Tip-2B el yanık kontraktürlerinin tedavisi
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2009
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info:eu-repo/semantics/openAccess
Özet
Tip-2B yanık kontraktürü demek, deri dışındaki kemik, tendon, eklem, gibi dokuların da hastalıktan etkilenmiş olduğu yanık kontraktürü demektir. Elde meydana gelen derin ikinci derece ve üçüncü derece yanıklar özellikle çocukluk çağında ortaya çıktıklarında erken dönemde gerekli önlemler alınmaz ve uygun tedaviler yapılmazsa hayatın sonraki dönemlerinde çok ciddi el deformitelerine yol açabilirler. El, günlük hayatımızda bize çok yardımı olan bir organ olmak dışında sosyal bir organ olarak da dikkatimizi çeker ve deformiteleri başkalarınca da kolaylıkla fark edilir. Yanığa bağlı bir komplikasyonla şekli ve işlevi bozulan bir ele yardımcı olmak isteyen cerrahlarda ise hastalığın adı yanık olduğu için sadece deriye yönelik işlemler yapmak eğilimi vardır. Bu ise tekrarlayan ameliyatlara rağmen hastalara pek bir kazanç sağlamayan işlemler manasına gelebilir. Bu tür, yararı olmayan, boşuna yapılmış cerrahi müdahalelerden kurtulmanın ilk şartı hastalığa doğru isim koymak ve ne yapılması gerektiğine doğru karar vermektir.Bunu bilen bir cerrah tip-2B el yanık kontraktürlerine eklemlere ve kemiklere yönelik işlem yapmaksızın yardımcı olmanın mümkün olamayacağını bilir. Bu makalede, bir ayak yanık kont-raktürünü de içeren 10 olgu eşliğinde bu konu ele alındı. Hastalara osteotomi, artrodez, eklem protezi ve gerektiğinde örtücü doku nakli ile yapıldı. Burada sunulan hastaların bazılarına bizden önce başvurdukları bazı hastanelerde tedavi amaçlı amputasyon bile önerilmişti. Yanık kontraktürlü bir el eğer median, ulnar ve radiyal sinire bağlı hissetme özelliklerini yitirmemişse amputasyon kararı vermek doğru değildir ve hastalar tarafından da deformite ne kadar acayip olursa olsun kabul görmemektedir. Burada sunulan hastaların en küçüğü 3 yaşında en büyüğü de 33 yaşındadır. Yanık kontraktürünün yaşı dikkate alındığında ise bu rakamların 1 ile 31 olarak değiştiğini gördük. Elde edilen sonuçlar hem hasta hem de cerrah için memnuniyet vericidir.
Type-2B burn contracture means a contracture in which tissues besides the skin such as bone, joint and tendon are affected. Any burn existing on the hand especially during early childhood if untreated properly may cause very disfiguring deformities later in life. The hand is a very helpful organ of us and we notice it as a social organ, and also it is easly noticed by other people when it has some deformities. On the other hand, the surgeons that attempt to treat a hand with burn contracture tend to underestimate the problem by doing only some skin surgery since at last it is a burn related deformity. This, however, even with repeated operations gives very little profit to the patients. To avoid such kind of operations that waste time and money, first of all the situation should be diagnosed correctly. A surgeon that knows how to manage a type 2B hand burn contracture also knows that it is impossible to help type-2B hand burn contractures without doing any surgical procedure on the joints and bones. In this paper 10 cases with type-2B hand burn contractures including one foot contracture were presented. We helped our patients by performing arthrothesis, osteoctomy, joint prosthesis and when necessary with coverage tissue transfers. We would like to emphasize that even surgical amputation in some other hospitals had been offered as a treatment modaility to the patients presented here. Yet no patient had accepted it no matter how big deformities they had and in our opinion it is not right to think over amputation when the patient has sensibility on the hand supported by ulnar, median and radial nerves. Ages of the patients were varied between 3 to 33. Pertaining to the ages of the contractures the numbers were varied between 1 to 31 years. The results obtained was considered as acceptable both by the surgeons and the patients.
Type-2B burn contracture means a contracture in which tissues besides the skin such as bone, joint and tendon are affected. Any burn existing on the hand especially during early childhood if untreated properly may cause very disfiguring deformities later in life. The hand is a very helpful organ of us and we notice it as a social organ, and also it is easly noticed by other people when it has some deformities. On the other hand, the surgeons that attempt to treat a hand with burn contracture tend to underestimate the problem by doing only some skin surgery since at last it is a burn related deformity. This, however, even with repeated operations gives very little profit to the patients. To avoid such kind of operations that waste time and money, first of all the situation should be diagnosed correctly. A surgeon that knows how to manage a type 2B hand burn contracture also knows that it is impossible to help type-2B hand burn contractures without doing any surgical procedure on the joints and bones. In this paper 10 cases with type-2B hand burn contractures including one foot contracture were presented. We helped our patients by performing arthrothesis, osteoctomy, joint prosthesis and when necessary with coverage tissue transfers. We would like to emphasize that even surgical amputation in some other hospitals had been offered as a treatment modaility to the patients presented here. Yet no patient had accepted it no matter how big deformities they had and in our opinion it is not right to think over amputation when the patient has sensibility on the hand supported by ulnar, median and radial nerves. Ages of the patients were varied between 3 to 33. Pertaining to the ages of the contractures the numbers were varied between 1 to 31 years. The results obtained was considered as acceptable both by the surgeons and the patients.
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26
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3
