Diyabetik Ayak Ülseri Hastalarında Major Amputasyonun Önlenmesi icin Bir Yöntem: Negatif Basınclı Yara Tedavisi ile Kombine İntralezyonel Epidermal Growth Faktör Kullanılması

Abstract

Amaç: Diyabetik ayak ülserleri (DAÜ), diyabetik hastaların %15’ini etkileyen bir sağlık problemidir. DAÜ, iş gücü kaybı, uzun süre hastanede yatış, maddi kayıp ve ayrıca alt ekstremite amputasyonu gibi nedenlerle hastaların yaşam kalitesinde düşüşe neden olmaktadır.

DAÜ’lerinin tedavisinde birçok yöntem uygulanmış fakat amputasyonların önüne geçilememiştir. Çalışmada major amputasyon (trans-metatarsal, tarsometatarsal, intertarsal ve diz altı amputasyonlar) kararı alınmış DAÜ hastalarına uyguladığımız tedavinin etkilerini sunmayı amaçladık.

Materyal ve Metod: Çalışmada, çeşitli sağlık kurumlarından hastanemize yönlendirilen ve majör amputasyon kararı alınmış fakat hastanemizde negatif basınçlı yara tedavisi (NBYT) ile kombine intralezyonel epidermal growth faktör (EGF) uygulanarak majör amputasyon yapılmadan tedavi edilen hastalar değerlendirildi. Hastalara EGF (haftada 3 kez veya cilt dokusu ile tam kapanma oluşuncaya kadar) ile kombine NBYT (haftada iki kez üç gün boyunca tam granulasyon dokusu oluşuncaya kadar) tedavileri uygulandı. Yara kapanması ve amputasyonu önlemeye yönelik tedavinin etkileri incelendi.

Bulgular: PEDİS sınıflamasına göre 32 hastanın 27’si (%84.3) grade 3, 5’i (%15.6) grade 4 DAÜ’ine sahipti. Hastaların 24’ünde (%75) infeksiyon mevcuttu. 22 hastada (%68.7) nekroz mevcuttu. Hastaların ortalama yara büyüklüğü 18 cm (10-25cm) idi. Uygulanan tedavi ile hastaların 27’ sinde (%84.3) tam cilt kapanması, 5 hastada (%15.6) yara zemininin tamamının granülasyon dokusu ile kapanmasısağlandı. Hastaların hiç birine major amputasyon yapılmadı. EGF ortalama 10 injeksiyon (7-12 injeksiyon) ile kombine NBYT ortalama 11 seans (8-13 seans) tedavisi ortalama 45 gün uygulandı. Yaklaşık bir yıllık takip süresi içinde üç hastada enfeksiyon gelişti ve medikal tedavi uygulandı.

Sonuç: Hastalarımız, major amputasyon önerilerek çeşitli hastanelerden yönlendirilen, major amputasyon riski yüksek olan hastalardı. Çalışmanın sonucunda, NBYT ve EGF’nin birlikte düzenli olarak uygulanması ile major

amputasyonların önlenebileceği kanısındayız.

Keywords

• diyabetik ayak,amputasyon,epidermal büyüme faktörü

A Method for Preventing Major Amputation in Patients with Diabetic Foot Ulcer: Negative-Pressure Wound Therapy Combined with Intralesional Epidermal Growth Factor

Abstract

Background:Diabetic foot ulcer (DFU) is a serious health problem affecting 15% of patients with diabetes mellitus. Diabetic foot ulcers cause a decrease in the quality of life of patients like job loss, long-term hospital stay, financial burden and also lower extremity amputation. Many methods have been applied to treat patients with DFU, but amputations have not been prevented. In this study, we presented patients who had been referred to us from various hospitals with a decision for major amputation, but treated by us using intralesional epidermal growth factor therapy (EGF) combined with negative-pressure wound therapy (NPWT) to prevent below-knee amputation.

 Methods:Patients who had been referred to us from various hospitals with a decision for major amputation, but treated by us using combined therapy to prevent below-knee amputation. The efficacy of treatment was assessed according to wound closure and amputation prevention.

 Results:According to Wagner's classification, 17 (51.6%) out of 33 patients were the grade 3, and 16 (48.4%) were the grade 4 patients. Major amputation was performed in one patient. Infection was present in 24 (75%) of the patients. Necrosis was present in 12 (37.5%) of these patients. The average wound size was 18 cm (10-25 cm). Complete skin closure was achieved in 27 patients (84.3%), and closure with 100% granulation was achieved in 5 patients (15.6%). None of the patients underwent major amputation. EGF+NPWT treatment were administered for 45 days on average. Infections were developed in three patients during one-year of follow-up approximately, and medical treatment was administered.

Conclusions: Our patients were in the high risk group for major amputation, which were referred from various hospitals with the recommendation of major amputation. We believe that the regular application of NPWT combined with EGF can prevent major amputations.

Keywords

• Diabetic foot,amputation,epidermal growth factor

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