Araştırma Makalesi
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The Effects of Type 2 Diabetes Mellitus on the Success of Free Tissue Transfer

Yıl 2020, Cilt: 4 Sayı: 1, 1 - 6, 23.04.2020
https://doi.org/10.25048/tudod.687683

Öz

Aim: Free tissue transfer is still gold standard in wide tissue defect treatments. Free tissue transfers whose success depends on vascular anastomosis will be affected by every situation which affects vessels. Diabetes mellitus is a worldwide well known vasculopatic disorder . Although, it has serious deteriorative effects on all vascular anatomy and physiology, the effects of diabetes mellitus on the success of free tissue transfer surgery hasn’t been well studied yet. In this study, we aimed to investigate the effects of diabetes mellitus on the success and complications of free tissue transfer surgery.


Material and Methods: 107 adult patients who undertook free tissue transfer surgery in Plastic, Reconstructive and Aesthetic Surgery Department of Atatürk University Medical Faculty between January 2010 and January 2019 were included in this study. Patients were divided into two groups as Group 1 (18 patients with Diabetes Mellitus) and Group 2 (89 patients without diabetes mellitus). The groups were compared for surgical complications and success.


Results: Arterial thrombosis was found as 22.2% in group 1 and 5.6% in Group 2 (p=0.021). Diabetic patients needed more revisional surgery than non-diabetic cases (p=0.030). Surgeries failed in 33.3% of cases in Group 1 and 13.5% of patients in Group 2 (p=0.040). The frequency of intra-postoperative anastomosis problems and heamatomas were higher in diabetics than non-diabetics, but the difference was not statistically significant.


Conclusion: In free tissue transfer surgery, we found more complications and low-success rate in diabetic cases than non-diabetics. Diabetic cases need more attention and close follow-up period after free tissue transfer surgery.

