Venöz Ayak Ülser Tedavisinde Güncel Yaklaşımlar

Yıl 2019, Cilt: 10 Sayı: 3, 333 - 339, 20.09.2019

Hossein Asgarpour

https://doi.org/10.22312/sdusbed.560995

Cited By: 1

Öz

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.  

Anahtar Kelimeler

Venöz ülser, ayak bileği kol basıncı indeksi

Current Approaches in Treatment of Venous Leg Ulcer

Öz

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.

Anahtar Kelimeler

Venous ulcer, ankle brachial pressure index

Kaynakça

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