DİABETİK AYAK ÜLSERLİ HASTADA MAGGOT DEBRİDMAN TEDAVİSİNE AĞRISIZ YAKLAŞIM: OLGU SUNUMU

Yıl 2018, Cilt: 4 Sayı: 1, 1 - 7, 14.05.2018

Nehir Uçar Fatma Selcan Kuş Tüzün Fırat

Öz

Diyabetik ayak ülserleri, morbidite, mortalite ve ampütasyonla sonuçlanma oranları açısından diyabetin ciddi komplikasyonlarından biridir. Nöropati, periferik arter hastalığı ve travma gibi nedenlerle oluşabilmektedir. Tedavisinde; konvansiyonel yara bakımı, antibiyoterapi hiperglisemi tedavisi, debridman ve rekonstrüktif cerrahi girişimleri uygulanırken, bunların yetersiz kaldığı durumlarda Maggot Debridman Tedavisi (MDT) tamamlayıcı tedavi seçeneği olarak kullanılabilmektedir. MDT, yeşil şişe camı sineği olarak adlandırılan Lucilia sericata larvalarının biyodebridman amaçlı kullanıldığı bir tedavi yöntemidir. Larvalar ağızlarında bulunan çengeller yardımıyla nekrotik dokuları küçük partiküllere ayırırlar ve yaraya nekroze materyali eriten tükrük enzimleri salgılayarak debridman sağlarlar. Antimikrobiyal ve kan dolaşımını artırma özellikleriyle iyileşmeyi hızlandırıcı etkiler sağlarlar. Bilinen yan etkileri gıdıklanma hissi, kanama ve ağrıdır. Bazı durumlarda ağrı, tedaviyi sonlandırma durumunda kalınacak kadar dayanılmaz düzeylere ulaşabilmektedir. Ağrının sağaltımına yönelik oral analjezikler, epidural anestezi, periferik sinir blokajı gibi tedavi modaliteleri kullanılmaktadır. Bu olgu sunumunda konvansiyonel yara tedavisine dirençli grade 2 diyabetik ayak yarası olan hastada MDT yapılması planlanmış ve oluşan ağrının sağaltımında Konvansiyonel TENS uygulaması yapılarak ağrı düzeylerinin değerlendirilmesi ve sunulması amaçlanmıştır.

Anahtar Kelimeler

Maggot debridman tedavisi, Transkutaneal elektrik sinir stimülasyonu (TENS), Diyabetik ayak, Ağrı, ayak ülseri

PAİNLESS APPROACH TO MAGGOT DEBRİDEMENT THERAPY IN PATİENT WİTH DİABETİC FOOT ULCER: A CASE REPORT

Öz

Diabetic foot ulcers (DPU) are one of the serious complications of diabetes in terms of rates of morbidity, mortality and amputation. DPU develop from underlying neuropathy, peripheral arterial disease and trauma. Conventional wound care, antibiotherapy, hyperglycaemia treatment, debridement and reconstructive surgery are used for treatment. In cases where these are inadequate, Maggot Debridement Therapy (MDT) can be used as a complementary treatment option. MDT is a method of treatment for biodegradation of the larvae of Lucilia sericata, which are called green bottle glass strains. Larvae found necrotic tissue with the help of hooks in their mouths and they allow small particles to carve wound debridement of necrotic material melted by the salivary enzymes secreted. They have antimicrobial and blood circulation enhancing properties. So they accelerate recovery. Known side effects are tickling, bleeding and pain. In some cases, pain can reach unbearable levels and the treatment may have to be terminated. Treatment modalities such as oral analgesics, epidural anesthesia, peripheral nerve blockade for the treatment of pain are used. In this case report, MDT was planned to be done in a patient with grade 2 diabetic foot wound resistant to conventional wound healing and it was aimed to evaluate and present pain levels by applying Conventional TENS to the treatment of pain.

Anahtar Kelimeler

Maggot debridement therapy, Transcuteneal electrical nerve stimulation (TENS), Diabetic feet, Foot ulcer, Pain

Kaynakça

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