PubMed İndeksli Açık & Kapalı Erişimli Yayınlar
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Item Comparison of Single-Dose Infraclavicular Brachial Plexus Block and Continuous Infraclavicular Brachial Plexus Block Applications in the Treatment of Finger Amputations(2019) Sahin, Mehmet Sukru; Cakmak, Gokhan; Birtay, Tayfun; 31814664Introduction The aim of this study is to evaluate the replantation success of single-dose infraclavicular brachial plexus block and continuous infraclavicular brachial plexus block (CIBPB) applied with bupivacaine and prilocaine in patients with finger amputation. Materials and Methods This prospective randomized nonblinded study was conducted between January 2012 and September 2017, and 47 patients, all male, were included. Patients were randomly separated into two groups as 23 patients CIBPB applied group (group A) and 24 patients single-dose infraclavicular block applied group (group B). In group B, after the effect of block is ceased, intravenous patient-controlled (PC) opioid analgesia and, where necessary, 1 mg/kg meperidine and 75 mg diclofenac sodium intramuscularly were alternately administered at 4 to 6 hours intervals. The average ages were 30.7 +/- 10.06 and 29 +/- 9.08, respectively. Replantations were applied as being two venous anastomoses to one artery, where possible. Hourly skin temperatures of fingers of the hands in which both surgeries applied and no surgery applied in both the groups were measured for 3 days with an infrared thermometer. Also, Numerical Rating Scale (NRS) evaluations in both the groups were performed in 3-hour intervals for 3 days. Results Replantations were successful in 22 patients in whom CIBPB was applied (95.6%) and in 19 patients in whom single block was applied (79.16%). Regarding the finger temperatures, no significant difference was detected between both the groups for 3 days following the operation. No significant difference was found between the length of hospital stays (4.73 +/- 2.21-4.71 +/- 1.53) and duration of operations (2.90 +/- 0.73-2.83 +/- 0.58). There was no significant difference between the temperature values of both the groups. NRS scores of group A were statistically significantly lower than those of group B. Conclusion In this prospective randomized study performed by using bupivacaine and prilocaine on 24 patients, the success rate of finger replantations with CIBPB was found to be higher. CIBPB is a very beneficial method that should be taken in consideration in hand injuries with anastomosis and high risk of vasospasm. Further studies with more number of cases would help reduce the question marks related with the success of this method.Item Hypothenar hammer syndrome: a case series and literature review(2015) Sahin, Mehmet Sukru; Ozyurekoglu, Tuna; Cakmak, Gokhan; 25741914Objectives: This study aims to report our experience regarding patients who were surgically treated due to hypothenar hammer syndrome and review the related literature. Patients and methods: The study included 11 hands of eight patients (5 males, 3 females; mean age 48 years; range 29 to 60 years) who underwent surgery due to hypothenar hammer syndrome between September 2004 and March 2013. Mean follow-up period was 50 months (range 3-103 months). The time of symptom onset, occupational history, and detailed physical examination findings were recorded. Surgery was performed under sedation and axillary anesthesia. Distal segment of the forearm, all thrombosed segments of the Guyon and superficial arch were removed. Reconstruction of the ulnar artery and the superficial arch was performed using vein grafts obtained from the forearm. Results: While all patients' dominant hand was affected, both hands were affected in three patients. All patients complained of pain and color change in one finger or multiple fingers. While minimal amputation and debridement of fingertip pulp was performed in two patients, all other patients recovered uneventfully. Patency of the ulnar artery was uneventful at follow-up in five of the eight patients, whereas three patients were performed revision surgery for a new vein graft. Most patient complaints resolved during the follow-up period. Conclusion: Hypothenar hammer syndrome is a disease of the upper extremities that should be considered in patients with digital ischemia, and a history of manual labor and smoking. Although this disease can be treated with conservative therapy, advance-stage patients who fail to respond to conservative treatment can be treated surgically with vein grafts.Item Effect of pentoxifylline on healing of segmental bone defects and angiogenesis(2015) Cakmak, Gokhan; Sahin, Mehmet Sukru; Ozdemir, B. Handan; Karadeniz, Emre; 26511696Objective: The aim of this study was to determine the effect of pentoxifylline (PTX) on angiogenesis and the healing of a critical-sized segmental defect of the radius diaphysis in a rat model, using radiological and histological grading systems. Methods: The study included 24 female Sprague-Dawley rats (weight: 300 +/- 20 g) divided into 4 groups. A critical-sized segmental defect was created in the radius diaphysis in all rats. In Group 1, morcellized iliac crest autografts were used to fill the segmental bone defect. In Group 2, segmental bone defects were filled using morcellized iliac crest autografts, and 25 mg/kg/day PTX was applied intraperitoneally. In Group 3, the segmental bone defects were not filled, and in Group 4 the segmental bone defects were left unfilled, and an intraperitoneal (IP) dose of 25 mg/kg/day PTX was applied. Rats were sacrificed at postoperative Week 8, and defects were evaluated using radiographic, histological and immunohistochemical methods. Results: There were significant differences between Group 1 and 2 according to radiological evaluation (p = 0.003) and quality of union at the defect site (p = 0.01). Union quality was higher in Group 4 than Group 3 (p = 0.01). Cluster of differentiation 31 (CD31) and vascular endothelial growth factor (VEGF) levels were higher in Group 2 than in Groups 3 and 4. Conclusion: According to radiological and histological parameters, PTX appears to improve angiogenesis and healing of segmental cortical bone defects of the radius in a rat model.