Clinical Results in the City Hospital Model for the Treatment of Diabetic Foot Infections: Mutlidisciplinary Approach in the Diabetic Wound Service

Yıl 2020, Cilt: 5 Sayı: 2, 5 - 10, 01.08.2020

Sabri Batın Kaan Gürbüz Yakup Ekinci İlhami Çelik

Öz

Objectives: We herein aimed to present the clinical findings of diabetic patients who were followed up and treated with a multidisciplinary approach in the Diabetic Foot and Pressure Sore Care Clinic.
Patients and Methods: Between July 2018 and 2018, 91 (19 males, 72 females; mean age 59.26,14 years) patients under prospectively followed-up with diabetic foot infection were retrospectively screened and included in the study. All cases were selected according to higher and/or grade 2 Wagner Classification with documented diabetic foot infection. The data, obtained by the same surgical team pre- and post-operatively in patients who had administered to the Diabetic Foot and Pressure Sore Care Clinic; age, sex, education level, blood glucose level, biomarkers of infection, co-morbidities, complications, applied surgical treatment options, length of hospital stay, follow-up period.
Results: According to Wagner's diabetic wound classification, half of the cases were in grade IV. It was noteworthy that almost half of the patients with an average hospital stay of 36.8 ± 23.01 days were only literate. Similar data were obtained in terms of neuropathy, vasculopathy, Charcot arthropathy, and smoking. Satisfactory results were obtained with 42.2% amputation without limb-sparing surgical treatment methods.
Conclusion: In the treatment of diabetic foot infection, which is the most common complication it is possible to achieve satisfactory results by approaching the disease multidisciplinary.

Anahtar Kelimeler

Diabetes Mellitus, Diabetic Foot, Infection, Foot Ulcers

Diyabetik Ayak Enfeksiyonlarının Tedavisine Dair Şehir Hastanesi Modelinde Klinik Sonuçlarımız: Diyabetik Yara Servisi’nde Mutlidisipliner Yaklaşım

Öz

Amaç: Bu çalışmada, Diyabetik Ayak ve Bası Yarası Servisi’nde yatırılarak multidisipliner yaklaşımla takip ve tedavileri yapılan diyabetik hastaların klinik bulgularını sunmayı amaçladık.
Gereç ve Yöntem: Temmuz 2018 ile Aralık 2019 tarihleri arasında diyabetik ayak enfeksiyonu tanısı ile kliniğimizde yatarak tedavi edilen prospektif takipli hastaların verileri retrospektif olarak kaydedildi. Wagner evre 2 ve üzeri diyabetik ayak enfeksiyonu ile başvuran ve kriterleri sağlayan 91 olgu çalışmaya dahil edildi. Olgular, demografik (yaş, cinsiyet, eğitim durumu vb.) ve klinik (anamnez, kan glukoz seviyesi, enfeksiyon belirteçleri, ek morbiditeler, postoperatif komplikasyonlar, uygulanan cerrahi tedaviler, hastanede kalış süresi ve takip süresi) olarak değerlendirilerek verileri kaydedildi.
Bulgular: Olguların 72’si kadın, 19’u erkek iken yaş ortalaması 59.26.14 yıl ve ortalama takip süresi 12.52±4.98 ay idi. Wagner diyabetik yara sınıflamasına göre olguların yarısı evre IV idi. Ortalama hastanede kalış süresi 36.8±23.01 gün olan hastaların neredeyse yarısının sadece okur-yazar olması dikkat çekiciydi. Nöropati, vaskülopati, charcot artropatisi ve sigara kullanımı yönünden benzer veriler elde edildi. %42.2 oranında ampütasyon yapılmadan uzuv koruyucu cerrahi tedavi yöntemleri ile tatmin edici sonuçlar elde edildi.
Sonuç: Kronik bir hastalığın en sık komplikasyonu olan diyabetik ayak enfeksiyonunun tedavisinde, hastalığa multidisipliner yaklaşarak yüz güldürücü sonuçlar elde etmek mümkündür.

