Ulus Travma Acil Cerrahi Derg. 2010; 16(5): 433-438

Soðutucu gaz ve sývýlarýn neden olduðu lokalize el donuklarý

Celalettin Sever¹, Yalcin Kulahci¹, Ali Acar², Ercan Karabacak^3
1Gülhane Askeri Týp Akademisi, Haydarpaþa Eðitim Hastanesi, Plastik Ve Rekonstrüktif Cerrahi Ve Yanýk Kliniði, Ýstanbul.
²Gülhane Askeri Týp Akademisi, Haydarpaþa Eðitim Hastanesi, Enfeksiyon Hastalýklarý Ve Klinik Mikrobiyoloji Kliniði
³Gülhane Askeri Týp Akademisi, Haydarpaþa Eðitim Hastanesi, Dermatoloji Kliniði, Ýstanbul

AMAÇ
Endüstri, tarým ve týp alanýnda yaygýn olarak kullanýlan soðutucu sývýlar ve gazlar soðutma özellikleri nedeniyle elde þiddetli lokalize donuklara neden olabilir. Bu sývý ve gazlarýn yaygýn olarak kullanýmýna raðmen, lokalize el donuklarýný bildiren sadece birkaç olgu yayýnlanmýþtýr. Bu çalýþmada, el donuklarýnýn tedavisi ve alýnacak önlemler tartýþýldý.
GEREÇ VE YÖNTEM
Bu geriye dönük çalýþmada, Haziran 2005 ve Haziran 2009 tarihleri arasýnda Ýstanbul’daki yanýk merkezine baþvuran, soðutucu gaz ve sývýlara temas nedeniyle elde lokalize donuðu olan 17 hasta (13 erkek, 4 kadýn) deðerlendirildi.
BULGULAR
Çalýþmaya dahil edilen hastalarýn %76,47’si erkekti. Hastalarýn ortalama yaþý 30,82 (daðýlým, 22-52 yaþ) olarak hesaplandý. Toplam 17 hastanýn 11’i konservatif olarak tedavi edildi. Hastalarýn hastanede kalýþ süresi ortalama olarak 30 gün (daðýlým, 16-52 gün) olarak hesaplandý.
SONUÇ
Elin lokalize donuklarý nadir olup, bu yaralanmalarýn etyolojisi çeþitlidir. Bu nedenle tedavi yaklaþýmýnda bazý karmaþalar yaþanmaktadýr. Tedavide, ilk yaklaþým maruz kalýnan soðutucu gaz ve sývýdan hastanýn bir an önce uzaklaþtýrýlmasý ve en yakýn yanýk merkezine hastanýn nakledilmesidir.

Anahtar Kelimeler: Kriyojenik yanýklar, soðuk yaralanmasý; soðuk ýsýrýðý; el yanýklarý; sývý nitrojen; dondurucu.

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Unusual hand frostbite caused by refrigerant liquids and gases

Celalettin Sever¹, Yalcin Kulahci¹, Ali Acar², Ercan Karabacak^3
1Department Of Plastic And Reconstructive Surgery And Burn Unit, Gülhane Military Medical Academy And Medical Faculty, Haydarpasa Training Hospital, Istanbul, Turkey
²Department Of Infectious Diseases And Clinical Microbiology. Gülhane Military Medical Academy And Medical Faculty, Haydarpasa Training Hospital, Istanbul, Turkey
³Department Of Dermatolgy. Gülhane Military Medical Academy And Medical Faculty, Haydarpasa Training Hospital, Istanbul, Turkey

BACKGROUND
The refrigerant liquids and gases used widely in industry, farming and medicine for their cooling properties may cause severe frostbite. Despite their widespread use, only a few reports on frostbite of the hand involving these liquids and gases have been published. In this study, the circumstances accompanying these injuries, several adjunctive therapies and preventive measures are discussed.
METHODS
A retrospective analysis of hand frostbite injuries was conducted between June 2005 to June 2009 in a burn care center in Istanbul, Turkey. Seventeen patients (13 men, 4 women) were treated for hand frostbite injuries due to contact with refrigerant liquids and gases.
RESULTS
There was a preponderance of male patients (76.5%). Ages ranged from 22 to 52 years (mean age, 30.82 years). Eleven patients were treated conservatively. The hospital stay for treatment of their burns ranged from 16 to 52 days, with a mean stay of 30 days.
CONCLUSION
Frostbite injuries of the hand are uncommon and their etiologies vary. Thus, the low incidence of these injuries and limited experience in handling rare cases of this nature may lead to misjudgments in treatment that can have grave consequences. Decreasing the exposure time is an important first step in the treatment approach. After exposure to gas, quick delivery of the patient to a burn center is essential.

Keywords: Cryogenic burns, cold injury; frostbite; hand burns; liquid nitrogen; refrigerant.

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ATIF KOPYALA