Sıçanlarda ezilme tipi travmatik ampütasyonların yönetiminde, ektopik replantasyonun ampütat yaşayabilirliği üzerine etkisinin araştırılması
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Tarih
2022
Yazarlar
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Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Klinik deneyimler ve raporlarda ektopik replantasyon yapılan olgularda gösterilen yüksek ampütat yaşayabilirliği başarısı bu konuda kontrollü çalışma yapılması ihtiyacını doğurmuştur. Bu çalışmada, deneysel kontrollü bir çalışmayla ezilme tipi yaralanma sonrasında ektopik replantasyonun diğer tekniklerle kıyaslanması ve ampütat yaşayabilirliğinin değerlendirilmesi amaçlanmıştır. Yöntem: Bu çalışma için 40 adet Wistar Albino cinsi erkek sıçan, 4 farklı gruba ayrıldı. Grup 1'deki hayvanlara giyotin tarzı ampütasyon ve ortotopik replantasyon, Grup 2'deki hayvanlara ezilme tipi ampütasyon ve ortotopik replantasyon, Grup 3'teki hayvanlara ezilme tipi ampüyasyon ve ven grefti kullanılarak ortotopik replantasyon, Grup 4'teki hayvanlara ezilme tipi ampütasyon ve ektopik replantasyon uygulandı. Yapılan cerrahi işlemler sonrasında, flep yaşayabilirliği ve perfüzyon yüzdesi 3'üncü günde infrared kamera ile, 7'nci günde ise sağ kalan flep alanı oranı ve pedikül damarlarda trombüs oluşup oluşmaması ile değerlendirildi. Ayrıca, 3'üncü ve 7'nci günler elde edilen verilerin birbirleriyle korele olup olmadıkları değerlendirildi. Bulgular: Cerrahi sonrası 3'üncü günde SPY cihazı kullanılarak yapılan değerlendirmelere göre flep perfüzyon yüzdeleri Grup 1'de ortalama %73,5, Grup 2'de ortalama %11,1, Grup 3'te ortalama %65, Grup 4'te ortalama %64,1 olarak tespit edildi. İstatistiki değerlendirmede Grup 1 en iyi Grup 2 en kötü sonuçlara sahipken (p<0,05), Grup 3 ve 4 arasında istatistiki anlamlı fark bulunamadı (p>0,05). 7'nci günde çekilen standart fotoğraflar Digimizer görüntü analiz programı ile değerlendirildiğinde, yaşayan flep alanları Grup 1'de ortalama %74,6, Grup 2'de ortalama %2,5, Grup 3'te ortalama %64,5, Grup 4'te ortalama %64 olarak tespit edildi. İstatistiki değerlendirmede Grup 1 en iyi Grup 2 en kötü sonuçlara sahipken (p<0,05), Grup 3 ve 4 arasında istatistiki anlamlı fark bulunamadı (p>0,05). 7'nci günde yapılan değerlendirmeye göre Grup 1'de 2 hayvanda, Grup 2'de 9 hayvanda, Grup 3 ve 4'te ise 3'er hayvanda damarlarda trombüs saptandı. Elde edilen veriler istatistiksel olarak değerlendirildiğinde gruplar arasında istatistiki anlamlı fark olduğu görüldüğü (p<0,05). 3'üncü gün yapılan perfüzyon değerlendirimesinde eşik değer altındaki tüm sıçanlarda 7. günde tam veya tama yakın nekroz görülürken, eşik değer üzerindeki sıçanlarda tam flep sağkalımı ya da parsiyel nekroz gözlendi. Sonuç: Ezilme tipi yaralanma sonrası meydana gelmiş olan ampütasyonlarda, ampütatın durumu replantasyona elverişli ise; güdüğün fazla kısaltılmadan tamamen tüm debris ve ezilmiş dokudan arındırılacak şekilde debride edilip güvenilir kan akımının sağlanabilmesinin mümkün olduğu durumlarda debridman ve ven grefti ile onarımı; bu şartların sağlanmasının mümkün olmadığı, tekrarlayan debridman gerektirebilecek, kirli ve kan akımınının şüpheli olduğu durumlarda ise geçici ektopik replantasyon uygulanmasını önermekteyiz.
