İSMAİL BÜLENT ÖZÇELİK, Hüsrev PURİSA, İlker SEZER, Berkan MERSA, Atakan AYDIN

Distal interfalangeal eklem ve distal falanks seviyesindeki replantasyon sonuçları

Amaç: Distal uç amputasyonlarında uygulanan replantasyonlar geriye dönük olarak değerlendirildi. Çalışma planı: Distal interfalangeal eklem distal seviyesinde total amputasyon gelişen 82 hastanın (75 erkek, 7 kadın; ort. yaş 29; dağılım 10-52) 98 parmağına uygulanan replantasyonlar incelendi. Tamai sınıflamasına göre amputasyonların 58’i zon 1, 40’ı zon 2’de idi. Yetmiş yedi (%93.9) hasta digital blok anestezisi altında ameliyat edildi. Kemik fiksasyonunu takiben arter anastomozu ve mümkün olan olgularda ven anastomozu ve nörorafi yapıldı. Ven anastomozu yapılamayan veya anastomoz yapılmasına karşın venöz yetmezlik oluşan olgularda tırnak yatağına iğneyle açılan delikler üzerine heparinize gaz konarak iki saatte bir heparin uygulandı. Hastaların fonksiyonel durumu ve kozmetik açıdan memnuniyeti değerlendirildi. Ortalama takip süresi 16 aydı (dağılım 3-46 ay). Sonuçlar: Altmış replantasyon (%61.2) başarılı, 38 replantasyon (%38.8) başarısız bulundu. Başarılı sonuç alınan olgularda, tırnağın ve parmak uzunluğunun korunması nedeniyle kozmetik olarak tatmin edici görünüm sağlandı; distal interfalangeal eklemi korunan olgularda fonksiyonel açıdan tatminkar sonuçlar alındı. Zon 1 amputasyonlardaki başarı oranının (%74.1) zon 2 amputasyonlara (%42.5) göre daha yüksek olduğu gözlendi. Çıkarımlar: Distal uç replantasyonları, teknik zorluklara karşın görünüm ve fonksiyonel açıdan tatmin edici sonuçlar verebilmektedir.

Anahtar Kelimeler:

Ampütasyon, travmatik, El parmağı yaralanmaları, Reimplantasyon, Mikrocerrahi

The results of digital replantations at the level of the distal interphalangeal joint and the distal phalanx

Objectives: We retrospectively evaluated replantations performed for distal amputations. Methods: The study included 82 patients (75 males, 7 females; mean age 29 years; range 10 to 52 years) who underwent replantations distal to the distal interphalangeal joint for a total of 98 amputations. According to the Tamai classification, there were 58 zone 1 and 40 zone 2 amputations. Local digital anesthesia was used in 77 patients (93.9%). Arterial anastomosis was accomplished after bone fixation, and venous anastomosis and nerve repair were performed whenever possible. When venous anastomosis was not possible or in case of venous insufficiency, venous decompression was performed with heparinized gauze placed on the bleeding nail matrix. Functional results and the degree of patients’ satisfaction with the cosmetic outcome were evaluated. The mean follow-up was 16 months (range 3 to 46 months). Results: Replantation was successful in 60 amputations (61.2%) and unsuccessful in 38 cases (38.8%). In successful cases, cosmetic results were satisfactory due to the preservation of the nail and finger length. Functional results were satisfactory in cases in which the distal interphalangeal joint could be preserved. Replantations for zone 1 amputations (74.1%) yielded better results than those performed for zone 2 amputations (42.5%). Conclusion: Despite technical difficulties, replantations for distal finger amputations can provide satisfactory functional and cosmetic results.

Keywords:

Amputation, Traumatic, Finger Injuries, Replantation, Microsurgery,

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