Ameliorating Effects of ß-Glucan on Epigastric Artery Island Flap Ischemia-Reperfusion Injury.

BACKGROUND: Ischemia-reperfusion injury has been one of the culprits of tissue injury and flap loss after island flap transpositions. Thus, significant research has been undertaken to study how to prevent or decrease the spread of ischemia-reperfusion injury. Preventive effects of ß-glucan on ischemia-reperfusion injury in the kidney, lung, and small intestine have previously been reported. In this study, we present the ameliorating effects of ß-glucan on ischemia-reperfusion injury using the epigastric artery island-flap in rats. MATERIALS AND METHODS: Thirty Wistar-Albino rats were equally divided into three groups: sham, experimental model, and treatment groups. In the sham group, an island flap was elevated and sutured back to the original position without any ischemia. In the experimental model group, the same-sized flap was elevated and sutured back with 8 h of ischemia and consequent 12 h of reperfusion. In the treatment group, 50 mg per kilogram ß-glucan was administered to the rats using an orogastric tube for 10 d before the experiment. The same-sized flap is elevated and sutured back to its original position with 8 h of ischemia and 12 h of consequent reperfusion in the treatment group. Tissue biopsies were taken on the first day of the experimental surgery. Tissue neutrophil aggregation and vascular responses were evaluated by histological examinations. Tissue oxidant and antioxidant enzyme levels are evaluated biochemically after tissue homogenization. Topographic follow-up and evaluation of the flaps were maintained, and photographs were taken on the first and seventh day of the experimental surgery. RESULTS: Topographic flap survival was significantly better in the ß-glucan administered group. The neutrophil number, malondialdehyde, and myeloperoxidase levels were significantly lower while glutathione peroxidase and superoxide dismutase levels were significantly higher in the ß-glucan administered group respective to the experimental model group. CONCLUSIONS: Based on the results of our study, we can conclude that ß-glucan is protective against ischemia-reperfusion injury. Our study presents the first experimental evidence of such an effect on skin island flaps.

Comparison of Systemic and Topical Hypericum Perforatum on Diabetic Surgical Wounds.

BACKGROUND: Surgical wounds in diabetic patients still remain a problem till the present day. As a common plant found around the world, Hypericum perforatum L. (Hypericaceae) is traditionally prepared as an oily extract and used as a folk remedy for various diseases such as wounds, burns, cuts, etc. This study aims to evaluate the effect of St. John's wort (Hypericum perforatum) on problematic wounds while comparing oral and topical applications. METHODS: Incisional and excisional wound models were made on the dorsal regions of 54 diabetic Spraque-Dawley rats. The rats were divided into the following six groups (n = 9): Group 1: control, Group 2: diabetic, Group 3: diabetic oral Hypericum perforatum, Group 4: diabetic topical Hypericum perforatum, Group 5: diabetic oral olive oil, and Group 6: diabetic topical olive oil. RESULTS: Groups 3 and 4 had significantly higher tensile strength, tissue hydroxyproline concentration, and collagen density compared with Group 2. Inflammatory cell density and collagen density on day 3 were significantly higher in Groups 3 and 6 compared with Group 2. On day 21, Groups 3 and 6 had significantly higher fibroblastic activity compared with Group 2. CONCLUSIONS: This study has proved that oral St. John's wort has more positive effects on problematic wounds compared with topical St. John's wort and olive oil, which is a vehicle. Hypericum perforatum results with faster inflammatory response and better healing. These results could be an addition to literature about the clinical usage of Hypericum perforatum on diabetic wounds.

Experience of 80 cases with Fournier's gangrene and "trauma" as a trigger factor in the etiopathogenesis.

BACKGROUND: The purpose of the present study was to retrospectively analyze the patients' data presented with Fournier's gangrene (FG), to compare obtained data with the literature and to investigate the role of "trauma" in the etiopathogenesis. METHODS: A retrospective study was conducted on 126 patients with FG that consulted to our department. RESULTS: There were 76 male and four female patients. The mean age of the patients was 53.5±13.6 years. The most common presentation of patients was swelling (n=74). The scrotum has been shown to be the most commonly affected area in the patients (n=75). Diabetes mellitus was the leading predisposing factor and trauma was the leading responsible cause for FG. Escherichia coli was the most frequently identified microorganism (n=43, 53.75%). Primary closure was the most common technique used for all patients. Three patients exhibited a mortal course due to sepsis and multi-organ failure. CONCLUSION: FG still has a high mortality rate. Rapid and correct diagnosis of the disease can avoid inappropriate or delayed treatment and even death of the patient. The healthcare professionals should be aware that any trauma in the perineal region could lead to FG.

Fractures of the mandible: a 20-year retrospective analysis of 753 patients.

