Effects of oriental sweet gum storax on porcine wound healing.

PURPOSE: The objective of the present study was to assess the effects of oriental sweet gum (Liquidambar orientalis Mill.) storax on partial-thickness and full-thickness wounds compared to conventional wound dressings in a porcine model. METHODS: Six young Yorkshire pigs were used. Sixteen square excisional wounds measuring 3 × 3 cm were performed per animal. The wounds were allocated to one of the four treatment modalities: storax, hydrocolloid dressing, silver sulfadiazine, and control groups. Partial-thickness wounds were created in two pigs, and tissue samples were harvested on days 4 and 8, respectively. Full-thickness wounds were created in four pigs, and tissue samples were taken on days 4, 8, 14, and 21, respectively. Histologically, all wounds were examined for re-epithelialization and granulation tissue formation. Tissue hydroxyproline content and wound contraction areas were measured. RESULTS: In storax-applied group, there was a greater depth of granulation tissue at 4 and 8 days compared to all other groups (p < .0125), and there was a faster re-epithelialization at 21 days compared to both hydrocolloid dressing and control groups in full-thickness wounds (p < .0125). Tissue hydroxyproline content and wound contraction did not differ significantly between the groups. CONCLUSION: The results of this study indicate that topical application of storax enhanced both re-epithelialization and granulation tissue formation in full-thickness wounds. Further studies are indicated in this important area of wound healing research to evaluate the clinical efficacy of this storax and search for the mechanisms that explain its effects.

Comparison of static and dynamic splinting regimens for extensor tendon repairs in zones V to VII.

The aim of this prospective, randomised, controlled trail was to compare two methods of rehabilitating extensor tendon repairs in zones V-VII. Patients who incurred simple and complete lacerations of their extensor tendons in zones V-VII enrolled into the study and underwent either static splinting (n = 25) or dynamic splinting (n = 27) after primary acute repair of tendons. Extension lag, flexion deficit, total active motion (TAM), grip strength, and functional status of upper extremities were measured. TAM was improved in the dynamic group when compared with the static group in the injured digits at 4 weeks (p = 0.001), at 12 weeks (p = 0.05), and at 6 months (p = 0.001). Grip strength outcomes demonstrated improved grip force for the dynamic group when compared with the static group at 12 weeks (p = 0.001). There were no ruptures in either group. Also, a better functional level was found in the dynamic splinting group at 6 months (p = 0.001). The findings of the current study suggest that dynamic splinting of complex lacerations of the extensor tendons in zones V-VII provides improved functional outcomes at 4 and 12 weeks and 6 months when compared with static splinting.

Comparison of two methods of controlled mobilisation of repaired flexor tendons in zone 2.

The results after primary repair of zone 2 flexor tendon injuries were evaluated in 263 fingers in 192 patients using two different early-controlled mobilisation programmes. There were 126 men and 66 women (age range 18 to 57 years) divided into two groups. Ninety-eight patients with 137 fingers were treated by early active mobilisation with dynamic splinting method according to a modified Kleinert regimen (Washington regimen), and 94 patients with 126 fingers were managed with a controlled passive movement regimen postoperatively. During this evaluation patients were evaluated for total active movement (TAM), grip strength, and disabilities of arm, shoulder, and hand (DASH) questionnaire. All patients were also reviewed 12 weeks after operation and the results assessed by the Buck-Gramcko-II system. Total active movement was "excellent" in the Washington regimen group (n=119, 87%), while excellent results of the fingers were achieved in the controlled passive movement group (n=94, 75%). The mean grip strength of the injured hand was 89% that of the non-injured side in the Washington regimen group, compared with 81% in the controlled passive movement group. The mean DASH score was 30 and 42 in the two groups, respectively. We think that controlled active mobilisation with dynamic splinting improves the outcome in the upper extremity, including range of movement, grip strength, and functional state of the hand in repairs of the flexor tendons.

A population-based questionnaire study on the prevalence and epidemiology of burn patients in Denizli, Turkey.

Epidemiological investigations of burn patients help health services to identify the need for burn care and to plan burn care facilities. Various epidemiological studies on burn injury have been conducted, but they have usually covered major burn victims who required hospitalization or minor burn victims who were treated at health care centers. Few studies have included burn victims who were not admitted to any health care center. Through a population-based questionnaire, we studied the epidemiology of the entire population of burn victims, including those who did not seek medical attention. Thus, we identified the actual frequency of hospital admission and the frequency of sequelae. In total, 1068 persons from the city of Denizli, Turkey were questioned about burns in the last 10 years and the burn prevalence was found to be 12.6%. Only 33.3% of the burn victims were treated at a health care center; thus, 66.7% of the victims were treated at home with traditional burn wound care methods. Etiologic factors such as the age and sex of each victim, the cause and anatomic location of the burn, and location of the victim when burned were all investigated. The overall percentage of sequelae was 31.3%; of these, 89.5% were cosmetic problems, 7.9% were functional impairments, and 2.9% were physiological problems. The low percentage of health care center admissions and high incidence of sequelae suggest the need for professional burn care centers that can be easily reached by burn victims.

