Suleyman YAZICI, Oğuz KARAHAN, Orkut GÜÇLÜ, Celal YAVUZ, Sinan DEMİRTAŞ, Ahmet ÇALIŞKAN, Orhan TEZCAN, Binali MAVİTAŞ

Periferik damar yaralanmaları analizi: Sosyal bir katastrofi

Giriş: Bu çalışmada, silahların neden olduğu vasküler yaralanmalar ve ilgili klinik sonuçları retrospektif olarak araştırıldı. Yöntemler: Ocak 2009 ile Aralık 2011 yılları arasında vasküler yaralanma nedeniyle cerrahi prosedür uygulanan 200 hasta çalışmaya dahil edildi. Hastalar retrospektif olarak değerlendirilerek; yaralanma tipi, lokalizasyonu, karakteristikleri ve cerrahi uygulama şekli açısından sınıflandırıldı. Bulgular: Silah ilişkili penetran yaralanmalar ateşli silah yaralanması (n= 55, %28), kesici delici alet yaralanması (n=143, %71) ve mayın yaralanması olarak (n=2, %1) sınıflandırıldı. Yetmiş yedi safen ven ile interpozisyon uygulaması (71 arteryal and 6 venöz), 16 polytetrafloroetilen ile arteryal interpozisyon uyuglaması ve 11 ven ligasyonu mevcuttu. Toplam 170 (134 arteryal and 36 venöz) direk onarım uygulandı. Hiçbir olguda ameliyat sonrası amputasyon gerekmezken, 4 (%2; 2 hasta hipovoloemik şok ve 2 hasta da asistol ile ilgili olarak) hastada yoğun bakım ünitesi takibi gerekti ve ameliyat sonrası izlem süresinde mortalite gözlenmedi. Sonuçlar: Bazı bölgeler yüksek düzeyde savaş yaralanmalarına sahiptir. Bu nedenle, bu bölgeler özelleşmiş müdahale merkezlerine ihtiyaç duyarlar. Bu yaralanmaların çoğu damarsaldır ve cerrahi ve hızlı girişimler mortalite ve morbidite oranlarını düşürmek için esastır. Bu vakalarda birçok medikal disiplinin ortak çalışması ile başarılı sonuçlar elde edilebilir.

Anahtar Kelimeler:

Periferal vasküler yaralanmalar, savaş cerrahisi, işbirlikçi yönetim

Analysis of peripheral vascular injuries: A social catastrophe

Objective: In the current study, peripheral vascular injuries caused from weapons and the associated clinical outcomes were retrospectively investigated. Methods: Two hundred patients who received a surgical procedure for a vascular injury between January 2009 and December 2011 were included in the study. The patients were evaluated retrospectively; type of injury, localization, characteristics, and type of surgical application were classified. Results: Weapon-related penetrating injuries were classified as gunshot injuries (n=55, 28%), stab wounds (n = 143, 71%), and mine injuries (n= 2, 1%). There were 77 interposition applications (71 arterial and 6 venous) with saphene vein grafts, 16 arterial interposition applications with polytetrafluoroethylene grafts, and 11 venous ligations. A total of 170 direct repairs (134 arterial and 36 venous) were performed. Postoperative amputation was required in none of the cases, advanced intensive care unit follow-up was required for four patients (2%; two cases were referred with hypovolemic shock and two case were referred with asystole), and a postoperative follow-up period for any mortality was not observed. Conclusion: Some regions contain higher levels of war injuries. Therefore, these regions require specialized intervention centres. A large amount of these injuries are vascular, and surgery and rapid interventions are essential for reducing mortality and morbidity rates. Successful results can be obtained in these cases through the collaboration of various medical disciplines.

Keywords:

Peripheral vascular injuries, war surgery, collaborative management,

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