ALİ ALP DOĞAN, İbrahim SUNGUR, Serkan BİLGİÇ, Mustafa USLU, Bekir ATİK, Önder TAN, Salih ÖZGÖKÇE, Dinçay ULUÇ, Hüseyin ÇOBAN, Metin TÜRKOĞLU, FUAT AKPINAR

Van bölgesindeki amputasyonlar: Çokmerkezli epidemiyolojik çalışma

Amaç: Amputasyonların etyolojileri birçok faktöre bağlı olarak ülkelere ve bölgelere göre farklılık göstermektedir. Bu çalışmada, Van ilindeki merkezlerde yapılan amputasyonlar geriye dönük olarak incelendi ve bölgemizin coğrafi ve kültürel özelliklerinden kaynaklanan amputasyon nedenleri ortaya konmaya çalışıldı. Çalışma planı: 1995-2005 yılları arasında Van ilindeki sağlık merkezlerinde toplam 440 hastada (345 erkek, 95 kadın; ort. yaş. 28.5; dağılım 3 ay-85 yaş) yapılan 475 amputasyon, hastaların yaş ve cinsiyeti, amputasyonun etyolojisi, taraf ve seviyesi ve uygulanan cerrahi girişimler yönünden geriye dönük olarak incelendi. Sonuçlar: Yaş açısından en büyük grubu 21-30 yaş grubundaki olgular (n=109) oluşturuyordu. On yaş altı çocukların tüm hastalara oranı %13.4 idi. Amputasyonların 218’i üst ekstremitede (%45.9), 257’si alt ekstremitede (%54.1) uygulandı. Olguların 223’ünde sağ, 188’inde sol, 29’unda birden fazla ekstremite amputasyonu yapıldı. En yaygın amputasyon nedeni travma (n=177, %40.2) idi. Ateşli silah yaralanması (n=45), mayın (n=33) ve el bombası (n=7) patlamaları travmatik nedenler içinde ilk sırayı almaktaydı. Travma nedenli amputasyonları diyabet (n=86), doğuştan hastalıklar (n=33) ve periferal vasküler hastalık (n=30) nedeniyle yapılan amputasyonlar izlemekteydi. Bölgeye özgü amputasyon nedenleri olarak tandır fırını yanıkları (n=7), sınıkçı müdahalelerine bağlı yanlış uygulamalar (n=3) ve donma (n=3) gözlendi. Yirmi dört olguda replantasyon yapıldı ve bunların 15’inde (%62.5) başarı sağlandı. Çıkarımlar: Bölgemizde ateşli silah yaralanması ve mayın patlamalarına bağlı travmatik amputasyonlar sık görülmektedir.

Anahtar Kelimeler:

Epidemiyoloji, Yaralar, delici, Yaralanma şiddeti skoru, Yaş faktörü, Patlama yaralanmaları, Tedavi sonucu, Epidemiyolojik çalışmalar, Yaralar, ateşli silah, Ekstremiteler, Ampütasyon

Amputations in eastern Turkey (Van): A multicenter epidemiological study

Objectives: The indications for amputations vary among countries and different regions depending on many factors. This study was designed to evaluate amputations performed in the province of Van and to determine specific causes of amputations associated with geographical and cultural characteristics of the region. Methods: A total of 475 amputations were performed in 440 patients (345 males, 95 females; mean age 28.5 years; range 3 months to 85 years) in medical institutions of Van between 1995 and 2005. The patients were evaluated with respect to age and sex, etiology, side and level of amputations, and surgical interventions performed. Results: Amputations were the most common in the 21 to 30- year age group with 109 patients. Pediatric patients below the age of 10 years accounted for 13.4%. Of all the amputations, 218 (45.9%) involved the upper extremity, and 257 (54.1%) involved the lower extremity. Amputations were right-sided in 223, left-sided in 188 patients, and 29 patients underwent multiple amputations. Trauma was the most common cause of amputations (n=177, 40.2%), with leading etiologies as gunshot injuries (n=45), land mine (n=33) and hand grenade (n=7) blasts. Other frequent indications apart from traumatic causes were diabetes mellitus (n=86), congenital diseases (n=33), and peripheral vascular disease (n=30). Causes more specific to regional characteristics were tandoor burns (n=7), mistreatment by traditional bonesetters (n=3), and frostbites (n=3). Replantation was performed in 24 patients, of which 15 (62.5%) were successful. Conclusion: Our region features gunshot injuries and land mine blasts as the most common traumatic causes of amputations.

Keywords:

Epidemiology, Wounds, Penetrating, Injury Severity Score, Age Factors, Blast Injuries, Treatment Outcome, Epidemiologic Studies, Wounds, Gunshot, Extremities, Amputation,

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