Tahir Sadık SÜGÜN, Kemal ÖZAKSAR, Sait ADA, Firdevs KUL, Fuat ÖZERKAN, İbrahim KAPLAN, Yalçın ADEMOĞLU, Murat KAYALAR, Emin BAL, Tulgar TOROS, Aslan BORA

Üst ekstremitede majör replantasyonların uzun dönem izlem sonuçları

Amaç: Üst ekstremitede majör replantasyon uygulanan olguların uzun dönem izlemlerinde elde edilen klinik ve fonksiyonel sonuçlar değerlendirildi. Çalışma planı: 1987-2003 yılları arasında 26 erkek hasta- ya (ort. yaş 27; dağılım 3-69) uygulanan üst ekstremite ma- jör replantasyon cerrahisi sonuçları, ortalama 11.3 yıl (da- ğılım 5-19 yıl) izlem süresi sonunda geriye dönük olarak değerlendirildi. Replantasyonlar transmetakarpal (n=6), el bileği (n=4), önkol (n=5), dirsek (n=4) ve kol (n=7) sevi- yesinden yapıldı. Yaralanma, yedi hastada keskin sınırlı, sekiz hastada ezilme, 11 hastada sıyrılma şeklindeydi. Ondokuz hastaya ikincil cerrahi uygulandı. Fonksiyonel sonuçların yorumlanmasında Chen ölçütleri ve DASH-T (Kol, Omuz ve El Sorunları Anketi-Türkçe) kullanıldı. Sonuçlar: Ameliyat sırasındaki kısaltma miktarı ortalama 37.2 mm, takip sonundaki radyograﬁk kısalma miktarı orta- lama 52.2 mm idi. Yaralı tarafta ortalama kavrama gücü 12.3 kg, çimdik gücü 3.6 kg (sağlam tarafta sırasıyla 37.6 kg ve 8.7 kg) bulundu. Monoﬁlaman testinde duyunun 20 hastada geri döndüğü görüldü. İki nokta ayrım testinde 18 hastanın medi- an sinir için, 17 hastanın ulnar sinir için iki nokta ayrımı ya- pabildiği görüldü. Chen ölçütlerine göre 17 hastada (%65.4) çok iyi veya iyi, üç hastada (%11.5) orta, altı hastada (%23.1) kötü sonuç elde edildi. Yaralanma seviyesi (r=0.71) ve yara- lanma türüyle (r=0.65) Chen ölçütleri arasında korelasyon saptandı. Dirsek seviyesindeki yaralanmaların ve sıyrılma tarzındaki yaralanmaların sonucu olumsuz etkilediği görül- dü. DASH-T skoru ortalaması 6.7 (dağılım 0-32.5) olarak he- saplandı. Chen I-II grubu ile III-IV grubu hastaların ortalama DASH-T skorları arasında anlamlı fark bulundu (p

Anahtar Kelimeler:

Rekonstrüktif cerrahi işlemler, Ampütasyon, travmatik, El parmağı yaralanmaları, İzleme çalışmaları, El yaralanmaları, Reimplantasyon, Mikrocerrahi, Geriyedönük çalışma, Seyir, Hareket açıklığı, eklem, Üst ekstremite

Long-term results of major upper extremity replantations

Objectives: The aim of this study was to evaluate long- term clinical and functional results of major upper extrem- ity replantations. Methods: We retrospectively evaluated 26 male patients (mean age 27 years; range 3 to 69 years) who underwent ma- jor upper extremity replantations and had a mean follow-up of 11.3 years (range 5 to 19 years). The levels of the replantations were transmetacarpal (n=6), wrist (n=4), forearm (n=5), elbow (n=4), and arm (n=7). Amputations were of clean-cut, crush, and avulsion types in seven, eight, and 11 patients, respec- tively. Secondary operations were performed in 19 patients. Functional results were assessed using the Chen’s criteria and the Turkish version of the DASH questionnaire (Disabilities of the Arm, Shoulder and Hand) was administered. Results: The mean surgical shortening was 37.2 mm, and the ﬁnal mean radiographic shortening was 52.2 mm. The mean grip and pinch strengths on the affected side were 12.3 kg and 3.6 kg, compared to the strengths of 37.6 kg and 8.7 kg on the normal side, respectively. Monoﬁlament testing showed sensory recovery in 20 patients. Two-point discrimination could be made by 18 patients for the me- dian nerve, and by 17 patients for the ulnar nerve. Accord- ing to the Chen’s criteria, the results were very good or good in 17 patients (65.4%), moderate in three patients (11.5%), and poor in six patients (23.1%). Functional results were corre- lated with the level (r=0.71) and type (r=0.65) of injury, with injuries at the elbow level and avulsion injuries being associ- ated with a worse outcome. The mean DASH score was 6.7 (range 0 to 32.5) and the mean scores of Chen’s grade I-II and grade III-IV patients differed signiﬁcantly (p<0.05). Conclusion: Lower DASH scores show increased satisfac- tion of the patients and improved use of their replanted ex- tremities as the helper arm whereby functional deﬁciency is somewhat compensated.

Keywords:

Reconstructive Surgical Procedures, Amputation, Traumatic, Finger Injuries, Follow-Up Studies, Hand Injuries, Replantation, Microsurgery, Retrospective Studies, Prognosis, Range of Motion, Articular, Upper Extremity,

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