Replantacija ruke: hirurška strategija i profilaksa akutne bubrežne slabosti usled ishemijskog reperfuzionog oštećenja

  • Predrag Kovačević University Clinical Center of Niš, Plastic and Reconstructive Surgery Clinic, Niš, Serbia; University of Niš, Faculty of Medicine, Department of Surgery, Niš, Serbia
  • Jefta Kozarski Military Medical Academy, Clinic for Plastic Surgery and Burns, Belgrade, Serbia; University of Defence Belgrade, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
  • Dragana Djordjević University Clinical Center of Niš, Anesthesia and Intensive Care Clinic, Niš, Serbia
  • Irena Janković University Clinical Center of Niš, Plastic and Reconstructive Surgery Clinic, Niš, Serbia; University of Niš, Faculty of Medicine, Department of Surgery, Niš, Serbia
  • Dimitrije Pavlović Plastic and Reconstructive Surgery Clinic, Clinical Centre Nis, Bul. Dr. Zorana Djindjica 48, 18000, Nis, Serbia
DOI: https://doi.org/10.2298/VSP200906120K
Ključne reči: ruka;, intenzivna nega, odeljenja;, hirurgija, rekonstruktivna, procedure;, replantacija;, disanje, mehaničko.

Sažetak


Uvod. Replantacija ruke je izuzetno retka i izazovna procedura. Jedna od komplikacija ove intervencije je mioglobinurija i posledična bubrežna insuficijencija izazvana ishemijsko reperfuzionim oštećenjem. Prikaz bolesnika. Prikazana su dva bolesnika starosti 24 i 46 godina, primljena nakon amputacije ruke izazvane traumom. Vreme ishemije iznosilo je šest, odnosno dva sata. Postoperativni tretman i intenzivna nega primenom asistirane ventilacije, sedacije i postizanja optimalne diureze sprečili su bubrežnu slabost izazvanu mioglobinom. U slučaju kada je vreme ishemije bilo kraće, urađena je samo jedna odložena rekonstrukcija defekata kože nakon fasciotomije, a u slučaju kada je ishemija trajala duže, bolesnik je imao dva sekundarna postupka sa prihvatljivim konačnim rezultatima. Zaključak. Replantacija ruke je siguran postupak čak i u slučajevima u kojima je vreme ishemije trajalo duže. Postoperativna kontrola diureze, korekcija acidoze i sprečavanje mioglobinom izazvane tubularne nekroze bubrega su presudne za stabilan postoperativni oporavak.

Biografije autora

Predrag Kovačević, University Clinical Center of Niš, Plastic and Reconstructive Surgery Clinic, Niš, Serbia; University of Niš, Faculty of Medicine, Department of Surgery, Niš, Serbia

MD, DMD, PhD

Jefta Kozarski, Military Medical Academy, Clinic for Plastic Surgery and Burns, Belgrade, Serbia; University of Defence Belgrade, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia

MD, PhD

Dragana Djordjević, University Clinical Center of Niš, Anesthesia and Intensive Care Clinic, Niš, Serbia

MD

Irena Janković, University Clinical Center of Niš, Plastic and Reconstructive Surgery Clinic, Niš, Serbia; University of Niš, Faculty of Medicine, Department of Surgery, Niš, Serbia

MD, PhD

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Objavljeno
2022/05/20
Broj časopisa
Vol. 79 Br. 4 (2022)
Rubrika
Prikaz bolesnika