Venöz Ayak Ülser Tedavisinde Güncel Yaklaşımlar

Year 2019, Volume: 10 Issue: 3, 333 - 339, 20.09.2019

Hossein Asgarpour

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

Cited By: 1

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

References

• 1. Heinen MM, Persoon A, van de Kerkhof P, Otero M, Van Achterberg T. Ulcer-related problems and health care needs in patients with venous leg ulceration: A descriptive cross-sectional study. International Journal of Nursing Studies 2007; 44(8): 1296-13032. Chamanga ET. Understanding venous leg ulcers. British Journal of Community Nursing 2018; 23(9): 6-153. Hecke AV, Grypdonck M, Defloor T. Interventions to enhance patient compliance with leg ulcer treatment: A review of the literature. Journal of Clinical Nursing 2008; 17(1): 29-394. Gillespie DL. Venous ulcer diagnosis treatment and prevention of recurrences. Journal of vascular surgery 2010; 52(5): 8-145. Harding K, Dowsett C, Fias L, Jelnes R, Mosti G, Öien R, Senet P. Simplifying venous leg ulcer management: Consensus recommendations. Wounds International 2015; 1-28.6. Collins L, Seraj S. Diagnosis and treatment of venous ulcers. American Family Physician 2010; 81(8): 989-996.7. Kapp S, Sayers V. Preventing venous leg ulcer recurrence: A review wound practice ve research. Journal of the Australian Wound Management Association 2008; 16(2): 38-47.8. Franks PJ, Barker J, Collier M, Gethin G, Haesler E, Jawien A, Weller C. Management of patients with venous leg ulcers: challenges and current best practice. Journal of Wound Care2016; 25(6): 1-679. Weller C, Evans S. Venous leg ulcer management in general practice: practice nurses and evidence based guidelines. Australian Family Physician 2012; 41(5): 331-337.10. Burrows C, Miller R, Townsend D, Bellefontaine R, MacKean G, Orsted HL, Keast DH. Best practice recommendations for the prevention and treatment of venous leg ulcers: Update 2006. Advances in Skin and Wound Care 2007; 20(11): 611-621.11. Fletcher J, Moffatt C, Partsch H, Vowden K, Vowden P. Principles of compression in venous disease: a practitioner’s guide to treatment and prevention of venous leg ulcers wounds. International Wounds International Enterprise House 2013; 1-24.12. Sinha S, ve Sreedharan S. Management of venous leg ulcers in general practice: A practical guideline. Australian Family Physician 2014; 43(9): 594-598.13. Tang JC, Marston WA, Kirsner RS. Wound healing society (WHS) venous ulcer treatment guidelines: what's new in five years? Wound Repair and Regeneration 2012; 20(5): 619-637.14. Yıldızhan E, Aydın Y. Yaşlılarda anemi ve klinik etkileri. Konuralp Tıp Dergisi 2014; (3): 67-71.15. Bui UT, Finlayson K, Edwards H. Risk factors for ınfection in patients with chronic leg ulcers: a survival analysis. International Journal of Clinical Practice 2018; 15 (2): 283-290.16. Al-Qaisi M, Nott DM, King DH, Kaddoura S. Ankle brachial pressure index (ABPI): An update for practitioners. Vascular Health And Risk Management 2009; 5: 833-841.17. Young T. Back To Basics: Understanding venous leg ulceration. Wounds UK 2017; 13(2): 71-76.18. Jull A, Slark J, Parsons J. Prescribed exercise with compression vs compression alone in treating patients with venous leg ulcers: A systematic review and meta-analysis. JAMA dermatology 2018; 3281.19. Dhillon K. Managing venous stasis ulcers compression therapy local wound care dressings antibiotics surgery and adjunctive methods play a role in management. Wound Care Advisor 2014; 3(1): 12-19.20. Caputo WJ, Beggs DJ, DeFede JL, Simm L, Dharma H. A prospective randomised controlled clinical trial comparing hydrosurgery debridmanement with conventional surgical debridmanement in lower extremity ulcers. International Wound Journal 2008; 5(2): 288-294.21. Gethin G, Cowman S, Kolbach DN. Debridement for venous leg ulcers. Cochrane Database of Systematic Reviews 2015; 14 (9):1-58.22. Michaels JA, Campbell WB, King BM, Macintyre J, Palfreyman SJ, Shackley P, Stevenson