Alt Ekstremitede Cerrahi Sonrası Kasık Bölgesi Yaraları ve Sekonder Lenfatik Problemlerin Tedavisi

Abstract

Amaç: Kapanması geciken kasık bölgesi yaraları ve sekonder lenfatik problemler hastanede yatış sürelerini uzatmaktadır. Femoral damarlardan girişim, kalp ve periferik vasküler cerrahi için en sık kullanılan erişim yollarındandır. Bu çalışmada femoral damarlara cerrahi girişimler sonrasında iyileşmeyen kasık yaraları ve alt ekstremitedeki sekonder lenfatik problemlerde vakum yardımlı kapatma (VAK) tedavilerinin iyileşme süresine etkisini araştırdık. Gereç ve Yöntem: Retrospektif özellikteki çalışmada, son iki yılda, kliniğimizdeki majör vasküler cerrahilerde femoral damarlara erişim için kasık insizyonu yapılmış 335 hasta dosyası tarama yapılarak incelenmiştir. Bu hastaların 32’sinde (%9,5) iyileşmeyen kasık yarası ve sekonder lenfore, lenfosel veya lenfödem gibi lenfatik problemler gözlenmiştir. İlk 10 günde yara iyileşmesi yetersiz olan ve ilişkili lenfatik problem gözlenen hastalara öncelikle femoral insizyonun cerrahi debridmanı, lenfatiklerin ligasyonu, lenfoselin çıkarılması uygulanmıştır. Sonrasında 16 hastada yalnızca cerrahi debridman ve yara bakımı (Grup 1) kullanılırken, 16 hastada ek olarak vakum yardımlı kapatma (VAC) cihazı da kullanılmıştır (Grup 2). Her iki gruptaki demografik veriler, risk faktörleri ve yara iyileşmesi için geçen tedavi süreleri karşılaştırılmıştır. Bulgular: Gruplar arasında demografik özellikler açısından fark bulunmamıştır. Eşlik eden hastalıklar karşılaştırıldığında gruplar arasında fark olmadığı saptandı. Lenfore için etyolojik risk faktörleri kaşılaştırıldığında; tekrarlayan operasyonlar, femoral bölgede prostetik greft bulunması, hipoalbuminemi açısından fark olmadığı ancak VAC kullanılan grupta obesitenin daha fazla olduğu gözlendi. Yara iyileşme süresi Grup 2 de daha kısaydı ancak istatistiksel olarak anlamlı değildi. Sonuç: Cerrahi sonrası sekonder lenfödem ve kasık yarası iyileşme probleminin temel tedavisi debridman ve optimal cerrahi yara bakımıdır. VAC kullanımı, alt ekstremitede lenfatik akımın drenajını arttırır ve granülasyon dokusu oluşumu ile yara tabanını güçlendirir. VAC tedavisi, alt ekstremite femoral yaralarının ve sekonder lenfatik problemlerin iyileşmesini hızlandırmak için etkili bir tedavi seçeneği olabilir.

Keywords

• Lenfore,sekonder lenfödem

Management of the Postsurgical Lower Extremity Groin Wounds and Secondary Lymphatic Disorders

Abstract

Background and Aims: Delayed wound closure and secondary lymphatic problems prolong hospital stay. The femoral exposure is one of the most commonly used access way for the cardiac and peripheral vascular surgery. In this study, we investigated the effect of vacuum-assisted closure (VAK) treatments on the recovery time in non-healing groin wounds after femoral vessel exposure and secondary lymphatic problems in the lower extremity. Materials and Methods: In this retrospective study, we examined 335 patients hospital records who had groin incision for access to femoral vessels in major vascular surgeries performed in our clinic in the last two years. We observed non healing inguinal wounds and lymphatic problems such as secondary lymphorrhea, lymphocele or lymphedema in 32 of these patiens (9.5%). The patients with insufficient wound healing in the first 10 days postoperatively and associated lymphatic disorders were primarily treated with surgical debridement of the femoral incision, ligation of lymphatics and removal of lymphocele. Afterwards, only surgical debridement and wound care was used in 16 patients (Group 1) and additional to these therapies vacuum assisted closure (VAC) device used in 16 patients (Group 2). Demographic data, risk factors and duration of the treatment for wound healing in both groups were compared. Results: There was no difference in demographic characteristics between groups. When comorbid diseases were compared, there were no difference between the groups. There was no difference with regard to etiological risk factors for wound site complications such as prosthetic grafts in the femoral region, hypoalbuminemia, recurrent operations. But there was more obese patients in Group 2. The mean wound healing time was shorter in Group 2 but it was not statistically significant. Conclusion: The basic treatment of postsurgical secondary lymphedema and groin wound healing problem is debridement and optimal surgical wound care. VAC usage enhances the drainage of the lymphatic flow of lower extremity and strengthen wound base by granulation tissue formation. VAC therapy may be an effective therapeutic option to accelerate healing of lower extremity femoral wounds and secondary lymphedema.

Keywords

• Lymphorrhea,Secondary lymphedema,Vacuum assisted closure

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