Amniyotik membran ile yapılan yeni mikrovasküler anastomoz modeli

Teknolojinin de gelişmesiyle birlikte özellikle ikinci dünya savaşı sonrası ciddi travmalar sonrası uzuv kayıpları gelişen tekniklerle azalmaya başlamış ve uzuv kurtarıcı cerrahiler ön plana çıkmaya başlamıştır. Uzuv kurtarıcı cerrahilerin artması mikrocerrahi tekniklerin ilerlemesi ile paralel olarak ilerlemiştir. Mikrovasküler anastomoz tekniğinin tanımlanması, mikrocerrahide en kritik cerrahi basamaklarından biri olmuştur. İlk damar anastomoz tanımı Alexis Carrel tarafından yapılmıştır (1). Carrel tarafından ortaya konulan prensipler doğrultusunda ilerleyen mikrocerrahi deneyimi, gelişen teknolojiyle birlikte yeni sütür materyalleri, cihazlar ve ilaçların bulunmasıyla yeni anastomoz yöntemlerinin tanımlanmasına neden olmuştur. Yeni yöntemlerin araştırılmasındaki temel amaçlar anastomoz sonrası damar patensini en yüksek yapan, damarı normal anatomisine en uygun Şekilde iyileştirici, lümende en az trombus oluşturucu, kolay öğrenilebilir ve hızlı uygulanabilir, maliyeti en ucuz anastomozu sağlayıcı yöntemleri geliştirmektir. Bütün bu amaç ıĢığında daha önce uygulanmamış bir model olarak amniyotik membran kullanılan anastomoz modeli uygulandı. 11 kontrol ve 11 deney hayvanı olmak üzere toplam 22 adet Wistar-Albino cinsi sıçan kullanıldı. Anestezi altında tek taraflı femoral arterleri kesilerek amniyotik membranın az sayıda dikişle kombine edildiği anastomoz modeli uygulandı. Kontrol grubuna ise konvansiyonel anastomoz tekniği uygulandı. Deney sonunda yapılan modelin damarların patensi ve histolojik yapısına olan etkileri değerlendirildi. Sonuç olarak, tüm anastomozlarda radyolojik ve makroskobik olarak patens saptandı. Hiçbir denekte tromboz veya anevrizma izlenmedi (n=0). Yapılan anjiyografik çalışmada kontrol ve deney gruplarında damar patensinin olduğu gözlendi. Deney grubunun anastomoz süresi istatistiksel olarak anlamlı Şekilde daha kısa sürede tamamlanmıştır. Histolojik çalışmalarda, anti-e-NOS boyama sonucunda deney grubunun endotelinin anlamlı olarak fazla boyandığı saptandı. Uygulanılan bu yöntem, mikrovasküler cerrahide, yeni bir anastomoz modelini tanımlamakta olup, sonuçları ek deneysel çalışmalar için ve kliniğe uygulanım açısından umut vaat edicidir. Ek çalışmalarla bu deneysel tekniğin klinik uygulamaya geçebileceği düşünülmektedir.With the development of technology, especially after second world war, limb amputations have begun to decrease with developing surgical techniques and limb salvage procedures have begun to come to the forefront. The increase in limb salvage surgeries has progressed parallel to the development of microsurgical techniques. The identification of the microvascular anastomosis technique has been one of the most critical surgical steps of microsurgery. Microvascular anastomosis was first described by Alexis Carrel (1) The microsurgery experience advancing in the direction of the principles described by Carrel, along with the developing technology, new suture materials, devices and medicines have led to the identification of new anastomosis methods. The main goals of investigating the new methods are obtaining the highest post-anastomotic vessel patency, repairing the vessel in anatomic fashion with minimum thrombosis, inventing easy, fast and cheaper anastomose methods. For this purpose, an anastomosis model using amniotic membrane was performed as a model that was not performed before. A total of 22 Wistar-Albino rats, 11 control and 11 experimental animals, were used in this study. Under general anesthesia, anastomosis model was applied to rat femoral artery in which amniotic membrane was combined with few stitches. Conventional anastomosis technique was performed to the control group. At the end of the experiment, the effects of the model on the patency and histological structure of the vessels were evaluated. As a result, normal patency was determined radiologically and macroscopically in all anastomoses. No thrombosis or aneurysm was detected in any anastomoses (n:0) In the angiographic study, vessel patency was detected in control and experimental groups. The duration of the anastomosis of the experiment group was completed in a shorter period in a statistically significant manner. In histological studies, anti-e-NOS staining revealed that endothelin was significantly oversprayed in the experimental group. This method describes a new anastomosis model in microvascular surgery and The results are promising for additional experimental studies and for implementation in the clinic. With additional studies, we believe that this experimental technique can be put into clinical practice as an alternative to the conventional microvascular anastomose technique

