Üst ekstremite arter yaralanmalarýnda self-mutilasyonun gittikçe artan predominansý: Düþük morbiditesi olsa da toplum için büyük tehdit

AMAÇ
Üst ekstremite vasküler yaralanma sýklýðý giderek artmakla beraber, mortalite ve morbidite oranlarý %0-%8 arasýnda kalmaktadýr. Son yýllarda self-mutilasyon olgularý belirgin olarak karþýmýza çýkmaktadýr. Üst ekstremite vasküler yaralanmalarýnda self-mutilasyon ve diðer penetran travma sonuçlarýný karþýlaþtýrmak ve self-mutilasyonun toplum için oluþturduðu tehditi ortaya koymak amacýyla bu çalýþmayý planladýk.
GEREÇ VE YÖNTEM
Üst ekstremite penetran vasküler yaralanmasý tanýsýyla ameliyat edilen 249 hastanýn verileri retrospektif olarak deðerlendirildi. Hastalarýn 214’ü (%86) erkek, 35’i kadýndý (%14). Ortalama yaþ 24,76±11,28 idi (daðýlým, 2-69 yaþ). Hastalarýn 129’u (%52) self-mutilatördü.

BULGULAR
En sýk yaralanan arter ulnar arterdi (n=140, %56). Ölüm ve uzuv kaybý yaþanmadý. Ancak, penetran travmalý 8 hastada parmak hareket kýsýtlýlýðý ortaya çýktý. Erkek baskýnlýðý, madde baðýmlýlýðý ve eþlik eden sinir yaralanmasý varlýðý self-mutilatör grupta anlamlý olarak daha yaygýndý (sýrasýyla p deðerleri <0,001, <0,001 ve 0,005). Buna karþýlýk brakiyal arter yaralanma sýklýðý, ven greft interpozisyon kullanýmý ve fasyotomi oranlarý penetran travma grubunda daha yüksekti (p deðerleri <0,001).
SONUÇ
Üst ekstremite penetran travmalarýnda, yaralanma þekli ve sebebi dikkatlice sorgulanmalý, self-mutilasyon varlýðýnda madde baðýmlýlýðý araþtýrýlmalý ve self-mutilatör hastalara hemen psikiyatrik destek baþlanmasý saðlanmalýdýr.

Gradually increasing predominance of self-mutilation in upper extremity arterial injuries: less morbidity but with high threat to society

BACKGROUND
Although vascular trauma of the upper extremity is increasingly more common, mortality and morbidity rates remain low, at between 0-8%. Self-mutilation has become evident in recent years. We planned this study to compare the results of self-mutilation with other penetrating trauma in upper extremity vascular injuries and also to emphasize the dangers of self-mutilation for society.
METHODS
Data of 249 patients with penetrating vascular injury of the upper extremity were retrospectively analyzed. There were 214 male (86%) and 35 female (14%) patients, with a mean age of 24.76 ± 11.28 years (range: 2-69 years). Of these, 129 (52%) were self-mutilators.
RESULTS
The ulnar artery was the most frequently affected (n=140, 56%). There was no mortality or limb loss. However, eight (3.21%) patients, who had penetrating trauma, had restriction in finger motions. Male predominance, substance abuse and associated nerve injury were significantly more common among self-mutilators (p values <0.001, <0.001 and 0.005, respectively), whereas brachial artery injury, vein graft interposition and fasciotomy rates were higher among the penetrating trauma group (p<0.001 for all).
CONCLUSION
The form of and reason for injuries and presence of substance abuse in case of self-mutilation must be investigated cautiously, and the immediate commencement of psychiatric treatment must be provided to the self-mutilators.