Negatif Basınçlı Yara Tedavisinin Diyabetik Ayak Ülseri İyileşmesi Üzerine Etkileri: Tek Merkez deneyimi

Yıl 2019, Cilt: 16 Sayı: 1, 148 - 153, 22.03.2019

Ali Erdal Güneş Mehmet Ali Eren Tevfik Sabuncu

Öz

Amaç:Diyabetik hastaların
%15’inde hayatının bir döneminde diyabetik ayak ülseri (DAÜ) gelişmekte olup,
bunların %3 kadarı alt ekstremite amputasyonu ile sonuçlanmaktadır. Negatif
basınçlı yara tedavisi (NBYT) modern, invaziv olmayan bir yardımcı tedavi
sistemidir. Bu çalışmanın amacı DAÜ olan hastalarımızda NBYT’nin kullanımı ile ilgili
tecrübelerimizi paylaşmak ve iyileşme üzerine olan etkilerini vurgulamaktır.  

Materyal ve metod:DAÜ
nedeniyle kliniğe yatan ve tedavisi sırasında NBYT kullanılan hastalar retrospektif
olarak incelendi.NBYT öncesi ve sonrası yaranın durumu daha önce çekilen
fotoğraflara bakılarak değerlendirildi. Yaraların iyileşme durumu iki farklı
doktorun gözlemine dayanarak “tamamen iyileşti”, “büyük oranda iyileşti”,
“kısmen iyileşti”, “iyileşme olmadı” ve “kötüleşti” şeklinde sınıflandırıldı.

Bulgular:Çalışmamıza 8’i kadın 5’i erkek olmak üzere
13 hasta dâhil edildi. Tüm hastalarımıza 6 seans NBYT uygulandı. Hastaların yaş
ortalaması 61,2±5,3 olup Wagner sınıfı beş hastada 2 iken, yedi hastada 3, bir
hastada ise 4 olarak değerlendirilmiştir. Hastaların %54’ünde kısmen iyileşme,
%39’unda büyük oranda iyileşme, %8’inde ise iyileşme olmadı.  NBYT ile birlikte C-reaktif protein (∆%:-88,9±70,3)
(p<0.007), sedimentasyon hızı (∆%:-40,7±13,4) (p<0.005) ve beyaz kan
hücrelerinde (∆%:-40.6±35,3) (p<0.007) anlamlı şekilde azalma olmuştur.

Sonuç: Klinik tecrübelerimize göre seçilmiş hastalarda NBYT
etkin kullanımı ile DAÜ ülserlerinde kan akımının artışını sağlayarak,
proinflamatuar belirteçleri ve eksüdayı azaltarak iyileşme oranlarının
artırabileceğini ve ampütasyon oranlarının azalabileceğini düşünüyoruz.

Anahtar Kelimeler

Diyabetik Ayak, Negatif-Basınçlı Yara Terapisi, Yara iyileşmesi

The Effects of Negative Pressure Wound Therapy on Diabetic Foot Ulcer Healing: Single Center Experience

Öz

Background:Diabetic foot ulcer (DFU) is developing in 15% of
diabetic patients and 3% of them have lower extremity amputation. Negative
pressure wound treatment (NPWT) is a modern, noninvasive adjunctive therapy
system. The aim of this study is to share our experience with the use of NPWT
in our patients with DFU and to emphasize its impact on healing.

 Methods:Patients who were admitted to the clinic due to DFU
and who used NPWT during their treatment were retrospectively reviewed. The
status of the injury before and after NPWT was evaluated by looking at the
photographs taken before. The recovery status of the wounds was classified as
"complete improvement", "large improvement", "partial
improvement", "no improvement" and "worsening" based
on the observation of two different specialists.

 Results:We enrolled 13 patients to our study, whom of 8 were
female and 5 were male. All our patients were treated six NBYT sessions. The
mean age of the patients was 61.2 ± 5.3 years and the Wagner class was 2 in
five patients, 3 in seven patients and 4 in one patient. Fifty four % of the
patients had partial improvement, 39% had a significant improvement, and 8% had
no improvement. With NBYT, C-reactive protein (±%: - 88,9 ± 70,3) (p
<0.007), sedimentation rate (±%: - 40,7 ± 13,4) (p <0.005) and white
blood cells (hücr%: - 40.6 ± 35.3) (p <0.007) levels was significantly
reduced.

Conclusions: According to our clinical experience we believe that
effective use of NPWT will increase blood flow in DFU ulcers and may improve
recovery rates by reducing proinflammatory markers and exudates and reduce
amputation rates in selected patients.

 

Anahtar Kelimeler

Diabetic Foot, Negative-Pressure Wound Therapy, Wound Healing

Kaynakça

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