Browsing by Author "Ince, B"

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    Factors determining poor prognostic outcomes following diabetic hand infections
    Ince, B; Dadaci, M; Arslan, A; Altuntas, Z; Evrenos, MK; Karsli, MF
    Background and Objective: Hand ulcers are seen in a small percentage of patients with diabetes. The predisposing factors of diabetic hand varies between different countries. However, the effects of predisposing factors on prognosis are not clear in diabetic hand infections. In this study, our aim was to determine the effects of predisposing factors on poor prognostic outcomes in patients with diabetes mellitus. Methods: Thirty-four patients with diabetes mellitus who were treated and followed up for a hand infection in between 2008 and 2014 were investigated retrospectively. Patients were evaluated according to predisposing factors defined in the literature that included disease period, age, gender, admission time, presence of neuropathy, smoking habits, HbA1c levels at admission time, peripheral vascular disease, end-stage renal disease (ESRD), and trauma. Death and minor/major amputation cases during treatment were defined as poor prognosis. Results: Patients who had ESRD, peripheral neuropathy, or an HbA1c level greater than 10% had significantly higher amputation rates. Conclusions: Peripheral neuropathy, ESRD, and HbA1c levels greater than 10% at the time of admission were determined as poor prognosis criteria for diabetic hand treatment.
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    Clinical Outcomes of Large Meningomyelocele Defect Repair by Bilateral Fasciocutaneous Rotation and Advancement Flaps with Perforators
    Evrenos, MK; Kamburoglu, HO; Seçer, M; Çinar, K; Dadaci, M; Ince, B
    Objective: Neural tube defects occur in approximately one in 1000 live births in the US. Myelomeningocele (MMC) is the most common and severe form of spina bifida aperta. In this study, we present a surgical modification of the bilateral fasciocutaneous rotation and advancement flap technique in MMC patients. Material and Methods: Twenty-four patients (12 male, 12 female) with MMC who were operated on between August 2011 and June 2013 were retrospectively evaluated. Presence of hydrocephalus, the neurological status, and the level and size of the MMC were recorded. We used bilateral perforator-based fasciocutaneous rotation and advancement flaps for defects larger than 3 cm in width, or in the presence of prominent kyphosis together with any defect size. Results: The follow-up period ranged from eight days to two years. One patient died on the eighth day after surgery because of sepsis secondary to aspiration pneumonia. One patient had cerebrospinal fluid accumulation under the repair zone. In another patient, cerebrospinal fluid leakage through the repaired incision was observed on the ninth day after surgery. Three patients had minimal wound dehiscence at the distal end of the suture line. Conclusion: In this study, 24 patients were treated with the described perforator-based technique by preserving at least one perforator vessel on each side. Reconstruction of MMC defects with paraspinal fasciocutaneous rotation and advancement flaps is still one of the best choices for closing moderate-to-large defects without using skin graft, and the safety of the flaps increases by preserving the perforators.
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    Negative pressure wound therapy in the early period after hand and forearm replantation: is it safe?
    Dadaci, M; Isci, ET; Ince, B; Altuntas, Z; Evrenos, MK; Uzun, H; Sönmez, E; Bitik, O
    Objective: In this study, effectiveness and reliability of negative pressure wound therapy (NPWT) in the early period after replantation will be examined retrospectively in a series of patients. Method: Patients who underwent replantation between 2007 and 2014, and had tissue defect or partial necrosis in the absence of a major circulation problem were included in this retrospective study. Following debridement of necrotic tissues on the postoperative 7-10 days, NPWT was applied to all patients one day later and adjusted as intermittent 75 mmHg pressure. Intermittent phase adjustment was arranged as 5 minutes suction and 2 minutes resting, and resting pressure was adjusted as 35 mmHg. NPWT was applied for six days and dressings were changed in every three days in the first six day period. Open wounds was debrided again and grafted with split-thickness skin graft and NPWT was continued over the graft for 4 days more. Results: There were 11 patients included of which nine amputations were complete and two were nearly total amputations of forearm. Granulation tissue was observed following 6 days of NPWT application in all patients. Graft survival was observed to be almost complete. Wound infection did not occur and tissue cultures obtained in the course of debridement were all negative. Partial oxygen saturations were between 96-99% during the NPWT. Conclusion: NPWT (75 mmHg) can be used in the intermittent mode in order to improve wound healing and shorten the period to start physical therapy in the early period after replantation and revascularisation.