Başkent Üniversitesi Yayınları
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Item Late and Most Severe Complication of Burn Injury: Marjolin Ulcer(Başkent Üniversitesi, 2024-12) Mustafa Akyürek; Güneş HafızOBJECTIVES: We analyzed the demographic characteristics, surgical interventions, results, and complications of patients in our clinic diagnosed with squamous cell carcinoma that developed on the base of burn scars. Our aim was to enhance the understanding and improve therapeutic strategies for the management of Marjolin ulcer. MATERIALS AND METHODS: We conducted a comprehensive review of patients who underwent surgery for squamous cell carcinoma from May 2013 to May 2023. We specifically identified those with squamous cell carcinoma originating from burn ulcers. For these patients, we systematically collected data, which encompassed demographic details, photographic evidence, details of surgical interventions, lymph node outcomes (if dissection occurred), and any recurrences or complications observed during postoperative follow-up. RESULTS: Of the 741 patients diagnosed with squamous cell carcinoma, 11 had a burn-related Marjolin ulcer. Average age was 53 years, and average time from burn to squamous cell carcinoma diagnosis was 12.2 years. Six patients had excisions with lymph node dissections. In 6 patients, the excision material was removed with a clean margin, whereas 3 patients had margins with pseudoepithelial hyperplasia and dysplastic epithelium. Local recurrence developed in 2 patients during postoperative follow-up, with an average follow-up period of 4.8 years. CONCLUSIONS: Marjolin ulcers derived from burn scars present major clinical challenges. A thorough surgical and clinical approach, coupled with careful follow-up, is essential for optimal management. In contrast to prevailing literature suggesting a poor prognosis for squamous cell carcinoma from burn scars, our findings showed no distant metastasis among our patients. For a more comprehensive understanding and improved patient care, multicenter studies are recommended and enhanced patient education is needed on protective measures and the importance of regular follow-up.Item A Case of Falling Into an Acid Tank From Height After High-Voltage Electrocution(Başkent Üniversitesi, 2024-12) Burak Özkan; Abdullah Kızmaz; Uğur Bak; Khalid Zeynalov; Süleyman Savran; Abbas Albayati; Çağrİ A. Uysal; Mehmet HaberalIn this case report, we present the management of a dramatic and rare combination of injuries: high-voltage electrical injury, chemical burn, and open tibial and calcaneal fractures resulting from a fall from height. The patient underwent early fasciotomies. After treatments administered by a multidisciplinary team consisting of plastic surgeons, general surgeons, orthopedic specialists, anesthesiologists, and physiotherapists, the patient was discharged without extremity loss after a 135-day hospital stay. This case report discusses the importance of early fasciotomy and debridement in management of extensive burns and fall-related injuries, the potential for extended hospitalization for reconstruction, and the necessity of a multidisciplinary approach.Item Utilization of Novel Keystone Flap Modification on Various Anatomic Sites(Başkent Üniversitesi, 2024-09) Burak İzkan; Mehmet Haberal; Çağrİ A. Uysal; Abbas Albayati; Ömer Uzun; Uğur Bak; Orkhan Shahbazov; Abdullah Kızmaz; Süleyman SavranABSTRACT We describe our proposed modification of the keystone flap, which adds a V-Y advancement in 3 directions, further optimizing the redistribution of tension forces. This new approach not only improves the overall stability of the flap but also reduces the risk of wound dehiscence and enhances the potential for better healing outcomes. We describe its use in 15 patients treated at our center (mean age of 58 years [range, 18-77 y]) with mean follow-up time of 14 months (range, 6-24 mo). All flaps survived, and no early or late complications were encountered. The keystone flap’s flexibility, combined with its multiple modifications, continues to expand its applicability across diverse anatomical locations, making it a vital tool in reconstructive surgery for complex defects.Item Pedicled Anterolateral Thigh Flap Reconstruction for Defects Between Umbilicus and Knee(Başkent Üniversitesi, 2024-06) Burak Özkan; Abdullah Kızmaz; Khalid Zeynalov; Süleyman Savran; Abbas Albayati; Çağrı A. Uysal; Mehmet HaberalABSTRACT OBJECTIVES: This study evaluated the efficacy and outcomes of pedicled anterolateral thigh flap reconstruction in addressing soft tissue defects between the umbilicus and the knee. MATERIALS AND METHODS: We evaluated 12 patients (8 males, 4 females; mean age of 56 years; range, 15-74 years) who underwent pedicled anterolateral thigh flap reconstruction between 2019 and 2022. Defect locations included the inguinal region, trochanteric region, medial thigh, posterior thigh, lateral knee, and umbilical region. RESULTS: The average operative time was 2.7 hours (range, 