Ulus Travma Acil Cerrahi Derg. 2023; 29(7): 764-771 | DOI: 10.14744/tjtes.2023.96702

Composite graft repair in distal finger injuries: emergency room or operating room?

Kemal Þener¹, Adem Çakýr⁵, Anvar Ahmedov², Murat Ýpteç³, Nazife Didem Hanoðlu¹, Ertuðrul Altuð¹, Ramazan Güven¹, Akkan Avci^4
1Department of Emergence Medicine, Baþaksehir Çam and Sakura City Hospital, Ýstanbul-Türkiye
²Department of Plastic, Reconstructive And Aesthetic Surgery, Baþaksehir Çam and Sakura City Hospital, Ýstanbul-Türkiye
³Department of Hand Surgery, Baþaksehir Çam and Sakura City Hospital, Ýstanbul-Türkiye
⁴Health Science University, Adana City Research and Training Hospital, Adana-Türkiye
⁵Çanakkale Mehmet Akif Ersoy State Hospital, Çanakkale-Türkiye

BACKGROUND: Fingertip amputations are common injuries presenting to the emergency room. However, all amputations do not have a chance of replantation, and composite graft is among the salvage treatments in this case. This treatment is both easy to apply and economical. Our study compares the success and cost of composite grafting in the emergency and operating rooms.
METHODS: Thirty-six patients who met the criteria were included in the study. The decision on the repair site was made by the sur-geon according to patient compliance and the intensity of the emergency clinic. Demographic and disease information of the patients were recorded. P<0.05 was accepted as the significance level.
RESULTS: Twenty-two cases were pediatric patients. Eighteen cases of crush injuries and 22 cases were treated in the emergency room. There was no significant difference in terms of complications, need for additional intervention, and short fingers related to interventions performed in the emergency room and operating room. Interventions in the emergency department were significantly lower in cost and shorter hospitalization times. There was no significant difference in terms of patient satisfaction.
CONCLUSION: Composite grafting is a simple and reliable method in fingertip injuries and gives satisfactory results in terms of patient satisfaction. In addition, composite graft application in fingertip injuries in the emergency department will both reduce the cost and prevent hospital infections that may occur due to the reduction in hospitalization.

Keywords: Composite graft, cost-effectiveness; emergency room; fingertip injury; operating room.

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Distal parmak yaralanmalarýnda kompozit greft onarýmý: Acil servis mi Ameliyathane mi?

Kemal Þener¹, Adem Çakýr⁵, Anvar Ahmedov², Murat Ýpteç³, Nazife Didem Hanoðlu¹, Ertuðrul Altuð¹, Ramazan Güven¹, Akkan Avci^4
1Baþakþehir Çam ve Sakura Þehir Hastanesi, Acil Servis, Ýstanbul, Türkiye
²Baþakþehir Çam ve Sakura Þehir Hastanesi, Plastik ve Rekonstrükif Cerrahi Kliniði, Ýstanbul, Türkiye
³Baþakþehir Çam ve Sakura Þehir Hastanesi, El Cerrahi Kliniði, Ýstanbul, Türkiye
⁴Adana Þehir Eðitim Araþtýrma Hastanesi, Acil Týp, Adana, Türkiye
⁵Çanakkale Mehmet Akif Ersoy Devlet Hastanesi, Çanakkale, Türkiye

AMAÇ: Parmak ucu amputasyonlarý, acil servise baþvuran yaygýn yaralanmalardýr. Ancak tüm amputasyonlarýn replantasyon þansý yoktur ve bu durumda kompozit greft kurtarma tedavileri arasýndadýr. Bu tedavi hem uygulamasý kolay hem de ekonomiktir. Çalýþmamýzda acil serviste ve ameli-yathanede kompozit greftlemenin baþarýsýný ve maliyetini karþýlaþtýrdýk.
GEREÇ VE YÖNTEM: Kabul ölçütlerini karþýlayan 36 hasta çalýþmaya alýndý. Tamir yeri kararý hasta uyumuna ve acil servisin yoðunluðuna göre cerrah tarafýndan verildi. Hastalarýn demografik ve hastalýk bilgileri kaydedildi. Anlamlýlýk düzeyi olarak p<0.05 kabul edildi.
BULGULAR: Yirmi iki olgu pediatrik hastaydý. Acil serviste 18 ezilme yaralanmasý ve 22 vaka tedavi edildi. Acil serviste ve ameliyathanede yapýlan giriþimlere göre komplikasyonlar, ek giriþim gereksinimi ve parmak kýsalýðý açýsýndan anlamlý fark yoktu. Acil servisteki müdahaleler, maliyet açýsýndan önemli ölçüde daha düþük ve hastanede kalýþ süreleri daha kýsaydý. Hasta memnuniyeti açýsýndan anlamlý bir fark yoktu.
TARTIÞMA: Kompozit greft parmak ucu yaralanmalarýnda basit ve güvenilir bir yöntemdir ve hasta memnuniyeti açýsýndan yüz güldürücü sonuçlar vermektedir. Ayrýca acil serviste parmak ucu yaralanmalarýnda kompozit greft uygulamasý hem maliyeti düþürecek hem de hastane yatýþlarýnýn azal-masý nedeniyle oluþabilecek hastane enfeksiyonlarýný önleyecektir.

Anahtar Kelimeler: Kompozit greft, maliyet etkinliði, Acil servis, parmak ucu yaralanmasý, ameliyathane.

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