Başkent Üniversitesi Yayınları
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Item Delayed Perforator Flaps for Reconstruction of Extensive Defects of the Posterior Trunk(Başkent Üniversitesi, 2024-03) Burak Ozkan; Abbas Albayati; Suleyman Savran; Cagri A. UysalABSTRACT 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.Item 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 HaberalABSTRACT 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.Item A Case of Progressive Mortal Thrombosis: Phlegmasia Cerulea Dolens(Başkent Üniversitesi, 2023-03) Khalid Zeynalov; Burak Ozkan; Tankut Akay; A. Cagri Uysal; Mehmet HaberalABSTRACT 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.Item 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 HaberalABSTRACT 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.Item 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 HaberalABSTRACT 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.Item 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 HaberalABSTRACT 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.Item Necrotizing Fasciitis Due To Mosquito Bite(Başkent Üniversitesi, 2022-09) Burak Ozkan; Abdullah Kizmaz; Orkhan Sahpazov; Cem Aydogan; Cagri A. Uysal; Mehmet HaberalABSTRACT 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.Item 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 HaberalABSTRACT 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.Item 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 HaberalABSTRACT 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 pathwaItem Flap Options in Reconstruction of a Burned Hand(Başkent Üniversitesi, 2021-12) Abbas Albayati; Mehmet Haberal; Cagri A. Uysal; Suleyman Savran; Burak OzkanABSTRACT 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.