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The Combined Effectiveness of Debridement and Vacuum-Asisted Closure (VAC) Method in the Management of Diabetic Foot

Year 2012, Volume: 19 Issue: 3, 132 - 137, 01.06.2012

Cemal Fırat Ahmet Hamdi Aytekin Serkan ErbaturCemal Fırat Ahmet Hamdi Aytekin Serkan Erbatur

Abstract

Objectives: Diabetic foot ulcerscause infections and tissue loss as a result of a vicious circle including peripheral neuropathy, vascular insufficiency, and immune disorders. This destructive period restrict the reconstruction options and highlights skin graft repair option. The success of the graft depends on the adequate granulation tissue without infection. Vacuum assisted closure system therapy is very successful and effective for providing of this dual effect. In this study, we analyzed the effectiveness of the VAC applications combined with debridement in 20 cases with diabetic foot ulcer retrospectively. Materials and Methods: VAC treatment was applied for 7 sessions meanly for 36 h under 125-150 mm Hg intermittently and waiting period for 12h combining with recurrent debridement. Decreasing in the wound dimensions by contractions and evident increasing the granulation tissue in the wounds were observed just from the second session of the VAC therapy. Results: After the sufficient thickness granulation tissue formation, the wounds were repaired by split thickness skin grafts. No recurrence was seen except of two patients with heel ulcers. Distal transmetatarsal reamputation was performed to 3 patients after 6 months. Conclusion: VAC treatment is very safe and effective in wound healing including the improvement of granulation tissue, drainage of infection, and wound contraction. The determining factor on the effectiveness of VAC treatment is debridement which is performing effectively on time. Key words: Diabetic Foot; Vacuum-Assisted Closure; Debridement.

Keywords

Diabetic Foot; Vacuum-Assisted Closure; Debridement.

