VENÖZ ÜLSERDE FİZYOTERAPİ

Öz

Kronik venöz hastalıklar telenjiektaziden venöz ülsere (VÜ) kadar geniş bir yelpaze içeren hastalık grubudur. Kronik venöz hastalıkların etyolojisinde ambulatuar hipertansiyon,  yüzeyel ve derin venleri birbirine bağlayan perforan venlerdeki yetmezlik, valvüler reflü, kanın geri kaçışı, baldır kas pompası zayıflıkları yaygındır. Venöz hipertansiyonla başlayan ve genetik yatkınlığın hazırlayıcı olduğu kompleks hücresel olayların en son noktası olan yara açılma durumudur. Kronik VÜ’ler 4-6 haftadan daha fazla süre açık kalan yaralardır ve batı ülkelerinde ve dünya çapında genel popülasyonun %1.5’ini, yaşlıların ise %5’ini etkileyen önemli bir hastalıktır. En sık görülen alt ekstremite ülseridir ve arteriyel, nöropatik, diyabetik ülserler de dahil tüm ülserasyonların %70’ini oluşturur VÜ fizyoterapi ve rehabilitasyonunda kompresyon başta olmak üzere, elektrik stimülasyonu, ultrason, manyetik alan tedavisi, balneoterapi gibi fizik tedavi modaliteleri kullanılmaktadır. Kronik ve tekrarlayıcı doğasından dolayı VÜ’ler ciddi sağlık bakımı yüküne sebep olmaktadır. Dolayısı ile hasta eğitimi oldukça önem taşımaktadır. Bu derlemede VÜ oluşum nedenleri, risk faktörleri, değerlendirme ve tedavi uygulamaları tartışılmaktadır.

Anahtar Kelimeler

• : Venöz ülser,Kompresyon,Fizyoterapi

Kaynakça

1. Abbade, L. P., Lastoria, S., & de Almeida Rollo, H. (2011). Venous ulcer: clinical characteristics and risk factors. International journal of dermatology, 50(4), 405-411.
2. Abbade, L. P. F., & Lastória, S. (2005). Venous ulcer: epidemiology, physiopathology, diagnosis and treatment. International journal of dermatology, 44(6), 449-456.
3. Al-Qaisi, M., Nott, D. M., King, D. H., & Kaddoura, S. (2009). Ankle brachial pressure index (ABPI): An update for practitioners. Vasc Health Risk Manag, 5(1), 833-841.
4. Alavi, A., Sibbald, R. G., Phillips, T. J., Miller, O. F., Margolis, D. J., Marston, W., . . . Kirsner, R. S. (2016). What's new: management of venous leg ulcers: treating venous leg ulcers. Journal of the American Academy of Dermatology, 74(4), 643-664.
5. Ashby, R. L., Gabe, R., Ali, S., Adderley, U., Bland, J. M., Cullum, N. A., . . . Soares, M. O. (2014). Clinical and cost-effectiveness of compression hosiery versus compression bandages in treatment of venous leg ulcers (Venous leg Ulcer Study IV, VenUS IV): a randomised controlled trial. The Lancet, 383(9920), 871-879.
6. Bergan, J. J., Schmid-Schönbein, G. W., Smith, P. D. C., Nicolaides, A. N., Boisseau, M. R., & Eklof, B. (2006). Chronic venous disease. N Engl J Med, 2006(355), 488-498.
7. Brown, A. (2005). Chronic leg ulcers, part 2: do they affect a patien s social life? British journal of nursing, 14(18), 986-1000. Callam, M., Harper, D., Dale, J., & Ruckley, C. (1987). Chronic ulcer of the leg: clinical history. Br Med J (Clin Res Ed), 294(6584), 1389-1391.
8. Charles, H. (1991). Compression healing of ulcers. J District Nurs, 10(3), 4-8.

