Başkent Üniversitesi Yayınları
Permanent URI for this communityhttps://hdl.handle.net/11727/13092
Browse
6 results
Search Results
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 Did COVID-19 Pandemic Conditions Change the Features of Pediatric Minor Burn Injuries? A Single-Center Experience(Başkent Üniversitesi, 2021) Ayse Ebru Abali; Mehmet Haberal; Nigar Turkmen; Semra Kamilova; Cem AydoganABSTRACT OBJECTIVES: Social life changes during the COVID-19 pandemic may have influenced burn injury characteristics among children. Here, we compared features among pediatric burn outpatients who were treated at our burn center before and during the COVID-19 pandemic. MATERIALS AND METHODS: We compared medical records of 217 patients treated between March 2018 and May 2019 (pre-pandemic; group I) and 212 patients treated between March 2020 and May 2021 (during the pandemic; group II). P < .05 was significant. RESULTS: In group I versus group II, mean age was 4.19 ± 0.4 versus 4.25 ± 0.3 years, male-to-female ratio was 0.9:1 versus 1.1:1, and mean total surface area burned was 1.87 ± 0.2% versus 1.93 ± 0.3%, respectively (P > .05). Most patients in both groups lived in urban settings, had mostly day-time injuries, and were under the umbrella of the social security system, with cause of burns being mostly scalds (P > .05). Injuries occurred mostly at home in both groups, but more patients in group II had outdoor burns (P < .05). Hands, head, and neck regions were more commonly involved in group I than in group II (P < .05). Group II patients were more frequently admitted on the same day as injury (P < .05), but rates of direct burn center admission were similar with resembling numbers of other medical center admissions before reaching to our burn-center (P > .05). CONCLUSIONS: The COVID-19 pandemic did not change primary burn injury features among our pediatric outpatients. Decreases in burns to hands, head, and neck and increases in admissions on the same day as injury during the pandemic may be a clue for enhanced caregiver precaution against injuries to children during lockdowns. Increased admissions on the same day as injury may reflect our uninterrupted burn care service, because many other medical centers had to serve COVID-19 patients rather than burn victims.Item Treatment of the Pediatric Patients With Fire Injuries(Başkent Üniversitesi, 2021-12) Anna Zioła; Tomasz Koszutski; Andrzej BulandraABSTRACT OBJECTIVES: Among children, adolescents are most at risk of burns from fire. These occurrences are often associated with unsafe behavior and experiments with fire, flammable materials, and explosive materials. In this report, we have presented our experiences with treating children severely burned by fire. MATERIAL AND METHODS: Our study involved 5 cases of children who were burned by fire over the past 2 years. RESULTS: Ages of the children ranged from 2 to 17 years, and patients were exclusively boys. Burn area ranged from 10% to 47% of total body surface area and were deep second-degree B and third-degree burns. All children required staged surgical treatment, including excision of necrosis, temporary wound closure with skin substitutes, and then split thickness skin grafts. Hospitalization time ranged from 3 to 23 weeks. All patients were discharged home with wounds healed. After discharge, outpatient rehabilitation with the use of physical therapy, compression therapy, and laser therapy were initiated. CONCLUSIONS: The applied treatment enabled the patients to fully return to physical well-being and normal social functionality.Item Development of Tissue Banks in Developing Nations: A Journey From Past to Future(Başkent Üniversitesi, 2021-03) Hari Shankar Meshram; Sanshriti Chauhan; Vivek B. KuteTissue banks are a relatively new concept in the emerging world. This review aims to comprehensively analyze the challenges and solutions for establishing tissue banks in developing nations. The burden of burns and road traffic accidents in the developing nations is disproportionately higher than in developed countries and so are the mortality rates associated with them. There is an unmet need for more tissue banks to counteract these problems. This was obvious from the historical aspect, with the era of tissue transplant emerging 3 decades later in developing nations versus developed nations and with many regions that have still not yet initiated tissue transplantation. The challenges ahead involve a lack of infrastructure, a lack of awareness, and many legal and ethical issues. A multidisciplinary team effort, even despite a lack of resources, is the mainstay of progress in tissue banks in resource-limited regions. The potential solutions to overcome this problem include simplified and applicable legislations, the development of continuous and long-term awareness programs, and integrated and harmonious efforts from all regions of the world. We hope that this review will help transplant authorities throughout the world to understand this problem statement and the need for timely action for concerting the path to successful tissue banking in emerging nations.Item Skin Substitutes as Treatment For Burn İnjuries(Başkent Üniversitesi, 2006-01) S. P. Fagan,; N. Nugent,; D. N. HerndonOver the last decades the mortality of severely burned patients decreased significantly. This is due to major achievements in burn surgery such as early resuscitation, improved respiratory management of inhalation injury, better control of infection, modulation of the hypermetabolic response after trauma, and to a vast amount the introduction of early burn wound excision and grafting. Early burn wound excision has been shown to have several benefits in severely burned patients, such as decreased operative blood loss, decreased length of hospital