Başarılı bir replantasyonda beklenmedik bir yenilgi: sigara?
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Dosyalar
Tarih
2012
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
İnönü Üniversitesi Sağlık Bilimleri
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışmada, başarılı bir başparmak replantasyonunun 9. gününde sigaraya bağlı başarısızlık görülen bir olgumuzu sunmayı
amaçladık. Kırk altı yaşında erkek hasta sağ el başparmağının proksimal falanks seviyesinden 3 saat önce spiralle kesilmesi nedeniyle
kliniğimize başvurdu. Başarılı bir replantasyon gerçekleştirildi. Sekiz gün boyunca heparin ve antikoagülan tedavi uygulandı.
Dokuzuncu günde parmak dolaşımının belirgin olarak bozulduğu ve giderek morarmaya başladığı görüldü. Hastanın o gün bir saatte 6
adet sigara içtiği öğrenildi. Arteryel yetmezliğin venöz yetmezlikle ilişkili olma ihtimali düşünülerek tırnak yatağı açılıp bir süre sülük
uyguladı. Ancak yaklaşık 10 saat sonra dolaşım tamamen kayboldu. İki gün sonra nekroz tamamen oturdu ve parmak alınarak güdük
onarımı yapıldı. Sigara hem trombosit agregasyonunu hem de katekolamin salınımını artırarak vazospazma yol açmaktadır. Heparinin
hasarlanmış damarlarda iyileşmeyi dramatik olarak artırdığı ve endotelial rejenerasyonun 14 günde gerçekleştiği gösterilmiştir. Bu
vakamızda sigaranın tetiklediği vazospazmın yanı sıra antikoagülan ajanları erken kestiğimizi düşünmekteyiz. Bu tür olgularda sigara
tüketiminin kısıtlanmasının ve iki hafta boyunca heparin uygulanmasının faydalı olacağı kanaatindeyiz.
In this study, we aimed to present a case that had been made a successful thumb replantation surgery but failed due to smoking only nine days after the surgery. A 46-year-old male patient admitted to our clinic because of his right-hand was cut down with spiral machine cutter from the level of the proximal phalanx of the hallux 3 hours before the admission. A successful replantation surgery was performed. Heparin and anticoagulant therapy was continued for 8 days. On the 9th day, it was seen that the circulation began to fail and the finger had get bruising. It was revealed that the patient smoked 6 cigarettes within an hour on that day. Arterial insufficiency may be associated with venous insufficiency so the leech applied for a while to the nail bed. However, circulation disappeared 10 hours after completely. Two days later, necrosis sat down and finger was taken away and stump was sutured. Cigarette led vasospasm by increasing both platelet aggregation and catecholamine secretion. It was shown that heparin dramatically increases the recovery of damaged blood vessels. Also, endothelial regeneration occurred within 14 days. In this case, we believe that the cause of failure on 9th day was due to smoking-induced vasospasm, as well as early stopping the anticoagulant agents. In such patients, it will be better to reduce smoking and heparin may be useful for two weeks.
In this study, we aimed to present a case that had been made a successful thumb replantation surgery but failed due to smoking only nine days after the surgery. A 46-year-old male patient admitted to our clinic because of his right-hand was cut down with spiral machine cutter from the level of the proximal phalanx of the hallux 3 hours before the admission. A successful replantation surgery was performed. Heparin and anticoagulant therapy was continued for 8 days. On the 9th day, it was seen that the circulation began to fail and the finger had get bruising. It was revealed that the patient smoked 6 cigarettes within an hour on that day. Arterial insufficiency may be associated with venous insufficiency so the leech applied for a while to the nail bed. However, circulation disappeared 10 hours after completely. Two days later, necrosis sat down and finger was taken away and stump was sutured. Cigarette led vasospasm by increasing both platelet aggregation and catecholamine secretion. It was shown that heparin dramatically increases the recovery of damaged blood vessels. Also, endothelial regeneration occurred within 14 days. In this case, we believe that the cause of failure on 9th day was due to smoking-induced vasospasm, as well as early stopping the anticoagulant agents. In such patients, it will be better to reduce smoking and heparin may be useful for two weeks.
Açıklama
İnönü Üniversitesi Sağlık Bilimleri Dergisi. (2012). Cilt:1, Sayı:1, 58-60 ss.
Anahtar Kelimeler
Ampütasyon, Replantasyon, Sigara, Papaverin, Amputation, Replantation, Smoking, Papaverine
Kaynak
İnönü Üniversitesi Sağlık Bilimleri Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
1
Sayı
1
Künye
Fırat, C. Erbatur, S. Elmas, Ö. Geyik, Y. Aytekin, A. H. (2012). Başarılı bir replantasyonda beklenmedik bir yenilgi: sigara? İnönü Üniversitesi Sağlık Bilimleri Dergisi. Cilt:1, Sayı:1, 58-60 ss.
