Ateşli Silah Yaralanmasına Bağlı Gecikmiş Femoral Arter Tamiri ve Sonrasında Gelişen Akut Kompartman Sendromunda Uygulanan Negatif Basınçlı Yara Tedavisi: Olgu Sunumu

Year 2018, Volume: 20 Issue: 1, 26 - 28, 03.08.2018

Hakan Çomaklı Özgür Altınbaş Ata Niyazi Ecevit

https://doi.org/10.18678/dtfd.441316

Abstract

Akut kompartman sendromu (AKS), fasiyal kompartmanların açılmasını gerektiren acil bir cerrahi durumdur. Bu tabloda, dokulardaki perfüzyon basıncı, metabolik talebi karşılamak için yetersizdir ve hipoksik hücre hasarı oluşabilir. Fasyotomi ile yeterli doku perfüzyonu için gerekli olan vasküler basınç gradiyenti yeniden oluşturulur. AKS sonrası açık fasyotomi takibinde negatif basınçlı yara tedavisinin (NBYT) etkili ve güvenli bir tedavi olarak kullanılabileceğini gösteren çok sayıda çalışma mevcuttur. Ancak bazı durumlarda kullanılması önerilmemektedir. NBYT süngeri açıkta bulunan damar, sinir, organ ve anastomoz alanlarına temas etmemelidir. Bu çalışmamızda, ateşli silah yaralanması sonucu vasküler tamir yapılan ve AKS gelişen hastada; arteriyel sistemi koruyucu-kapatıcı bir pansuman, tedavi modunun modifikasyonu ve yakın takip ile NBYT uygulama deneyimimizi paylaştık.

Keywords

Ateşli silah yaralanması, akut kompartman sendromu, negatif basınçlı yara tedavisi, vasküler yaralanma

Negative Pressure Wound Therapy Applied in Acute Compartment Syndrome Following Delayed Femoral Artery Repair after Gunshot Injury: A Case Report

Abstract

Acute compartment syndrome (ACS) is an urgent surgical condition that requires the opening of the facial compartments. In this situation, the perfusion pressure in the tissues is insufficient to supply the metabolic demand and hypoxic cell damage may occur. The vascular pressure gradient required for adequate tissue perfusion is reconstructed with fasciotomy. There are a number of studies showing that negative pressure wound therapy (NPWT) can be used as an effective and safe treatment following open fasciotomy after ACS. However, in some cases it is not recommended to use it. NPWT sponges should not touch exposed veins, nerves, organs and anastomosis areas. In this study, we shared our experience with NBYT with a protective-occlusive dressing of the arterial system, modification of the treatment modality and close follow-up in the patient who underwent vascular repair and developed ACS after gunshot injury.

Keywords

Gunshot injury, acute compartment syndrome, negative pressure wound therapy, vascular injury

References

• 1) Kayacıoğlu I, Konuralp C, İdiz M, Ünal M, Yangel M. An Interesting Case of Pseudoaneurysm Caused by Gunshot Injury. J Turkish Thorac Cardiovasc Surg 2001;9:59-61
• 2) Fackler ML. Wound Ballistics: A Review of Common Misconceptions. JAMA 1988; 259(18): 2730-2736
• 3) Saziye K, Mustafa C, Ilker U, Afksendyios K. Comparison of vacuum-assisted closure device and conservative treatment for fasciotomy wound healing in ischaemia-reperfusion syndrome: preliminary results. Int Wound J 2011;8(3):229-236
• 4) Yang CC, Chang DS, Webb LX. Vacuum-assisted closure for fasciotomy wounds following compartment syndrome of the leg. J Surg Orthop Adv 2006;15(1):19-23
• 5) Zannis J, Angobaldo J, Marks M, DeFranzo, David L, Molnar J, Argenta L. Comparison of fasciotomy wound closures using traditional dressing changes and vacuum-assisted closure device. Ann Plast Surg 2009; 62(4): 407-409
• 6) Yilmaz AT, Arslan M, Demirkiliç U,Ozal E, Kuralay E, Tatar H, Ozturk OY. Missed arterial injuries in millitary patients. Am J Surg 1997;173:110-114
• 7) Graham AN, Barros D’Sa AA. Missed arteriovenous fistulae and false aneurysms in penetrating lower limb trauma: Relerning old lessons. Injury 1991; 22:179-182
• 8) Duckworth AD, Mitchell SE, Molyneux SG, White TO, Court-Brown CM, McQueen MM. Acute compartment syndrome of the forearm. J Bone Joint Surg Am 2012; 94(10): e63
• 9) Boogaard VDM, Laat ED, Spauwen PL. The effectiveness of topical negative pressure in the treatment of pressure ulcers: a literature review. European Journal of Plastic Surgery 2008; 31:1-7
• 10) Lee BY. The Wound Management Manual. New York: The McGraw-Hill Companies Inc.2005
• 11) V.A.C. Dressing Technology. http://www.kci1.com/KCI1/vacdressingtechnology 01 Ocak, 2012
• 12) Morykwas MJ, David LR, Schneider AM, Whang C, Jennings DA, Canty C, Parker D, White WL, Argenta LC. Use of subatmospheric pressure to prevent progression of partial-thickness burns in a swine model. J Burn Care Rehabil 1999; 20:15-21
• 13) Morykwas MJ, Howell H, Bleyer AJ, Molnar JA, Argenta LC. The effects of externally applied subatmospheric pressure on serum myoglobin levels after a prolonged crush/ischemia injury. J Trauma 2002; 53(3):537-540