İyad FANSA, Mehmet ACIPAYAM, Celalettin KARATEPE, Cem LALE

Suriye\'deki iç savaşta damar cerrahisi deneyimlerimiz

Amaç: Suriye\'de devam eden iç savaş nedeniyle hastanemize çok sayıda ateşli silah yaralanması sonucu oluşmuş vasküler yaralanmalı hasta başvurmaktadır. Biz çalışmamızda; ateşli silah yaralanması nedeniyle hastanemize başvuran vasküler yaralanmalı hastaların yaralanma bölgeleri, ek yaralanmaları, yapılan cerrahi müdahaleler ve sonuçlarının değerlendirilmesi amaçladık. Yöntemler: Çalışmaya 01.01.2012 ve 01.09.2014 tarihleri arasında Suriye iç savaşında yaralanarak hastanemize başvuran ve vasküler cerrahi müdahale yapılan 58 hasta dâhil edilmiştir. Bulgular: Başvuran 58 hastanın %5,1\'i Kadın (n=3), %94,9\'u Erkek (n=55) olarak tespit edilmiştir. Hastaların yaş aralığı 5–75 olup yaş ortalaması 28,61 olarak tespit edilmiştir. Hastaların % 12,1\'inde (n=7) yaygın doku defektiyle birlikte olan kas-sinir-kemik yaralanması tespit edilmiş olup, bu hastalarda yapılan vasküler müdahalelere rağmen hastaların %8,6\'sında (n=5) ekstremite ampute edilmiştir. Müdahale edilen 58 hastadan %15,5\'i (n:9) ex olmuştur. Sonuç: Ateşli silah yaralanması ile başvuran vasküler yaralanmalı hastalarda yapılan müdahalelere rağmen, geç başvuru, ek yaralanmaların bulunması, yaralanma bölgeleri ve doku defektinin genişliği mortaliteyi etkileyen nedenlerdir.

Anahtar Kelimeler:

İç savaş, damar cerrahi, damar yaralanması

Our vascular surgery experiences in Syrian civil war

Objective: Due to the ongoing civil war in Syria, numerous vascular injured patients are admitted to our hospital with gunshot wounds. In this study, patients who admitted our hospital, diagnosed with vascular trauma due to gunshot were evaluated with the respect of injury site, additional injuries, surgical interventions and outcomes. Methods: The study included 58 patients wounded in Syrian war and admitted to our hospital between 01.01.2012 and 01.09.2014. Results= There were 5.1% (n=3) female and 94.9% (n=55) male patients. Age range is 5-75 years and the average of age was identified as 28.61. In 12.1% (n=7) of patients with extensive tissue defects of the muscle-nerve-bone injury has been identified, despite the vascular interventions in these patients, 8.6% (n=5) of patients, the limb has been amputated. Totally 15.5% (n=9) of 58 operated patients died. Two patients died because of major vascular injury with intra-abdominal organ injuries. In one patient; infection induced sepsis and multi organ failure was detected. Six patients were lost due to hypovolemic shock as a result of late arriving. Conclusion: In patients admitted with gunshot vascular injury arrival time, the presence of additional injuries and the location of injury affect mortality rates.

Keywords:

Civil war, vascular surgical, vascular injury,

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Garfield RM, Neugut AI. Epidemiologic analysis of warfare: a historical review. JAMA 1991;266:688.
Meddings DR. Civilians and war: a review and historical overview of the involvement of non-combatant populations in con-flict situations. Med Confl Surviv 2001;17:6-16.
Pretre R, Bruschweiler I, Rossier J, et al. Lower limb trauma with injury to the popliteal vessels. J Trauma 1996;40.595- 601.
Menzolian JO, Doyle JE, Cantelmo NL, et al. A compre- hensive approach to extremity vascular trauma. Arch Surg 1985;120:801-805.
Özkökeli M, Günay R, Kalaycıoğlu İ, ve ark. Periferik da- mar yaralanmaları. Türk Göğüs Kalp Damar Cer Derg 1998;6:249-253.
Hess JR, Holcomb JB. Transfusion practice in military trau- ma. Transfus Med 2008;18:143-150.
Ceviz M, Yekeler İ, Ates A, ve ark. Periferik arter yaralan- malarında cerrahi tedavi: 175 vakanın değerlendirilmesi. Damar Cer Derg 1996;2:66-72.
Yavuz S, Tiryakioğlu O, Celkan A, ve ark. Periferik damar yaralanmalarında acil cerrahi girişimler. Damar Cerrahisi Dergisi 2000;1:15-20.
Solak H, Yeniterzi M, Yüksek T, et al. Injuries of the periph- eral arteries and their surgical treatment. Thorac Cardiovasc Surg 1990;38:96-98.
Mataracı İ, Polat A, Songur M, et al. Amputation-free trea- ment of vascular trauma patients. Türk Göğüs Kalp Damar Cer Derg 2010;18:17-22.
Van Waes OJ, Van Lieshout EM, Hogendoorn W, Halm JA, Vermeulen J. Treatment of penetrating trauma of the extremities: ten years’ experience at a Dutch level 1 trauma center. Scand J Trauma Resusc Emerg Med 2013;21:2.
Martin LC, McKenney MG, Sosa JL, et al. Management of lower extremity arterial trauma. J Trauma 1994;37:591- 599.
Cargile JS, Hunt JL, Purdue GF. Acute trauma of the femo- ral artery and vein. J Trauma 1992;32:364-371.
Pretre R, Bruschweiler I, Rossier J, et al. Lower limb trauma With injury to the popliteal vessels. J Trauma 1996;40:595- 601.
Starr AJ, Hunt JL, Reinert CM. Treatment of femur fracture with associated vascular injury. J Trauma 1996;40:17-21.
Winkelaar GB, Taylor DC: Vascular trauma associated with fractures and dislocations. Semin Vasc Surg 1998;11:261- 273.
Kluger Y, Gonze MD, Paul DB, et al. Blunt vascular injury associated with closed mid-shaft femur fracture: a plea for concern. J Trauma 1994;36:222-225.
Hardaway 3rd RM. Vietnam wound analysis. J Trauma 1978;18:635-643.
VanRooyen MJ, Sloan EP, Radvany AE, et al. The inci- dence and outcome of penetrating and blunt trauma in cen- tral Bosnia: The Nova Bila Hospital for War Wounded. J Trauma 1995;38:863-6.13
Topal AE, Eren MN, Celik Y. Lower extremity arterial in- juries over a six-year period: outcomes, risk factors, and management. Vasc Health Risk Manag 2010;6:1103-1110.
Bellamy RF. Combat trauma over view. In: Zajtchuk R, Grande CM, editors. Textbook of military medicine, anes- thesia and peri-operative care of the combat casualty. Falls Church, VA: Office of the Surgeon General, United States Army; 1995. p. 1-42.
VanRooyen MJ, Sloan EP, Radvany AE, et al. The inci- dence and outcome of penetrating and blunt trauma in cen- tral Bosnia: The Nova Bila Hospital for War Wounded. J Trauma 1995;38:863-866.