Mehmet Oğuz YENİDÜNYA, Songül BAVLİ, Ali Özgür KARAKAŞ

Guillauma dupuytren'den 178 yıl sonra dupuytren hastalığı: 18 olgu eşliğinde literatürün gözden geçirilmesi

1989 yılı ile 2010 yılı arasında takip ve tedavi edilen 18 olgu sunuldu. Hastaların 15’i erkek, 3’ü kadın olmak üzere tüm olguların 6'sında hastalık iki yanlı idi. En sık tutulan palmar fasiya bölgesi 4. parmak rayına ait bölge oldu. Bunu 5. parmak ve 3. parmak sırası ile izledi. Hiç 2. parmak bölgesinde nodülü olup da gelen hastamız olmadı. Bütün olgularda genel anestezi (n:16) ve her zaman turnike altında çalışıldı. Sadece 2 olguda rejiyonal intravenöz anestezi tekniği kullanıldı. İki yanlı olgularda eş zamanlı olarak iki tarafı da ameliyat edilen hastalar da oldu. Bütün ameliyatlardan sonra ameliyat alanı içerisine Penrose diren yerleştirildi. Ameliyat sırasında çıkarılan tüm dokular histopatolojik değerlendirme için patoloji laboratuarına gönderildi. Eşlik eden hastalıklar ve bulgu-lar olarak hastaların 3’ünde diyabetes mellitus dikkati-mizi çekerken, diğer tür fibromatöz bulguları olan sadece 1 hastamız oldu ki onun da pilantar fibromatozisi vardı. Bize genellikle erken dönemde hastalar başvurdu. Tüm olgular arasında 30 dereceden daha fazla fleksiyon kontraktürü ile gelenlerin sayısı 3 oldu. Hastalarımızdan 3 tanesi daha önce de aynı sebeple ameliyat edilmişlerdi. Nüks olgulardan birinde ameliyat sonrası cilt fleplerinde kısmi nekroz gelişti ve defekt alan küçük olduğundan ikincil iyileşmeye bırakıldı. Ameliyat sonrası sonuçlar tatminkar oldu. Bazı olgularımızda (n:2) patolojik doku etrafında Pasini cisimciklerinin hiperplazik ve hipertrofik olduklarına da şahit olundu.

Dupuytren disease 178 years after Guillauma Dupuytren: A look out to the literature under the guidance of 18 cases

We presented 18 cases with Dupuytren’s disease treated surgically from 1989 to 2010. 15 of cases were male and 3 of them were female. The disease was bilateral in 6 cases. The most common involved palmar fascia region was 4th finger’s ray. It was followed by 5th and 3rd respectively. There were no patient that has had 2nd finger involvement. We worked under general anesthesia (n:16) and pneumatic tourniquet in all cases. Only in two cases we used regional intravenous anestheisa. Among the bilaterally involved patients there were some cases in which we operated on both sides at the same session. A Penrose drain was inserted after operation in all cases. We sent all speciemens to the pathology laboratory after the operation for histopathologic examination. Diabetes mellitus was noted as associated problem in 3 cases and there was only one cases that included an associated fibromatosis condition. Generally patients were in early contracture stages. Only three cases were found with contractures much more than 30 degrees. Three cases were associated with reccurrent disease and they had already been operated on before. Among this recurrent contractures, marginal skin necrosis existed and we şeft it secondary healing. We satisfied with the results obtained. We also observed somewhat hyperplastic and hypertrophic Pascini corpuscle in two cases.

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