment of facial burn scars with CO2 laser resurfacing and thin skin grafting.

Background: Facial burns are very common and have significant clinical impact. Facial scars are easily recognized in the community and become a source of lifelong guilt, shame, and regret for the patients. In the presented clinical study, we aimed to investigate the effectiveness of CO2 laser resurfacing and thin skin grafting for burn scars of face. Methods: Sixteen white men, whose ages ranged from 20 to 26 years (mean, 22 y), were operated on for elimination of facial burn scars. Burn areas were de-epithelialized by CO2 laser. Each area was grafted with a split-thickness skin graft. The follow-up period for these patients ranged from 3 to 15 months, with a mean follow-up period of 9 months. Results: The scars were successfully treated and converted to a socially acceptable appearance. The color match was good or excellent in all patients. No new hypertrophic scar developed. Conclusions: Facial burn scars may be dermabraded in a short time, and a bloodless and smooth raw surface may be created by a flashed-scanned CO2 laser. The CO2 laser resurfacing and thin skin grafting method is effective in treating facial burn scars.

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 mini incision technique for carpal tunnel decompression using nasal instruments.

AIM Mini incision techniques for carpal tunnel release have become increasingly popular for the treatment of carpal tunnel syndrome. The main advantages of mini incision techniques are shorter recovery and return-to-work time. However, the risk of neurovascular injury still remains worrisome. We present a novel method to release the carpal tunnel by using nasal instruments. This novel technique combines the advantages of endoscopic and open techniques while utilizing standard instruments. The advantages, disadvantages and results of this technique are discussed. MATERIAL AND METHODS Forty-five patients (15 male, 30 female, age 28-62; mean 48) with isolated carpal tunnel syndrome were enrolled to the study. Atotal of 55 wrists (bilateral in 7 cases, the right wrist in 41 and the left wrist in 14) underwent carpal tunnel decompression with a mini longitudinal incision technique. Grip strength--key pinch and sensorial evaluations were performed in all patients by one examiner using the Pressure-Specified Sensory Device. RESULTS Significant differences between the pre- and postoperative periods were observed in either grip strength or pinch strength (p<0.05). No recurrence or injury to the neurovascular structures was noted in the follow-up period. CONCLUSION The technique is simple and effective, employs inexpensive instruments, and has a low complication rate.

Multiple Recurrence of Trichilemmal Carcinoma of the Scalp in a Young Adult

Trichilemmal carcinoma is a rare, cutaneous adnexal malignant tumor deriving from the outer root sheath of hair follicles. This rare cutaneous cancer usually occurs on the sun-exposed areas of the elderly, although it can appear as multiple lesions on non-sun-exposed skin. Clinically, it may be mistaken for squamous cell carcinoma, basal cell carcinoma, nodular melanoma, or keratoacanthoma. It has been shown to be a malignant form of a trichilemmoma. Trichilemmal carcinoma generally has a nonaggressive course. Boscaino and colleagues reported that, after excision of the lesions in seven patients, there was no recurrence of the tumor within a 2-month to 4-year follow-up. Trichilemmal carcinoma poorly mimics differential squamous cell carcinoma, and its biological behavior is unpredictable because it rarely can produce distant metastasis. Most of the time there is a unique lesion that presents a papulonodular aspect with possible keratosis or ulceration on the top of it. Simple excision with adequate safety margin is a safe, low-cost, effective mode of treatment. The appropriate treatment also includes wide resection and postoperative follow-up of the patient to facilitate early diagnosis of the recurrence and distant metastasis.

One-and-a-half-barrel vascularized free fibular flap for the reconstruction of segmental mandibular defect.

We designed one-and-a-half-barrel vascularized free fibular flap which is a further modification of the double-barrel technique, and we tried to overcome the discrepancy between mandible and fibula flap. We used this flap in case of a segmental mandibular defect that occurred as a result of a giant cell reparative granuloma excision. This new modification eliminated volume insufficiency of the classical technique and volume excess of the double-barrel technique.A segmental mandibular defect that occurred as a result of giant cell reparative granuloma excision was reconstructed using one-and-a-half-barrel vascularized free fibular flap. The size discrepancy between mandible and free fibula flap is a well-known problem, and this new modification of free fibular flap eliminated volume insufficiency or excess problems of the other techniques.

Subungual Squamous Cell Carcinoma Masquerading as an Onychomycosis

DOI: 10.4328/JCAM.488 Received: 20.11.2010 Accepted: 28.11.2010 Printed: 01.04.2012 J Clin Anal Med 2012;3(2): 231-3 Corresponding Author: Celalettin Sever, GATA Haydarpasa Egitim Hastanesi. Plastik ve Rekonstruktif Cerrahi Servisi. Selimiye Mah. Tibbiye Cad. 34668 Kadikoy, Istanbul, Turkey. T.: +902165422656 E-Mail: drcsever@hotmail.com Ozet Tirnagin tumorleri iyi veya habis nitelikte olabilir. Tirnaga ait tumorlerin degisik histolojik tipleri literaturlerde rapor edilmistir. Tirnagin yassi epitel hucreli karsinomu oldukca nadirdir ve yanlis tani konulmaktadir. Bu nedenle bu tumorun insidansini belirlemek oldukca guctur. Biz bu olgu sunumunda yanlis tani konulan ve bu yuzden tedavide gecikmeye neden olan tirnagin yassi epitel hucreli karsinomunu sunmayi hedefledik. Tirnak lezyonlari, tedavide gecikmeye neden olmamak icin dikkatlice incelenmeli ve gerekirse bu lezyonlar histopatolojik olarak incelenmelidir. Histopatolojik taniya gore uygun tedavi planlanmalidir.