Browsing by Author "Burak Ozkan"

Now showing 1 - 14 of 14

A Case of Progressive Mortal Thrombosis: Phlegmasia Cerulea Dolens
(Başkent Üniversitesi, 2023-03) Khalid Zeynalov; Burak Ozkan; Tankut Akay; A. Cagri Uysal; Mehmet Haberal
ABSTRACT Phlegmasia cerulea dolens is a very rare set of conditions associated with acute, massive venous thromboembolism. Medical and surgical options can be combined in treatment. Patients may experience sudden onset and severe leg pain, edema, cyanosis, compartment syndrome, and post-venous gangrene amputation and death. Medical and surgical treatments can be combined in treatment. Anticoagulants, thrombectomy, percutaneous procedures and amputations are among the treatment options. We present a 60-year-old female patient with a diagnosis of diabetes mellitus with swelling, pain, and discoloration in the left lower extremity who died due to progressive venous thrombosis despite various treatment modalities. Wound debridement and thrombectomy were performed. On day 10 of hospitalization, the patient was intubated to treat resistant low saturation. Despite the interventions, the patient died on day 10 of hospitalization due to cardiopulmonary arrest. Early diagnosis and treatment are vitally important. As in the case we presented, sometimes patients die as a result of rapid clinical progression and side effects, despite the use of different medical and surgical treatments.
Delayed Perforator Flaps for Reconstruction of Extensive Defects of the Posterior Trunk
(Başkent Üniversitesi, 2024-03) Burak Ozkan; Abbas Albayati; Suleyman Savran; Cagri A. Uysal
ABSTRACT OBJECTIVES: The delay phenomenon involves neovascularization of tissue after ischemic preconditioning. When employed, the delay phenomenon promotes flap survival and increases length-to-width ratio in conventional flaps. Although well-planned perforator flaps cover defects without tension, the success rate is unpredictable in extensive defects that are closed because of the unknown vascularity of perforasomes. We aimed to increase perforator flap size by utilizing the delay phenomenon for broad defects of posterior trunks. MATERIALS AND METHODS: Between 2019 and 2020, 10 patients (6 female, 4 male) underwent posterior trunk reconstruction with delayed perforator flaps. We retrospectively analyzed etiology, defect size, flap size and type, postoperative complications, and long-term results. The etiology of defects was meningomyelocele, soft tissue sarcoma, and pressure ulcers in 3, 3, and 4 patients, respectively. Defects were covered with delayed lumbar, intercostal, and thoracodorsal perforator flaps. Flaps were planned unilateral or bilaterally. Perforators were located preoperatively with a handheld Doppler. In the first session, delaying incisions and pedicle dissection were performed. The delayed incision was primarily sutured. Perforator flaps were elevated 1 week later, and defects were closed. RESULTS: Mean defect size was 375 cm2, and mean flap size was 420 cm2 (202-625 cm2). The donor site was closed primarily for 7 patients. Two patients required split-thickness skin grafts. One patient had donor site closed with secondary healing. No flap losses among patients were shown. Hematoma was seen in 2 patients in the immediate postoperative period. After 2 weeks, seroma and donor site dehiscence were shown in 2 and 1 patient, respectively. CONCLUSIONS: The delay phenomenon can be utilized in perforator flaps as in random pattern local flaps. Perforasome areas can be extended with delayed incision. In addition, broad defects of the posterior trunk can be safely covered with delayed perforator flaps.
Flap Options in Reconstruction of a Burned Hand
(Başkent Üniversitesi, 2021-12) Abbas Albayati; Mehmet Haberal; Cagri A. Uysal; Suleyman Savran; Burak Ozkan
ABSTRACT Hand burns are commonly seen in large burn injuries. Although the mortality of hand burns is imperceptible, morbidity can be of great importance. The possible disabling outcomes of hand burns necessitate a precise and accurate management, at both early and late stages, to allow optimal functional outcomes. The main goal of management is to maintain a favorable function that also preserves esthetics. Commonly used reconstructive options are skin grafts, skin flaps, and myocutaneous flaps. In this article, we discuss skin flap options in the reconstruction of a burned hand.
