Burn-induced Oxidative Stress and Serum Glutathione Depletion; a Cross Sectional Study.

INTRODUCTION: Several studies have shown the role of oxidative stress in pathophysiology of burn injuries. This study aimed to evaluate the changes of oxidant-antioxidant levels during the week following burn injuries and its correlation with grade of burn. METHODS: In this prospective cross-sectional study, changes of total glutathione, reduced glutathione (GSH), oxidized GSH (GSSG), GSH/GSSG ratio, as well as Pro-oxidant-antioxidant balance (PAB) were investigated on the 1st, 2nd and 7th days of admission in patients with > 15 % burns. RESULTS: 40 patients with the mean age of 21.1 ± 14.5 were studied (47.5% male). More than 50% of patients were in the 18 - 55 years age range and over 70% had 20% - 60% grade of burn. Total serum glutathione level and GSH had significant decreasing trends (P < 0.001) and GSSG and GSH/GSSG ratio had increasing trends (p < 0.001). No significant correlation was observed between serum GSH level and the total body surface area (TBSA) of burn injury (r = 0.047; p = 0.779). The evaluation of PAB and its correlation with TBSA showed a significant and direct association between them on the 1st (coefficient = 0.516; p = 0.001), 2nd (coefficient = 0.62; p <0.001), and 3rd (coefficient = 0.471; p = 0.002) day of follow up. CONCLUSION: According to this study, the redox perturbation occurred in burn injury which was measured and proved by decreased GSH/GSSG ratio as well as the shift of PAB in favour of oxidants. Besides, since PAB positively correlated with the severity of dermal damage, it might suggest the application of antioxidants as a part of therapeutic protocol for which the dosage should be proportionate to the surface area of the damaged skin.

Evaluation of Subclinical Extension of Basal Cell Carcinoma.

BACKGROUND: Basal cell carcinoma (BCC) is the most common malignancy with increasing incidence worldwide. The tumor invades surrounding tissues in an irregular pattern via subclinical and microscopic finger-like growths known as subclinical extension. Subclinical extension may be responsible for incomplete resection of the tumor. This study investigates the subclinical extension of BCC. METHODS: In a retrospective study for evaluation of subclinical extension of BCC, Patients' demographic data and characteristics (disease duration, location, size, and history of radiotherapy) were documented. Pathology samples were assessed in terms of histological type, subclinical extension, depth, and involvement of margins. RESULTS: The study was conducted on 102 pathological samples of 84 patients (49 males, 35 females) with BCC. The mean age was 65.4±12.55 years. Overall, 83% of pathology samples had subclinical extension. Subclinical extension had no correlation with lesion size (p=0.591; r=0.056), but had a direct correlation with lesion depth (p=0.033; r=0.220). Resection of the tumor with a margin of 5.5 mm eliminated the entire lesion and its subclinical extension area with a confidence rate of 95%. CONCLUSION: Based on this study, resection of BCC lesions with a margin of 5.5 mm will eradicate the whole lesion including the subclinical extension area with 95% confidence rate. Depth of the tumor, not its size or histologic subtype, affects the required margin of excision.

Can Skin Allograft Occasionally Act as a Permanent Coverage in Deep Burns? A Pilot Study.

BACKGROUND: Skin allograft is the gold standard of wound coverage in patients with extensive burns; however, it is considered as a temporary wound coverage and rejection of the skin allograft is considered inevitable. In our study, skin allograft as a permanent coverage in deep burns is evaluated. METHODS: Skin allograft survival was assessed in 38 patients from March 2009 to March 2014, retrospectively. Because of the lack of tissue specimen from the skin donors, patients with long skin allograft survival in whom the gender of donor and recipient of allograft was the same were excluded. Seven cases with skin allograft longevity and opposite gender in donor and recipient were finally enrolled. A polymerase chain reaction (PCR) test on the biopsy specimen from recipients and donors were undertaken. RESULTS: PCR on the biopsy specimen from recipients confirmed those specimens belong to the donors. All patients received allograft from the opposite sex. Two (28.57%) patients received allograft from their first-degree blood relatives, and in one (14.29%) case, the allograft was harvested from an alive individual with no blood relation. The rest were harvested from multiorgan donors. In eight months of follow up, no clinical evidence of graft rejection was noted. CONCLUSION: Long term persistence of skin allograft in patients is worthy of more attention. Further studies An increase in knowledge of factors influencing this longevity could realize the dream of burn surgeons to achieve a permanent coverage other than autograft for major burn patients.

Relationship between Hyperactivity of Depressor Septi Nasi Muscle and Changes of Alar Base and Flaring during Smile.

BACKGROUND: Hyperactivity of depressor septi nasi muscle leads to smiling deformity and nasal tip depression. Lateral fascicles of this muscle help in widening the nostrils. The purpose of this study was to evaluate the relationship between the nasal length changes and the alar base and the alar flaring changes during smile. METHODS: Standard photographs are performed in the face and lateral views with forward gaze in the repose and maximum smile. Nasal length, alar base, and alar flaring were measured on the prints of the photographs. To decrease possible errors in the size of the printed photographs, middle face height from glabella to ANS was measured in the lateral view and the interpupil distance in the face view to standardize the measurements. RESULTS: Fifty cases were enrolled in this study. In 39 cases (78%), the nasal length was increased during smile. Forty-six cases (92%) had an increase in alar base diameter during smile. Alar flaring during smile increased in 48 cases (96%). Nasal length and alar base changes during smiling were not significantly correlated. Nasal length and alar flaring changes during smiling were not significantly related too. On the other hand, alar base and alar flaring changes during smile showed correlation. Alar base and alar flaring changes during smile were not significantly different in hyperactive and non-hyperactive cases. CONCLUSION: Nasal length change during smiling and hypertrophy of the medial fascicles of depressor septi nasi were not related to alar base or alar flaring change during smile.