9. Chase, S. K., Melloni, M., & Savage, A. (1997). A forever healing: the lived experience of venous ulcer disease. Journal of Vascular Nursing, 15(2), 73-78.
10. Chi, Y.-W., & Raffetto, J. D. (2015). Venous leg ulceration pathophysiology and evidence based treatment. Vascular Medicine, 20(2), 168-181.
11. Comerota, A., & Lurie, F. (2015). Pathogenesis of venous ulcer. Paper presented at the Seminars in Vascular Surgery. Dissemond, J., Assenheimer, B., Bültemann, A., Gerber, V., Gretener, S., Kohler‐von Siebenthal, E., . . . Läuchli, S. (2016).
12. Compression therapy in patients with venous leg ulcers. JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 14(11), 1072-1087.
13. Douglas, V. (2001). Living with a chronic leg ulcer: an insight into patients' experiences and feelings. Journal of wound care, 10(9), 355-360.
14. Eriksson, G., Eklund, A., Liden, S., & Zetterquist, S. (1984). Comparison of different treatments of venous leg ulcers: A controlled study using stereophotogrammetry. Current therapeutic research, 35(4), 678-684.
15. FRANKS, P. J., OLDROYD, M. I., DICKSON, D., SHARP, E. J., & MOFFATT, C. J. (1995). Risk factors for leg ulcer recurrence: a randomized trial of two types of compression stocking. Age and Ageing, 24(6), 490-494.
16. Gloviczki, P. (2008). Handbook of venous disorders: Guidelines of the American venous forum third edition: CRC Press. Goldman, R. J., & Salcido, R. (2002). More than one way to measure a wound: an overview of tools and techniques. Advances in skin & wound care, 15(5), 236-243.
17. Gould, L. J., Dosi, G., Couch, K., Gibbons, G. W., Howell, R. S., Brem, H., & Tomic-Canic, M. (2016). Modalities to Treat Venous Ulcers: Compression, Surgery, and Bioengineered Tissue. Plastic and Reconstructive Surgery, 138(3S), 199S-208S.
18. Green, J., Jester, R., McKinley, R., & Pooler, A. (2014). The impact of chronic venous leg ulcers: a systematic review. Journal of wound care, 23(12), 601-612.
19. Grey, J. E., Enoch, S., & Harding, K. G. (2006). Wound assessment. BMJ: British Medical Journal, 332(7536), 285.
20. Heinen, M., Evers, A., Van Uden, C., Van der Vleuten, C., Van De Kerkhof, P., & Van Achterberg, T. (2007). Sedentary patients with venous or mixed leg ulcers: determinants of physical activity. Journal of advanced Nursing, 60(1), 50-57.
21. Heinen, M. M., van der Vleuten, C., de Rooij, M. J., Uden, C. J., Evers, A. W., & van Achterberg, T. (2007). Physical activity and adherence to compression therapy in patients with venous leg ulcers. Archives of dermatology, 143(10), 1283-1288.
22. Jones, J. E., Nelson, E. A., & Al‐Hity, A. (2013). Skin grafting for venous leg ulcers. The Cochrane Library.
23. Kelechi, T. J., Johnson, J. J., & Yates, S. (2015). Chronic venous disease and venous leg ulcers: an evidence-based update. Journal of Vascular Nursing, 33(2), 36-46.
24. Kelly, O. (2010). Living with a chronic leg ulcer. Journal of Community Nursing, 24(5).
25. Lal, B. K. (2015). Venous ulcers of the lower extremity: definition, epidemiology, and economic and social burdens. Paper presented at the Seminars in Vascular Surgery.
26. Launois, R. (2015). Health-related quality-of-life scales specific for chronic venous disorders of the lower limbs. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 3(2), 219-227. e213.
27. Mehta, A. A., Pereira, R. R., Nayak, C. S., & Dhurat, R. S. (2010). Acroangiodermatitis of mali: A rare vascular phenomenon. Indian Journal of Dermatology, Venereology, and Leprology, 76(5), 553.
28. Mosti, G. (2014). Compression in leg ulcer treatment: inelastic compression. Phlebology, 29(1 suppl), 146-152.
29. Nelson, E. A., & Bell‐Syer, S. E. (2014). Compression for preventing recurrence of venous ulcers. The Cochrane Library.
30. Nelson, E. A., Bell‐Syer, S. E., Cullum, N. A., & Webster, J. (2000). Compression for preventing recurrence of venous ulcers. The Cochrane Library.
31. Nelson, E. A., Harper, D. R., Prescott, R. J., Gibson, B., Brown, D., & Ruckley, C. V. (2006). Prevention of recurrence of venous ulceration: randomized controlled trial of class 2 and class 3 elastic compression. Journal of Vascular Surgery, 44(4), 803-808.
32. Neumann, M., Cornu-Thénard, A., Jünger, M., Mosti, G., Munte, K., Partsch, H., . . . Streit, M. (2016). Evidence based (S3) guidelines for diagnostics and treatment of venous leg ulcers. Im Internet: http://www. euroderm. org/edf/index. php/edf-guidelines/category/5-guidelines-miscellaneous.
