.: ORİJİNAL ARAŞTIRMA
Çocukluk Çağı Damar Yaralanmalarında Cerrahi Tedavi Tecrübelerimiz
Our Surgical Treatment Experiences in Childhood Vascular Injuries
Turkiye Klinikleri J Cardiovasc Sci. 2020;32(2):53-8
doi: 10.5336/cardiosci.2019-72646
Makale Dili: TR
Tam Metin
ÖZET
Amaç: Çocuklarda vasküler yaralanmalar, uzun dönemde ekstremitede gelişim bozukluğu gibi ciddi komplikasyonlara neden olabileceğinden ayrı bir öneme sahiptir. Biz bu yazıda çocukluk çağı vasküler yaralanmalarında uyguladığımız tedavi yöntemlerini ve sonuçlarını paylaşmayı amaçladık. Gereç ve Yöntemler: Çocukluk çağı vasküler yaralanma nedeni ile opere edilen 32 hasta retrospektif olarak incelendi. Hastaların 30 (%93,75)'u erkek, 2 (6,25)'si kadındı. Ortalama yaş 11.2 idi. On sekiz hastada (%56,2) kesici-delici alet yaralanması, 9 hastada (%28,1) ateşli silah yaralanması ve 5 hastada (%15,6) travmaya sekonder yaralanma mevcuttu. Revaskülarizasyon tekniği olarak üst ekstremite arteriyel yaralanması ile başvuran 3 hastada ucuca tamir tekniği, 1 hastada otolog ven ile patchplasti, 2 hastada otolog ven interpozisyonu uygulandı. Alt ekstremite yaralanmalarında ise, hastaların 18' inde uc-uca tamir, 4 hastada ven interpozisyonu, 2 hastada venöz patchplasti ve 2 hastada primer onarım uygulandı. Bulgular: Radial artere primer tamir uygulanan bir hastada 1. ayda iskemi oluşturmayan oklüzyon gelişti. Alt ekstremitede venöz patchplasti ve primer onarım yapılan birer olguda psödoanevrizma gelişti. İzole popliteal arter yaralanması olan ve uc-uca tamir uygulanan bir olguda 1. Ayda popliteal vende derin venöz tromboz saptandı ve medikal tedavi düzenlendi. Uyuşturucu madde kullanım öyküsüne sahip bir hastada yara yeri enfeksiyonu gözlendi. Sonuç: Çocukluk çağında artan arteriyel yaralanmalar ilk planda en doğru ameliyat yöntemi ve gereklilik halinde en doğru greft seçimi ile revaskülarize edilmeli, özellikle erken çocuk yaş gurubunda büyüme ve gelişmenin devam ettiği göz ardı edilmemelidir.
Anahtar Kelimeler: Çocukluk çağı; periferik arter yaralanmaları
Amaç: Çocuklarda vasküler yaralanmalar, uzun dönemde ekstremitede gelişim bozukluğu gibi ciddi komplikasyonlara neden olabileceğinden ayrı bir öneme sahiptir. Biz bu yazıda çocukluk çağı vasküler yaralanmalarında uyguladığımız tedavi yöntemlerini ve sonuçlarını paylaşmayı amaçladık. Gereç ve Yöntemler: Çocukluk çağı vasküler yaralanma nedeni ile opere edilen 32 hasta retrospektif olarak incelendi. Hastaların 30 (%93,75)'u erkek, 2 (6,25)'si kadındı. Ortalama yaş 11.2 idi. On sekiz hastada (%56,2) kesici-delici alet yaralanması, 9 hastada (%28,1) ateşli silah yaralanması ve 5 hastada (%15,6) travmaya sekonder yaralanma mevcuttu. Revaskülarizasyon tekniği olarak üst ekstremite arteriyel yaralanması ile başvuran 3 hastada ucuca tamir tekniği, 1 hastada otolog ven ile patchplasti, 2 hastada otolog ven interpozisyonu uygulandı. Alt ekstremite yaralanmalarında ise, hastaların 18' inde uc-uca tamir, 4 hastada ven interpozisyonu, 2 hastada venöz patchplasti ve 2 hastada primer onarım uygulandı. Bulgular: Radial artere primer tamir uygulanan bir hastada 1. ayda iskemi oluşturmayan oklüzyon gelişti. Alt ekstremitede venöz patchplasti ve primer onarım yapılan birer olguda psödoanevrizma gelişti. İzole popliteal arter yaralanması olan ve uc-uca tamir uygulanan bir olguda 1. Ayda popliteal vende derin venöz tromboz saptandı ve medikal tedavi düzenlendi. Uyuşturucu madde kullanım öyküsüne sahip bir hastada yara yeri enfeksiyonu gözlendi. Sonuç: Çocukluk çağında artan arteriyel yaralanmalar ilk planda en doğru ameliyat yöntemi ve gereklilik halinde en doğru greft seçimi ile revaskülarize edilmeli, özellikle erken çocuk yaş gurubunda büyüme ve gelişmenin devam ettiği göz ardı edilmemelidir.
