Kadir ERTEM, İrfan ESENKAYA, M. Akif KAYGUSUZ, Caner TURAN

Yılan sokmalarının tedavisinde klinik deneyimimiz

Amaç: Bu çalışmada, zehirli yılan sokması nedeniyle başvuran olgularda uygulanan tıbbi ve cerrahî tedavilerin sonuçları değerlendirildi, güncel ilkyardım ve tedavi yöntemleri irdelendi. Çalışma planı: Çalışmaya, zehirli yılan sokması nedeniyle kliniğimize başvuran 14 hasta (8 erkek, 6 kadın; ort. yaş 22; dağılım 7-75) alındı. Altı hastaya sadece tıbbi tedavi uygulandı; sekiz hasta ise tıbbi tedavi yanı sıra cerrahi tedavi gördü. Yılan sokmasına bağlı yaralanma dokuz olguda kolda, beş olguda ise bacaktaydı. Ekstremitede gelişen şişlik ve etkilenen bölge adalelerinde pasif germeyle şiddetlenen ağrı saptanan yedi olguda kompartman sendromu nedeniyle fasyotomi yapıldı. Üç olguda fasyotomi alanı primer olarak kapatıldı, dört olguda lezyon yerinin erken debridmanı ve cilt grefti kullanmak gerekti. Bir olguda ise, etkilenen parmağa ilkyardım amacıyla uygulanmış olan sıkı turnikeye bağlı olarak nekroz gelişmesi üzerine, üçüncü parmak orta falankstan amputasyon uygulandı. Ortalama izlem süresi 11.5 ay (dağılım 3-30 ay) idi. Sonuçlar: Fasyotomi uygulanan olguların tümünde uzun keşi izi veya konulan cilt greftiyle ilişkili geniş skar dokusu, iki olguda ise dirsekte fleksiyon kontrak-türü (35 ve 105 derece) gelişti. Bir olguda görülen hemoperikard tıbbi tedaviyle iyileşti. Hastanede kalma süresi, yalnız tıbbi tedavi görenlerde ortalama 11.3 gün, tıbbi ve cerrahi tedavi uygulananlarda 18.2 gün bulundu. Hiçbir olguda geç dönemde serum hastalığı veya ölüm görülmedi. Çıkarımlar: Zehirli yılan sokmalarında, bilinçli ilkyardım ve hastanede uygun tedavinin uygulanması; kompartman sendromu geliştiğinde klinik olarak ve ölçümlerle fasyotomi endikasyonunun konması gerekir.

Anahtar Kelimeler:

Kompartman sendromları, Antiveninler, Fasya, Yılan zehirleri, Yılan ısırmaları

Our clinical experience in the treatment of snakebites

Objective: We evaluated the results of medical and surgical treatment for venomous snakebites and reviewed current principles of first aid and therapy for affected patients. Methods: Fourteen venomous snakebite victims (8 males, 6 females; mean age 22 years; range 7 to 75 years) were enrolled in the study. Six patients received medical treatment alone, while eight patients required both medical and surgical treatments. Injury was in the upper and lower extremities in nine and five patients, respectively. Fasciotomy was performed in seven patients due to ensuing compartment syndrome, which was manifest with extreme swelling in the affected extremity and severe pain on passive stretching of the muscles at the site of the lesion. Fasciotomy site was primarily closed in three patients, whereas four patients required debridement and skin grafting. One patient, who developed necrosis due to an excessively tight tourniquet at the time of first aid, underwent amputation of the third finger at the level of the middle phalanx. The mean follow-up was 11.5 months (range 3 to 30 months). Results: Following fasciotomy, a long incision line remained in all the patients and a marked scar tissue due to skin grafting, which were associated with flexion contracture deformities in two elbows (35 and 105 degrees). Hemopericardium detected in one patient was dealt with by medical treatment. The mean length of hospital stay was 11.3 days for medically treated patients, and 18.2 days following surgical treatment. No incidence of late serum disease or mortality was encountered. Conclusion: Management of snakebite victims include an appropriate first aid and treatment at the hospital; identification of compartment syndrome through clinical means and measurements should lead to an indication for fasciotomy.

Keywords:

Compartment Syndromes, Antivenins, Fascia, Snake Venoms, Snake Bites,

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