Negatif Basınçlı Yara Tedavisinin Diyabetik Ayak Ülseri İyileşmesi Üzerine Etkileri: Tek Merkez deneyimi

Abstract

Amaç:Diyabetik hastaların %15’inde hayatının bir döneminde diyabetik ayak ülseri (DAÜ) gelişmekte olup, bunların %3 kadarı alt ekstremite amputasyonu ile sonuçlanmaktadır. Negatif basınçlı yara tedavisi (NBYT) modern, invaziv olmayan bir yardımcı tedavi sistemidir. Bu çalışmanın amacı DAÜ olan hastalarımızda NBYT’nin kullanımı ile ilgili tecrübelerimizi paylaşmak ve iyileşme üzerine olan etkilerini vurgulamaktır.  

Materyal ve metod:DAÜ nedeniyle kliniğe yatan ve tedavisi sırasında NBYT kullanılan hastalar retrospektif olarak incelendi.NBYT öncesi ve sonrası yaranın durumu daha önce çekilen fotoğraflara bakılarak değerlendirildi. Yaraların iyileşme durumu iki farklı doktorun gözlemine dayanarak “tamamen iyileşti”, “büyük oranda iyileşti”, “kısmen iyileşti”, “iyileşme olmadı” ve “kötüleşti” şeklinde sınıflandırıldı.

Bulgular:Çalışmamıza 8’i kadın 5’i erkek olmak üzere 13 hasta dâhil edildi. Tüm hastalarımıza 6 seans NBYT uygulandı. Hastaların yaş ortalaması 61,2±5,3 olup Wagner sınıfı beş hastada 2 iken, yedi hastada 3, bir hastada ise 4 olarak değerlendirilmiştir. Hastaların %54’ünde kısmen iyileşme, %39’unda büyük oranda iyileşme, %8’inde ise iyileşme olmadı.  NBYT ile birlikte C-reaktif protein (∆%:-88,9±70,3) (p<0.007), sedimentasyon hızı (∆%:-40,7±13,4) (p<0.005) ve beyaz kan hücrelerinde (∆%:-40.6±35,3) (p<0.007) anlamlı şekilde azalma olmuştur.

Sonuç: Klinik tecrübelerimize göre seçilmiş hastalarda NBYT etkin kullanımı ile DAÜ ülserlerinde kan akımının artışını sağlayarak, proinflamatuar belirteçleri ve eksüdayı azaltarak iyileşme oranlarının artırabileceğini ve ampütasyon oranlarının azalabileceğini düşünüyoruz.

Keywords

• Diyabetik Ayak,Negatif-Basınçlı Yara Terapisi,Yara iyileşmesi

The Effects of Negative Pressure Wound Therapy on Diabetic Foot Ulcer Healing: Single Center Experience

Abstract

Background:Diabetic foot ulcer (DFU) is developing in 15% of diabetic patients and 3% of them have lower extremity amputation. Negative pressure wound treatment (NPWT) is a modern, noninvasive adjunctive therapy system. The aim of this study is to share our experience with the use of NPWT in our patients with DFU and to emphasize its impact on healing.

 Methods:Patients who were admitted to the clinic due to DFU and who used NPWT during their treatment were retrospectively reviewed. The status of the injury before and after NPWT was evaluated by looking at the photographs taken before. The recovery status of the wounds was classified as "complete improvement", "large improvement", "partial improvement", "no improvement" and "worsening" based on the observation of two different specialists.

 Results:We enrolled 13 patients to our study, whom of 8 were female and 5 were male. All our patients were treated six NBYT sessions. The mean age of the patients was 61.2 ± 5.3 years and the Wagner class was 2 in five patients, 3 in seven patients and 4 in one patient. Fifty four % of the patients had partial improvement, 39% had a significant improvement, and 8% had no improvement. With NBYT, C-reactive protein (±%: - 88,9 ± 70,3) (p <0.007), sedimentation rate (±%: - 40,7 ± 13,4) (p <0.005) and white blood cells (hücr%: - 40.6 ± 35.3) (p <0.007) levels was significantly reduced.

Conclusions: According to our clinical experience we believe that effective use of NPWT will increase blood flow in DFU ulcers and may improve recovery rates by reducing proinflammatory markers and exudates and reduce amputation rates in selected patients.