The Roles of Injury Type, Injury Level and Amputation Type in the Need for Revision Surgery after Replantation: Retrospective Clinical Outcome with 296 Finger Replantation

Background With the development of microsurgical techniques, the replantation survival rate has increased, but in some cases, revision surgery is required. Although there are many studies on replantation survival rate, studies on revision surgery are limited. In this study, we evaluated replantation patients requiring revision surgery in terms of amputation level, injury type, and amputation type (single-multiple). Methods This is a retrospective study.Two hundred fifty-six patients (296 fingers) who were operated on for total finger amputation in our hospital between 2013 and 2018 were included in the study. In the postoperative period, revision surgery was required for 24 fingers due to vascular insufficiency. Patients were evaluated in terms of amputation level, injury type, and amputation type. Results Two hundred sixty-four fingers were saved after primary surgery. Eight fingers failed before they could undergo revision surgery. Revision surgery was performed for 24 fingers. After revision surgery, 19 fingers were saved, and five fingers were failed. There was no significant effect of gender and age in terms of revision (p > 0.05).There was no statistically significant difference in injury level and injury type, but there was a statistically significant difference in terms of amputation type (p < 0.05). Conclusion Despite advanced microsurgery and experience, vascular insufficiency can be observed after replantation. Surgical re-exploration is necessary for salvage

Ezilmiş alt ekstremitenin gecikmiş rekonstrüksiyonu: Yumuşak doku tedavisi

Ege Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim DalıObjectives: This study aims to propose a new, practical and versatile algorithm for the management of traumatic lower limb soft tissue wounds for patients who did not undergo early reconstruction. Materials and methods: A total of 81 patients (54 males, 27 females; mean age 37.1 years; range 11 to 64 years) managed due to complex lower limb injuries at our institution between January 2008 and December 2012 were analyzed retrospectively in this study. Age and gender of the patients, type of trauma, utilization of vacuum assisted closure (VAC) therapy, time lapse between injury and definitive reconstruction, as well as major and minor complications were recorded and analyzed. Results: The average time from injury to definitive reconstruction procedure was 20.4 days. Sixty two percent of the patients were treated with VAC therapy before the definitive reconstruction. Hospital stay ranged from 5 to 100 days, with a mean stay of 42.7 days. Thirteen and a half percent of patients had a soft-tissue defect in the proximal one third, 33.3% in the middle one third and 53.2% in the distal one third of the leg. Overall, the rate of complications was 12.3%. Conclusion: Based on the findings of this study, we believe that post-traumatic lower extremity reconstruction may safely be performed when the wound is adequately debrided and when the surgeon follows the basic principles of reconstructive surgery even in a sub-acute or delayed fashion. We also proposed a clinical algorithm regarding the reconstructive optionsAmaç: Bu çalışma erken rekonstrüksiyon yapılmayan hastalarda travmatik alt ekstremite yumuşak doku yaralarının tedavisi için yeni, pratik ve çok yönlü bir algoritma önermektedir. Gereç ve yöntemler: Bu çalışmada Ocak 2008 ile Aralık 2012 tarihleri arasında kompleks alt ekstremite yaralanması nedeni ile kliniğimizde tedavi edilen toplam 81 hasta (54 erkek, 27 kadın; ort. yaş 37.1 yıl; dağılım 11-64 yıl) geriye dönük olarak incelendi. Hastaların yaş ve cinsiyeti, travma tipi, vakum yardımlı kapama (VAC) tedavisinin kullanımı, yaralanma ile definitif rekonstrüksiyon arasındaki zaman aşımı ve ayrıca majör ve minör komplikasyonlar kaydedildi ve analiz edildi. Bulgular: Yaralanmadan definitif rekonstrüksiyon işlemine kadar geçen ortalama süre 20.4 gündü. Definitif rekonstrüksiyon yapılmadan önce hastaların %62’ine VAC tedavisi uygulandı. Hastanede kalış süresi ortalama 5 ile 100 gün, ortalama 42.7 gün idi. Hastaların %13.5’inin bacağın proksimal 1/3’ünde, %33.3’ünün orta 1/3’ünde ve %53.2’sinin distal 1/3’ünde yumuşak doku defekti vardı. Genel olarak komplikasyon oranı %12.3 idi. Sonuç: Bu çalışmanın bulgularına dayanarak, post-travmatik alt ekstremite rekonstrüksiyonu, yaranın yeterince debride edilmesi ve cerrahın rekonstrüktif cerrahinin temel prensiplerini subakut veya gecikmiş bir şekilde izlediği durumlarda dahi güvenli bir şekilde uygulanabilir. Ayrıca rekonstrüktif seçeneklerle ilgili olarak klinik bir algoritma önerilmişti