2-4 hours). All donor sites were closed primarily, with no major complications. Mean hospital stay was 7 days (range, 4-18 days). CONCLUSIONS: The pedicled anterolateral thigh flap is a versatile and reliable solution for defects in the lower abdomen and lower extremities, offering excellent outcomes with minimal donor site morbidity.Item Geriatric Burns in Ain Shams University Burn Unit: A Comparative Epidemiological Study(Başkent Üniversitesi, 2023-09) Amr Mabrouk; Mai Raafat Hammad; Adel Mabrouk; Mohamed Samir BadawyABSTRACT OBJECTIVES: In Egypt, the geriatric burn population faces unique challenges, and understanding the problem is crucial for effective management. Here, we examined the epidemiology and outcomes of geriatric patients presenting to the Ain Shams University burn unit, over a period from January 2019 to July 2022. MATERIALS AND METHODS: This prospective study investigated all patients older than 60 years of age who presented to the Ain Shams University Burn Unit from January 2019 to July 2022; we compared findings with our previous work published 20 years ago, in which we examined the same population from May 1995 to October 2001. The parameters investigated were patient characteristics/demographics, seasonal and day/hour variations in burn incidence, place of residence and site where burn injury occurred, type and extent of burns, treatment and hospital stay, and morbidity/mortality rates. RESULTS: Despite the number of geriatric patients presenting to our burn unit being higher, a lower percentage required admission. Early excision and grafting were performed with a higher frequency, which may be attributed to the fewer patients with chronic illnesses. There was a reduction in both morbidity and mortality. CONCLUSIONS: Substantial changes have been made in recent years in the approach to geriatric burns, including with prevention strategies and early intervention, which have led to a reduction in both morbidity and mortality among our patients. Multidisciplinary care, involving a team of health care professionals, including burn and plastic surgeons, geriatricians, and occupational therapists, is necessary to address the complex needs of this population.Item Late and Most Severe Complications of Burn Injury: Marjolin Ulcer(Başkent Üniversitesi, 2023-06) Mustafa Akyurek; Gunes HafizABSTRACT OBJECTIVES: The goal of our study was to analyze and present the demographic characteristics, surgical interventions, results, and complications of patients diagnosed with squamous cell carcinoma that developed on the base of burn scars in our clinic. Through this research, we aimed to enhance the understanding and to improve therapeutic strategies for the management of Marjolin ulcer. MATERIALS AND METHODS: We conducted a comprehensive review of patients who underwent surgery for squamous cell carcinoma from May 2013 to May 2023. We specifically identified those with squamous cell carcinoma originating from burn ulcers. For these patients, we systematically collected data, which encompassed demographic details, photographic evidence, details of surgical interventions, lymph node outcomes (if dissection occurred), and any recurrences or complications observed during the postoperative follow-up. RESULTS: Of the 741 patients diagnosed with squamous cell carcinoma, 11 had a burn-related Marjolin ulcer. The average age was 53 years, with an average time from burn to squamous cell carcinoma diagnosis of 12.2 years. Six patients had excisions with lymph node dissections. In 6 patients, the excision material was removed with a clean margin, whereas 3 had margins with pseudo-epithelial hyperplasia and dysplastic epithelium. Local recurrence developed in 2 patients during postoperative follow-up. Average follow-up period was 4.8 years. CONCLUSIONS: Marjolin ulcers derived from burn scars present substantial clinical challenges. A thorough surgical and clinical approach, coupled with careful follow-up, is essential for optimal management. In contrast to the prevailing literature that suggests a poor prognosis for squamous cell carcinoma from burn scars, our findings showed no distant metastasis. For a more comprehensive understanding and improved patient care, multicenter studies are recommended, and there is a pressing need to enhance patient education about protective measures and the importance of regular follow-up.Item Outpatient Management of Pediatric Burns in Chile(Başkent Üniversitesi, 2023-02) María Dora Espinosa González; Orlando FloresABSTRACT Most burn injuries can be treated on an outpatient basis. However, data on burn injuries treated at outpatient centers are largely omitted from the burn literature. Patients suitable for pediatric outpatient burn care are mostly children younger than 5 years old at the time of the injury, with the hand as the prevalent burn location and total body surface area of <1%. The main causal agent in this population are scalds and hot objects, and patients have an average healing time of 13 days. The