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YARA İYİLEŞMESİ, BAKIMI VE TEDAVİSİ

Year 2021, Volume: 54 Issue: 2, 341 - 351, 31.08.2021
https://doi.org/10.20492/aeahtd.931499

Abstract

Dokuların bütünlüğünün ve işleyişlerinin bozul¬masına yara adı verilir. Bu işleyişin yeniden sağlanmasına ve doku bütünlüğünün yeniden kazanılmasına ise yara iyileşmesi adı verilir.
Akut yara, travmatik veya cerrahi olarak oluşan, genellikle iyileşme sürecine iyi yanıt veren, temiz yaralardır. Kronik yara ise geç veya güç iyileşen ya da iyileşmeyen yaralardır. Kronik yaraların en sık sebepleri ise diyabetik ayak, venöz ülser, basınç yarası, arteriyel yetmezlik yarası ve radyasyon hasarı olarak sıralanabilir. Yara iyileşmesinde birbirinden ayrı ancak iç içe geçmiş üç basamağı bulunmaktadır: İnflamasyon fazı, proliferasyon fazı, olgunlaşma ve yeniden şekillenme fazı. Yara iyileşme sürecinde pek çok sitokin de etkin rol oynar. PDGF (Platelet Derived Growth Factor), TNF (Tumor Necrosis Factor), TGF-beta (Transforming Growth Factor-beta) fibroblast göçünü sağlar ve bu fibroblastlar, yarayı bir arada tutan pıhtıdan daha kuvvetli bir yapı oluşturur. Geçici matriks; fibrin, fibronektin ve kollajen tip 3’ten oluşurken sekonder matriks Kolajen tip 1 ile oluşur. 2002 yılında yara uzlaşma grubu yara iyileşmesinde önemli kriterleri belirlemişlerdir. TIME başlığında belirlenen bu kriterler; T (Tissue: doku özellikleri), I (İnfection: enfeksiyon), M (moisture: doku nemliliği) ve E (Edge: doku kenar özellikleri) olarak tanımlanmıştır. Yara örtüleri beş temel kategoride incelenebilir: Filmler, köpükler, hidrokolloid, aljinat ve hidrojeller. Son yıllarda biyomühendislik metodları ile üretilen teknolojik ürünler yara tedavisinde kullanılmaya başlanmıştır. Bu ürünler giderek canlı deriyi daha iyi taklit eder hale gelmektedir. Bununla birlikte gümüş gibi yüzlerce yıldır kullanılmakta olan ürünler de halen tedavideki değerlerini korumaktadır. Bu makalede yaranın oluşum mekanizmaları, evrelendirilmesi, bakım, tedavi ve kayıt tutulmasındaki önemli noktalar vurgulanmıştır. Yara tedavisi zor, sabır gerektiren ve multidisipliner yaklaşımın gerekli olduğu bir takım çalışmasıdır.

