Clinical case report based studySuccesfull multidisciplinary treatment in a case of Buerger
Introduction
Buerger's disease is an idiopathic, chronic, segmental, thrombotic, inflammatory and nonatherosclerotic occlusive illness.1 Although pathogenesis is not clearly known, tobacco usage plays a significant role in the pathogenesis and progression of the diseases.2 In the literature, it is mentioned that vasodilator, antiplatelet and cytoprotective effective medicals such as iloprost, prostacyclin analogs and acetylsalicylic are used during the medical treatment with varying achievement drives.3 Buerger's disease mostly affects the distal channel. Thus, in many cases, the result of surgical revascularization is not very pleasant. Another surgical treatment option is lumbar and thoracic sympathectomy. The aim of sympathectomy is to relieve the ischemic pain and prevents amputation by providing vasodilatation.4
Certain cilostazols and metabolites that suppress the distortion of cyclic adenosine monophosphate (cAMP) and cause the cAMP level to increase in certain tissues including the thrombocytes and blood vessels are the phosphodiesterase III (PDE III) inhibitors. This mechanism leads to platelet aggregation inhibition, vasodilatation and an anti-inflammatory effect.5 Cilostazol has been proven beneficial for patients with de novo lesions of peripheral arteries and cilostazol seems to avoid restenosis process in the majority of patients.6
Fingertip injuries involving subtotal or total loss of the digital pulp are common types of hand injuries and require reconstruction that is able to provide stable padding and sensory recovery. Despite some disadvantages, cross finger pulp flap is a relatively simple procedure without significant complications or requiring special techniques. The article (Fig. 1) which dealt with the cross finger flap was published by Michael Gurdin and John W. Pangman in 1950.7 After approximately 3 weeks, the receptor starts to be nourished from the channel and the pedicle on the donor finger is cut.8
Section snippets
Case report
58-year-old male patient smoked two packs of cigarettes per day for 40 years. Buerger's disease was diagnosed 30 years ago. For the cladicatio intermittens 20 years ago right common femoral-superficial femoral artery by-pass and 17 years ago bilateral lumber sympathectomy applied to the patient. Because of gangrene 15 years ago left below-knee and right metatarsal amputations applied to him. 4 years ago for the right upper extremity pain bilateral thoracic sympathectomy was applied to the
Discussion
Buerger disease was firstly defined 130 years ago and the details were defined by Leo Buerger by means of hystopathologically examining the amputation specimens.9 Amputation risk of the long-term results of Buerger disease are 25% per 5 years, 38% per 10 years and 46% per 20 years.10 Tissue loss is tried to be prevented by applying medical treatment. Endovascular recovery is not a commonly applied method and by-pass operations are made only if they are beneficial without touching the diseased
Conclusion
We believe that complex Buerger's disease patients with non-healing scar assessed with multidisciplinary. Succesfull reconstruction with Buerger's disease should be provided with a good blood flow. The prevention of stenosis and maintenance of good blood flow after endarterectomy or other vascular surgical procedures cilostazol is an appropriate drug.
Conflicts of interest
All authors have none to declare.
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Cited by (2)
Thromboangiitis obliterans (Buerger's disease)
2016, Annals of Medicine and SurgeryCitation Excerpt :The typical histopathologic findings include a highly inflammatory thrombus infiltrated with polymorphonuclear leukocytes and multinucleated giant cells, affecting both arteries and veins [14]. Amputation risk of the long-term results of TAO management are 25% per 5 years, 38% per 10 years and 46% per 20 years [15]. Fazeli et al. described 108 patients with Shionoya's criteria.
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