 

Keywords

• Diabetic Foot,Negative-Pressure Wound Therapy,Wound Healing

References

1. 1. Lavery LA, Davis KE, Berriman SJ, Braun L, Nichols A, Kim PJ, et al. WHS guidelines update: Diabetic foot ulcer treatment guidelines. Wound Repair Regen. 2016 Jan;24(1):112–26.
2. 2. Boulton AJ, Vileikyte L, Ragnarson-Tennvall G, Apelqvist J. The global burden of diabetic foot disease. Lancet. 2005 Nov 12;366(9498):1719–24.
3. 3. Hutchinson A, McIntosh A, Feder G, Home PD, Young R. Clinical Guidelines for Type 2 Diabetes: Prevention and Management of Foot Problems. London, England: Royal College of General Practitioners; 2000.
4. 4. R.J. Hinchliffe, G. Andros, J. Apelqvist, K. Bakker, S. Friederichs, J. Lammer, et al. A systematic review of the effectiveness of revascularization of the ulcerated foot in patients with diabetes and peripheral arterial disease. Diabetes Metab Res Rev. 2012 Feb;28 Suppl 1:179-217.
5. 5. Söylemez MS, Özkan K, Kılıç B, Erinç S. Intermittent negative pressure wound therapy with instillation for the treatment of persistent periprosthetic hip infections: a report of two cases. Ther Clin Risk Manag. 2016;12:161–6.
6. 6. Mouës CM, van den Bemd GJCM, Heule F, Hovius SER. Comparing conventional gauze therapy to vacuum-assisted closure wound therapy: A prospective randomised trial. J Plast Reconstr Aesthetic Surg. 2007 Jun 1;60(6):672–81.
7. 7. Chariker ME, Jeter KF, Tintle TE BJ. Effective management of incisional and cutaneous fistulae with closed suction wound drainage. Vol. 34, Contemporary Surgery. 1989.
8. 8. Gupta S. The impact of evolving V.A.C ® Therapy technology on outcomes in wound care. Prologue. Int Wound J. 2012 Aug;9:iii–vii.

9. 9. Soares MO, Dumville JC, Ashby RL, Iglesias CP, Bojke L, Adderley U, et al. Methods to assess cost-effectiveness and value of further research when data are sparse: negative-pressure wound therapy for severe pressure ulcers. Med Decis Making. 2013 Apr 27;33(3):415–36.
10. 10. Karam RA, Rezk NA, Abdel Rahman TM, Al Saeed M. Effect of negative pressure wound therapy on molecular markers in diabetic foot ulcers. Gene. 2018 Aug 15;667:56-61.
11. 11. Yazdanpanah L, Nasiri M, Adarvishi S. Literature review on the management of diabetic foot ulcer. World J Diabetes. 2015;6(1):37-53.
12. 12. Apelqvist J. Diagnostics and treatment of the diabetic foot. Endocrine. 2012 Jun;41(3):384-97.
13. 13. Özkayın N, Erdem M, Tiftikcioğlu YÖ. Negatif basınçlı yaratedavisi ve ortopedi pratiğinde kullanımı. TOTBID Derg. 2017;16(3):203–8.
14. 14. Janis JE, Harrison B. Wound healing: part I. Basic science. Plast Reconstr Surg. 2014;133(2):199e-207e.
15. 15. DeFranzo AJ, Argenta LC, Marks MW, Molnar JA, David LR, Webb LX et al. The use of the vacuum-assisted closure therapy fortreatment of lower-extremity wound with exposed bone.Plast Reconstr Surg 2001;108:1184-1191.
16. 16. Blume PA, Walters J, Payne W, Ayala J, Lantis J. Comparison of negative pressure wound therapy using vacuumassisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers. Diabetes Care 2008; 31(4): 631-636.
17. 17. Frykberg RG, Williams DV. Negativepressure wound therapy and diabetic foot amputations. J Am Podiatr Assoc 2007; 97(5): 351-359.
18. 18. Lu F, Ogawa R, Nguyen DT, Chen B, Guo D, Helm DL, et al. Micro deformation of three-dimensional cultured fibroblasts induces gene expression and morphological changes. Ann Plast Surg 2011; 66: 296–300.
19. 19. Zhou M, Yu A, Wu G, Xia C, Hu X, Qi B. Role of different negative pressure values in the process of infected wounds healing treated by vacuum-assisted closure: an experimental study. Int Wound J 2012; 29: 1742–8.
20. 20. Liu, D; Zhang, L; Li, T; Wang, G; Du, H; Hou, H; Han, L; Tang, P, Negative-Pressure Wound Therapy Enhances Local Inflammatory Responses in Acute Infected Soft-Tissue Wound. Cell Biochemistry & Biophysics . Sep2014, Vol. 70 Issue 1, p539-547. 9p.
21. 21. Philbeck TE Jr, Whittington KT, Millsap MH, Briones RB, Wight DG. The clinical and cost effectiveness of externally applied negative pressure wound therapy in the treatment of wounds in home healthcare Medicare patients.Ostomy Wound Manage. 1999 Nov;45(11):41-50.
22. 22. Vaidhya N, Panchal A, Anchalia MM.A New Cost-effective Method of NPWT in Diabetic Foot Wound.Indian J Surg. 2015 Dec;77(Suppl 2):525-9.