Ömer ERŞEN, Nisa Selin KILINÇ, Ahmet Burak BİLEKLİ, Yusuf ERDEM, Doğan BEK

Indications, complications, and revisions of amputations in Turkey

Aim: The objective of this study is to determine the incidence of indications for amputations, major amputation related complications and revision numbers in Level I trauma center; which consists burn care unit, hyperbaric oxygen unit and hand surgery department in Turkey. Materials and Methods: Amputation procedures were retrospectively reviewed and evaluated according to the amputation levels, etiology, and demographic data. Major complications that require surgical intervention, type of surgical intervention for these complications and interval between index surgery and first complication related surgery were recorded. Re-amputations were evaluated according to interval between index and revision surgery, revision indication, and revised level. Results: A total of 558 amputations were performed for 476 patients (367 male, 109 female) in fiveyear period. The most common indication of amputation was diabetic complications, 250 amputations for 215 diabetic patients (44.8%) were performed. Peripheral arterial disease and trauma were the second and third common indications. The most common indication for upper extremity amputation was trauma. The most common amputation levels were hand amputations in the upper extremity, and below-knee amputation in the lower extremity. Fifty-seven of the surgical procedures were reamputations and the interval between index surgery and revision amputation was 5.0±15.8 months. The most common indication for revision amputation was diabetic complications. Complications that required surgical intervention were infection in 46 patients, local soft tissue necrosis in 28 patients, and wound dehiscence in 2 patients. Conclusions: This is the first study investigating amputation etiology from high capacity hospital in capital city of Turkey that can demonstrate the whole country. The most common indications in this study were diabetic foot, PAD, and trauma as it is in developed countries. The results of this study can be the first step of multicenter epidemiological studies about amputations.

Türkiye’de ampütasyonların endikasyonları, komplikasyonları ve revizyonları

Amaç: Bu çalışmanın amacı, Türkiye’deki ampütasyon endikasyonlarının insidansını, ampütasyon sebepli majör komplikasyonları ve revizyon sayılarını yanık merkezi, hiperbarik oksijen ünitesi, el cerrahisi kliniği olan birinci seviye travma merkezinde belirlemektir. Gereç ve Yöntemler: Ampütasyonlar geriye dönük olarak incelendi ve amputasyon seviyeleri, etiyoloji ve demografik verilere göre değerlendirildi. Cerrahi gerektiren komplikasyonlar,bu cerrahilerin çeşitleri, revizyon cerrahisinin zamanı ve ilk cerrahi kaynaklı komplikasyonlar kaydedildi. Yeniden ampütasyonlar revizyon cerrahisi zamanına, revizyon endikasyonuna ve revize edilen seviyeye göre değerlendirildi. Bulgular: Beş yıllık dönemde 476 hastaya (367 erkek, 109 kadın) toplam 558 amputasyon yapıldı. En sık amputasyon endikasyonu diyabetik komplikasyonlardı, 215 diyabetik hastaya (%44,8) 250 amputasyon uygulandı. Periferik arter hastalığı ve travma ikinci ve üçüncü sık endikasyonlardı. Üst ekstremite amputasyonu için en yaygın endikasyon travmaydı. En sık görülen amputasyon seviyeleri üst ekstremitede yapılan el amputasyonları ve alt ekstremitede diz altı ampütasyon olarak bulundu. Cerrahi işlemlerin 57'si yeniden ampütasyondu ve ilk cerrahi ile revizyon amputasyonu arasındaki süre 5,0 ± 15,8 aydı. Revizyon ampütasyonunun en sık endikasyonu diyabetik komplikasyonlardı. Komplikasyonlar 46 hastada enfeksiyon, 28 hastada lokal yumuşak doku nekrozu ve 2 hastada yara ayrılmasıydı. Sonuç: Bu çalışma, Türkiye'nin başkentinde bulunan yüksek kapasiteli ve tüm ülkeyi temsil edebilecek bir hastanede ampütasyon etiyolojisini araştıran ilk çalışmadır. Bu çalışmada en sık endikasyonlar, gelişmiş ülkelerde olduğu gibi diyabetik ayak, PAH ve travmadır. Bu çalışmanın sonuçları, ampütasyonlarla ilgili çok merkezli epidemiyolojik çalışmaların ilk adımı olabilir.

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