Larval Terapi ve Kronik Yaralar

Year 2019, GETAT Special Issue, 55 - 60, 30.09.2019

Umut Gazi Ayşegül Taylan Özkan Kosta Mumcuoğlu

https://doi.org/10.34084/bshr.536577

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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