| Abstract | Replantacija je metoda pri kojoj se dio tijela, najčešće prst, šaka ili ruka, koji su kompletno amputirani sa tijela, kirurški povrate na svoje anatomsko mjesto. Cilj replantacije je vratiti anatomsku, funkcionalnu i estetsku funkciju amputiranog dijela tijela, u ovom slučaju šake. Najčešće replantacije u području šake su replantacije jednog ili više prstiju odnosno dijelova jednog prsta ili dijelova više prstiju koji su zahvaćeni traumatskom amputacijom. Amputacija predstavlja veliki gubitak za pacijenta, kako fizički, tako i psihički pa je za liječenje takvih ozljeda potreban multidisciplinaran pristup. Odluka o tome hoće li se izvršiti replantacija ovisi o stanju prsta, odnosno amputiranog dijela šake, o razini ozljede te o stanju pacijenta. Replantacija se danas najčešće izvodi mikrokirurškom metodom koja zahtjeva kirurški mikroskop, iskusnog i vještog kirurga te obučeno osoblje. Operacija započinje lociranjem i označavanjem krvnih žila i živaca. Slijedi debridman pri čemu se odstranjuju svi nevitalni i zagađeni djelovi amputata i bataljka. Tada slijedi osteosinteza te rekonstrukcija ozlijeđenih tetiva. Nakon toga se pristupa najosjetljivijem dijelu operacije, rekonstrukciji krvnih žila i živaca. Na kraju operacije se zatvara rana odnosno koža. Da bi se povećale šanse za uspješnu operaciju potrebno ju je učiniti što prije, najbolje unutar nekoliko sati od amputacije. Važnu ulogu ima i način zbrinjavanja amputata, prije svega u sterilnim i hladnim uvjetima, ali pazeći da ne dođe do smrzavanja amputata ili/i nastanka ozeblina. Do traumatskih amputacija prstiju i šake najčešće dolazi kod rukovanja poljoprivrednim ili građevinskim alatom te alatom koji se koristi u drvnoj industriji, zatim u prometnim nesrećama te kod nepravilnog rukovanja vatrenim oružjem. Danas su replantacijske procedure postale duboko ukorijenjene u struku. O uspješnim operacijama gotovo uvijek se piše u popularnim medijima pa je to dovelo do toga da, bez obzira na to kako velik i kakvog stanja bio amputat, pacijent dolazi u zdravstvenu ustanovu s nadom da će njegov amputirani dio tijela biti uspješno replantiran. |
| Abstract (english) | Replantation is a method in which a part of the body, usually the finger, hand or arm, after being completely amputated from the body, is surgically reattached to its anatomical site. The purpose of replantation is to restore the anatomical, functional and aesthetic function of the amputated body part, in this case the hand. The most common replantations in the area of the hand include replantations of one or more fingers or parts of one finger or parts of multiple fingers that are affected by traumatic amputation. Amputation is a major loss for the patient, both physically and mentally, so a multidisciplinary approach is required to treat such injuries. The decision to perform a replantation depends on the condition of the finger or the amputated part of the hand, the level of injury and the condition of the patient. Today, the most common way of replantation is the microsurgical method, which requires a surgical microscope, an experienced and skilled surgeon and trained staff. Operation begins with location and tagging of the vessels and nerves. Afterwards, debridement in which all nonviable and contaminated tissue is removed from amputated part and amputatation stump. Next step in operation is osteosynthesis and reconstruction of the injured tendon. Then, surgeon approaches to the most sensitive part of surgery, reconstruction of blood vessels and nerves. At the end of the operation skin closure is applied. In order to increase the chances of successful surgery it should be done as soon as possible, preferably within a few hours of the amputation. Emergency care of amputated part plays an important role. It should be preserved in sterile and cold conditions, but making sure that there is no freezing or/and cold injuries of amputated part. Traumatic amputations of fingers and hand are most commonly experienced when handling agricultural or construction tools, tools used in the wood industry, traffic accidents and improper handling of firearms. Today, replantation procedures have become deeply entrenched in the profession. Successful surgeries are almost always reported in the popular media, and this has led to the fact that, no matter how large and what the condition of the amputated part is, the patient comes to a health care facility with the hope that amputated part of his body will be successfully replanted. |