Infectious Features of Burn Wounds and Their Influence on the Course of Clinical Outcomes in Burn Victims
(Başkent Üniversitesi, 2023-06) Ayse Ebru Abali; Cem Aydogan; Burak Ozkan; Elif Unlu; Mehmet Haberal
ABSTRACT OBJECTIVES: This study sought to determine the interactions between infectious features of burn wounds and in-hospital clinical outcomes among patients treated at our burn center. MATERIALS AND METHODS: Our study group included 192 inpatients seen from 2020 to 2023. We collected data on age, sex, etiology, total body surface area burned, length of hospital stay, documentation of isolated microorganisms at admission and during hospitalization, requirement of antibiotic therapy, and mortality. We evaluated data among 3 subgroups: group 1 (length of hospital stay of 0-10 days), group 2 (length of hospital stay of 11-30 days), and group 3 (length of hospital stay of >30 days). RESULTS: Mean ± SE age was 32.2 ± 1.6 years (range, 0-86 y), and male-to-female patient ratio was 2.1:1. Mean ± SE total body surface area burned was 12.6 ± 1.3% (range, 1%-85%). Scalds were the most common burn cause. Mean ± SE length of hospital stay was 17 ± 2.4 days (range, 1-363 d). Among the 27 positive wound swab cultures at admission, 9 were resistant. Gram-positive bacteria were the most common at admission. During hospitalization, microorganisms were isolated in wound swabs or tissues in 48 cases. Staphylococcus epidermidis and multidrug-resistant Acinetobacter baumannii were the most common bacteria. Therapeutic antibiotherapy was needed for 83.3% of group 3, 53.1% of group 2, and 20.2% of group 1. Mortality rate was 3.6% (n = 7/192 patients), with 3 patients in group1, 2 patients in group 2, and 2 patients in group 3 who had at least 1 microorganism at admission. CONCLUSIONS: Evaluations of microflora in burn centers and precautions against wound contamination during emergency and transport phases can contribute to informed decisions at burn centers.
Necrotizing Fasciitis Due To Mosquito Bite
(Başkent Üniversitesi, 2022-09) Burak Ozkan; Abdullah Kizmaz; Orkhan Sahpazov; Cem Aydogan; Cagri A. Uysal; Mehmet Haberal
ABSTRACT Necrotizing fasciitis more often occurs in patients with diabetic vasculopathies, in those who are immuno-compromised, or in those exposed to blunt or penetrating trauma. Aggressive debridement and salvage of the relevant extremity are important in the treatment to prevent patients from entering sepsis. In this case report, we describe a 66-year-old male patient with diabetes mellitus who developed necrotizing fasciitis after a mosquito bite.
Our Experience on Topical Usage of Acetic Acid in Pediatric Major Burns
(Başkent Üniversitesi, 2022-12) Ayse Ebru Abali; Burak Ozkan; Cem Aydogan; Ahmet Cagri Uysal; Mehmet Haberal
ABSTRACT OBJECTIVES: We discuss the0 topical usage of acetic acid in pediatric patients with major burns and wound infections caused by multidrug-resistant bacteria. PATIENTS AND METHODS: Patients were 5 boys; mean age was 11 years (range, 4-16 years), and mean total body surface burn area was 45.2% (range, 15%-74%). Two patients had high-voltage electrical injuries (with 1 patient having concomitant flame burns), 2 patients had flame burns, and 1 patient had scald injuries. Systemic treatment with topical 3% acetic acid application was started as soon as the septic conditions due to isolated bacteria were identified. RESULTS: Mean length of elimination period was 12 ± 5.1 days for multidrug-resistant Acinetobacter baumannii. For 2 patients who had concomitant Pseudomonas aeruginosa isolation, colonization of Pseudomonas aeruginosa continued during a longer period, although infectious findings regressed. Septic conditions regressed, and burn wounds totally healed after surgical debridement, split-thickness grafting, and amputation plus flap surgeries during mean length of hospital stay of 59.8 days (range, 35-90 days). CONCLUSIONS: Topical acetic acid (3%) administration is feasible for clearance of multidrug-resistant Acinetobacter baumannii and for reduction of Pseudomonas aeruginosa quantity in the burn wounds.
