گزارش يك مورد قطع كامل اندام فوقاني در مچ دست و پيوند مجدد آن

Transplantation of a full-cut upper limb (in wrist): A cases study

زمينه: قطع تروماتيك كامل اندام فوقاني در ناحيه مـچ دست، نسبتاً كمياب است. در خلال سال‌هاي گذشته با پيشرفت علم در روش‌هاي جراحي ميكروسكوپي دست و اعصاب محيطي، ميزان موفقيت جراحي‌هاي پيوند اعضا افزايش يافته است. معرفي بيمار: آقايي 18 ساله در زمستان 1387 با قطع كامل دست چپ از ناحيـه مچ به اورژانس بيمارستان طالقـاني كرمانشاه آورده شد. ضايعه در اثر تصادف با ماشين در استان همجوار ايجاد شده و در زمان پذيرش، 6 ساعت از وقوع حادثه گذشته بود. بيمار هوشيار و بي‌قرار بود. فشارخون، 50/90 ميلي‌متر جيوه و نبض، 120 در دقيقه بود. به همراه بيمار، عضو قطع‌شده با لبه‌هاي له‌شدگي آلوده به خاك در پارچه‌اي پيچيده شده و به مركز درماني ارسال شده بود. نتيجه‌گيري: در پيگيري‌هاي 24 ماهه از بيمار، حس لمس، حرارت و فشار در ديستال اندام فوقاني وجود داشت و ميزان موفقيت بسيار عالي بود.

Background: Complete traumatic amputation of upper limb in wrist area is relatively rare. During the past years thanks to advances in scientific and microscopic methods peripheral nerve surgery has increased the success rate of such surgeries. Case Presentation: An 18 year old man with his wrist has been cut for about 6 hours in an accident was referred to emergency Ward of Taleqani Hospital of Kermanshah. The patient suffered from complete cut of left wrist in car accident in 2008. The patient was really agitated and restless. His Blood pressure was 50/90 mm Hg and pulse rate was 120 per minute. Cut hand has been pressed and contaminated with soil and was wrapped in cloth and sent to the medical center. At first radius and ulnar bones were fixed by pin and articular capsule was sutured. In the second stage muscles were sutured. Arteries and veins in the third stage were anastomosed. Vessels were anastomosed end-to-end. Median, radial and ulnar nerves were restored by microscopic surgery after blood supply of hand has been flown. Finally, fasciotomy of organ was done to prevent compartment syndrome. Conclusion: Two years later it was realized that the patientsʹ sense of touch, heat and pressure of hand was remarkably good in transplanted hand and the surgery was really successful.