hospitalization rate varies from 1% to 6%. The success of ambulatory care depends on careful patient selection. The criteria for outpatient management can vary based on the center’s experience and resources and mainly involve partial thickness burns affecting <5% of the total body surface area and burns with minimal involvement of special areas. A careful review of the patient’s social and economic situation is an essential component of the assessment for successful outpatient burn care, as the child’s family should be able to support the wound care, attend to follow-up consultation, and have access to transportation for timely access to a specialized burn center. The treatment goal should be to close the burn wounds as soon as possible. The outpatient care strategy should include adequate pain management, local wound care, home instructions, and follow-up until the burn wounds are well reepithelialized. The most important potential complication is wound infection. It is relevant to know the symptoms and signs of local and systemic infection, so that infections can be treated in a timely and adequate manner. At our outpatient burn center in Chile, we can successfully manage 85% to 90% of patients with burns by making adequate patient selection, having an outpatient management strategy that includes family education, and knowing the possible complications.Item Knowledge and Attitude of Health Care Staff in First Aid for Minor Burns(Başkent Üniversitesi, 2022-09) Ayse Gul Atay Doygaci; Ayse Ebru Abali; Elif Unlu; Santiago J. Santelis; Eylem Gul; Mehmet HaberalABSTRACT OBJECTIVES: This study aimed to assess the level of knowledge and awareness of first aid for minor burns of health care workers in a university hospital. MATERIALS AND METHODS: A total of 402 subjects including nurses (n = 163), medical technicians (n = 94), technicians/patient care support personnel (n = 145) participated. Data were collected by face-to-face interview technique using our 2 evaluation forms (characteristics of participants was form 1 and first aid knowledge on minor burns was form 2) (P < .005). RESULTS: Mean age was 29.7 years. Female to male ratio was 1:0.7. Form 2 was correctly answered by 76.9% of participants. Participants who stated that they have received first aid training on burns was 41.5%, but only 38.3% of the subjects felt confident for providing first aid. Running water was preferred by 85.6%. High education level, receiving first aid training, and seniority in the profession and in the institution were the effective factors for providing proper first aid (P < .005). Female (58.5%), single (59.8%), child-free (61.7%) participants and those who had attended first aid education programs more recently were prone to providing proper first aid than the others (P < .005). CONCLUSIONS: In the present study, many participants had basic knowledge about first aid for minor burns, but they felt unconfident. Health care staff need periodical educational programs specific to them in addition to the basic awareness programs for burn injuries.Item Policy of Burn Care at the Baskent University Ankara Hospital During the COVID-19 Period(Başkent Üniversitesi, 2021-03) Cem Aydoğan; Emre Karakaya; Ayşe Ebru Abalı; Ebru H. Ayvazoğlu Soy; Mehmet HaberalOBJECTIVES: Although hospital admissions and elective surgeries were recommended to be reduced during the COVID-19 pandemic period, the same could not be done for burn patients. It is vital that burn treatment starts immediately and continues without interruption. With this in mind, burn centers should take added precautions during this pandemic. In the present study, we present our experiences in our burn center during the pandemic period. MATERIALS AND METHODS: From March 2020 to February 2021, 457 patients were successfully treated at our center. We implemented training immediately for all hospital staff, with all staff provided with personal protective equipment. We minimized the risk of contamination by completely isolating burn patients and reducing the number of beds. We determined a 3-degree protection protocol according to the general condition of the patients and the diagnosis of COVID-19. During the pandemic period, we continued to treat burn patients by adhering to our protection protocols. RESULTS: During pandemic period, 381 patients (83.4%) were treated as outpatients and 76 patients (16.6%) were hospitalized. The most common cause of burns was scalding, with 172 adult patients (61.4%) and 152 pediatric patients (85.8%). Mean total burn surface area of hospitalized patients was 25.34% in adult patients and 9.95% in pediatric patients. During the treatment process, only 2 patients were diagnosed with COVID-19, and burn treatments were successfully completed, with patients discharged without any problems. CONCLUSIONS: Ensuring isolation among patients in our burn center and determining protection protocols for burn center health care workers played key roles in the continuity of uninterrupted care during