Our experiences on the replantations of zone 2 level in children
Journal Title: Dicle Tıp Dergisi - Year 2012, Vol 39, Issue 2
Abstract
Objectives: The aim of this study is assessment of eight children who were operated on our clinic between 2010 and 2012 for replantation or revascularization of amputation at the level of zone 2. Materials and methods: From June 2010 to February 2012 eight children, aged between 3 and 15, were operated in our department with zone 2 amputations. Types of amputations were crash injury in 4 children and gyotin type regular amputation in 4 children. Mean ischemia time of the amputates was 3,5 hours (range 1,5-8 hours). In 5 children successful replantation were achieved but in 3 children the replantation was failed because of insufficient circulation despite recurrent anastomosis. Papaverin was used preoperatively in all cases. Mean follow-up period was 9 months (range 2-16 months). Results: Local administration of papaverin facilitates the replantation with promoting vasodilatation meaningfully. In addition, solutions used preoperatively such as lidocain, heparin, warm irrigation solutions (mean 28°C 0,9% NaCl) and also postoperatively administration of low molecular weight dextran and heparin, acetyl salicylic acid, pentoxyphyllin increase the success rate of replantation. Another important factor is also short of mean ischemia time. Conclusion: Some tools and methods are essential for management of the replantation at zone 2 in pediatrics such as, a good magnification, sensitive microsurgery equipment, 10/0-11/0 micro-sutures, effective vasodilatation per-operatively, adequate bone shortening and surgical exploration and close follow-up postoperatively. Postoperative rehabilitation is also an obligation to increase the success of the replantation.
Authors and Affiliations
Cemal Fırat, Ahmet Aytekin, Serkan Erbatur, Yılmaz Geyik, Ömer Elmas
Keywords
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