DİABETİK AYAK ÜLSERLİ HASTADA MAGGOT DEBRİDMAN TEDAVİSİNE AĞRISIZ YAKLAŞIM: OLGU SUNUMU

Year 2018, Volume: 4 Issue: 1, 1 - 7, 14.05.2018

Nehir Uçar Fatma Selcan Kuş Tüzün Fırat

Abstract

Diyabetik ayak ülserleri, morbidite, mortalite ve ampütasyonla sonuçlanma oranları açısından diyabetin ciddi komplikasyonlarından biridir. Nöropati, periferik arter hastalığı ve travma gibi nedenlerle oluşabilmektedir. Tedavisinde; konvansiyonel yara bakımı, antibiyoterapi hiperglisemi tedavisi, debridman ve rekonstrüktif cerrahi girişimleri uygulanırken, bunların yetersiz kaldığı durumlarda Maggot Debridman Tedavisi (MDT) tamamlayıcı tedavi seçeneği olarak kullanılabilmektedir. MDT, yeşil şişe camı sineği olarak adlandırılan Lucilia sericata larvalarının biyodebridman amaçlı kullanıldığı bir tedavi yöntemidir. Larvalar ağızlarında bulunan çengeller yardımıyla nekrotik dokuları küçük partiküllere ayırırlar ve yaraya nekroze materyali eriten tükrük enzimleri salgılayarak debridman sağlarlar. Antimikrobiyal ve kan dolaşımını artırma özellikleriyle iyileşmeyi hızlandırıcı etkiler sağlarlar. Bilinen yan etkileri gıdıklanma hissi, kanama ve ağrıdır. Bazı durumlarda ağrı, tedaviyi sonlandırma durumunda kalınacak kadar dayanılmaz düzeylere ulaşabilmektedir. Ağrının sağaltımına yönelik oral analjezikler, epidural anestezi, periferik sinir blokajı gibi tedavi modaliteleri kullanılmaktadır. Bu olgu sunumunda konvansiyonel yara tedavisine dirençli grade 2 diyabetik ayak yarası olan hastada MDT yapılması planlanmış ve oluşan ağrının sağaltımında Konvansiyonel TENS uygulaması yapılarak ağrı düzeylerinin değerlendirilmesi ve sunulması amaçlanmıştır.

Keywords

Maggot debridman tedavisi, Transkutaneal elektrik sinir stimülasyonu (TENS), Diyabetik ayak, Ağrı, ayak ülseri

PAİNLESS APPROACH TO MAGGOT DEBRİDEMENT THERAPY IN PATİENT WİTH DİABETİC FOOT ULCER: A CASE REPORT

Abstract

Diabetic foot ulcers (DPU) are one of the serious complications of diabetes in terms of rates of morbidity, mortality and amputation. DPU develop from underlying neuropathy, peripheral arterial disease and trauma. Conventional wound care, antibiotherapy, hyperglycaemia treatment, debridement and reconstructive surgery are used for treatment. In cases where these are inadequate, Maggot Debridement Therapy (MDT) can be used as a complementary treatment option. MDT is a method of treatment for biodegradation of the larvae of Lucilia sericata, which are called green bottle glass strains. Larvae found necrotic tissue with the help of hooks in their mouths and they allow small particles to carve wound debridement of necrotic material melted by the salivary enzymes secreted. They have antimicrobial and blood circulation enhancing properties. So they accelerate recovery. Known side effects are tickling, bleeding and pain. In some cases, pain can reach unbearable levels and the treatment may have to be terminated. Treatment modalities such as oral analgesics, epidural anesthesia, peripheral nerve blockade for the treatment of pain are used. In this case report, MDT was planned to be done in a patient with grade 2 diabetic foot wound resistant to conventional wound healing and it was aimed to evaluate and present pain levels by applying Conventional TENS to the treatment of pain.

Keywords

Maggot debridement therapy, Transcuteneal electrical nerve stimulation (TENS), Diabetic feet, Foot ulcer, Pain

References

• 1. Reiber GE, Pecoraro RE, Koepsell TD. Risk Factors for Amputation in Patients with Diabetes MellitusA Case-Control Study. Annals of internal medicine. 1992;117(2):97-105.
• 2. Leibson CL, Ransom JE, Olson W, Zimmerman BR, O’Fallon WM, Palumbo PJ. Peripheral arterial disease, diabetes, and mortality. Diabetes care. 2004;27(12):2843-2849.
• 3. Reiber GE, Boyko EJ, Smith DG. Lower extremity foot ulcers and amputations in diabetes. Diabetes in America. 1995;2:409-427.
• 4. Baer WS. The treatment of chronic osteomyelitis with the maggot (larva of the blow fly). JBJS. 1931;13(3):438-475.
• 5. Sherman RA, Pechter EA. Maggot therapy: a review of the therapeutic applications of fly larvae in human medicine, especially for treating osteomyelitis. Medical and veterinary entomology. 1988;2(3):225-230.
• 6. Pechter EA, Sherman RA. Maggot therapy: the surgical metamorphosis. Plastic and Reconstructive Surgery. 1983;72(4):567-570.
• 7. Mumcuoglu K, Davidson E, Avidan A, Gilead L. Pain related to maggot debridement therapy. journal of wound care. 2012;21(8).
• 8. Bexfield A, Nigam Y, Thomas S, Ratcliffe NA. Detection and partial characterisation of two antibacterial factors from the excretions/secretions of the medicinal maggot Lucilia sericata and their activity against methicillin-resistant Staphylococcus aureus (MRSA). Microbes and Infection. 2004;6(14):1297-1304.
• 9. Chambers L, Woodrow S, Brown A, et al. Degradation of extracellular matrix components by defined proteinases from the greenbottle larva Lucilia sericata used for the clinical debridement of non‐healing wounds. British Journal of Dermatology. 2003;148(1):14-23.
• 10. Steenvoorde P, Budding T, Oskam J. Determining pain levels in patients treated with maggot debridement therapy. Journal of Wound Care. 2005;14(10):485-488.
• 11. Thomas S, Wynn K, Fowler T, Jones M. The effect of containment on the properties of sterile maggots. British journal of nursing. 2002;11(Sup2):S21-S28.
• 12. Gilead L, Mumcuoglu K, Ingber A. The use of maggot debridement therapy in the treatment of chronic wounds in hospitalised and ambulatory patients. journal of wound care. 2012;21(2).
• 13. Slovenkai MP. Foot problems in diabetes. Medical Clinics of North America. 1998;82(4):949-971.
• 14. Ramsey SD, Newton K, Blough D, et al. Incidence, outcomes, and cost of foot ulcers in patients with diabetes. Diabetes care. 1999;22(3):382-387.