Yıl 2019, Cilt 16 , Sayı 2, Sayfalar 174 - 181 2019-08-29

Diyabetik Ayak Ülseri Hastalarında Major Amputasyonun Önlenmesi icin Bir Yöntem: Negatif Basınclı Yara Tedavisi ile Kombine İntralezyonel Epidermal Growth Faktör Kullanılması
A Method for Preventing Major Amputation in Patients with Diabetic Foot Ulcer: Negative-Pressure Wound Therapy Combined with Intralesional Epidermal Growth Factor

Bayram ÇOLAK [1] , Atilla ORHAN [2] , İlhan ECE [3] , Serdar YORMAZ [4] , Hüseyin YILMAZ [5] , Mustafa ŞAHİN [6]


Amaç: Diyabetik ayak ülserleri (DAÜ), diyabetik hastaların %15’ini etkileyen bir sağlık problemidir. DAÜ, iş gücü kaybı, uzun süre hastanede yatış, maddi kayıp ve ayrıca alt ekstremite amputasyonu gibi nedenlerle hastaların yaşam kalitesinde düşüşe neden olmaktadır.

DAÜ’lerinin tedavisinde birçok yöntem uygulanmış fakat amputasyonların önüne geçilememiştir. Çalışmada major amputasyon (trans-metatarsal, tarsometatarsal, intertarsal ve diz altı amputasyonlar) kararı alınmış DAÜ hastalarına uyguladığımız tedavinin etkilerini sunmayı amaçladık.

Materyal ve Metod: Çalışmada, çeşitli sağlık kurumlarından hastanemize yönlendirilen ve majör amputasyon kararı alınmış fakat hastanemizde negatif basınçlı yara tedavisi (NBYT) ile kombine intralezyonel epidermal growth faktör (EGF) uygulanarak majör amputasyon yapılmadan tedavi edilen hastalar değerlendirildi. Hastalara EGF (haftada 3 kez veya cilt dokusu ile tam kapanma oluşuncaya kadar) ile kombine NBYT (haftada iki kez üç gün boyunca tam granulasyon dokusu oluşuncaya kadar) tedavileri uygulandı. Yara kapanması ve amputasyonu önlemeye yönelik tedavinin etkileri incelendi.

Bulgular: PEDİS sınıflamasına göre 32 hastanın 27’si (%84.3) grade 3, 5’i (%15.6) grade 4 DAÜ’ine sahipti. Hastaların 24’ünde (%75) infeksiyon mevcuttu. 22 hastada (%68.7) nekroz mevcuttu. Hastaların ortalama yara büyüklüğü 18 cm (10-25cm) idi. Uygulanan tedavi ile hastaların 27’ sinde (%84.3) tam cilt kapanması, 5 hastada (%15.6) yara zemininin tamamının granülasyon dokusu ile kapanmasısağlandı. Hastaların hiç birine major amputasyon yapılmadı. EGF ortalama 10 injeksiyon (7-12 injeksiyon) ile kombine NBYT ortalama 11 seans (8-13 seans) tedavisi ortalama 45 gün uygulandı. Yaklaşık bir yıllık takip süresi içinde üç hastada enfeksiyon gelişti ve medikal tedavi uygulandı.

Sonuç: Hastalarımız, major amputasyon önerilerek çeşitli hastanelerden yönlendirilen, major amputasyon riski yüksek olan hastalardı. Çalışmanın sonucunda, NBYT ve EGF’nin birlikte düzenli olarak uygulanması ile major

amputasyonların önlenebileceği kanısındayız.

Background:Diabetic foot ulcer (DFU) is a serious health problem affecting 15% of patients with diabetes mellitus. Diabetic foot ulcers cause a decrease in the quality of life of patients like job loss, long-term hospital stay, financial burden and also lower extremity amputation. Many methods have been applied to treat patients with DFU, but amputations have not been prevented. In this study, we presented patients who had been referred to us from various hospitals with a decision for major amputation, but treated by us using intralesional epidermal growth factor therapy (EGF) combined with negative-pressure wound therapy (NPWT) to prevent below-knee amputation.