stay, fewer septic complications, and decreased mortality in non-elderly adult burned patients. But especially severely burned patients lack the skin donor sites necessary to achieve definite burn wound coverage by autografting. As conventional meshing procedures of autograft skin only can provide 4:1 (Tanner/ Brennan mesher) up to 9:1 (modified Meek technique) expansion of the skin graft definite coverage of excised burn wound remains problematic. The approach using cultured epidermal autograft (CEA) sheets (Epicel™ - Genzyme Tissue Repair Corporation) with or without an additional dermal layer (Integra™ - Integra Life Sciences/ Johnson&Johnson, Alloderm™ -Life Cell Corporation) is promising. However the excised wound requires additional temporary cover for about 3 weeks until the keratinocytes harvested at admission are grown to large enough sheet grafts to obtain full coverage of the wounds. Currently, the inferior long term durability and the increased fragility of CEA leads to a significant amount of graft failure and an increased need for re-grafting procedures A new product (FDA approval for chronic venous ulcer wound) Apligraf™ - Organogenesis/Novartis was introduced to avoid the waiting period until CEA are available. It is a “shelf product” manufactured from human male foreskin tissue consisting of an epidermal keratinocyte layer and a dermal layer of fibroblasts in a bovine collagen matrix. It can be applied immediately and is gradually replaced by the ingrowth of autologous skin cells. At current time it has been used in chronic venous ulcers and partial thickness wounds. As for temporary coverage all new technologies have to compare to the gold standard of homograft or xenograft (pig skin) coverage. TransCyte™ - Smith&Nephew, and Dermagraft® are other bioengineered “shelf products” consisting of human neonatal foreskin fibroblasts which are integrated in a synthetic epidermal layer (siliconepolymer). It can be applied immediately after excision but requires removal and second stage autografting for definite wound coverage Its use in partial thickness burns is promising, but in our view other more cost-effective dressing materials, which yield basically the same results (Biobrane™ - Bertek, Hydrocolloids as Duoderm™ - Convatec, or occlusive dressing as Opsite™) should be preferred. The major issues to be addressed in the future of tissue-engineered skin are delay in definite permanent coverage, the improvement of long term results regarding durability, fragility of the epidermal surface, and scar formation, as well as the enormous financial costs. In conjunction with gene therapy, it may become possible to differentially stimulate autologous cells in tissue engineered skin constructs and eventually achieve a permanent esthetically and functionally optimal restoration of skin integrityItem Türkiye’deki Plastik ve Rekonstrüktif Cerrahi Kliniklerinin Yanık Tedavi Kapasitelerine Bir Bak›f(Başkent Üniversitesi, 2003-05) Y. Karabağlı; A. A. Köse; C. ÇetinAmaç: Türkiye’de akut yanık bakımı yapan Plastik ve Rekonstrüktif Cerrahi klinikleri arasında koordinasyon, işbirliği, eğitim, bilgi, görgü alışverişi sağlamak, yanık tedavi kapasitelerini ortaya koymak amaçlandı. Materyal ve Metod: Hazırlanan 14 soruluk anket Türk Plastik, Rekonstrüktif ve Estetik Cerrahi Derneğinden adresi alınan Plastik ve Rekonstrüktif Cerrahi kliniklerine gönderildi. Anket yanıtları derlenerek, Plastik ve Rekonstrüktif Cerrahi kliniklerinin yanık bakımına ayrılan fizik ve personel koşulları ortaya konmaya çalışıldı. Sonuç: Ulaşılabilen 23 kliniğin 13 ünde akut yanık bakımı yapılmakta idi. Diğer kliniklerde akut yanık bakımı yapılmamakla beraber, yanık sekellerinin kozmetik ve fonksiyonel rekonstrüksiyonu yapılmakta idi. Yorum: Ülkemizde sayıca az da olsa ideal şartların sağlanabildiği yanık bakım organizasyon sistemleri mevcuttur. Ülkemizin ekonomik şartlarında, yanık bakımının sadece ideal şartların sağlanabildiği yerlere bırakılması, bu sistemlere ulaşamayan yanıklı bireylerin tedaviden yoksun kalmaları ile sonuçlanabilir. Bu nedenle var olan ünite/merkezlerin ideal şartlara sahip olana dek optimal koşullarda çalıştırılması gerekir. The Burn Care Capacities of Plastic and Reconstructive Surgery Clinics in Turkey Objective: The aim of this study was to establish core information for coordinating, cooperating and exchanging knowledge and education among Plastic and Reconstructive Surgery Departments in Turkey that deal with acute burn management. Materials and Methods: A questionnaire was prepared and sent to all Plastic and Reconstructive Surgery Departments registered with the Turkish Plastic, Reconstructive and Aesthetic Surgery Association. Responses were evaluated, and the physical capacities and manpower of the departments that provide acute burn care were assessed. Results: Thirteen of the 23 clinics that were contacted reported that they currently care for patients with acute burns. The remaining 10 were strictly involved with cosmetic and functional reconstruction of burn sequelae. Nine of 13 clinics stated that they have special burn units, and the remaining 4 reported that they only have separate rooms for burn patients. The 13 clinics stated that they hospitalized 30 to 500 acute burn victims annually. Forty-six percent of the 13 centers reported having ventilators, 47% reported having cardiac monitors, and 23% reported having operating rooms within the unit. Conclusion: Only a few institutions in Turkey have highquality burn care systems. If all acute burn care remains concentrated in this small group of centers, burn patients who cannot access these sites will not be able to get the care they need. It is essential that all centers that currently provide any level of burn care make an effort to improve their management systems.