The high success rate of amputate viability in ectopic replantation cases at clinical experiences and reports necessitated a controlled study on this subject. In this study, it was aimed evaluate to amputate viability at ectopic replantation after crush injury and to compare the success rate with other replantation techniques with an experimental controlled study. Methods: For this study, 40 male Wistar Albino rats were divided into 4 different groups. Animals in Group 1 underwent guillotine amputation and orthotopic replantation, animals in Group 2 underwent crush-type amputation and orthotopic replantation, animals in Group 3 underwent crush-type amputation and orthotopic replantation with vein graft, and animals in Group 4 underwent crush-type amputation and ectopic replantation. After the surgical procedures, flap viability and perfusion rate were evaluated with infrared perfusion evaluation system on the 3rd day. And on the 7th day the surviving flap area ratio and the formation of thrombus in the pedicles were evaluated. In addition, it was evaluated whether the data obtained on the 3rd and 7th days were correlated with each other or not. Results: According to the evaluations made by using SPY on the 3rd postoperative day, the average flap perfusion percentages were 73.5% in Group 1, 11.1% in Group 2, 65% in Group 3, and 64% in Group 4. In the statistical evaluation, while Group 1 had the best and Group 2 the worst results (p<0.05), no statistically significant difference was found between Groups 3 and 4 (p>0.05). When the standard photographs taken on the 7th day were evaluated with the Digimizer image analysis program, the average surviving flap areas were 74.6% in Group 1, 2.5% in Group 2, 64.5% in Group 3, and 64% in Group 4. In the statistical evaluation, while Group 1 had the best and Group 2 the worst results (p<0.05), no statistically significant difference was found between Groups 3 and 4 (p>0.05). According to the evaluation made on the 7th day, there were trombus formation in the pedicles of 2 animals in Group 1, 9 animals in Group 2, 3 animals in Group 3 and 3 animals in Group 4. When the obtained data were evaluated statistically, it was seen that there was a statistically significant difference between the groups (p<0.05). In all the flaps that were below the threshold level in the perfusion evaluation performed on the 3rd day, complete or nearly complete necrosis were observed on the 7th day. While complete flap survival or partial necrosis were observed in the flaps that were above the threshold level. Conclusion: In crush amputations, when the condition of the amputate is suitable for replantation; we recommend debridement and repair with vein grafting, if it is possible to debride the stump without too much shortening, remove all debris and crushed tissue completely and ensure reliable blood flow at the stump. We recommend temporary ectopic replantation in the cases that it is not possible to meet these conditions, in which the wound contaminated or would probably require repeated debridements and blood flow of the stump is doubtful.
The high success rate of amputate viability in ectopic replantation cases at clinical experiences and reports necessitated a controlled study on this subject. In this study, it was aimed evaluate to amputate viability at ectopic replantation after crush injury and to compare the success rate with other replantation techniques with an experimental controlled study. Methods: For this study, 40 male Wistar Albino rats were divided into 4 different groups. Animals in Group 1 underwent guillotine amputation and orthotopic replantation, animals in Group 2 underwent crush-type amputation and orthotopic replantation, animals in Group 3 underwent crush-type amputation and orthotopic replantation with vein graft, and animals in Group 4 underwent crush-type amputation and ectopic replantation. After the surgical procedures, flap viability and perfusion rate were evaluated with infrared perfusion evaluation system on the 3rd day. And on the 7th day the surviving flap area ratio and the formation of thrombus in the pedicles were evaluated. In addition, it was evaluated whether the data obtained on the 3rd and 7th days were correlated with each other or not. Results: According to the evaluations made by using SPY on the 3rd postoperative day, the average flap perfusion percentages were 73.5% in Group 1, 11.1% in Group 2, 65% in Group 3, and 64% in Group 4. In the statistical evaluation, while Group 1 had the best and Group 2 the worst results (p<0.05), no statistically significant difference was found between Groups 3 and 4 (p>0.05). When the standard photographs taken on the 7th day were evaluated with the Digimizer image analysis program, the average surviving flap areas were 74.6% in Group 1, 2.5% in Group 2, 64.5% in Group 3, and 64% in Group 4. In the statistical evaluation, while Group 1 had the best and Group 2 the worst results (p<0.05), no statistically significant difference was found between Groups 3 and 4 (p>0.05). According to the evaluation made on the 7th day, there were trombus formation in the pedicles of 2 animals in Group 1, 9 animals in Group 2, 3 animals in Group 3 and 3 animals in Group 4. When the obtained data were evaluated statistically, it was seen that there was a statistically significant difference between the groups (p<0.05). In all the flaps that were below the threshold level in the perfusion evaluation performed on the 3rd day, complete or nearly complete necrosis were observed on the 7th day. While complete flap survival or partial necrosis were observed in the flaps that were above the threshold level. Conclusion: In crush amputations, when the condition of the amputate is suitable for replantation; we recommend debridement and repair with vein grafting, if it is possible to debride the stump without too much shortening, remove all debris and crushed tissue completely and ensure reliable blood flow at the stump. We recommend temporary ectopic replantation in the cases that it is not possible to meet these conditions, in which the wound contaminated or would probably require repeated debridements and blood flow of the stump is doubtful.
Açıklama
Anahtar Kelimeler
Ezilme Tipi Yaralanma, Replantasyon, Mikrocerrahi, Damar Anastomozu, Ektopik Replantasyon, Crush Type Injury, Replantation, Microsurgery, Vascular Anastomosis, Ectopic Replantation
Kaynak
WoS Q Değeri
Scopus Q Değeri
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Künye
Kendir, M. S. (2022). Sıçanlarda ezilme tipi travmatik ampütasyonların yönetiminde, ektopik replantasyonun ampütat yaşayabilirliği üzerine etkisinin araştırılması. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Plastik Cerrahi Anabilim Dalı, Konya.