Sentinel node mapping in Marjolin's ulcers: is it feasible?

INTRODUCTION: This study evaluated the feasibility of sentinel node biopsy in Marjolin's ulcers using peritumoral injection of the radiotracer and blue dye. MATERIALS AND METHODS: Ten patients with Marjolin's ulcers (5 male and 5 females) ranging in age from 39-65 years, and who were candidates for surgical removal of their tumors, were included in this study. The patients received 2 mCi technetium 99m (99mTc) antimony sulfide colloid in 2 divided doses subcutaneously in the peritumoral region. Immediately after anesthesia induction, 1 cc patent blue V in 2 divided doses was also injected in the same fashion as the radiotracer. Lymphatic mapping and sentinel node biopsy was performed using a gamma probe. Any hot and/or blue lymph nodes were harvested as a sentinel node. Primary lesions were then excised and wounds grafted with a splitthickness skin graft. RESULTS: A sentinel node could be identified on the lymphoscintigraphy images in only 2 patients. Sentinel node mapping was successful during surgery in these 2 patients. None of the harvested sentinel nodes were blue. CONCLUSION: Lymphatic mapping and sentinel node biopsy do not seem feasible in Marjolin's ulcers located in areas of extensive burn scarring due to a low detection rate. Larger studies are needed to validate the results of this study.

Does orientation of full-thickness groin grafts affect hyperpigmentation in burn contracture and syndactyly hands?

BACKGROUND: Some grafts harvested from the groin area do not become hyperpigmented and in an individual with multiple pieces of grafts, the hyperpigmentation of the pieces may vary. This study evaluates the orientation of the inset of groin grafts according to their donor sites (superior-inferior) and its role in graft hyperpigmentation. METHODS: Patients with hand burn contracture or syndactyly who required at least 2 pieces of grafts were enrolled. In each patient, one piece of the graft was inset in the same direction of the orientation of the donor site and the other in the opposite direction. Six months after the operation, the pigmentation was scored by a subjective scaling from 1 to 5. RESULTS: Thirty-four fingers of 15 patients were included. The mean grade of pigmentation in grafts inset in the direction of the donor site was 3.00±1.118 and in those inset in the opposite direction was 2.88±1.409. This was not statistically significant. CONCLUSION: Our findings revealed that although the grafts inset in the opposite direction of the donor site, they were less pigmented. So orientation of full thickness groin grafts did not affect hyperpigmentation of the grafts in burn contracture and syndactyly hands.

Smile analysis in rhinoplasty: a randomized study for comparing resection and transposition of the depressor septi nasi muscle.

BACKGROUND: The depressor septi nasi muscle is responsible for smiling deformity. Its manipulation is beneficial in patients with muscle hypertrophy. In addition, it enhances the smile and tip-lip relationship. In this study, depressor septi nasi muscle excision through a transfixion incision is compared with its transposition through an upper labial sulcus incision. METHODS: Two techniques of depressor septi nasi muscle treatment were performed randomly for rhinoplasty cases. Smile analysis in rhinoplasty, consisting of measurements of nasal length, nasal diagonal, tip projection, and upper lip height, and noting transverse upper labial crease in repose and full smile, was performed on preoperative and postoperative photographs. RESULTS: One hundred patients were studied in two equal groups. Preoperatively, tip projection and upper lip height were decreased significantly with smiling. Generally, the effect of smiling on all five parameters was decreased significantly following rhinoplasty. The two different techniques were not significantly different in decreasing the effects of smiling on nasal length, nasal diagonal, tip projection, upper lip height, or transverse crease. CONCLUSIONS: The two different techniques were the same in decreasing the effects of smiling. The authors recommend smile analysis in rhinoplasty, consisting of measurement of nasal length, nasal diagonal, tip projection, and upper lip height, and noting transverse upper labial crease in repose and during smiling, before rhinoplasty for preoperative evaluation and after the operation for outcome assessment. Depressor septi nasi muscle treatment should be considered if a decrease in tip projection or upper lip height with smiling or a transverse upper labial crease during smiling is extraordinary or unsightly. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Effect of depressor septi nasi muscle activity on nasal lengthening with time.

BACKGROUND: The depressor septi nasi (DSN) muscle is an important muscle in nose dynamics. Its hyperactivity causes smile deformity including nasal tip depression. The nasal tip of individuals with a hyperactive DSN muscle depresses repeatedly while they are speaking and smiling. This may result in nasal lengthening as they age. METHODS: Pairs of cases consisting of a child and one of his or her parents were studied in two groups: case group (with DSN muscle hyperactivity) and the control group (with DSN muscle inactivity in both child and parent). Nasal length from nasion to tip and facial length from nasion to menton were measured during repose and during smiling. RESULTS: This study investigated 80 pairs of children and parents. In both groups, a significant linear correlation between the nasal length of the parent and the child was found. In both groups (case and control), the nasal length of the child differed significantly from that of the parent. The increase in the nasal length of the parents compared with the children was greater in the control group. CONCLUSIONS: This study demonstrated that nasal length increases with age and that DSN muscle hyperactivity is not an effective factor in this increase. This unpredictable result may affect the presumption that patients with DSN muscle hyperactivity will have longer noses in the future. Long-term prospective studies investigating cohort groups are required to clarify the variables affecting nasal lengthening with aging, and interventional studies are needed to examine the effects of DSN muscle resection on this phenomenon.