Does corticosteroid usage in rhinoplasty cause mood changes?

In this study, the psychological effects of single-dose corticosteroids administered to patients who had undergone rhinoplasty were assessed. A total of 30 rhinoplasty patients were included in the study and were randomly assigned to 1 of 2 groups. Preoperatively, patients completed the Bech Rafaelsen Mania Scale and the Beck Depression Inventory. Dexamethasone 10 mg was given intravenously just before surgery to the first group, but no medication was administered to the second group. On the first postoperative day, patients were seen again, and the Bech Rafaelsen Mania Scale and the Beck Depression Inventory were again completed. Periorbital edema and ecchymosis were graded, and psychological well-being was measured on a standard visual analog scale. All patients and physicians were blinded to treatment until the end of the study. Results show that administration of a single-dose of dexamethasone 10 mg caused neither euphoria nor depression. No significant differences were observed between steroid and control groups in terms of patients' psychological well-being. With single-dose dexamethasone, periorbital edema was significantly reduced on the first 2 postoperative days, and upper eyelid ecchymosis was significantly decreased only on the first postoperative day. However, reoperative steroid administration had no influence on ecchymosis of the lower eyelid. The authors conclude that single-dose dexamethasone 10 mg can be used safely to reduce periorbital edema and ecchymosis in rhinoplasty patients.

Does creating a subperiosteal tunnel influence the periorbital edema and ecchymosis in rhinoplasty?

PURPOSE: The study goal was to determine whether creating a subperiosteal tunnel before lateral osteotomy had an effect on postoperative periorbital edema, ecchymosis, and subconjunctival ecchymosis. PATIENTS AND METHODS: Eighteen consecutive patients who underwent septorhinoplasty were included in the study. In all patients lateral osteotomies were carried out bilaterally, after creating a subperiosteal tunnel on a randomly chosen side and without creating a subperiosteal tunnel on the other side. The patients were seen on the second postoperative day, and a different surgeon who was unaware of the side with the periosteal tunnel determined the side of the face with more edema and ecchymosis. Subconjunctival ecchymosis was evaluated and recorded, as well. RESULTS: Creating subperiosteal tunnels before lateral osteotomy statistically increased periorbital ecchymosis. Although there was no statistically significant difference, creating subperiosteal tunnels also increased development and severity of subconjunctival ecchymosis and edema. CONCLUSIONS: We suggest performing lateral osteotomy without creating subperiosteal tunnels.

Effects of antibiotics and Saccharomyces boulardii on bacterial translocation in burn injury.

PURPOSE: To investigate the effects of antibiotics and the probiotic, Saccharomyces boulardii, on indigenous microflora and bacterial translocation (BT) in burned rats. METHODS: Twenty-three male albino rats were divided into a sham burn group (group 1, n = 7) exposed to 21 degrees C water, a burn + antibiotic group (group 2, n = 8), and a burn + antibiotic + S. boulardii group (group 3, n = 8) exposed to 95 degrees C water for 10 s, producing a full-thickness burn to 30% of the total body surface area. Ampicillin-sulbactam (1,000 mg/kg per day) was given as two doses via an orogastric feeding tube to groups 2 and 3. Saccharomyces boulardii (1 mg/g body weight per day) was given as two doses via the same route to group 3. All rats were killed on the fifth day postburn and cultures of the mesenteric lymph nodes, liver, spleen, blood, and cecal contents were done. RESULTS: The incidences of BT were 0% (0/7) in group 1, 87.5% (7/8) in group 2, and 37.5% (3/8) in group 3. A significant increase in the BT incidence was found in group 2 (P < 0.01), while a significant decrease was found in group 3 when compared with group 1. The total bacteria count of cecal flora was significantly lower in group 3 than in group 1 (P < 0.01). The decrease in Gram-negative bacteria in the cecal flora was significant in group 3. CONCLUSION: These results suggest that the incidence of BT in burn injury is enhanced by using an antibiotic, and that S. boulardii decreases the incidence of antibiotic-induced BT. Thus, we conclude that S. boulardii can effectively protect the intestinal ecologic equilibrium and prevent BT in burn injury victims.

Laurence-Moon-Biedl syndrome with vaginal atresia.

A 15-year-old girl presented with the rare Laurence-Moon-Biedl syndrome, accompanied by vaginal atresia, and cervical dysgenesis. She was treated by hysterectomy and construction of a neovagina with bilateral pudendal thigh flaps. Two brothers and a sister (one of twins) were unaffected but the remaining brother also had the disease.