Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Comparative Evaluation of Naltrexone Implants Placed in Different Anatomical Regions According to the Suitability for Opioid Treatment and Wound Placement: A Plastic Surgery Perspective
Farklı Anatomik Bölgelere Yerleştirilmiş Naltrekson İmplantların Opioid Tedavisine Uygunluk ve Yara Yerleşimine Göre Karşılaştırmalı Değerlendirilmesi: Plastik Cerrah Perspektifi
Serhat ŞİBARa, Oğuzhan KARASUa, Erkan DENİZa, Buğra DEMİRBAŞa, Melike KÜÇÜKKARAPINARb
aDepartment of Plastic, Reconstructive & Aesthetic Surgery, Gazi University Faculty of Medicine, Ankara, Türkiye
bDepartment of Psychiatry, Gazi University Faculty of Medicine, Ankara, Türkiye
Turkiye Klinikleri J Med Sci. 2023;43(1):96-103
doi: 10.5336/medsci.2022-93637
Article Language: EN
Full Text
ABSTRACT
 Objective: Today, increasing opioid substance addiction has made implantation of subcutaneous opioid antagonists (such as naltrexone) a more popular treatment modality. In the literature, although the abdominal region is generally preferred for implantation, there is no study on the ideal location of these implants. In our study, it was aimed to evaluate and compare which of the dorsal or abdominal regions is the more ideal site for implantation, treatment compliance, surgical wound site and complications in these patient groups. Material and Methods: For this purpose, 181 patients who were referred to us by the psychiatry department in our clinic for subcutaneous implant placement for the treatment of opioid addiction between 2016 and 2019 were included in the study. Demographic characteristics, how many times and in which areas implantation was performed, whether the patients discontinued the treatment, if they did, the reasons for discontinuation, presence of signs of infection, implant extrusion, and secondary interventions were examined. Results: Subcutaneous naltrexone implant was placed in the back region in 95 patients and in the abdominal region in 86 patients. Based on the area where the implants were placed, the patients were evaluated in terms of parameters such as compliance to treatment, infection, secondary procedure requirement, and implant extrusion in the postoperative period. It was determined that patients with implants in the back area adapted better to the treatment, required fewer secondary procedures, and experienced less infection and implant extrusion. Conclusion: In the light of these findings, in cases where subcutaneous implantation is planned for the treatment of opioid addiction, the back region is a more ideal area for implantation compared to the abdominal region.

Keywords: Drug implants; naltrexone; opioid-related disorders; wound infection
ÖZET
 Amaç: Günümüzde, dünya genelinde artan opioid madde bağımlılığı, beraberinde cilt altı opioid antagonistlerinin de (naltrekson) implantasyonunu daha popüler bir tedavi seçeneği hâline getirmiştir. Literatürde, implantasyon için genellikle abdominal bölge tercih edilmesine rağmen bu implantların ideal yerleşim yeri ile ilgili bir çalışma bulunmamaktadır. Çalışmamızda bu hasta gruplarında sırt veya abdominal bölgeden hangisinin implantasyon için daha ideal bir alan olduğu, tedavi uyumu, cerrahi yara yeri ve komplikasyonların değerlendirilerek karşılaştırılması amaçlanmıştır. Gereç ve Yöntemler: Kliniğimizde bu amaçla psikiyatri bölümünce tarafımıza 2016-2019 yılları arasında opioid bağımlılık tedavisi için cilt altı implant yerleştirilmesi amacıyla yönlendirilen 181 hasta çalışmaya dahil edilmiştir. Demografik özellikler, kaç kez ve hangi bölgelere implantasyon yapıldığı, hastaların tedaviyi yarıda bırakıp bırakmadıkları, eğer bıraktılarsa bırakma nedenleri, enfeksiyon bulgusu varlığı, implant ekstrüzyonu, yapılan ikincil girişimler açısından incelendi. Toplanan veriler analiz edildi. Bulgular: Hastaların 95'inde sırt bölgesine, 86'sında ise abdominal bölgeye cilt altı planda naltrekson implant yerleştirilmiştir. Hastalar, ameliyat sonrası dönemde implantların yerleştirildiği bölgeye göre tedavi uyumu, enfeksiyon, ikincil işlem gereksinimi, implant ekstrüzyonu gibi parametreler açısından değerlendirilmiştir. Sırt bölgesine implant yerleştirilen hastaların tedaviye daha iyi uyum sağladığı, daha az ikincil işleme ihtiyaç duydukları, daha az enfeksiyon ve implant ekstrüzyonu ile karşılaşıldığı saptanmıştır. Sonuç: Bu bulgular eşliğinde, opioid bağımlılığı tedavisi için cilt altı implantasyon planlanan olgularda, sırt bölgesi abdominal bölgeye kıyasla implantasyon için daha ideal bir alan olma niteliğindedir.

Anahtar Kelimeler: İlaç implantları; naltrekson; opiyat ilişkili bozukluklar; yara enfeksiyonu
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