MD. A prospective randomised controlled trial and economic modelling of antimicrobial silver dressings versus non-adherent control dressings for venous leg ulcers: The vulcan trial. Health Technol Assess 2009; 13(56): 1-114.23. Gethin G, Cowman S. Manuka honey vs hydrogel- a prospective open label multicentre randomised controlled trial to compare desloughing efficacy and healing outcomes in venous ulcers. Journal of Clinical Nursing 2009; 18(3): 466-474.24. Gethin G, Cowman S. Bacteriological changes in sloughy venous leg ulcers treated with manuka honey or hydrogel: An rct. Journal of Wound Care 2008; 17(6): 241-247.25. Jull AB, Arroll B, Parag V, Waters J. Pentoxifylline for treating venous leg ulcers. The Cochrane Database of Systematic Review 2012; 12(12): 17-33.26. Katsenis K. Micronized purified flavonoid fraction (MPFF): A review of its pharmacological effects therapeutic efficacy and benefits in the management of chronic venous ınsufficiency. Current Vascular Pharmacology 2005; 3(1): 1-9.27. Beckert S, Warnecke J, Zelenkova H, Kovnerystyy O, Stege H, Cholcha W, Coerper S. Efficacy of topical pale sulfonated shale oil in the treatment of venous leg ulcers: A randomized controlled multicenter study. Journal Of Vascular Surgery 2006; 43(1): 94-100.28. Ferrara F, Meli F, Raimondi F, Amato C, Bonura F, Mulè G, Novo S. The treatment of venous leg ulcers: A new therapeutic use of iloprost. Annals Of Surgery 2007; 246(5): 860-865.29. Hussain SMA. A comparison of the efficacy and cost of different venous leg ulcer dressings: A retrospective cohort study. International Journal Of Vascular Medicine 2015; 1-6. 30. Amsler F, Willenberg T, Blättler W. In search of optimal compression therapy for venous leg ulcers: A meta-analysis of studies comparing divers bandages with specifically designed stockings. Journal of Vascular Surgery 2009; 50(3): 668-674.31. Xie T, Ye J, Rerkasem K, Mani R. The venous ulcer continues to be a clinical challenge: An update. Burns & Trauma 2018; 6(1): 1-7.32. Wong IK, Andriessen A, Lee DT, Thompson D, Wong LY, Chao DV, Abel M. Randomized controlled trial comparing treatment outcome of two compression bandaging systems and standard care without compression in patients with venous leg ulcers. Journal of Vascular Surgery 2012;55(5): 1376-138533. O’Meara S, Tierney J, Cullum N, Bland JM, Franks PJ, Mole T, Scriven M. Four layer bandage compared with short stretch bandage for venous leg ulcers: Systematic review and meta-analysis of randomised controlled trials with data from individual patients. British Medical Journal 2009; 338: 1344.34. Wiedmann RI, Bennett M, Kranke P. Systematic review of hyperbaric oxygen in the management of chronic wounds. British Journal Of Surgery 2005; 92(1): 24-32.35. Ubbink DT, Westerbos SJ, Evans D, Land L, Vermeulen H. Topical negative pressure for treating chronic wounds. The Cochrane Database of Systematic Reviews 2008; 31-29.36. Vuerstaek JD, Vainas T, Wuite J, Nelemans P, Neumann MH, Veraart JC. State-of-the-art treatment of chronic leg ulcers: a randomized controlled trial comparing vacuum-assisted closure (VAC) with modern wound dressings. Journal Of Vascular Surgery (2006); 44(5): 1029-1037.37. Gonzalez-Zeh R, Armisen R, Barahona S. Endovenous laser and echo-guided foam ablation in great saphenous vein reflux: One-year follow-up results. Journal Of Vascular Surgery (2008); 48(4): 940-946.38. Baron HC, Wayne MG, Santiago CA, Grossi R. Endoscopic subfascial perforator vein surgery for patients with severe, chronic venous insufficiency. Vascular And Endovascular Surgery (2004); 38(5): 439-442.39. Zenilman J, Valle MF, Malas MB, Maruthur N, Qazi U, Suh Y, Lazarus G. Chronic venous ulcers: A comparative effectiveness review of treatment modalities. Europe PMC 2013; 13(14): 1-306.40. Upton D, Solowiej K. Pain and stress as contributors to delayed wound healing. Wound Practice & Research: Journal of the Australian Wound Management Association 2010; 18(3): 114.