References

  • Demir S, Demir Y. Acrochordon and Impaired Carbohydrate Metabolism. Acta Diabetol 2002; 39(2): 57- 9. DOI: 10.1007/s005920200014
  • Brem H, Sheehan P, Rosenberg HJ, et al. Evedience Based Protocol for Diabetic Foot Ulcers. Plast Reconstr Surg 2006; 117(7): 193-211. DOI: 10.1097/01. prs.0000225459.93750.29
  • Singh N, Armstrong DG, Lipsky BA. Preventing Foot Ulcers in Patients with Diabetes. JAMA 2005; 293(2): 217-28. DOI:10.1001/jama.293.2.217
  • Jeffcoate WJ, Harding KG. Diabetic Foot Ulcers. Lancet 2003; 361(9368): 1545-51. DOI:10.1001/jama.293.2.260
  • Temple ME, Nahata MC. Pharmacotherapy of Lower Limb Diabetic Ulcers. J Am Geriatr Soc 2000; 48(7): 822- 8.
  • Pedowitz WJ. Diagnosis and Treatment of Infections of the Diabetic Foot. Foot Ankle Clin 1997; 2: 89-98.
  • Siemionow M, Demir Y. Diabetic Neuropathy: Pathogenesis and Treatment. J Reconstr Microsurg 2004; 20(3): 241-52.
  • Demir Y, Demir S, Gökçe Ç. Diabetik Ayak: Fizyopatolojisi, Tanısı ve Rekonstrüksiyon Öncesi Tedavisinde Güncel Yaklaşımlar. Kocatepe Tıp Dergisi 2004; 5: 1-12.
  • Steed DL. Foundations of Good Ulcer Care. Am J Surg 1998; 176: 20-5.
  • Zgonis T, Roukis TS. A Systematic Approach to Diabetic Foot Infections. Adv Ther 2005; 22(3): 244-62.
  • Armstrong DG, Lavery LA. Negative Pressure Wound Therapy After Partial Diabetic Foot Amputation: A Multicentre Randomised Controlled Trial. Lancet 2005; 366(9498): 1704-10. DOI: 10.1016/j.ejvs.2008.06.010
  • Demirtas Y, Guven E, Aslan O, et al. Vacuum Assisted Closure After Free Flap Failure. Turk Plast Surg 2009; 17: 139-44.
  • Argenta LC, Morykwas MJ, Marks MW, et al. Vacuum Assisted Closure: State of Clinic Art. Plast Reconstr Surg 2006; 117(7): 127-37. DOI: 10.1097/01.prs.0000222551. 10793.51
  • Demir A, Çiftçi M, Karacalar A. Topikal Negatif Basınç (TNB) Uygulama Alanları ve Etki Mekanizmaları. OMÜ Tıp Dergisi 2006; 23: 141-7.
  • Morykwas MJ, Argenta LC, Shelton-Brown EI, et al. Vacuum Assisted Closure: A New Method for Wound Control and Treatment: Animal Studies and Basic Foundation. Ann Plast Surg 1997; 38(6): 553-62.
  • Fleichmann W, Strecker W, Bombelli M, et al. Vacum Sealing As A Treatment of Soft Tissue Damage In Open Fractures.Unfallchirurg 1993; 96(9): 488-92.
  • Argenta LC, Morykwas MJ. Vacuum Assisted Closure: A New Method for Wound Control and Treatment: Clinical Experience. Ann Plast Surg 1997; 38(6): 563-76. DOI: 10.1111/j.1742-481X.2009.00628.x
  • Venturi ML, Attinger CE, Mesbahi AN, et al. Mechanisms and Clinical Applications of theVacuum- Assisted Closure (VAC) Device. Am J Clin Dermatol 2005; 6(3): 185-94.
  • Chen SZ, Li J, Li XY, et al. Effects of Vacuum Assisted Closure on Wound Microcirculation: An Experimental Study. Asian J Surg 2005; 28(3): 211-7. DOI: 10.1016/S1015-9584(09)60346-8
  • De Franzo AJ, Marks MW, Argenta LC, et al. Vacuum Assisted Closure for Treatment of Degloving Injuries. Plast Reconstr Surg 1999; 104(7): 2145-8.
  • Kirby JP, Fantus RJ, Ward S, et al. Novel Uses of Negative Pressure Wound Care System. J Trauma 2002; 53(1): 117-21.
  • Saxena V, Hwang CW, Huang S, et al. Vacuum-Assisted Closure: Microdeformations of Wounds and Cell Proliferation. Plast Reconstr Surg 2004; 114(5): 1086-96. DOI: 10.1097/01.PRS.0000135330.51408.97
  • Taub PJ, Schulman MR, Sett S, Et Al. Revisiting Vascularised Muscle Flaps for Complicated Sternal Wounds in Children. Ann Plast Surg 2005; 55(5): 535-7. Doi: 10.1097/01.sap.0000183681.56595.0a
  • Fuchs U, Zitterman A, Stuettgen B, et al. Clinical Outcome of Patients with Deep Sternal Wound Infection Managed by Vacuum Assisted Closure Compared to Conventional Therapy with Open Packing: A Retrospective Analysis. Ann Thoracsurg 2005; 79(2): 526- 31. DOI: 10.1016/j.athoracsur.2004.08.032
  • Frykberg RG, Williams DV. Negative-Pressure Wound Therapy and Diabetic Foot Amputations: A Retrospective Study of Payer Claims Data. J Am Pediatr Med Assoc 2007; 97(5): 351-9.
  • Lambert KV, Hayes P, McCarty M. Vacuum Assisted Closure: A Review of Development and Current Applications. Eur J Vasc Endovasc Surg 2005; 29(3): 219- 26. DOI: 10.1016/j.ejvs.2004.12.017
  • Norton SE, De Souza B, Marsh D, et al. Vacuum Assisted Closure (VAC Therapy) and Risk of Fluidloss in Acute Trauma. Ann Plast Surg 2006; 56(2): 194-5. DOI: 10.1097/01.sap.0000194273.56832.ca
  • Bu makaleye atıf yapmak için: Fırat C, Aytekin
  • AH, Erbatur S. Diabetik Ayak Sağaltımında Vakum
  • Destekli Kapama (VAC) Metodu ve Debridmanın
  • Birlikte Etkinliği. JIUMF 2012; 19(3): 132-7. DOI:
  • 7247/jiumf.19.3.1

