Venöz Ayak Ülser Tedavisinde Güncel Yaklaşımlar

Abstract

Venöz ayak ülseri alt ekstremite ülserlerin etiyolojisinde en yaygın görülen, açık bir lezyon şeklinde 4 hafta süresince iyileşmeyen ve diz ile ayak bileği arasında gelişen ülserdir. Tüm yaşlar için görülme oranı %1, 65 yaşı üstü kişilerde %3-5 arasındadır. Yaranın tedavisindeki amaç ödemi azaltmak, yara iyileşmesini sağlamak ve tekrarlamasını önlemektir. Yaranın tedavisinden önce; yaranın ilk oluştuğu zaman, yaranın çapı, yeri, sayısı, yatağındaki doku tipi, eksuda türü ve miktarı, yara kenarları ve çevresi cilt durumu, yaranın evresi, ayak bileği kol basıncı indeksi ve ayak lenfödem durumunun değerlendirilmesi gerekir. Venöz ülser tedavisinde ayak elevasyonu, yüksek basınçlı kompresyonlar, pansuman, pentoksifilin, mikronize arıtılmış flavanoid fraksiyonu, topikal işlenmemiş petrol yağı, kalsiyum dobesilat ve aspirin kullanımı önerilmektedir. Sitokin büyüme faktörlerin kullanımı, sklerotherapi ile birlikte kompresyona yönelik çalışmalar mevcuttur. Vakum yardımlı kapama ile hiperbarik oksijen tedavi kombinasyonu için kanıtlar yetersizdir. Yara debridmanı için cerrahi ve mekanik yöntemler önerilmektedir. Altı aydan fazla diğer tedavilere dirençli ve yara çapı  > 10 cm² olan ülserlerde pinch ya da mesh greftler kullanılabilir. Tedavi sürecinde aktif planter fleksiyona direnç ve topuk kaldırma egzersizleri, protein ve sıvı ihtiyacının izlenimi, elektrolit ve albümin değerlerinin takibi, düzenli ayak bakımı için hasta-aile eğitimi ve psikososyal destek önem taşımaktadır.  

Keywords

• Venöz ülser,ayak bileği kol basıncı indeksi

Current Approaches in Treatment of Venous Leg Ulcer

Abstract

Venous leg ulcer is the most common etiology of lower extremity ulceration, is as an open lesion between ankle and foot which does not heal for 4 weeks. The incidence is 1% for all ages and 3-5% for those over 65 years of age. The goals of treatment are reduce edema, improve ulcer healing, and prevent recurrence. The first time that ulcer occurs, size of the wound, the location, number, the type of tissue in the wound bed, the exudate type and amount, the skin condition of the wound edges and surrounding area, wound stage, ancle-brachial pressure index and leg lymphedema before the wound begins treatment is needed. The management methods recommended for venous ulcers consist of leg elevation, high pressure compression, dressings, pentoxifylline, micronized refined flavanoid fraction, pale sulfonated shale oil, calcium dobesilate and aspirin therapy. There are studies on the use of cytokine growth factors, compression therapy with sclerotherapy as well as. Insufficient evidence available for use combination of vaccum assisted clouser with hyperbaric oxygen therapy.  Surgical and mechanical methods are recommended for wound debridment. Pinch or mesh grafts can be used for ulcers with a diameter of >10 cm² and resistant to other treatments for more than 6 months. Active planter flexion resistance, heel lifting exercises, monitoring of protein and fluid requirements, monitoring of electrolyte and albumin levels, patient-family education about regular foot care, and psychosocial support are important in treatment process.

Keywords

• Venous ulcer,ankle brachial pressure index

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