BACKGROUND: The craniofacial region is one of the most frequently injured parts of the body, and mandibular fracture is one of the commonest facial skeletal injuries. The most frequent causes of mandibular fractures are the traumas related to traffic accidents, falls, interpersonal violence, and sports activities, etc. METHODS: Seven hundred fifty-three cases (615 male, 138 female; megan age 36.2 years) (age >16) with mandibular fracture were evaluated retrospectively. Patient records were examined in terms of age, sex, etiology, seasonal variation, fracture localization, accompanying traumas, treatment modality, and postoperative complications. RESULTS: Traffic accidents were the most common etiologic cause in all age groups and both sexes. All cases had a total of 1090 fractures, and the most common fracture localization was the parasymphysis (28.6%), followed by the condyle, corpus, angulus, symphysis, dentoalveolar process, ramus, and coronoid process, respectively. In 25 (3.3%) patients with fissure-like, non-displaced fracture, only symptomatic treatment was applied. Closed reduction with elastic bandage, arch bar, quick-fix screws or Ivy Loop was the only method performed in 280 (37.2%) patients. Osteosynthesis by open reduction and internal fixation (miniplates, screws or transosseous wiring) was performed in 403 (53.5%) patients; closed reduction techniques were also performed in 134 of these patients. CONCLUSION: In the recent years, double-road constructions, increased traffic audits and regulation of the traffic rules decreased the incidence of mandibular fractures.

The impact of lidocaine on flap survival following reperfusion injury.

BACKGROUND: Inflammatory events triggered by the mediators released from free oxygen radicals and infiltrated leukocytes play a direct role in formation of the ischemia-reperfusion (IR) injury. The aim of this study was to investigate the impact of lidocaine on IR injury due to its anti-inflammatory properties. MATERIALS AND METHODS: Following delivery of lidocaine to the ischemic flaps in two different doses prior to the reperfusion, flap survival, malondialdehyde (MDA) level, myeloperoxidase (MPO) level, neutrophil count, and measurement of vascular diameters were studied. Twelve hours after reperfusion, tissue specimens were collected for measurement of MDA level, MPO level, neutrophil count, and vascular diameters. Flap survival was evaluated on the fifth day. RESULTS: Flap survival rate was 15.54% ± 8.23% in the control group, whereas the groups treated wtih lidocaine showed remarkable elevations in survival rates as follows: 70.83% ± 33.53% and 67.42% ± 30.81%, respectively. MDA levels in sham and lidocaine treatment groups were significantly lower than those observed in control group. CONCLUSION: Lidocaine inhibited the increase in MDA level associated with IR injury while showing no influence over increases in number of neutrophils and tissue MPO level, and it elevated the flap survival rate.

Comparison of preincisional infiltrated levobupivacaine and ropivacaine for acute postoperative pain relief after septorhinoplasty.

BACKGROUND: To maintain a high standard of patient care, it is essential to provide adequate pain management in patients who undergo nasal surgery. Levobupivacaine and ropivacaine are relatively new long-acting local anesthetics. OBJECTIVE: The aim of this study was to compare the analgesic effect and blood loss of preincisional levobupivacaine HCl 0.25% and ropivacaine HCl 0.375% in patients undergoing septorhinoplasty. METHODS: Sixty American Society of Anesthesiologists (ASA) I and II patients (18-55 years old) who were scheduled for elective open technique septorhinoplasty under general anesthesia were recruited for this study. The anesthetic technique was standardized for both groups. Preoperative and postoperative hemoglobin levels were recorded for all patients. Patients were assigned randomly to 1 of 2 study groups, and preincisional surgical field infiltration with 5 mL of 0.5% levobupivacaine plus 5 mL of 0.9% saline (group L; n = 30) or 5 mL of 0.75% ropivacaine plus 5 mL of 0.9% saline (group R; n = 30) was performed by the same surgeon. The degree of pain was measured by visual analogue scale (VAS) for pain and recorded at multiple time points in all patients after surgery. RESULTS: The analgesic effect at 2 hours in the postanesthesia care unit (PACU) and at 24 hours postoperatively did not differ significantly between the 2 local anesthetics (P > 0.05). Pain scores of patients decreased after the 24 hours in levobupivacaine group and ropivacaine group when compared with 0-minute VAS values, and this was statistically significant (P < 0.05). No significant difference was observed between groups with respect to the preoperative and postoperative hemoglobin (P = 0.767 and 0.824, respectively) values. CONCLUSIONS: Local tissue infiltration with 0.25% levobupivacaine or 0.375% ropivacaine is similarly effective in reducing the postoperative pain associated with septorhinoplasty.

Retrospective analysis of two hundred thirty-five pediatric mandibular fracture cases.

Maxillofacial fractures are encountered less commonly during childhood period due to anatomic, social, cultural, and environmental factors. Although the incidence of all maxillofacial fractures is 1% to 15% among pediatric and adolescent patients, this rate drops to less than 1% in children below 5 years age. Two hundred thirty-five cases (

A new proposal of classification of zygomatic arch fractures.

