Diyabetik Ayak Ülseri Hastalarında Major Amputasyonun Önlenmesi icin Bir Yöntem: Negatif Basınclı Yara Tedavisi ile Kombine İntralezyonel Epidermal Growth Faktör Kullanılması

Yıl 2019, Cilt: 16 Sayı: 2, 174 - 181, 29.08.2019

Bayram Çolak , Atilla Orhan , İlhan Ece Serdar Yormaz , Hüseyin Yılmaz Mustafa Şahin

https://doi.org/10.35440/hutfd.462031

Cited By: 1

Öz

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.

Anahtar Kelimeler

diyabetik ayak, amputasyon, epidermal büyüme faktörü

A Method for Preventing Major Amputation in Patients with Diabetic Foot Ulcer: Negative-Pressure Wound Therapy Combined with Intralesional Epidermal Growth Factor

Öz

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.

Anahtar Kelimeler

Diabetic foot, amputation, epidermal growth factor

Kaynakça

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