33. O'brien, J., Grace, P., Perry, I., Hannigan, A., Clarke Moloney, M., & Burke, P. (2003). Randomized clinical trial and economic analysis of four‐layer compression bandaging for venous ulcers. British Journal of Surgery, 90(7), 794-798. O'donnell, T. F., & Passman, M. A. (2014). Clinical practice guidelines of the Society for Vascular Surgery (SVS) and the American Venous Forum (AVF)—management of venous leg ulcers. Introduction. J Vasc Surg, 60(2 suppl), 1S-2S.
34. O’Donnell, T. F., Passman, M. A., Marston, W. A., Ennis, W. J., Dalsing, M., Kistner, R. L., . . . Eklöf, B. G. (2014). Management of venous leg ulcers: Clinical practice guidelines of the Society for Vascular Surgery® and the American Venous Forum. J Vasc Surg, 60(2 Suppl), 3S-59S.
35. O’Meara, S., Cullum, N., Nelson, E. A., & Dumville, J. C. (2012). Compression for venous leg ulcers. Cochrane Database Syst Rev, 11. Olin, J. W., Beusterien, K. M., Childs, M. B., Seavey, C., McHugh, L., & Griffiths, R. I. (1999). Medical costs of treating venous stasis ulcers: evidence from a retrospective cohort study. Vascular Medicine, 4(1), 1-7.
36. Parker, C., Finlayson, K., Shuter, P., & Edwards, H. (2015). Risk factors for delayed healing in venous leg ulcers: a review of the literature. International journal of clinical practice, 69(9), 967-977.
37. Partsch, H. (2013). Compression therapy in leg ulcers. Reviews in Vascular Medicine, 1(1), 9-14.
38. Partsch, H. (2014). Compression for the management of venous leg ulcers: which material do we have? Phlebology, 29(1 suppl), 140-145.
39. Partsch, H., Clark, M., Mosti, G., Steinlechner, E., Schuren, J., Abel, M., . . . Flour, M. (2008). Classification of compression bandages: practical aspects. Dermatologic Surgery, 34(5), 600-609.
40. Phillips, T. J., Machado, F., Trout, R., Porter, J., Olin, J., Falanga, V., & Group, T. V. U. S. (2000). Prognostic indicators in venous ulcers. Journal of the American Academy of Dermatology, 43(4), 627-630.
41. Pimentel, M. I. F., Cuzzi, T., Azeredo-Coutinho, R. B. G. d., Vasconcellos, É. d. C. F. E., Benzi, T. S. C. G., & Carvalho, L. M. V. d. (2011). Acroangiodermatitis (pseudo-Kaposi sarcoma): a rarely-recognized condition. A case on the plantar aspect of the foot associated with chronic venous insufficiency. Anais brasileiros de dermatologia, 86(4), 13-16.
42. Renner, R., Gebhardt, C., & Simon, J. C. (2010). Compliance to compression therapy in patients with existing venous leg ulcers. Results of a cross-sectional study. Medizinische Klinik (Munich, Germany: 1983), 105(1), 1-6.
43. Roaldsen, K. S., Rollman, O., Torebjörk, E., Olsson, E., & Stanghelle, J. K. (2006). Functional ability in female leg ulcer patients—a challenge for physiotherapy. Physiotherapy Research International, 11(4), 191-203.
44. Rubin, J. R., Alexander, J., Plecha, E. J., & Marman, C. (1990). Unna's boot Vs polyurethane foam dressings for the treatment of venous ulceration: A randomized prospective study. Archives of Surgery, 125(4), 489-490.
45. Singh, S. K., & Manchanda, K. (2014). Acroangiodermatitis (Pseudo-Kaposi sarcoma). Indian dermatology online journal, 5(3), 323. Smith, J. J., Guest, M. G., Greenhalgh, R. M., & Davies, A. H. (2000). Measuring the quality of life in patients with venous ulcers. Journal of Vascular Surgery, 31(4), 642-649.
46. Stücker, M., Link, K., Reich-Schupke, S., Altmeyer, P., & Doerler, M. (2013). Compression and venous ulcers. Phlebology, 28(1_suppl), 68-72.
47. Vasquez, M., & Munschauer, C. (2008). Venous Clinical Severity Score and quality-of-life assessment tools: application to vein practice. Phlebology, 23(6), 259-275.
48. Vlajinac, H., Marinkovic, J., Maksimovic, M., & Radak, D. (2014). Factors related to venous ulceration: a cross-sectional study. Angiology, 65(9), 824-830.
49. Walshe, C. (1995). Living with a venous leg ulcer: a descriptive study of patients’ experiences. Journal of advanced Nursing, 22(6), 1092-1100.
50. Widener, J. M. (2015). Venous leg ulcers: Summary of new clinical practice guidelines published August 2014 in the Journal of Vascular Surgery. Journal of Vascular Nursing, 33(2), 60-67.
51. Wong, I. K., Andriessen, A., Charles, H., Thompson, D., Lee, D., So, W., & Abel, M. (2012). Randomized controlled trial comparing treatment outcome of two compression bandaging systems and standard care without compression in patients with venous leg ulcers. Journal of the European Academy of Dermatology and Venereology, 26(1), 102-110.
52. Yim, E., Richmond, N. A., Baquerizo, K., Van Driessche, F., Slade, H. B., Pieper, B., & Kirsner, R. S. (2014). The effect of ankle range of motion on venous ulcer healing rates. Wound Repair and Regeneration, 22(4), 492-496.
53. Zaulyanov, L., & Kirsner, R. S. (2007). A review of a bi-layered living cell treatment (Apligraf®) in the treatment of venous leg ulcers and diabetic foot ulcers. Clinical interventions in aging, 2(1), 93.