Kronik Bacak Yaralarına Çok Yönlü Bir Bakış: Tersiyer Merkez Deneyimi

Year 2025, Volume: 26 Issue: 3, 350 - 355, 22.09.2025

Mustafa Akyürek , Berkay Kaya Anıl Bolca

https://doi.org/10.69601/meandrosmdj.1738164

Abstract

Amaç:
Kronik alt ekstremite yaraları, etiyolojilerinin çok faktörlü olması, iyileşme sürecinin uzunluğu ve sosyoekonomik yükü nedeniyle giderek artan bir halk sağlığı sorunudur. Bu çalışmada, üçüncü basamak yara bakım merkezimize başvuran hastaların demografik özellikleri, altta yatan nedenleri ve tedavi süreçlerinin analiz edilmesi amaçlandı.

Gereç ve Yöntem:
Mayıs 2014 ile Ocak 2022 tarihleri arasında kronik alt ekstremite yarası tanısıyla kliniğimize başvuran 783 hastanın dosyaları retrospektif olarak incelendi. Hastaların demografik verileri, eşlik eden hastalıklar, yara etiyolojileri, mikrobiyolojik ve histopatolojik bulguları, uygulanan tedavi yöntemleri ve takip süreçleri değerlendirildi. Ortopedik cerrahi sonrası travmatik nedenlerle oluşan yaralar ve takipsiz kalan hastalar çalışma dışı bırakıldı.

Bulgular:
Hastaların ortalama yaşı 62,1 olup, %32’si kadındı. En sık yara etiyolojisi diyabet (%68,6) olup, bunu diyabetik olmayan hastalarda görülen periferik arter hastalığı (%21), venöz yetmezlik (%5,6) ve staz dermatiti (%3) izledi. Daha nadir nedenler arasında piyoderma gangrenozum, topikal ilaç reaksiyonları ve spina bifida gibi nörolojik hastalıklar yer aldı. Diyabetik ayak hastalarının %55’i Wagner evre 1–2 iken, %45’i evre 3 ve üzerindeydi. Hastaların %74’ü aktif sigara içicisiydi ve bu grup daha uzun tedavi süresi gerektirdi. Yaraların %58’i greftleme ile, %21’i sekonder iyileşme ile, %12’si amputasyonla tedavi edildi. %15 hastada negatif basınçlı yara kapama tedavisi uygulandı. En sık izole edilen mikroorganizmalar Staphylococcus aureus (%28), Enterococcus spp. (%20) ve Pseudomonas spp. (%16) idi. Altı hastada biyopsi ile piyoderma gangrenozum tanısı doğrulandı.

Sonuç:
Diyabet ve periferik arter hastalığı, kronik alt ekstremite yaralarının en sık nedenleri olmaya devam etmektedir. Sigara kullanımının yaygınlığı, geç başvuru ve ileri evre Wagner sınıflamaları, multidisipliner erken müdahalenin ve standart tedavi algoritmalarının gerekliliğini vurgulamaktadır. Negatif basınçlı yara kapama tedavisinin uygun olgularda faydalı olduğu, ancak iskemik ekstremitelerde dikkatli kullanılması gerektiği görülmüştür. Mikrobiyolojik izlem, antibiyotik direnci ve sistemik enfeksiyon açısından önem arz etmektedir. Non-enfeksiyöz nedenlerin (örneğin piyoderma gangrenozum) da akılda tutulması, doğru tanı ve tedaviye ulaşmayı kolaylaştıracaktır. Ulusal düzeyde yapılacak çok merkezli, prospektif çalışmalar; kronik yara yükünü azaltmaya yönelik kanıta dayalı stratejilerin geliştirilmesini sağlayacaktır.

Keywords

Diyabetik ayak , Yara iyileşmesi , Ayak ülseri , Ayak yaralanması

Ethical Statement

Beyanım yoktur

Supporting Institution

yok

Thanks

Teşekkür ederiz.

Multifactorial Insights into Chronic Leg Ulcers: Experience from a Tertiary Wound Care Center

Abstract

Objective:
To analyze the demographic features, etiological factors, clinical profiles, and treatment outcomes of patients with chronic lower extremity wounds managed at a tertiary wound care center.

Materials and Methods
A retrospective review was conducted on 783 patients treated for chronic lower extremity wounds between May 2014 and January 2022. Patient demographics, comorbidities, wound etiology, microbiological data, histopathological findings, and treatment modalities were evaluated. Patients with trauma-related wounds or incomplete follow-up were excluded.

Results:
The mean age was 62.1 years, with females comprising 32% of the cohort. Diabetes was the leading cause of chronic lower extremity wounds (68.6%), followed by PAD in non-diabetic patients (21%), venous insufficiency (5.6%), and stasis dermatitis (3%). Pyoderma gangrenosum and drug reactions represented less common etiologies. Among diabetic foot ulcer patients, 55% were Wagner Grade 1–2, while 45% were Grade 3 or higher. Smoking prevalence was 74%, and associated with longer healing times. Wound closure was achieved via skin grafting in 58% of cases, secondary intention in 21%, and amputation in 12%. Negative pressure wound therapy was employed in 15% of cases. Staphylococcus aureus, Enterococcus spp., and Pseudomonas spp. were the most commonly isolated pathogens. Pyoderma gangrenosum was histologically confirmed in 6 patients.

Conclusion:
Diabetes and PAD remain the predominant etiologies of chronic lower extremity wounds. High smoking prevalence, delayed referrals, and advanced Wagner grades at presentation underscore the importance of early multidisciplinary intervention and standardized treatment protocols. The judicious use of negative pressure wound therapy, tailored antibiotic stewardship, and consideration of non-infectious etiologies in non-healing wounds are vital. Nationwide multicenter prospective studies are needed to develop uniform strategies for reducing the clinical and economic burden of chronic lower extremity wounds. a multidisciplinary approach are essential to improving outcomes and reducing the risk of limb loss.

Keywords

Foot injuries , Wound healing , Diabetic Foot , ; Foot Ulcer

Ethical Statement

We have no conflict of interest

Supporting Institution

None

Thanks

Thank you for your effort.

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