Başarılı Bir Replantasyonda Beklenmedik Bir Yenilgi: Sigara?

Year 2012, Volume: 1 Issue: 1, 58 - 60, 01.04.2012

Cemal Fırat Serkan Erbatur Ömer Elmas Yılmaz Geyik Ahmet Hamdi Aytekin

Abstract

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

Keywords

Ampütasyon, Replantasyon, Sigara, Papaverin

An Unusual Fail in A Successful Replantation: Smoking?

Abstract

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

Keywords

Amputation, Replantation, Smoking, Papaverine.

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