Kaynakça

  • Referans1 Wong CH, Wei FC. Microsurgical free flap in head and neck reconstruction. Head Neck 2010;32:1236–1245.
  • Referans2 Rosado P, Cheng HT, et al. Influence of diabetes mellitus on postoperative complications and failure in head and neck free flap reconstruction: a systematic review and meta-analysis. Head Neck. 2015;37(4):615-618.
  • Referans3 Valentini V, Cassoni A, et al. Diabetes as main risk factor in head and neck reconstructive surgery with free flaps. J Craniofac Surg. 2008;19(4):1080-1084.
  • Referans4 Alberdas JL, Shibahara T, et al. Histopathologic damage to vessels in head and neck microsurgery. J Oral Maxillofac Surg 2003;61:191–196.
  • Referans5 Oh TS, Lee HS, et al. Diabetic foot reconstruction using free flaps increases 5-year-survival rate. J Plast Reconstr Aesthet Surg. 2013;66(2):243-250.
  • Referans6 Colen LB, Stevenson A, et al. Microvascular anastomotic thrombosis in experimental diabetes mellitus. Plast Reconstr Surg 1997;99:156-162.
  • Referans7 Onat A, Can G, ve ark. Özet ve sonuçlar. Onat A, Editör. TEKHARF 2017 Tıp Dünyasının Kronik Hastalıklara Yaklaşımına Öncülük. İstanbul. Logos Yayıncılık. 2017; 5.
  • Referans8 Ducic I, Attinger CE. Foot and ankle reconstruction: pedicled muscle flaps versus free flaps and the role of diabetes. Plast Reconstr Surg. 201;128(1):173-180.
  • Referans9 Attinger CE, Ducic I, et al. The role of intrinsic muscle flaps of the foot for bone coverage in foot and ankle defects in diabetic and nondiabetic patients. Plast Reconstr Surg. 2002;110(4):1047-57.
  • Referans10 İ.Satman ve TURDEP çalışma grubu, 2013.
  • Referans11 Barr LC, Joyce AD. Microvascular anastomoses in diabetes: an experimental study. Br J Plast Surg 1989;42:50-53.
  • Referans12 Cooley BC, Hanel DP, et al. The influence of diabetes on free flap transfer: I. Flap survival and microvascular healing. Ann Plast Surg. 1992; 29(1):58-64.
  • Referans13 Beckman JA, Creager MA, et al. Diabetes and atherosclerosis: epidemiology, pathophysiology, and management. J Am Med Assoc 2002;287(19):2570-2581.
  • Referans14 McCullough PA, Agrawal V, et al. Accelerated atherosclerotic calcification and Monckeberg’s sclerosis: a continuum of advanced vascular pathology in chronic kidney disease. Clin J Am Soc Nephrol 2008;3(6):1585-1598.
  • Referans15 Aagenaes O, Moe H. Light-and electron-microscopic study of skin capillaries of diabetics. Diabetes 1961;10: 253-259.
  • Referans16 Katz MA, McCuskey P, et al. Relationships betvveen microvascular function and capillary structure in diabetic and nondiabetic human skin. Diabetes 1989;38: 1245-1250.
  • Referans17 Randon C, Vermassen F, et al. Outcome of arterial reconstruction and free-flap coverage in diabetic foot ulcers: long-term results. World J Surg 2010;34(1):177-184.
  • Referans18 Bozikov K, Arnez ZM. Factors predicting free flap complications in head and neck reconstruction. J Plast Reconstr Aesthet Surg 2006;59:737-742.
  • Referans19 Levin ME. Diabetic foot ulcers: pathogenesis and management. JET Nurs. 1993; 20(5):191-198.
  • Referans20 Hatz RA, Niedner R, et al. In Diabetic leg ulcer, Woundhealing and wound management, Berlin, Springer-Vcrlag, 1994;98-105.
  • Referans21 Aygıt AC, Top H, ve ark. Diyabetik ayak ülserinde yara bakımı ve cerrahi girişimler. Türk Plast Rekonstr Est CerDerg 2003; 11(3):153-158.
  • Referans22 Lee YK, Park KY, et al. Analysis of multiple risk factors affecting the result of free flap transfer for necrotising soft tissue defects of the lower extremities in patients with type 2 diabetes mellitus. J Plast Reconstr Aesthet Surg. 2014;67(5):624-628.

Tip 2 Diabetes Mellitusun Serbest Doku Nakli Başarısına Etkisi

Yıl 2020, Cilt: 4 Sayı: 1, 1 - 6, 23.04.2020
https://doi.org/10.25048/tudod.687683

Öz

Amaç: Geniş doku defektlerinde serbest doku nakli hâlâ altın standarttır. Başarısı damar anastomozuna bağlı olan serbest doku nakli,damarı etkileyen her durumdan etkilenecektir. Bunların başında da Tip 2 Diabetes Mellitus gelmektedir. Bununla birlikte serbest doku nakli işlemlerinde diyabetin başarıya etkisi hâlâ yeteri kadar incelenmemiştir. Bu nedenle, bu çalışmada serbest doku nakli yapılan, diyabetik ve non-diyabetik hasta gruplarını, komplikasyon ve başarı oranları açısından karşılaştırmayı amaçladık.

Gereç ve Yöntemler: Atatürk Üniversitesi, Tıp Fakültesi, Plastik, Rekonstrüktif ve Estetik Cerrahi Kliniği’nde Ocak 2010 - Ocak 2019 arasında, serbest doku nakli yapılan, 40 yaş üstü 107 hasta çalışmaya dahil edildi. Tip 2 Diabetes Mellitus tanısı olan 18 (Grup 1) ve diyabeti olmayan 89 (Grup 2) olgu, komplikasyon oranları ve ameliyat başarısı açısından karşılaştırıldı.


