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Kahramanmaraş earthquake: From a microsurgical perspective of an orthopaedic hand surgery unit
Uğur Bezirgan1, Yener Yoğun2, Merve Dursun Savran3
1Ankara University Medical Faculty, Orthopedics and Traumatology Department, Hand and Upper Surgery Division.
Background:
Earthquakes stand as the most devastating form of natural disaster. Turkey, situated within fault zone has witnessed numerous catastrophic earthquakes throughout its history. On February 6th, a powerful earthquake severely impacted eleven cities in the southeastern part of the country. The purpose of this study is to evaluate the treatment management of a specific group of patients initially advised amputation but who rejected this procedure were referred to our clinic for reconstruction.
Methods:
This is single-center retrospective analysis included 15 patients (8 female, 7 male) with 17 flaps. Cases not requiring microsurgery were excluded. Data on admission conditions, time spent under debris, debridement surgeries, flap surgeries, anastomosis details, lab values, angiography, reoperations, wound closure times, complications, flap outcomes, hospitalization duration and amputations or death were collected.
Results:
The average age of 15 patients was 30.67+-18.51, with 5 of the patients being pediatric (33.33%). Patients spent an average of 41.77+-40.68 hours under debris with an 11.40 +- 5.80-day admission delay. They underwent an average of 4.41+-3.02 debridement surgeries before flap surgery, occurring around 21.06+-18.24 days post-admission. Wound closure took about 37.93+-37.58 days on average, with an average hospital stay of 77.33+-36.67 days. 46% received hyperbaric oxygen treatment. Various flap types were used, with no failures in anterolateral thigh (ALT) or sural artery flaps. Latissimus dorsi + serratus anterior chimeric flaps were for larger defects, required more blood product replacements and fraught with difficulties. In total, 4 of the flaps were failed, 3 patients needed amputation despite all efforts, and 1 patient has died.
Conclusion:
Earthquake victims with 'worse than it seems' nature due vascular and infectious concerns require careful microsurgery. Proximal anastomosis, venous complication monitoring, meticulous debridement, VAC therapy and adjuvant treatments like hyperbaric oxygen therapy are crucial in managing these complex cases.