Salvage of Devascularized and Amputated Upper Extremity Digits with Temporary Ectopic Replantation: Our Clinical Series

Background One of the reasons for unsuccessful replantation is recipient site problems. In cases where proximal stump status cannot be predicted exactly, reamputation may be required depending on the result of infection and tissue necrosis. The ectopic banking method has been defined for this type of injury. In this study, we presented the amputated or devascularized upper extremity digit ectopic banking application results in our clinical practice. Methods Nineteen digits (17 patients) banking ectopically were included in the study. All digits ectopically banked in the forearm volar of the non-injured upper limb. Transfers were made after waiting for the appropriate time. Ectopic banking periods, postoperative complications, and other descriptive data were recorded. In the postoperative 6th month, the range of motion (ROM) values of the digits were measured and compared with the ROM values of the same digit on the non-injured extremity.Also, in the postoperative 6th month, a questionnaire with a score of 1–5 was conducted for cosmetic results. Results The mean follow-up time was 13.6 months. The mean patient age was 39.5 years. The ectopic banking success rate is 94.1% (16/17). The orthotopic/heterotopic transfer success rate is 100% (17/17). Ectopic banking time is, on average, 19.2 days (min 5–max 55). Average cosmetic scale is 3.54. Conclusions We think that the results of our study will shed light on surgeons who make ectopic banking applications

Solid organ transplantation and vascularized composite allotransplantation:Past and present

Ege Üniversitesi, Tıp Fakültesi, Histoloji ve Embriyoloji Anabilim DalıClinica Cavadas Reconstructive Surgery Unit, ValenciaSolid organ nakline göre yeni ve deneysel olan vaskülarize kompozit allotransplantasyonda sadece klinik yönde gelişmeler olmamıştır. Bu derlemede, klinik uygulamalar sonrası elde edilen başarı ve başarısızlıklar derlenmeye çalışıldı ve bunları destekleyici ya da sorunlarına çare olacağı düşünülen deneysel çalışmalar da beraberinde anlatıldı. Birbirine paralel seyreden bu deneysel ve klinik çalışmalar sonrasında solid organ naklinde olduğu gibi alıcı-verici kriterleri, rejeksiyon evrelemeleri ve rejeksiyonu önleyici tedaviler araştırılmış ve halen araştırılmaya devam edilmektedir. Son 20 yılda klinik uygulamalar ve çalışmalar oldukça cesaret verici niteliktedir. Solid organ nakli, ileri organ yetmezliği olan çoğu hastada altın standart tedavi iken; vaskülarize kompozit allotransplantasyon, uzuv kaybı sonrası fiziksel ve psikososyal eksiklik hisseden hastalarda kendi dokuları ile onarımın mümkün olmadığı durumlarda tamamlayıcı bir seçenek olarak düşünülebilir. Bu derlemede, vasküler kompozit ve solid organ allotransplantasyonunda endikasyon, yan etki, red, hasta ve greft sağkalımı açısından farkları ve benzerlikleri ve son yıllardaki gelişmeleri araştırıldıThere has not only been improvements in clinical aspects for vascularized composite allotransplantation, which is new and experimental compared to solid organ transplantation. In this review, we compiled the achievements obtained and the failures after clinical applications, accompanied with the explanations of experimental studies that are supposed to support them or solve their problems. Following these parallel experimental and clinical studies, recipient-donor criteria, rejection staging and rejection preventive treatments were researched as in solid organ transplantation and are still being investigated. In the last 20 years, clinical practices and studies have been very encouraging. While solid organ transplantation is the gold standard treatment for most patients with advanced organ failure, vascularized composite allotransplantation can be considered as a complementary option in cases where it is not possible to remedy the patients with their own tissues in patients with physical and psychosocial deficits after extremity loss. In this review, we examined the differences and similarities in terms of indications, side effects, rejection, patient and graft survival in vascular composite and solid organ allotransplantation, and their development in recent year