Anahtar Kelimeler: Çocukluk çağı; periferik arter yaralanmaları
ABSTRACT
Objective: Vascular injuries in children carry high importance, as they can cause serious complications, such as a developmental disoders of limbs in the long term. In this article, we aimed to share the treatment methods and results we used in childhood vascular injuries. Material and Methods: 32 patients who underwent operation depending on pediatric vascular injury were examined retrospectively. 30 (%93,75) patients were male and 2 (6,25) patients were female. Mean age was 11.2.Vasculary injuries were due to penetrating trauma in 18 (%56,2) patients,firearm injury in 9 (%28,1) patients and secondary to trauma in 5 (%15,6) patients. End to end repair was performed in 3 patients,patchplasty was performed in 1 patient and vein interposition was performed in 2 patients in upper extremity. In lower extremity, 18 patients underwent end to end repair, 4 patients underwent vein interposition, 2 patients underwent patchplasty and 2 patients underwent primary repair. Results: In one patient who underwent primary repair in radial artery, non-ischemic occlusion was detected in 1 month. Pseudoaneurysm developed in one patient with patchplasty and in one patient with primary repair in the lower extremity. In one patient with isolated popliteal artery injury and end-toend repair,deep venous thrombosis was detected in popliteal vein after 1 month and medically treated. Wound infection was observed in one patient with a history of drug use. Conclusion: Increased arterial injuries in childhood should be revascularized with the most accurate surgical method and,if necessary,with the right graft selection, and it should not be overlooked that the growth and development continue especially in early childhood group.
Keywords: Childhood; peripheral arterial injuries
Objective: Vascular injuries in children carry high importance, as they can cause serious complications, such as a developmental disoders of limbs in the long term. In this article, we aimed to share the treatment methods and results we used in childhood vascular injuries. Material and Methods: 32 patients who underwent operation depending on pediatric vascular injury were examined retrospectively. 30 (%93,75) patients were male and 2 (6,25) patients were female. Mean age was 11.2.Vasculary injuries were due to penetrating trauma in 18 (%56,2) patients,firearm injury in 9 (%28,1) patients and secondary to trauma in 5 (%15,6) patients. End to end repair was performed in 3 patients,patchplasty was performed in 1 patient and vein interposition was performed in 2 patients in upper extremity. In lower extremity, 18 patients underwent end to end repair, 4 patients underwent vein interposition, 2 patients underwent patchplasty and 2 patients underwent primary repair. Results: In one patient who underwent primary repair in radial artery, non-ischemic occlusion was detected in 1 month. Pseudoaneurysm developed in one patient with patchplasty and in one patient with primary repair in the lower extremity. In one patient with isolated popliteal artery injury and end-toend repair,deep venous thrombosis was detected in popliteal vein after 1 month and medically treated. Wound infection was observed in one patient with a history of drug use. Conclusion: Increased arterial injuries in childhood should be revascularized with the most accurate surgical method and,if necessary,with the right graft selection, and it should not be overlooked that the growth and development continue especially in early childhood group.
Keywords: Childhood; peripheral arterial injuries
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