Bulgular: Grup 1’de %22,2, Grup 2’de %5,6 oranında arteriyel trombüs gelişti (p=0,021). Grup 1’deki hastalara istatistiksel olarak anlamlı derecede daha fazla revizyon ameliyatı gerekti (p=0,030). Grup 1’de %33,3, Grup 2’de ise %13,5 oranında nakledilen doku başarısızlıkla sonuçlandı (p=0,040). İstatistiksel olarak anlamlı bulunmasa da Grup 1’deki hasta grubunda daha sık intra-postoperatif anastomoz problemi ve hematom komplikasyonu görüldü.


Sonuç: Serbest doku nakli yapılacak diyabetik hastalarda, daha fazla komplikasyon görülür ve başarı oranı daha düşüktür. Bu nedenle ameliyat öncesi ayrıntılı değerlendirme ve ameliyat sonrası sıkı takip gerektirmektedir.

Kaynakça

  • Referans1 Wong CH, Wei FC. Microsurgical free flap in head and neck reconstruction. Head Neck 2010;32:1236–1245.
  • Referans2 Rosado P, Cheng HT, et al. Influence of diabetes mellitus on postoperative complications and failure in head and neck free flap reconstruction: a systematic review and meta-analysis. Head Neck. 2015;37(4):615-618.
  • Referans3 Valentini V, Cassoni A, et al. Diabetes as main risk factor in head and neck reconstructive surgery with free flaps. J Craniofac Surg. 2008;19(4):1080-1084.
  • Referans4 Alberdas JL, Shibahara T, et al. Histopathologic damage to vessels in head and neck microsurgery. J Oral Maxillofac Surg 2003;61:191–196.
  • Referans5 Oh TS, Lee HS, et al. Diabetic foot reconstruction using free flaps increases 5-year-survival rate. J Plast Reconstr Aesthet Surg. 2013;66(2):243-250.
  • Referans6 Colen LB, Stevenson A, et al. Microvascular anastomotic thrombosis in experimental diabetes mellitus. Plast Reconstr Surg 1997;99:156-162.
  • Referans7 Onat A, Can G, ve ark. Özet ve sonuçlar. Onat A, Editör. TEKHARF 2017 Tıp Dünyasının Kronik Hastalıklara Yaklaşımına Öncülük. İstanbul. Logos Yayıncılık. 2017; 5.
  • Referans8 Ducic I, Attinger CE. Foot and ankle reconstruction: pedicled muscle flaps versus free flaps and the role of diabetes. Plast Reconstr Surg. 201;128(1):173-180.
  • Referans9 Attinger CE, Ducic I, et al. The role of intrinsic muscle flaps of the foot for bone coverage in foot and ankle defects in diabetic and nondiabetic patients. Plast Reconstr Surg. 2002;110(4):1047-57.
  • Referans10 İ.Satman ve TURDEP çalışma grubu, 2013.
  • Referans11 Barr LC, Joyce AD. Microvascular anastomoses in diabetes: an experimental study. Br J Plast Surg 1989;42:50-53.
  • Referans12 Cooley BC, Hanel DP, et al. The influence of diabetes on free flap transfer: I. Flap survival and microvascular healing. Ann Plast Surg. 1992; 29(1):58-64.
  • Referans13 Beckman JA, Creager MA, et al. Diabetes and atherosclerosis: epidemiology, pathophysiology, and management. J Am Med Assoc 2002;287(19):2570-2581.
  • Referans14 McCullough PA, Agrawal V, et al. Accelerated atherosclerotic calcification and Monckeberg’s sclerosis: a continuum of advanced vascular pathology in chronic kidney disease. Clin J Am Soc Nephrol 2008;3(6):1585-1598.
  • Referans15 Aagenaes O, Moe H. Light-and electron-microscopic study of skin capillaries of diabetics. Diabetes 1961;10: 253-259.
  • Referans16 Katz MA, McCuskey P, et al. Relationships betvveen microvascular function and capillary structure in diabetic and nondiabetic human skin. Diabetes 1989;38: 1245-1250.
  • Referans17 Randon C, Vermassen F, et al. Outcome of arterial reconstruction and free-flap coverage in diabetic foot ulcers: long-term results. World J Surg 2010;34(1):177-184.
  • Referans18 Bozikov K, Arnez ZM. Factors predicting free flap complications in head and neck reconstruction. J Plast Reconstr Aesthet Surg 2006;59:737-742.
  • Referans19 Levin ME. Diabetic foot ulcers: pathogenesis and management. JET Nurs. 1993; 20(5):191-198.
  • Referans20 Hatz RA, Niedner R, et al. In Diabetic leg ulcer, Woundhealing and wound management, Berlin, Springer-Vcrlag, 1994;98-105.
  • Referans21 Aygıt AC, Top H, ve ark. Diyabetik ayak ülserinde yara bakımı ve cerrahi girişimler. Türk Plast Rekonstr Est CerDerg 2003; 11(3):153-158.
  • Referans22 Lee YK, Park KY, et al. Analysis of multiple risk factors affecting the result of free flap transfer for necrotising soft tissue defects of the lower extremities in patients with type 2 diabetes mellitus. J Plast Reconstr Aesthet Surg. 2014;67(5):624-628.
Toplam 22 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma Makalesi
Yazarlar

