Larval Terapi ve Kronik Yaralar

Abstract

İyileşmeyen yaralar günümüzde halk sağlığı için önemli bir sorun teşkil etmeye devam etmektedir ve antibiyotiğe dirençli mikroorganizmaların sebep olduğu cilt ve yumuşak doku enfeksiyon prevalansındaki artış gibi faktörler nedeniyle bugün ilişkili oldukları vaka sayıları hâlâ artmaktadır. Yara iyileşmesi, genellikle sorunsuz ilerleyen dört örtüşen fizyolojik aşamadan oluşur: homeostaz, iltihaplanma, çoğalma ve yeniden şekillenme / olgunlaşma. Bununla birlikte, iyileşmeyen yaralarda, iyileşme genellikle doku döküntülerinin uzaklaştırılması, lokal enfeksiyon ve / veya proteazlar gibi yıkıcı ürünlerin yara yatağından uzaklaştırılması ile alakalı olan enflamatuar fazda durur. Larval terapi (LT) umut verici tedavi yöntemlerinden biridir ve esas olarak nekrotize edilmiş dokularla beslenen yeşil şişe sineği Lucilia sericata'nın dezenfekte edilmiş larvalarının (kurtçukların) kullanılmasını içerir. LT'nin esas olarak üzerinde en fazla çalışmanın yayımlandığı debridmanın yanında  dezenfeksiyon ve büyüme uyarımı ile yara iyileşmesine yardımcı olduğu düşünülmektedir. Kronik yaraların tedavisi pahalıdır ve LT uygun maliyetli bir alternatif tedavi stratejisi sunar. Öte yandan, bakteriyel kaynaklı ülserlerin tedavisine ek olarak, mikotik enfeksiyon ve leishmaniasis ile ilişkili semptomlar için de kullanılabilir. Günümüzde LT, iyileşmeyen cilt ve yumuşak doku yaralarına karşı FDA onaylı bir terapidir. Bu derlemede, iyileşmeyen yaraların tedavisinde LT tarafından kullanılan etki mekanizmaları hakkındaki güncel literatürü özetledik.

Keywords

• Larval tedavi,debridman,dezenfeksiyon,büyüme uyarımı

Larval Theraphy and Chronic Wounds

Abstract

Non-healing wounds are still a burden to public health, and their prevalence in the population is increasing with the time due to antibiotic-resistant, microbe-associated skin and soft tissue infections as well as to the ever aging population. Wound healing is composed of four overlapping physiological phases which usually progress smoothly: homeostasis, inflammation, proliferation, and remodelling / maturing. In cases of nonhealing wounds, however, healing is usually trapped in inflammatory phase which is associated with the removal of tissue debris, local infection, and/or destructive products such as proteases from the wound bed. Maggot debridement therapy (MDT) is one of the promissing treatment modalities and it involves the use of disinfected larvae  (maggots) of the green bottle fly Lucilia sericata, which feed primarily on necrotized tissue. MDT is thought to aid wound healing mainly by debridement, disinfection, and growth stimulation, among which debridement is the best studied. Management of chronic wounds is expensive, and MDT provides a cost-effective alternative treatment. In addition to to the treatment of bacterial caused ulcers, it can also be used for symptoms associated with mycotic infection, and leishmaniasis. Today, MDT is a FDA-approved therapy against non-healing skin and soft tissue wounds. In this review we summarised the current literature regarding the action mechanisms used by MDT during the treatment of non-healing wounds.

Keywords

• Maggot therapy,debridement,disinfection,growth stimulation

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