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

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

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