the pandemic period.Item Yetmişaltı Ağır Yanıklı Olguda Yoğun Bakımda Mekanik Ventilasyon Uygulamaları, Gelişen Komplikasyonlar ve Prognoz(Başkent Üniversitesi, 2006-09)Amaç: Bu çalışmada, kliniğimizde ağır yanık nedeniyle izlediğimiz olgular yanık nedeni, yanığın ciddiyeti, mekanik ventilasyon uygulanması, Reanimasyon Ünitesi'nde yatış sırasında gelişen komplikasyonlar ve prognoz açısından incelendi. Materyal ve Metod: Çalışmaya Mayıs 1999-Ağustos 2004 yılları arasında yoğun bakım desteğine ihtiyaç duyan 76 ağır yanık olgusu alındı. % 30 ve üzeri II. ve III. derece yanıklar ağır yanık olarak kabul edildi. Parkland formülüne göre standart sıvı replasmanı uygulandı. Yara bakımları nitrofurazon %0.2 pomad ile yapıldı ve gerekli durumlarda plastik cerrahi uzmanları tarafından debritman, eskaratomi veya fasiyotomi uygulandı. Olgular demografik özellikleri, yanık nedenleri ve ağırlığı, mekanik ventilasyon uygulanması, Reanimasyon Ünitesi'nde kalış süreleri ile mortalite açısından retrospektif olarak değerlendirildi. Sonuçlar: Elli-yedi olgu (%75) erkek, 19 olgu (%25) kadın olup yaş ortalaması 27.8 ± 17.5 (1-71 yaş) idi. Kırkdokuz olguda termal yanık, 17 olguda elektrik yanığı ve 10 olguda ise su veya süt ile yanık (olguların tamamı çocuk) mevcuttu. Yanık olgularının %91’inde (69 olgu) olay kaza ile meydana gelmişti. Elli-iki olguda (%68.4) mekanik ventilasyon uygulandı. Yirmi-bir (%27) olguda inhalasyon hasarı saptandı. Mekanik ventilasyon uygulanan olguların ortalama mekanik ventilasyon süresi 11.5 ± 15 gün (1-70), ortalama yoğun bakımda kalış süresi 13.6 ± 16.9 gün (2-93) ve ortalama yanık yüzdesi 47.4 ± 20.3 idi. Yedi olguda (%9) böbrek yetersizliği gelişti. Otuz olgu (%39.5) kaybedildi. Ölüm nedenleri; 24 olguda septik şok, 4 olguda kardiyak sorunlar ve 2 olguda ise kanama olarak belirlendi. Yanık yüzdelerine göre 49 olguda %30-50, 15 olguda %50-75, 12 olguda %75-100 arasında yanık mevcuttu. Mortalite; yanık alanı %30-50 arası olanlarda %28, %50-75 arası olanlarda %60, %75 ve üzerinde ise %92 olarak saptandı. Yorum: Yoğun bakımda tedavi ettiğimiz ağır yanık olguları büyük oranda (%68.4) mekanik ventilasyon desteğine ihtiyaç duymuştur. Hastaların ortalama Reanimasyon Ünitesi'nde kalış süresi 13.6 ± 16.9 gün ve mortalite %39.5 olarak saptanmıştır. Yanık hastalarında en sık ölüm nedeninin hastane enfeksiyonuna bağlı gelişen septik şok ve ilişkili organ yetersizlikleri olduğu belirlenmiştir. Mechanical ventilation, complications, and prognosis in patients with a severe burn Objective: In this study, patients with a severe burn injury were evaluated according to the cause and severity of the burn, the need for mechanical ventilation, the development of complications during the intensive care unit stay, and prognosis. Patients and Methods: Seventy-six severely burned patients who required intensive care management between May 1999 and August 2004 were included in the study. A severe burn was defined as a burn injury in which the superficial dermal or deep dermal burn area exceeded 30% of the patient’s total body surface. Volume replacement was standardized according to the Parkland formula. Wound care was managed with 0.2% nitrofurazone pomade, and plastic and reconstructive surgeons performed debridement, escharotomy, or fasciotomy when needed. The patients were retrospectively evaluated in terms of demographic characteristics, the type of burn injury, the need for mechanical ventilation, the duration of the intensive care unit stay, and mortality. Results: Seventy-five (75%) male patients and 19 (25%) female patients with a mean age of 27.8 ± 17.5 years (range, 1-71 years) were studied. The causes of burns in those patients were as follows: thermal injury, 49 patients; electrical injury, 17 patients; and hot water or milk, 10 patients (all of whom were children). The burn injury was accidental in 69 (91%) of the patients. Mechanical ventilation was required by 52 (68.4%) patients. Inhalation injury was diagnosed at 21 (27%) patients. The mean duration of mechanical ventilation was 11.5 ± 15 days (range, 1-70 days), the mean intensive care unit stay was 13.6 ± 16.9 days (range, 2-93 days), and the mean percentile of burned body surface area was 47.4% ± 20.3 %. Renal insufficiency progressed in 7 (9%) patients. Thirty patients (39.5%) died from the following cause: septic shock (24 patients), a cardiac disorder (4 patients), or hemorrhage (2 patients). The percentage of the total body surface burned was 30% to 50% in 49 patients, 28% of whom died from that injury; 50% to 75% in 15 patients, 60% of whom died; and 75% to 100% of the body surface in 12 patients, 92% of whom died. Conclusion: The need for mechanical ventilation in the severely burned patients treated in our intensive care unit was high (68.4%). The mean duration of the intensive care unit stay of our subjects was 13.6 ± 16.9 days, and the overall mortality rate was 39.5%. Septic shock and subsequent multiorgan failure were the most common causes of death in patients with severe burns.