PURPOSE: Among facial fractures, zygomatic arch fractures occur rather frequently. Facial fractures have recently been classified in fine detail according to computed tomographic findings. Nevertheless, there exists no classification of the zygomatic arch fracture, which has a physiognomically important place, to provide guidance for treatment. We aimed to make a detailed classification of zygomatic fractures in various shapes, which does not exist in the literature, and to form an algorithm for treatment. PATIENTS AND METHODS: A total of 451 patients with zygomatic arch fractures treated in our clinic from 1987 through 2004 were assessed retrospectively from the treatment viewpoint together with radiological and clinical findings. RESULTS: At the end of this assessment, arch fractures were divided into 2 groups: 1) isolated fractures in which the zygomatic arch alone broke, and 2) combined fractures in which the zygomatic arch broke together with the other facial bones. Isolated fractures were also divided into 2 subgroups as A) 2 fractures in the arch, and B) more than 2. Isolated arch fractures with more than 2 fracture lines were also classified as V-shaped fractures where fragments are partially reduced and those where fragments are displaced. As for combined fractures, they were subgrouped as A) single fracture in the arch, and B) plural. Plural fractures were further classified within their own group, also according to whether fragments were displaced or not. CONCLUSION: In the 2 fractures and V-shaped fracture subgroups of isolated fractures, preservation of fragments in reduced position was satisfactory during the closed reduction and afterwards. As for those with more than 2 fractures of isolated arch fractures, they required open reduction and internal rigid fixation. The same treatment was used in combined zygomatic arch fractures where there were more than one displaced fractures. In addition to classification, we formed an algorithm to guide us in treatment based on our series.

Repair of traumatic orbital wall defects using conchal cartilage.

BACKGROUND: The authors' aim was to investigate the efficiency of conchal cartilage grafts in defective orbital wall fractures, which are encountered isolated or in combination with other orbitozygomatic fractures. The authors assessed, for this purpose, the follow-up results of patients treated by using conchal cartilage grafts. METHODS: Ten patients who had defective orbital wall fractures and were treated by using conchal cartilage graft among those treated for facial fractures in the authors' clinic were included in the study. The wall defects in the patients were detected either with preoperative radiologic images or with orbital exploration performed to look for a possible defect accompanying the fracture with orbital extension during the operation. In all patients (four isolated and six combined orbital fractures), who had defects varying from 100 to 400 mm, conchal cartilage grafts were adapted to the defect. In the postoperative follow-up, Hertel exophthalmometry was also performed together with clinical examination so that enophthalmos that might develop as a complication could be assessed. RESULTS: In the postoperative period, cartilage graft was palpated slightly in two patients at the edge of the infraorbital rim. Limitation in eye movement, diplopia, and enophthalmos did not occur in our patients, except for one who reported to us 1 year after the primary trauma. No complication in the donor area was observed. CONCLUSIONS: Conchal cartilage could be considered one of the autogenous materials among those materials suitable for the repair of defective orbital wall fractures that are not oversized. It has the advantages of being adequate for reconstruction of the fracture, easy to obtain, easily adaptable to the orbital walls, and having minimum morbidity at the donor site.

The effects of topical estriol and vehicle cream on the mechanical and histological properties of normal rat skin.

BACKGROUND: The biomechanical and histological effects of topical estriol in normal rat skin are not clearly defined, although several favourable effects of estrogens have been suggested, especially in the postmenopausal period. Our goal was to determine whether estrogens have any such effects on skin histology and biomechanical properties in an experimental rat model. MATERIAL/METHODS: Estriol cream or vehicle cream was topically applied to the dorsum of Sprague Dawley rats of both genders in three separate groups for two weeks, and the results of the estriol and vehicle groups, as well as the non-treated control groups, were compared in terms of mechanical tensometric test results and histopathological evaluation. RESULTS: After the application of topical estriol, histologically, subcutis thinned (p<0.01), the thickness of collagen fibrils increased (p<0.01), and elastic fibrils and dermal connective tissue cells appeared denser in female estriol group rats; mechanically, the elasticity modulus increased in the estriol groups of both sexes (p<0.05), whereas breaking strength, tensile strength and strain decreased in female estriol group rats (p<0.05). CONCLUSIONS: Estrogens can change the mechanical and histological features of normal skin, and these changes are observed differently in female and male rats. Further studies to investigate the collagen structure and its interaction with ground substance, as well as effects of estriol on rat skin without a vehicle cream, are necessary to better understand the effects of estriol on skin mechanics.

The effects of topical prostacyclin and prostaglandin E1 on flap survival after nicotine application in rats.

The aim of this study is to examine and compare the effects of topical prostacyclin and prostaglandin E1 on flap survival after nicotine application in rats. In the designed experiment, group 1 was treated with 1 mL saline, and groups 2, 3, and 4 were treated with 2 mg/kg of nicotine subcutaneously for 4 weeks. At the end of 4 weeks, surgery was done, and topical applications of vaseline base on groups 1 and 2, prostacyclin (PgI2-iloprost) on group 3, and prostaglandin E1 (PgE1-misoprostol) on group 4 were performed. At the end of the seventh day following the operation, all survival areas in all groups were identified. For groups 1, 2, 3, and 4, survival areas were measured as 59.05% +/- 5.13%, 50.40% +/- 4.74%, 67.89% +/- 4.69%, and 62.45% +/- 7.80%, respectively. As a result, the authors concluded that survival areas can be increased with topical applications of these prostaglandins on the flaps (that are under nicotine effect), and there were no differences between these 2 medications in terms of flap survival.