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    Factors determining poor prognostic outcomes following diabetic hand infections
    (Professional Medical Publications, 2015) Ince, Bilsev; Dadaci, Mehmet; Arslan, Abdullah; Altuntas, Zeynep; Evrenos, Mustafa Kursat; Karsli, Mehmet Fatih
    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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    Factors determining poor prognostic outcomes following diabetic hand infections
    (Professional Medical Publications, 2015) Ince, Bilsev; Dadaci, Mehmet; Arslan, Abdullah; Altuntas, Zeynep; Evrenos, Mustafa Kursat; Karsli, Mehmet Fatih
    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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    Versatility of delayed reverse-flow islanded sural flap for reconstructing pretibal defects among high-risk patients
    (K Faisal Spec Hosp Res Centre, 2014) Ince, Bilsev; Daaci, Mehmet; Altuntas, Zeynep; Sodali, Tugba; Bilgen, Fatma; Evrenos, Mustafa Kursat
    BACKGROUND AND OBJECTIVE: Reconstructing defects related to the leg soft tissue may be quite difficult because the soft tissue over the bone is rather thin and the tendons lie right under the skin. Distal pedicle sural neurocutaneous flap with its long pedicle composed of skin, subcutaneous tissue and fascia is suitable for superficial defects. This study aimed to determine the usability of the delayed reverse-flow (distally based) islanded sural flap for correcting tibial and ankle defects. DESIGN AND SETTINGS: A prospective clinical trial conducted from 2012 to 2013 in Plastic & Reconstructive and Aesthetic Surgery clinic, Necmettin Erbakan University, Turkey. METHOD: Eleven patients with pretibial defects and a visible open bone who underwent reconstruction with reverse-flow islanded sural flap between 2012 and 2013 were included in the study. All patients who had defects between the middle of the tibia and the foot underwent surgery in 2 sessions under spinal anesthesia. In the first session, necrotic tissues were debrided and cultures were taken, and the flap was delayed. Reconstruction was performed in the second session. RESULTS: The biggest flap was 16x11 cm and the smallest one was 5x6 cm. The longest pedicle was 27 cm long and the shortest one 21 cm. A total of 6 patients were smokers and 3 had diabetes mellitus. One patient had partial necrosis of the flap, and the necrosis was healed secondarily. No complications were seen in other patients. CONCLUSION: Delayed reverse-flow islanded sural flaps can be used as an easy, quick, and secure surgical alternative to free flaps for correcting in leg defects involving an exposed bone between the middle portion of the tibia and the heel.