Supporting Institution

yok

Project Number

yok

Thanks

Teşekkür ederim

References

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  • Li J, Chen J, Kirsner R. Pathophysiology of acute wound healing. Clinics in Dermatology. 2007; 25, 9–18. Han G, Ceilley R. Chronic Wound Healing: A Review of Current Management and Treatments. Adv Ther. 2017; 34: 599–610.
  • Broughton G 2nd, Janis JE, Attinger CE. The basic science of wound healing. Plast Reconstr Surg. 2006; 117:12S-34S.
  • Pappas PJ, You R, Rameshwar P et al. Dermal tissue fibrosis in patients with chronic venous insufficiency is associated with increased transforming growth factor-beta1 gene expression and protein production. J Vasc Surg. 1999; 30: 1129-45.
  • Raffetto JD, Ligi D, Maniscalco R et al. Why Venous Leg Ulcers Have Difficulty Healing: Overview on Pathophysiology, Clinical Consequences, and Treatment. J Clin Med. 2020; 10: 29.
  • Wang PH, Huang BS, Horng HC et al. Wound healing. J Chin Med Assoc. 2018; 81: 94-101.
  • Powers JG, Higham C, Broussard K et al. Wound healing and treating wounds. Chronic wound care and management. J Am Acad Dermatol. 2016; 74: 607-25.
  • Aktaş Ş. “Kronik yara tipleri”. 2. Uygulamalı yara bakım kursu; 23-25 Ekim, 2019, Çanakkale/Türkiye.
  • Jamal M, Ahmad W, Andleeb S et al. Bacterial biofilm and associated infections. J Chin Med Assoc. 2018; 81: 7-11.
  • Williams DL, Kawaguchi B, Taylor NB et al. In vivo efficacy of a unique first-in-class antibiofilm antibiotic for biofilm-related wound infections caused by Acinetobacter baumannii. Biofilm. 2020; 17:100032.
  • Parsak CK, Sakman G, Çelik Ü. Yara İyileşmesi, Yara Bakımı ve Komplikasyonları. Arşiv. 2007; 16: 145.
  • Evans DC, Corkins MR, Malone A et al. The Use of Visceral Proteins as Nutrition Markers: An ASPEN Position Paper. Nutr Clin Pract. 2021; 36: 22-28.
  • Dumlu EG, Bozkurt B, Tokaç M ve ark. Cerrahi Hastalarda Malnütrisyon ve Beslenme Desteği. Ankara Medical Journal. 2013; 13: 33-39.
  • Stechmiller JK. Understanding the Role of Nutrition and Wound Healing. Nutr Clin Pract. 2010; 25: 61-8.
  • Barchitta M, Maugeri A, Favara G, et al. Nutrition and Wound Healing: An Overview Focusing on the Beneficial Effects of Curcumin. Int J Mol Sci. 2019; 20: 1119.
  • Bowers S, Franco E. Chronic Wounds: Evaluation and Management. Am Fam Physician. 2020; 101: 159-166.
  • Keast DH, Bowering CK, Evans AW et al. MEASURE: A proposed assessment framework for developing best practice recommendations for wound assessment. Wound Repair Regen. 2004; 12: 1-17.
  • Edsberg LE, Black JM, Goldberg M et al. Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System. J Wound Ostomy Continence Nurs. 2016; 43: 585-597.
  • Latimer S, Shaw J, Hunt T et al. Kennedy Terminal Ulcers: A Scoping Review. J Hosp Palliat Nurs. 2019; 21: 257-263.
  • Kumara DU, Fernando SS, Kottahachchi J, et al. Evaluation of bactericidal effect of three antiseptics on bacteria isolated from wounds. J Wound Care. 2015; 24: 5-10.
  • Mama M, Abdissa A, Sewunet T. Antimicrobial susceptibility pattern of bacterial isolates from wound infection and their sensitivity to alternative topical agents at Jimma University Specialized Hospital, South-West Ethiopia. Ann Clin Microbiol Antimicrob. 2014; 13:14.
  • Lipsky BA, Hoey C. Topical antimicrobial therapy for treating chronic wounds. Clin Infect Dis. 2009; 49:1541-1549.
  • Kaya Tİ, Bostancı S. Sentetik Örtüler. T Klin J Dermatol. 1997, 7: 65-73.
  • Dunn LJ, Wilson P. Evaluating of permeability of hydrocolloid dressings to multi-resistant Staphylococcus aureus. Pharm J. 1990; 248: 50.
  • Witkowski JA, Parish LL. Rational approach to wound care. Int J Dermatol. 1992; 31: 27-28.
  • Kaya Tİ. Doku Mühendisliği. Turkiye Klinikleri J Int Med Sci. 2005; 1: 165-9.
  • Kranke P, Bennett MH, Martyn-St James M, Schnabel A, Debus SE. Hyperbaric oxygen therapy for chronic wounds. Cochrane Database Syst Rev. 2012; 4: CD004123.
  • Barwell JR, Davies CE, Deacon J, et al. Comparison of surgery and compression with compression alone in chronic venous ulceration (ESCHAR study): randomised controlled trial. Lancet. 2004; 363: 1854-1859.
  • Jull AB, Arroll B, Parag V, Waters J. Pentoxifylline for treating venous leg ulcers. Cochrane Database Syst Rev. 2012;12: CD001733.
  • Dissemond J, Böttrich JG, Braunwarth H et al. Evidence for silver in wound care - meta-analysis of clinical studies from 2000-2015. J Dtsch Dermatol Ges. 2017; 15: 524-535.
  • Kostenko V, Lyczak J, Turner K et al. Impact of silvercontaining wound dressings on bacterial biofilm viability and susceptibility to antibiotics during prolonged treatment. Antimicrob Agents Chemother. 2010; 54: 5120-31.
Year 2021, Volume: 54 Issue: 2, 341 - 351, 31.08.2021
https://doi.org/10.20492/aeahtd.931499

