Management of upper extremity war injuries in the subacute period: A review of 62 cases

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dc.authorid0000-0003-3416-5666
dc.authorid0000-0002-1972-9518
dc.authorid0000-0002-3437-6394
dc.authorscopusid57196712908
dc.authorscopusid15052599600
dc.authorscopusid57218672513
dc.authorscopusid57195986685
dc.authorscopusid56519703400
dc.authorscopusid55908952400
dc.authorscopusid57215291132
dc.authorwosidsari, abdulkadir/ABH-3293-2021
dc.authorwosidsari, abdulkadir/AAF-3143-2021
dc.authorwosidOZCELIK, ISMAIL BULENT/AAC-1183-2022
dc.contributor.authorSarı, Abdulkadir
dc.contributor.authorÖzçelik, İsmail Bülent
dc.contributor.authorBayırlı, Derya
dc.contributor.authorAyık, Ömer
dc.contributor.authorMert, Murat
dc.contributor.authorErçin, Burak Sercan
dc.contributor.authorMersa, Berkan
dc.date.accessioned2022-05-11T14:36:15Z
dc.date.available2022-05-11T14:36:15Z
dc.date.issued2020
dc.departmentFakülteler, Tıp Fakültesi, Cerrahi Tıp Bilimleri Bölümü, Ortopedi ve Travmatoloji Ana Bilim Dalı
dc.description.abstractObjective: In this study, we aimed to describe the relationship between the localization of rarely seen upper extremity war injuries and their complications in the subacute period, and define our preferences for surgery and antibiotic use. Methods: Patients with an upper extremity war injury who presented to our institution between 2015 and 2018 were retrospectively evaluated. Data regarding demographics, time between injury and presentation, location of injury, type of damage, complications, treatment methods, infection rates and antibiotic use were recorded. Tissue defects, fracture fixation, neurovascular damage, infection development and treatment approaches were analyzed. Results: Sixty-two male patients with isolated upper extremity injuries (mean age: 31.66 +/- 8.28 years) were included in the study. The average time between trauma and hospitalization was 14 days. The mean hematocrit (Hct) level at presentation was 36.3 +/- 6.8%. Patients had been followed up for an average period of 95.6 +/- 32.1 days. Twenty-nine patients (46.8%) had nerve injury, eight (12.9%) had arterial injury that required repair, and 23 had infection (37.1%), of which five developed osteomyelitis. Infection was polymicrobial in nine cases and monobacterial in 14. A positive correlation was found between the presence of fracture and nerve injury (p = 0.013). The frequency of nerve injuries due to gunshot wounds was higher in the mid-section and lower part of the arms and in the proximal forearm when compared to other regions (p = 0.011). The infection rates were significantly higher in patients with fractures (p = 0.033). The mean hematocrit (Hct) level at presentation of the patients with infection (32.1 +/- 6.3%) was significantly lower than that of those who did not have infection (38.8 +/- 5.9%) (p<0.001). Conclusion: Upper extremity war injuries require case-specific solutions. Microbiological samples should be taken prior to empirical antibiotic treatment for infection management and rational antibiotic use principles should be applied according to the culture and antibiogram results. The holistic and ambiguous character of nerve injuries often requires early exploration and combined reconstructive interventions. Arterial injuries can be overlooked by physical examination alone and thus routine angiography should be performed. Completion of the bone and soft tissue reconstructions in the same session using a holistic approach minimizes the possible risks. (C) 2020 Elsevier Ltd. All rights reserved.
dc.identifier.doi10.1016/j.injury.2020.08.028
dc.identifier.endpage2611
dc.identifier.issn0020-1383
dc.identifier.issn1879-0267
dc.identifier.issue11en_US
dc.identifier.pmid32868071
dc.identifier.scopus2-s2.0-85089976555
dc.identifier.scopusqualityQ1
dc.identifier.startpage2601
dc.identifier.urihttps://doi.org/10.1016/j.injury.2020.08.028
dc.identifier.urihttps://hdl.handle.net/20.500.11776/8421
dc.identifier.volume51
dc.identifier.wosWOS:000583236600035
dc.identifier.wosqualityQ2
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakScopus
dc.indekslendigikaynakPubMed
dc.institutionauthorSarı, Abdulkadir
dc.language.isoen
dc.publisherElsevier Sci Ltd
dc.relation.ispartofInjury-International Journal of the Care of the Injured
dc.relation.publicationcategoryDiğeren_US
dc.rightsinfo:eu-repo/semantics/closedAccess
dc.subjectGunshot wound
dc.subjectFirearm injury
dc.subjectMicrosurgery
dc.subjectNerve transfer
dc.subjectReconstruction
dc.subjectUpper extremity
dc.subjectWar injury
dc.subjectGunshot-Induced Fractures
dc.subjectMuscle Flap Coverage
dc.subjectPeripheral-Nerve
dc.subjectReconstruction
dc.subjectTrauma
dc.subjectWounds
dc.subjectArteriography
dc.subjectCasualties
dc.subjectDefects
dc.subjectHand
dc.titleManagement of upper extremity war injuries in the subacute period: A review of 62 cases
dc.typeReview Article

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