Diabetik Ayak Sağaltımında Vakum Destekli Kapama (VAC) Metodu ve Debridmanın Birlikte Etkinliği

Year 2012, Volume: 19 Issue: 3, 132 - 137, 01.06.2012

Cemal Fırat Ahmet Hamdi Aytekin Serkan ErbaturCemal Fırat Ahmet Hamdi Aytekin Serkan Erbatur

Abstract

Amaç: Diabetik ayak ülserleri periferik nöropati, vasküler yetmezlik ve immün sistem bozukluklarından oluşan kısır döngünün sonucu olup enfeksiyon ve doku kayıplarına neden olmaktadır. Bu yıkıcı süreç cerrahi onarım seçeneklerini oldukça kısıtlamakta ve greftle onarım seçeneğini öne çıkarmaktadır. Greftlerin başarısı enfeksiyondan arındırılmış yeterli granülasyon dokusunun varlığına bağlıdır. Vakum yardımlı yara kapama sistemi (VAC) tedavisi bu iki etkiyi aynı anda sağlamada oldukça etkili ve başarılıdır. Bu çalışmamızda debritmanlarla birlikte VAC tedavisi uygulamalarının etkinliğini, 20 diabetik ayak ülserli olguda, geriye dönük olarak inceledik. Gereç ve Yöntem: VAC tedavisi mükerrer debridmanlarla birlikte ortalama 7 seans uygulandı. 36 saat 125-150 mm Hg intermittan basınç altında uygulandı. Seanslar arasında 12 saat bekleme süresi vardı. VAC tedavi uygulamasının ikinci seansından itibaren yaralarda belirgin granülasyon dokusu artışı ve kontraksiyonla yara boyutlarında küçülme gözlendi. Bulgular: Yeterli kalınlıkta granülasyon dokusu oluşturulduktan sonra yaralar kısmi kalınlıkta deri grefti ile onarıldı. Ayak topuğuna lokalize yarası olan 2 hasta dışında nüks görülmedi. 3 hastaya 6 ay sonra distal seviye transmetatarsal reamputasyon yapıldı. Sonuç: VAC tedavisi, yara enfeksiyonunun drenajında, yaranın kontraksiyonunda ve granülasyon dokusunun artmasında oldukça güvenli ve etkili bir yöntemdir. VAC tedavisinin bu etkinliğinde belirleyici olan uygun zaman aralıklarında yapılan etkili debridmanlardır. Anahtar kelimeler: Diyabetik Ayak; Vakum Destekli Kapama; Debridman.

Keywords

Diyabetik Ayak; Vakum Destekli Kapama; Debridman.

