Bacterial flora of Hirudo medicinalis and their antibiotic sensitivities in the Middle Black Sea Region, Turkey.

The rate of infectious complications of leech therapy is almost 20% because Hirudo medicinalis has endosymbiotic bacteria. The aim of this study was to determine the bacterial flora of H. medicinalis and their antibiotic sensitivities in a region in Turkey. Sixteen adult leeches were collected in Middle Black Sea region, Turkey. They were rubbed onto blood agar plates directly under ether anesthesia to obtain surface cultures. They were then killed to obtain mouth and gut cultures. Culture swabs were applied to blood agar, eosin methylene blue agar, and ampicillin blood agar plates. Gut contents were applied to blood culture medium as well. Bacteria were isolated in 15 of 16 leech surfaces, in 7 of 16 mouths, and in 15 of 16 guts. Isolated bacteria were identified with Analytical Profile Index 32 E and Analytical Profile Index 20 NE (fermentative and nonfermentative respectively). Most common types of cultured bacteria were Aeromonas hydrophila (N = 25), Ochrobacter anthropi (N = 23), nonfermenting Gram-negative rods (N = 12), Acinetobacter lwoffi (N = 3), and A. sobria (N = 2) in 73 isolates. A standard disk diffusion test was performed on isolated bacteria. All isolates were 100% susceptible to ciprofloxacin, cefotaxime, ceftazidime, gentamicin, and trimethoprim/sulfamethoxazole. Because leeches are carriers of Aeromonas and other bacteria, appropriate antibiotic prophylaxis should be administrated to the patient who needs leech therapy. Antibacterial agents can be determined by the resistance pattern of the bacterial flora of regional H. medicinalis.

The extended V-Y flap for coverage of a mid-planatar defect.

A mid-plantar ulcer was successfully reconstructed with an extended V-Y flap incorporating part of the flexor digitorum brevis muscle to achieve more volume and increase the safety of the flap. This flap can be used as a reliable alternative to other techniques to repair a moderately sized defect of the plantar midfoot.

Use of iliac bone graft for saddle nose deformity.

The reconstruction of the saddle nose deformity presents an arduous task for the reconstructive surgeon. A large variety of graft materials have been used for augmentation rhinoplasty. The modern trend is to prefer autologous material. Iliac bone grafts are extremely suitable for augmenting moderate to severe saddle nose deformity. In our study, autogenous iliac bone grafts were used in the nasal reconstruction of 14 patients. The follow up has been from 1-4 years, with no significant resorption noted during that time. Complication was limited to one hematoma on the donor side.

Unusual penetrating faciocranial injury caused by a knife: a case report.

Penetrating head and neck trauma in children is uncommon and are potentially life-threatening injuries. Penetrating trauma to the head in children is a challenging problem for both the initial evaluating physicians and surgeons. We report upon a patient who had fallen from a tree while cutting vegetables and sustained a penetrating faciocranial injury caused by his knife. Clinical examination showed a knife which had entered his face in the right preauricular, pre-temporomandibular joint area below the zygomatic arch. His left bulbus oculi was exophthalmic and a complete ptosis was present. He was fully conscious. The only abnormal finding was complete left visual loss. The other neurological ophthalmological and systemic physical evaluations were normal. The Glasgow Coma scale score was 14. The modalities of treatment and the outcome of the operation are described and the management of similar injuries is discussed.