Our Experience With Free Microvascular Tissue Transfer in Burn Reconstruction
(Başkent Üniversitesi, 2021-12) Burak Ozkan; Abbas Albayati; Suleyman Savran; Cem Aydogan; Cagri A. Uysal; Mehmet Haberal
ABSTRACT OBJECTIVES: Free microvascular tissue transfer can provide excess tissue in 1 stage for extensive injuries when locoregional flap options cannot be performed. Free flaps are an important reconstructive option in burn reconstruction whenever neurovascular and skeletal structures are exposed. This sophisticated technique needs surgical expertise and an understanding of burn physiology. Here, we have shared our experiences in burn reconstruction with free flaps. MATERIALS AND METHODS: Between 2017 and 2021, our center performed 26 free flap procedures in 20 burn patients. Fifteen flaps were performed in 12 patients at an early phase (first 21 days postinjury); 11 free flaps were performed in 8 patients for postburn contracture sequelae. Among these procedures, 60% were skin flaps (anterior lateral thigh, radial forearm, superficial circumflex iliac artery perforator flap, parascapular), 20% were musculocutaneous flaps (latissimus dorsi, vastus lateralis), 10% were fascia flaps (temporal fascia, serratus anterior), and 10% were pure muscle flaps (gracilis, latissimus dorsi). RESULTS: Two free flaps for early-phase reconstruction and 1 free flap for postburn contracture release were lost. Reasons for flap loss were venous congestion in 2 cases, with arterial occlusion due to hematoma formation in 1 case. All patients with flap loss had high-voltage electric burns. Debridement of the necrotic flaps was delayed until demarcation formation settled and until subflap granulation formation started. Skin grafts were performed after debridement of these flaps. All other flaps survived, with no recurrence of contractures or defects encountered in these patients. CONCLUSIONS: Although free flaps have changed the reconstructive ladder to a reconstructive elevator, performing these flaps have unique challenges in burn reconstruction, such as risk of thrombosis in those with electric burns, hemodynamic instabilities, and difficulties in patient positioning due to sedation. Meticulous care should be taken and the patient’s general condition should be well evaluated before free flap surgery.
Reconstruction of a Burn Sequel of the Hand With Long-Narrow Free Radial Forearm Flap
(Başkent Üniversitesi, 2021-12) Burak Ozkan; Cagri A. Uysal; Suleyman Savran; Abbas Albayati; Mehmet Haberal
ABSTRACT Skin grafting may not always be possible for deep burns of the hand, due to possible exposure of tendons and bones. Although planning and use of free flaps is easier when used to cover broad defects, reconstruction of long and narrow defects is challenging. Here, we describe a patient with severe burns to his right hand who underwent reconstruction of his hand with a long narrow free radial forearm flap in a one-stage reconstruction.
Reconstruction of Trochanteric Pressure Ulcers With Pedicled Vastus Lateralis-Anterior Lateral Thigh Flap
(Başkent Üniversitesi, 2021-09) Burak Ozkan; Abbas Albayati; Suleyman Savran; Cagri A. Uysal; Mehmet Haberal
OBJECTIVES: The trochanteric region is a frequent site for pressure ulcer development. The etiology is due to immobilization and prolonged hospitalization. Loss of the subcutaneous fat layer is another predisposing factor in cachectic patients. For patients with grade 3 to 4 sores with trochanteric major of femur exposition, flap reconstruction is generally needed. Musculocutaneous flaps are preferred to cover exposed bone and fill dead space. Although locoregional flaps such as tensor fascia lata and gluteus maximus muscle flaps have been used for trochanteric ulcers, these involve mandatory muscles for ambulation during rehabilitation. Another disadvantage is donor site complications due to pressure loading. Here, we describe the vastus lateralis-anterolateral thigh flap to decrease donor site morbidity and tension. MATERIALS AND METHODS: Between 2019 and 2021, we treated 9 trochanteric pressure ulcers in 8 patients (mean age of 38 years; range, 27-52 y). Defect sizes ranged from 5 × 5 to 10 × 12 cm. Flap sizes were planned according to exact defect size. Vastus lateralis muscle was retrieved according to dead space size. Donor sites could be closed in 5 patients, but 2 patients required split thickness skin grafts. Patients were hospitalized in lateral decubitus or supine position during follow-up. RESULTS: Mean follow-up time was 10 months (range, 6-18 mo). All flaps survived. One patient developed hematoma at donor site, which was treated with bedside debridement; no recurrence occurred during follow-up. No restrictions or morbidities were encountered during ambulation. CONCLUSIONS: The vastus lateralis-anterolateral thigh musculocutaneous flap provides both the required tissue for dead space filling and for defect closing. Advantages include lower donor site morbidity, perfect match in terms of skin quality and bulk, and protection of major muscles such as gluteus maximus and tensor fascia lata. The technique requires knowledge of quadratus femoris anatomy, which has a short learning curve.
Superficial Temporal Fascia Flap in Burn Patients: Old However Savior. A Case Report
(Başkent Üniversitesi, 2022-03) Abbas Albayati; Burak Ozkan; Cagri A. Uysal; Mehmet Haberal
ABSTRACT Deep burn wounds over hands and feet require thin and pliable flaps to cover underlying structures and to provide free range of motion. In the case reported here, we present the use of free superficial temporal fascia flap for coverage in a patient with third-degree burns on the lateral side of the left foot and ankle joint. We believe that this flap is a good alternative in patients with extensive burns where other options of thin flaps are not available or applicable.