References

  • Demir S, Demir Y. Acrochordon and Impaired Carbohydrate Metabolism. Acta Diabetol 2002; 39(2): 57- 9. DOI: 10.1007/s005920200014
  • Brem H, Sheehan P, Rosenberg HJ, et al. Evedience Based Protocol for Diabetic Foot Ulcers. Plast Reconstr Surg 2006; 117(7): 193-211. DOI: 10.1097/01. prs.0000225459.93750.29
  • Singh N, Armstrong DG, Lipsky BA. Preventing Foot Ulcers in Patients with Diabetes. JAMA 2005; 293(2): 217-28. DOI:10.1001/jama.293.2.217
  • Jeffcoate WJ, Harding KG. Diabetic Foot Ulcers. Lancet 2003; 361(9368): 1545-51. DOI:10.1001/jama.293.2.260
  • Temple ME, Nahata MC. Pharmacotherapy of Lower Limb Diabetic Ulcers. J Am Geriatr Soc 2000; 48(7): 822- 8.
  • Pedowitz WJ. Diagnosis and Treatment of Infections of the Diabetic Foot. Foot Ankle Clin 1997; 2: 89-98.
  • Siemionow M, Demir Y. Diabetic Neuropathy: Pathogenesis and Treatment. J Reconstr Microsurg 2004; 20(3): 241-52.
  • Demir Y, Demir S, Gökçe Ç. Diabetik Ayak: Fizyopatolojisi, Tanısı ve Rekonstrüksiyon Öncesi Tedavisinde Güncel Yaklaşımlar. Kocatepe Tıp Dergisi 2004; 5: 1-12.
  • Steed DL. Foundations of Good Ulcer Care. Am J Surg 1998; 176: 20-5.
  • Zgonis T, Roukis TS. A Systematic Approach to Diabetic Foot Infections. Adv Ther 2005; 22(3): 244-62.
  • Armstrong DG, Lavery LA. Negative Pressure Wound Therapy After Partial Diabetic Foot Amputation: A Multicentre Randomised Controlled Trial. Lancet 2005; 366(9498): 1704-10. DOI: 10.1016/j.ejvs.2008.06.010
  • Demirtas Y, Guven E, Aslan O, et al. Vacuum Assisted Closure After Free Flap Failure. Turk Plast Surg 2009; 17: 139-44.
  • Argenta LC, Morykwas MJ, Marks MW, et al. Vacuum Assisted Closure: State of Clinic Art. Plast Reconstr Surg 2006; 117(7): 127-37. DOI: 10.1097/01.prs.0000222551. 10793.51
  • Demir A, Çiftçi M, Karacalar A. Topikal Negatif Basınç (TNB) Uygulama Alanları ve Etki Mekanizmaları. OMÜ Tıp Dergisi 2006; 23: 141-7.
  • Morykwas MJ, Argenta LC, Shelton-Brown EI, et al. Vacuum Assisted Closure: A New Method for Wound Control and Treatment: Animal Studies and Basic Foundation. Ann Plast Surg 1997; 38(6): 553-62.
  • Fleichmann W, Strecker W, Bombelli M, et al. Vacum Sealing As A Treatment of Soft Tissue Damage In Open Fractures.Unfallchirurg 1993; 96(9): 488-92.
  • Argenta LC, Morykwas MJ. Vacuum Assisted Closure: A New Method for Wound Control and Treatment: Clinical Experience. Ann Plast Surg 1997; 38(6): 563-76. DOI: 10.1111/j.1742-481X.2009.00628.x
  • Venturi ML, Attinger CE, Mesbahi AN, et al. Mechanisms and Clinical Applications of theVacuum- Assisted Closure (VAC) Device. Am J Clin Dermatol 2005; 6(3): 185-94.
  • Chen SZ, Li J, Li XY, et al. Effects of Vacuum Assisted Closure on Wound Microcirculation: An Experimental Study. Asian J Surg 2005; 28(3): 211-7. DOI: 10.1016/S1015-9584(09)60346-8
  • De Franzo AJ, Marks MW, Argenta LC, et al. Vacuum Assisted Closure for Treatment of Degloving Injuries. Plast Reconstr Surg 1999; 104(7): 2145-8.
  • Kirby JP, Fantus RJ, Ward S, et al. Novel Uses of Negative Pressure Wound Care System. J Trauma 2002; 53(1): 117-21.
  • Saxena V, Hwang CW, Huang S, et al. Vacuum-Assisted Closure: Microdeformations of Wounds and Cell Proliferation. Plast Reconstr Surg 2004; 114(5): 1086-96. DOI: 10.1097/01.PRS.0000135330.51408.97
  • Taub PJ, Schulman MR, Sett S, Et Al. Revisiting Vascularised Muscle Flaps for Complicated Sternal Wounds in Children. Ann Plast Surg 2005; 55(5): 535-7. Doi: 10.1097/01.sap.0000183681.56595.0a
  • Fuchs U, Zitterman A, Stuettgen B, et al. Clinical Outcome of Patients with Deep Sternal Wound Infection Managed by Vacuum Assisted Closure Compared to Conventional Therapy with Open Packing: A Retrospective Analysis. Ann Thoracsurg 2005; 79(2): 526- 31. DOI: 10.1016/j.athoracsur.2004.08.032
  • Frykberg RG, Williams DV. Negative-Pressure Wound Therapy and Diabetic Foot Amputations: A Retrospective Study of Payer Claims Data. J Am Pediatr Med Assoc 2007; 97(5): 351-9.
  • Lambert KV, Hayes P, McCarty M. Vacuum Assisted Closure: A Review of Development and Current Applications. Eur J Vasc Endovasc Surg 2005; 29(3): 219- 26. DOI: 10.1016/j.ejvs.2004.12.017
  • Norton SE, De Souza B, Marsh D, et al. Vacuum Assisted Closure (VAC Therapy) and Risk of Fluidloss in Acute Trauma. Ann Plast Surg 2006; 56(2): 194-5. DOI: 10.1097/01.sap.0000194273.56832.ca
  • Bu makaleye atıf yapmak için: Fırat C, Aytekin
  • AH, Erbatur S. Diabetik Ayak Sağaltımında Vakum
  • Destekli Kapama (VAC) Metodu ve Debridmanın
  • Birlikte Etkinliği. JIUMF 2012; 19(3): 132-7. DOI:
  • 7247/jiumf.19.3.1
There are 32 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