 Methods:Patients who had been referred to us from various hospitals with a decision for major amputation, but treated by us using combined therapy to prevent below-knee amputation. The efficacy of treatment was assessed according to wound closure and amputation prevention.

 Results:According to Wagner's classification, 17 (51.6%) out of 33 patients were the grade 3, and 16 (48.4%) were the grade 4 patients. Major amputation was performed in one patient. Infection was present in 24 (75%) of the patients. Necrosis was present in 12 (37.5%) of these patients. The average wound size was 18 cm (10-25 cm). Complete skin closure was achieved in 27 patients (84.3%), and closure with 100% granulation was achieved in 5 patients (15.6%). None of the patients underwent major amputation. EGF+NPWT treatment were administered for 45 days on average. Infections were developed in three patients during one-year of follow-up approximately, and medical treatment was administered.

Conclusions: Our patients were in the high risk group for major amputation, which were referred from various hospitals with the recommendation of major amputation. We believe that the regular application of NPWT combined with EGF can prevent major amputations.

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Birincil Dil en
Konular Tıp
Bölüm Araştırma Makalesi
Yazarlar

Orcid: 0000-0003-1403-6963
Yazar: Bayram ÇOLAK
Kurum: SELÇUK ÜNİVERSİTESİ, TIP FAKÜLTESİ
Ülke: Turkey


Orcid: 0000-0003-0110-3290
Yazar: Atilla ORHAN
Kurum: SELÇUK ÜNİVERSİTESİ, TIP FAKÜLTESİ
Ülke: Turkey


Orcid: 0000-0002-6966-7036
Yazar: İlhan ECE
Kurum: SELÇUK ÜNİVERSİTESİ, TIP FAKÜLTESİ
Ülke: Turkey


Orcid: 0000-0002-6273-3643
Yazar: Serdar YORMAZ
Kurum: SELÇUK ÜNİVERSİTESİ, TIP FAKÜLTESİ
Ülke: Turkey


Orcid: 0000-0001-5409-440X
Yazar: Hüseyin YILMAZ
Kurum: SELÇUK ÜNİVERSİTESİ, TIP FAKÜLTESİ
Ülke: Turkey


Orcid: 0000-0002-2118-5388
Yazar: Mustafa ŞAHİN
Kurum: SELÇUK ÜNİVERSİTESİ, TIP FAKÜLTESİ
Ülke: Turkey


Tarihler

Başvuru Tarihi : 24 Eylül 2018
Kabul Tarihi : 10 Mayıs 2019
Yayımlanma Tarihi : 29 Ağustos 2019