Hakan Çinal 0000-0002-9797-5730

Ensar Barın Bu kişi benim 0000-0002-0380-8553

Yayımlanma Tarihi 23 Nisan 2020
Kabul Tarihi 22 Nisan 2020
Yayımlandığı Sayı Yıl 2020 Cilt: 4 Sayı: 1

Kaynak Göster

APA Çinal, H., & Barın, E. (2020). Tip 2 Diabetes Mellitusun Serbest Doku Nakli Başarısına Etkisi. Türkiye Diyabet Ve Obezite Dergisi, 4(1), 1-6. https://doi.org/10.25048/tudod.687683
AMA Çinal H, Barın E. Tip 2 Diabetes Mellitusun Serbest Doku Nakli Başarısına Etkisi. Turk J Diab Obes. Nisan 2020;4(1):1-6. doi:10.25048/tudod.687683
Chicago Çinal, Hakan, ve Ensar Barın. “Tip 2 Diabetes Mellitusun Serbest Doku Nakli Başarısına Etkisi”. Türkiye Diyabet Ve Obezite Dergisi 4, sy. 1 (Nisan 2020): 1-6. https://doi.org/10.25048/tudod.687683.
EndNote Çinal H, Barın E (01 Nisan 2020) Tip 2 Diabetes Mellitusun Serbest Doku Nakli Başarısına Etkisi. Türkiye Diyabet ve Obezite Dergisi 4 1 1–6.
IEEE H. Çinal ve E. Barın, “Tip 2 Diabetes Mellitusun Serbest Doku Nakli Başarısına Etkisi”, Turk J Diab Obes, c. 4, sy. 1, ss. 1–6, 2020, doi: 10.25048/tudod.687683.
ISNAD Çinal, Hakan - Barın, Ensar. “Tip 2 Diabetes Mellitusun Serbest Doku Nakli Başarısına Etkisi”. Türkiye Diyabet ve Obezite Dergisi 4/1 (Nisan 2020), 1-6. https://doi.org/10.25048/tudod.687683.
JAMA Çinal H, Barın E. Tip 2 Diabetes Mellitusun Serbest Doku Nakli Başarısına Etkisi. Turk J Diab Obes. 2020;4:1–6.
MLA Çinal, Hakan ve Ensar Barın. “Tip 2 Diabetes Mellitusun Serbest Doku Nakli Başarısına Etkisi”. Türkiye Diyabet Ve Obezite Dergisi, c. 4, sy. 1, 2020, ss. 1-6, doi:10.25048/tudod.687683.
Vancouver Çinal H, Barın E. Tip 2 Diabetes Mellitusun Serbest Doku Nakli Başarısına Etkisi. Turk J Diab Obes. 2020;4(1):1-6.

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