Cemal Fırat This is me

Ahmet Hamdi Aytekin This is me

Serkan ErbaturCemal Fırat This is me

Ahmet Hamdi Aytekin This is me

Serkan Erbatur This is me

Publication Date June 1, 2012
Published in Issue Year 2012 Volume: 19 Issue: 3

Cite

APA Fırat, C., Aytekin, A. H., Fırat, S. E., Aytekin, A. H., et al. (2012). Diabetik Ayak Sağaltımında Vakum Destekli Kapama (VAC) Metodu ve Debridmanın Birlikte Etkinliği. Journal of Turgut Ozal Medical Center, 19(3), 132-137.
AMA Fırat C, Aytekin AH, Fırat SE, Aytekin AH, Erbatur S. Diabetik Ayak Sağaltımında Vakum Destekli Kapama (VAC) Metodu ve Debridmanın Birlikte Etkinliği. J Turgut Ozal Med Cent. June 2012;19(3):132-137.
Chicago Fırat, Cemal, Ahmet Hamdi Aytekin, Serkan ErbaturCemal Fırat, Ahmet Hamdi Aytekin, and Serkan Erbatur. “Diabetik Ayak Sağaltımında Vakum Destekli Kapama (VAC) Metodu Ve Debridmanın Birlikte Etkinliği”. Journal of Turgut Ozal Medical Center 19, no. 3 (June 2012): 132-37.
EndNote Fırat C, Aytekin AH, Fırat SE, Aytekin AH, Erbatur S (June 1, 2012) Diabetik Ayak Sağaltımında Vakum Destekli Kapama (VAC) Metodu ve Debridmanın Birlikte Etkinliği. Journal of Turgut Ozal Medical Center 19 3 132–137.
IEEE C. Fırat, A. H. Aytekin, S. E. Fırat, A. H. Aytekin, and S. Erbatur, “Diabetik Ayak Sağaltımında Vakum Destekli Kapama (VAC) Metodu ve Debridmanın Birlikte Etkinliği”, J Turgut Ozal Med Cent, vol. 19, no. 3, pp. 132–137, 2012.
ISNAD Fırat, Cemal et al. “Diabetik Ayak Sağaltımında Vakum Destekli Kapama (VAC) Metodu Ve Debridmanın Birlikte Etkinliği”. Journal of Turgut Ozal Medical Center 19/3 (June 2012), 132-137.
JAMA Fırat C, Aytekin AH, Fırat SE, Aytekin AH, Erbatur S. Diabetik Ayak Sağaltımında Vakum Destekli Kapama (VAC) Metodu ve Debridmanın Birlikte Etkinliği. J Turgut Ozal Med Cent. 2012;19:132–137.
MLA Fırat, Cemal et al. “Diabetik Ayak Sağaltımında Vakum Destekli Kapama (VAC) Metodu Ve Debridmanın Birlikte Etkinliği”. Journal of Turgut Ozal Medical Center, vol. 19, no. 3, 2012, pp. 132-7.
Vancouver Fırat C, Aytekin AH, Fırat SE, Aytekin AH, Erbatur S. Diabetik Ayak Sağaltımında Vakum Destekli Kapama (VAC) Metodu ve Debridmanın Birlikte Etkinliği. J Turgut Ozal Med Cent. 2012;19(3):132-7.