Bibtex @araştırma makalesi { hutfd462031, journal = {Harran Üniversitesi Tıp Fakültesi Dergisi}, issn = {1304-9623}, eissn = {1309-4025}, address = {tipdergisi@harran.edu.tr}, publisher = {Harran Üniversitesi}, year = {2019}, volume = {16}, pages = {174 - 181}, doi = {10.35440/hutfd.462031}, title = {A Method for Preventing Major Amputation in Patients with Diabetic Foot Ulcer: Negative-Pressure Wound Therapy Combined with Intralesional Epidermal Growth Factor}, key = {cite}, author = {ÇOLAK, Bayram and ORHAN, Atilla and ECE, İlhan and YORMAZ, Serdar and YILMAZ, Hüseyin and ŞAHİN, Mustafa} }
APA ÇOLAK, B , ORHAN, A , ECE, İ , YORMAZ, S , YILMAZ, H , ŞAHİN, M . (2019). A Method for Preventing Major Amputation in Patients with Diabetic Foot Ulcer: Negative-Pressure Wound Therapy Combined with Intralesional Epidermal Growth Factor. Harran Üniversitesi Tıp Fakültesi Dergisi , 16 (2) , 174-181 . DOI: 10.35440/hutfd.462031
MLA ÇOLAK, B , ORHAN, A , ECE, İ , YORMAZ, S , YILMAZ, H , ŞAHİN, M . "A Method for Preventing Major Amputation in Patients with Diabetic Foot Ulcer: Negative-Pressure Wound Therapy Combined with Intralesional Epidermal Growth Factor". Harran Üniversitesi Tıp Fakültesi Dergisi 16 (2019 ): 174-181 <https://dergipark.org.tr/tr/pub/hutfd/issue/47757/462031>
Chicago ÇOLAK, B , ORHAN, A , ECE, İ , YORMAZ, S , YILMAZ, H , ŞAHİN, M . "A Method for Preventing Major Amputation in Patients with Diabetic Foot Ulcer: Negative-Pressure Wound Therapy Combined with Intralesional Epidermal Growth Factor". Harran Üniversitesi Tıp Fakültesi Dergisi 16 (2019 ): 174-181
RIS TY - JOUR T1 - A Method for Preventing Major Amputation in Patients with Diabetic Foot Ulcer: Negative-Pressure Wound Therapy Combined with Intralesional Epidermal Growth Factor AU - Bayram ÇOLAK , Atilla ORHAN , İlhan ECE , Serdar YORMAZ , Hüseyin YILMAZ , Mustafa ŞAHİN Y1 - 2019 PY - 2019 N1 - doi: 10.35440/hutfd.462031 DO - 10.35440/hutfd.462031 T2 - Harran Üniversitesi Tıp Fakültesi Dergisi JF - Journal JO - JOR SP - 174 EP - 181 VL - 16 IS - 2 SN - 1304-9623-1309-4025 M3 - doi: 10.35440/hutfd.462031 UR - https://doi.org/10.35440/hutfd.462031 Y2 - 2019 ER -
EndNote %0 Harran Üniversitesi Tıp Fakültesi Dergisi A Method for Preventing Major Amputation in Patients with Diabetic Foot Ulcer: Negative-Pressure Wound Therapy Combined with Intralesional Epidermal Growth Factor %A Bayram ÇOLAK , Atilla ORHAN , İlhan ECE , Serdar YORMAZ , Hüseyin YILMAZ , Mustafa ŞAHİN %T A Method for Preventing Major Amputation in Patients with Diabetic Foot Ulcer: Negative-Pressure Wound Therapy Combined with Intralesional Epidermal Growth Factor %D 2019 %J Harran Üniversitesi Tıp Fakültesi Dergisi %P 1304-9623-1309-4025 %V 16 %N 2 %R doi: 10.35440/hutfd.462031 %U 10.35440/hutfd.462031
ISNAD ÇOLAK, Bayram , ORHAN, Atilla , ECE, İlhan , YORMAZ, Serdar , YILMAZ, Hüseyin , ŞAHİN, Mustafa . "A Method for Preventing Major Amputation in Patients with Diabetic Foot Ulcer: Negative-Pressure Wound Therapy Combined with Intralesional Epidermal Growth Factor". Harran Üniversitesi Tıp Fakültesi Dergisi 16 / 2 (Ağustos 2019): 174-181 . https://doi.org/10.35440/hutfd.462031
AMA ÇOLAK B , ORHAN A , ECE İ , YORMAZ S , YILMAZ H , ŞAHİN M . A Method for Preventing Major Amputation in Patients with Diabetic Foot Ulcer: Negative-Pressure Wound Therapy Combined with Intralesional Epidermal Growth Factor. Harran Üniversitesi Tıp Fakültesi Dergisi. 2019; 16(2): 174-181.
Vancouver ÇOLAK B , ORHAN A , ECE İ , YORMAZ S , YILMAZ H , ŞAHİN M . A Method for Preventing Major Amputation in Patients with Diabetic Foot Ulcer: Negative-Pressure Wound Therapy Combined with Intralesional Epidermal Growth Factor. Harran Üniversitesi Tıp Fakültesi Dergisi. 2019; 16(2): 181-174.