Üst Ekstremite Yaralanmalarına Bağlı Gelişen Dijital Amputasyonlar: Acil Servise Başvuran Hastaların Geriye Dönük Analizi

Yıl 2022, Cilt: 11 Sayı: 4, 1528 - 1533, 22.12.2022

Fatma Çakmak , Sinem Doğruyol , Mehmet Akif Çakmak

https://doi.org/10.37989/gumussagbil.1181163

Öz

Bu çalışmada amacı acil serviste değerlendirilip replantasyon ve revaskülarizasyona aday olmuş travmatik minör digital ampütasyon hastalarına ait özellikleri ve bu hastaların klinik sonlanımlar incelenmiştir. 01.01.2018 ile 01.01.2021 tarihleri arasında Özel Erzurum Buhara Hastanesi acil servise başvuran üst extremite total/subtotal ampütasyon olguları retrospektif olarak incelendi. 134 hastaya ait demografik özellikler, çalışma durumu, yaralanma etyolojisi ve tipi, yaralanmanın lokalizasyonu ve seviyesi, hastaneye ulaşma ve operasyona alınma süreleri, hastanede kalış süreleri ve survival durumlarına dair sonuçlar kayıt altına alınmıştır. Hastaların %88,1’i erkekti ve ortalama yaş 36,45±20,87 idi. En çok yaralanma %61,4 oranıyla tarım alanında çalışanlarda görülmüştü. En sık yaralanma tipi avülsiyon tipi yaralanma (%45,5) idi. En sık spesifik neden (%16,4) patos kayışı yaralanmasıydı. Yaralanma zamanı ile acil servise ulaşma zamanları arasındaki ortalama süre 2,51 ± 1,88 saat olarak hesaplandı. Survival oranları tüm hastalar için %71,6, sadece çocuk hastalar için ise %75,9 şeklinde tespit edilmiştir. Sonuçta giyotin tipi yaralanmaların ve çocuk hastalarda survival oranlarının daha yüksek olduğu görüldü. Çalışmamızın geçtiği coğrafi bölge itibariyle, minör digital ampütasyon vakalarımızın etyolojisinde farklı mekanizmaların devreye girdiğini tespit edildi. Bu durumun, bölgede tarım alanında çalışan halkın bilgilendirilmesi ve böylelikle travmaların azaltılması konusunda yol gösterici olabileceğini düşünülmektedir.

Anahtar Kelimeler

Parmak ampütasyonu, Replantasyon, Revaskülarizasyon, Digital amputation, Replantation, Revascularization

Digital Amputations Due To Upper Extremity Injuries: A Retrospective Analysis of Patients Presenting To The Emergency Department

Öz

This study aimed to examine the characteristics of traumatic minor digital amputations in patients presenting to the emergency department, who were candidates for replantation and revascularization and to discuss the clinical outcomes of these patients. Upper extremity total/subtotal amputation cases presenting to Private Erzurum Buhara Hospital emergency department between January 1, 2018, and January 1, 2021, were retrospectively evaluated. The demographic characteristics, occupational status, etiology and type of injury, localization and level of injury, time to arrive at hospital and undergo surgery, length of hospital stay, and survival outcomes were recorded for a total of 134 patients. Of the patients, 88.1% were male, and the mean age was 36.45±20.87 years. Injuries were most commonly seen in those working in agriculture, at a rate of 61.4%. The most common injury type was avulsion (45.5%). The most common specific cause (16.4%) was related to throttle belt use. The mean time from the time of injury to arrival at the emergency department was calculated as 2.51±1.88 hours. It was found that, the survival rate was 71.6% for all the patients and 75.9% for the pediatric patients alone. In conclusion, it is found that the survival rate was higher in guillotine type injuries and in pediatric patients. It is determined that different mechanisms were involved in the etiology of these minor digital amputation cases due to the geographical region where the study was conducted. It is consider that it can be a guide for informing people working in agriculture in this region, and thus reducing the incidence of similar traumas.

Anahtar Kelimeler

Digital amputation, Replantation, Revascularization

Kaynakça

• 1. Sears, E.D. and Chung, K.C. (2011). “Replantation of finger avulsion injuries: a systematic review of survival and functional outcomes”. Journal of Hand Surgery, 36 (4), 686-694.
• 2. Win, T.S. and Henderson, J. (2014). “Management of traumatic amputations of the upper limb”. BMJ Journal, 10 (2), 348.
• 3. Lin, P.Y, Jeng, S.F, Lin T.S. and Hsieh, C.H. (2012) “Upper limb replantation. Trauma, 14 (4), 313-326.
• 4. Chung, K.C. and Alderman, A.K. (2002). “Replantation of Upper Extremity: Indication And Outcomes”. Journal of the American Society for Surgery of the Hand, 2 (2), 78.
• 5. Zhang, L, Azmat, C.E. and Buckley, C.J. (2022). “Digit Amputation”. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, Available from: https://www.ncbi.nlm.nih.gov/books/NBK538153/.
• 6. Pomares, G, Coudane, H, Dap, F. and Dautel, G. (2018). “Epidemiology of traumatic upper limb amputations”. Orthopaedics and Traumatology: Surgery and Research, 104 (2), 273-276.
• 7. Struckmann, V.F, Gaus, S, Schilling, T, Bickert, B, Kneser, U. and Harhaus, L. (2020). “Digital avulsion injuries: epidemiology and factors influencing finger preservation”. Archives of Orthopaedic and Trauma Surgery, 140 (10), 1575-1583.
• 8. Bamba, R, Malhotra, G, Bueno, R.A, Thayer, W.P. and Shack, R.B. (2018). Ring Avulsion Injuries: A Systematic Review, 13 (1), 15-22.
• 9. Chai, Y, Kang, Q, Yang, Q. and Zeng, B. (2008). “Replantation of amputated finger composite tissues with microvascular anastomosis”. Microsurgery, 28, 314-320.
• 10. Ma, Z, Guo, F, Qi, J, Xiang, W. and Zhang, J. (2016). “Effects of non-surgical factors on digital replantation survival rate: a meta-analysis”. Journal of Hand Surgery (European Volume), 41 (2), 157-163.
• 11. Conn, J.M, Annest, J.L, Ryan, G.W. and Budnitz, D.S. (2005). “Non–work-related finger amputations in the United States, 2001-2002”. Annals of Emergency Medicine, 45 (6), 630-635.
• 12. Sebastin, S.J. and Chung, K.C. (2011). “A systematic review of the outcomes of replantation of distal digital amputation”. Plastic and Reconstructive Surgery, 128 (3), 723-737.