Ulus Travma Acil Cerrahi Derg. 2010; 16(6): 516-520

Bacaðýn kurtarýlmasý amacýyla travmalý ekstremitenin tek arterine uygulanan uç-yan anastomoz

Mohammad Reza Ghazisaidi¹, Naser Mozafari¹, Masoud Yavari¹, Seyed Nejat Hosseini^2
1Shahid Behesti Týp Bilimleri Üniversitesi, 15 Khordad Hastanesi Plastik Ve Mikrocerrahi Bölümü, Tahran, Ýran
²Zanjan Týp Bilimleri Üniversitesi Plastik Bölümü, Zanjan, Ýran

AMAÇ
Bu yazýda, bacaklarda serbest flep transferiyle tek arterli travmalý ekstremitenin kurtarýldýðý olgularda, uç-yan anastomoz tekniði deneyimlerimizi vurgulayarak tanýmlamak amaçlandý.
GEREÇ VE YÖNTEM
Travma sonrasý ekstremite rekonstrüksiyonu için serbest flep transferi ihtiyacý olan 32 hasta Mart 2006 ile Kasým 2008 tarihleri arasýnda hastanemize sevk edildi. Tüm hastalara anjiyografi yapýldý. On bir olgu tek bir arterli olarak doðrulandý (Gustilo IIIC). Alýcýnýn ve vericinin akýmlarýnýn sürdürüldüðü 11 hastada, tek arterli ekstremite rekonstrüksiyonunda ekstremite kurtarýlmasý için uç-yan anastomoz tekniði uygulandý.
BULGULAR
Anastomoz uygulanan arterler, popliteal arter (n=3), posterior tibial arter (n=2), peroneal arter (n=5) ve radial arterdi (n=1). Yaralanma ile flep rekonstrüksiyonu arasýnda geçen ortalama süre 34 gündü. Tüm hastalarda ciddi kýrýklar, kemik açýðýyla birlikte yumuþak doku defekti vardý. Ameliyat sonrasý hastanede kalýþ süresi 12-18 gün idi. Yaralanma ve sevk edilme arasýndaki süre 27-45 gün idi. Kýsmi kalýnlýkta deri grefti sekiz hastaya yapýldý.
SONUÇ
Tek bir arterle ekstremite kurtarýlmasý için uç-yan anastomozla serbest flep transferi güvenli bir iþlemdir, bir ven grefti ve T ve Y þeklinde anastomoz gerekli deðildir.

Anahtar Kelimeler: Uç-yan anastomoz, serbest flep; tek arterli ekstremite.

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End-to-side anastomosis for limb salvage in the single artery of a traumatized extremity

Mohammad Reza Ghazisaidi¹, Naser Mozafari¹, Masoud Yavari¹, Seyed Nejat Hosseini^2
1Plastic And Microsurgery Department,15 Khordad Hospital, Shahid Beheshti University Of Medical Sciences, Tehran, Iran
²Plastic Department,zanjan University Of Medical Sciences, Zanjan, Iran

BACKGROUND
The purpose of this article is to describe and highlight our experience of end-to-side anastomosis technique in such cases for limbs salvage in the single artery of a traumatized extremity with free-flap transfer.
METHODS
Thirty-two traumatized patients in need of free-flap transfer for their extremity reconstruction were referred to our hospital from March 2006 to November 2008. Angiography was performed in all patients. A single artery was confirmed in 11 cases (Gustilo IIIC). End-to-side anastomosis was applied for limb salvage in single-artery extremity reconstruction, such as preserving recipient’s flow and preserving donor’s flow in 11 patients.
RESULTS
The anastomosis arteries included the popliteal artery (n=3), posterior tibial artery (n=2), peroneal artery (n=5) and radial artery (n=1). The mean time from the injury to the flap reconstruction was 34 days. All patients had severe fracture or bone deficit plus soft tissue defect. Postoperative hospital stay was 12-18 days. Time interval between the injury and referral was 27-45 days. Split thickness skin graft was performed in eight patients.
CONCLUSION
Free-flap transfer by end-to-side anastomosis for limb salvage with a single artery is a safe procedure, so a vein graft and T and Y shape anastomosis are not necessary.

Keywords: End-to-side anastomosis, free flap; single-artery extremity.

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ATIF KOPYALA