Abstract

Project Number

yok

References

  • Aktaş Ş. Kronik yarada lokal faktörler ve yardımcı tedaviler. ANKEM Derg. 2012; 26: 217-222.
  • Li J, Chen J, Kirsner R. Pathophysiology of acute wound healing. Clinics in Dermatology. 2007; 25, 9–18. Han G, Ceilley R. Chronic Wound Healing: A Review of Current Management and Treatments. Adv Ther. 2017; 34: 599–610.
  • Broughton G 2nd, Janis JE, Attinger CE. The basic science of wound healing. Plast Reconstr Surg. 2006; 117:12S-34S.
  • Pappas PJ, You R, Rameshwar P et al. Dermal tissue fibrosis in patients with chronic venous insufficiency is associated with increased transforming growth factor-beta1 gene expression and protein production. J Vasc Surg. 1999; 30: 1129-45.
  • Raffetto JD, Ligi D, Maniscalco R et al. Why Venous Leg Ulcers Have Difficulty Healing: Overview on Pathophysiology, Clinical Consequences, and Treatment. J Clin Med. 2020; 10: 29.
  • Wang PH, Huang BS, Horng HC et al. Wound healing. J Chin Med Assoc. 2018; 81: 94-101.
  • Powers JG, Higham C, Broussard K et al. Wound healing and treating wounds. Chronic wound care and management. J Am Acad Dermatol. 2016; 74: 607-25.
  • Aktaş Ş. “Kronik yara tipleri”. 2. Uygulamalı yara bakım kursu; 23-25 Ekim, 2019, Çanakkale/Türkiye.
  • Jamal M, Ahmad W, Andleeb S et al. Bacterial biofilm and associated infections. J Chin Med Assoc. 2018; 81: 7-11.
  • Williams DL, Kawaguchi B, Taylor NB et al. In vivo efficacy of a unique first-in-class antibiofilm antibiotic for biofilm-related wound infections caused by Acinetobacter baumannii. Biofilm. 2020; 17:100032.
  • Parsak CK, Sakman G, Çelik Ü. Yara İyileşmesi, Yara Bakımı ve Komplikasyonları. Arşiv. 2007; 16: 145.
  • Evans DC, Corkins MR, Malone A et al. The Use of Visceral Proteins as Nutrition Markers: An ASPEN Position Paper. Nutr Clin Pract. 2021; 36: 22-28.
  • Dumlu EG, Bozkurt B, Tokaç M ve ark. Cerrahi Hastalarda Malnütrisyon ve Beslenme Desteği. Ankara Medical Journal. 2013; 13: 33-39.
  • Stechmiller JK. Understanding the Role of Nutrition and Wound Healing. Nutr Clin Pract. 2010; 25: 61-8.
  • Barchitta M, Maugeri A, Favara G, et al. Nutrition and Wound Healing: An Overview Focusing on the Beneficial Effects of Curcumin. Int J Mol Sci. 2019; 20: 1119.
  • Bowers S, Franco E. Chronic Wounds: Evaluation and Management. Am Fam Physician. 2020; 101: 159-166.
  • Keast DH, Bowering CK, Evans AW et al. MEASURE: A proposed assessment framework for developing best practice recommendations for wound assessment. Wound Repair Regen. 2004; 12: 1-17.
  • Edsberg LE, Black JM, Goldberg M et al. Revised National Pressure Ulcer Advisory Panel Pressure Injury Staging System. J Wound Ostomy Continence Nurs. 2016; 43: 585-597.
  • Latimer S, Shaw J, Hunt T et al. Kennedy Terminal Ulcers: A Scoping Review. J Hosp Palliat Nurs. 2019; 21: 257-263.
  • Kumara DU, Fernando SS, Kottahachchi J, et al. Evaluation of bactericidal effect of three antiseptics on bacteria isolated from wounds. J Wound Care. 2015; 24: 5-10.
  • Mama M, Abdissa A, Sewunet T. Antimicrobial susceptibility pattern of bacterial isolates from wound infection and their sensitivity to alternative topical agents at Jimma University Specialized Hospital, South-West Ethiopia. Ann Clin Microbiol Antimicrob. 2014; 13:14.
  • Lipsky BA, Hoey C. Topical antimicrobial therapy for treating chronic wounds. Clin Infect Dis. 2009; 49:1541-1549.
  • Kaya Tİ, Bostancı S. Sentetik Örtüler. T Klin J Dermatol. 1997, 7: 65-73.
  • Dunn LJ, Wilson P. Evaluating of permeability of hydrocolloid dressings to multi-resistant Staphylococcus aureus. Pharm J. 1990; 248: 50.
  • Witkowski JA, Parish LL. Rational approach to wound care. Int J Dermatol. 1992; 31: 27-28.
  • Kaya Tİ. Doku Mühendisliği. Turkiye Klinikleri J Int Med Sci. 2005; 1: 165-9.
  • Kranke P, Bennett MH, Martyn-St James M, Schnabel A, Debus SE. Hyperbaric oxygen therapy for chronic wounds. Cochrane Database Syst Rev. 2012; 4: CD004123.
  • Barwell JR, Davies CE, Deacon J, et al. Comparison of surgery and compression with compression alone in chronic venous ulceration (ESCHAR study): randomised controlled trial. Lancet. 2004; 363: 1854-1859.
  • Jull AB, Arroll B, Parag V, Waters J. Pentoxifylline for treating venous leg ulcers. Cochrane Database Syst Rev. 2012;12: CD001733.
  • Dissemond J, Böttrich JG, Braunwarth H et al. Evidence for silver in wound care - meta-analysis of clinical studies from 2000-2015. J Dtsch Dermatol Ges. 2017; 15: 524-535.
  • Kostenko V, Lyczak J, Turner K et al. Impact of silvercontaining wound dressings on bacterial biofilm viability and susceptibility to antibiotics during prolonged treatment. Antimicrob Agents Chemother. 2010; 54: 5120-31.
There are 31 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Review
Authors

Pınar Öztaş 0000-0002-8902-9170

Project Number yok
Publication Date August 31, 2021
Submission Date May 2, 2021
Published in Issue Year 2021 Volume: 54 Issue: 2

Cite

AMA Öztaş P. YARA İYİLEŞMESİ, BAKIMI VE TEDAVİSİ. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi. August 2021;54(2):341-351. doi:10.20492/aeahtd.931499