The Impact of Fat Rich Enteral Feeding on the Histopathological Changes of Liver in Third Degree Burns: An Experimental Study
(Başkent Üniversitesi, 2022-12) Santiago J. Santelis; Ayse Ebru Abali; Gonca Ozgun; Binnaz Handan Ozdemir; Burak Ozkan; Mehmet Haberal
ABSTRACT OBJECTIVES: This study aimed to describe the histo-pathological changes in the liver secondary to severe burns and to investigate the effects of a fat-rich diet during the initial 7 days post burn in a rat model. MATERIALS & METHODS: We randomly assigned 21 Wistar-albino rats into 3 groups: sham group, burn + standard-diet group, and burn + fatty-diet group. A full-thickness burn wound was induced on the dorsa of the animals in both burn groups. Seven days after sham procedures/burn induction, hepatic tissues were examined under light microscopy; hepatocyte size, portal-triad size, and binuclear hepatocyte numbers were calculated. RESULTS: The mean number of binuclear hepatocytes was higher in burn + standard-diet group than in the sham group. Mean hepatocyte area and mean portal-triad area were narrower in the burn + standard-diet group compared with the sham group (P < .05). Mean hepatocyte area and mean portal-triad area in the burn + fatty-diet group were closer to those shown in the sham animals, and binuclear hepatocytes number in the burn + fatty diet group was slightly higher than in the burn + standard diet group(P > .05). CONCLUSIONS: Liver damage was mildly influenced by fat-rich enteral feeding in the 7 days postburn. Further studies must focus on dynamic feeding protocols designed according to the phases involved in the burn trauma instead of seeking a stable suitable protocol.
The Role of Pedicled Perforator Flaps in Burn Reconstruction
(Başkent Üniversitesi, 2021-03) Burak Ozkan; Cem Aydogan; Cagri A. Uysa; Abbas Albayati; Nilgun Markal Ertas; Mehmet Haberal
ABSTRACT OBJECTIVES: Perforator arteries raised from muscles and intermuscular septum are generally protected in burn injuries. Thus, pedicled perforator flaps are considered more reliable than conventional flaps in burn reconstruction. The role of pedicled perforator flaps changes according to injury timing. In the acute phase of injury (first 21 days), pedicled perforator flaps are used to cover exposed neurovascular and musculoskeletal systems. In the late phase of burn injuries, they are used to correct burn-related complications such as contractures and persistent defects. In this study, we present our experience with pedicled perforator flaps in both the acute and chronic phases of burn injury. MATERIALS AND METHODS: Between 2017 and 2020, our center performed 25 pedicled perforator flap procedures in 20 patients (17 men/3 women) for burn injury reconstruction. Of the 25 total pedicled perforator flaps, 4 were utilized for acute defects and 21 were performed during the late phase of injury. In the acute phase, the main indication was to cover exposed vessels. In the late phase, 16 of the 21 flaps were used to cover defects (burn scar contracture release in axilla, neck, popliteal, and antecubital region), 2 were used to cover pressure ulcers due to prolonged hospitalization, and 2 were used for persistent defects in the extremities. RESULTS: Average age of patients was 34 years (range, 28-62 years). Our success rate with pedicled perforator flaps was 88%, with 2 total losses (1 supraclavicular artery perforator flap, 1 superior epigastric artery perforator flap) and 1 partial necrosis (superior gluteal artery perforator flap) encountered in the late phase in flap with 180-degree rotation arc. CONCLUSIONS: The role of pedicled perforator flaps vary depending on the timing of burn injuries. We found that pedicled perforator flaps were a reliable reconstruction option in both acute and late phases of burn injury.
The Use of Growth Factors in Wound Healing: An Update
(Başkent Üniversitesi, 2023-03) A. Cagri Uysal; Burak Ozkan; Orkhan Shahbazov; Ebru Sakallioglu Abali; Mehmet Haberal
ABSTRACT Wound healing is a complex and well-integrated process. Growth factors have an important role in modulation of wound healing steps. Because of their important role in wound healing, growth factors have been used as triggering agents in chronic wounds. In this article, we provide an up-to-date review of growth factors found to be effective in chronic ulcers and are commercially available on the market for treatment of chronic ulcers.
Two Cases of an Unusual Presentation of Electrical Burn Injuries
(Başkent Üniversitesi, 2022-03) Burak Ozkan; Santiago J. Santelis; Abbas Albayati; Ayse Ebru Abali; Cagri A. Uysal; Mehmet Haberal
ABSTRACT Electric injuries have a wide variety of consequences ranging from disfigurements, extremity loss, and death. The limbs are the most affected sites because of the high resistance of muscles and tendons to electricity. The most common pathway of entry to exit point is upper limb to lower limb, so the thigh to foot pathway is exceptional. In this case report, we aimed to present the mechanisms in 2 construction workers who had high-voltage electric burns that followed this unusual pathwa