Anahtar Kelimeler

Diyabetes Mellitus, Diyabetik Ayak, Enfeksiyon, Ayal Ülseri

Kaynakça

• 1. World Health Organization: Diabetes Factsheet No: 312. [cited 2011 January 23]. Available from: http://www.who. int/mediacentre/factsheets/fs312/en/index.html.
• 2. Jeffcoate WJ, Harding KG. Diabetic foot ulcers. Lancet 2003; 361:1545-51.
• 3. Lavery LA, van Houtum WH, Armstrong DG, Harkless LB, Ashry HR, Walker SC. Mortality following lower extremity amputation in minorities with diabetes mellitus. Diabetes Res Clin Pract 1997; 37:41-7.
• 4. Unachukwu C, Babatunde S, Ihekwaba AE. Diabetes, hand and/or foot ulcers: a cross-sectional hospital-based study in Port Harcourt, Nigeria. Diabetes Res Clin Pract 2007; 75:148-52.
• 5. Boulton AJ, Vileikyte L, Ragnarson-Tennvall G, et al. The global burden of diabetic foot disease. Lancet 2005; 366:1719-1724.
• 6. Demir T, Yesil S, Akinci B, et al. Predictors Of Major Amputatıons In Diabetic Foot Ulcers: Evaluatıon Of Episodes In 232 Patıents From Western Turkey. In ENDO 2006. Boston, USA, 2006.
• 7. Jeffcoate WJ, Harding KG. Diabetic foot ulcers. Lancet (London, England) 2003; 361: 1545-51.
• 8. Lavery LA, Van Houtum WH, Armstrong DG, et al. Mortality following lower extremity amputation in minorities with diabetes mellitus. Diabetes Res Clin Pract 1997; 37: 41-47.
• 9. Jeffcoate WJ, Harding KG: Diabetic foot ulcers. Lancet 2003; 361:1545-51.
• 10. Reiber GE, Vileikyte L, Boyko EJ, et al. Causal pathways for incident lower-extremity ulcers in patients with diabetes from two settings. Diabetes Care 1999; 22:157-62.
• 11. Armstrong DG, Nguyen HC, Lavery LA, et al. Off-loading the diabetic foot wound: a randomized clinical trial. Diabetes Care 2001; 24:1019-22.
• 12. Ozan F, Gürbüz K, Celik I, Dursun ZB, Uzun E. Evaluation of minör and major lower extremity amputation in diabetic foot patients. Turkish journal of medical sciences, 2017;47(4), 1109-16.
• 13. Unachukwu C, Babatunde S, Ihekwaba AE. Diabetes, hand and/or foot ulcers: A cross-sectional hospital-based study in Port Harcourt, Nigeria. Diabetes Res Clin Pract 2007; 75: 148-52.
• 14. Li X, Xiao T, Wang Y. et al. Incidence, risk factors for amputation among patients with diabetic foot ulcer in a Chinese tertiary hospital. Diabetes Res Clin Pract 2011; 93: 26-30.
• 15. Zoberi KA, Salas J, Morgan CN, et al. Comparison of family medicine and general internal medicine on diabetes management. Mo Med 2017; 114: 187-94.
• 16. Boulton, A. J., Armstrong, D. G., Hardman, M. J., Malone, M., Embil, J. M., Attinger, C. E, Kirsner, R. S. (2020). Diagnosis and Management of Diabetic Foot Infections.
• 17. Mills, J. P., Patel, P., Broekhuizen, E., Burdick, S., DeGeorge, C., Gallagher, K. A, Seagull, F. J. (2019). Diabetic Foot Infections.
• 18. Faglia E, Favales F, Morabito A. New Ulceration, New Major Amputation, and Survival Rates in Diabetic Subjects Hospitalized for Foot Ulceration From 1990 to 1993. Diabetes Care 2001; 24:78-83.
• 19. Levin ME. Foot Lesions in Patient with Diabetes Mellitus. Endocrinol Metab Clin North Am 1996; 25:447-62.
• 20. Arıcan Ö ve Şaşmaz S. Diyabetik Hastalarda Ayak Bakımı. Turkiye Klinikleri J Med Sci 2004; 24(5):541-6.
• 21. Ozan F, Gürbüz K, Celik I, Dursun ZB, Uzun E. Evaluation of major and minor lower extremity amputation in diabetic foot patients. Turkish Journal of Medical Sciences, 2017;47(4):1109-16.
• 22. Dinççağ A, Baktıroğlu S, Dinççağ N. Diyabetik ayak: Amputasyon önlenebilir mi? İst Tıp Fak Mecmuası 1999; 62:1-11.
• 23. Bostanoğlu S, Erverdi N, Karabulut Z ve ark. Diyabetik ayak ve amputasyonu: Risk faktörleri ve risk skorlamasının önemi.İnsizyon 2000; 3:201-6.
• 24. Rooh-UI-Muqim, Ahmed M, Griffin S. Evaluation and management of diabetic foot according to Wagner’s classification. A study of 100 cases. J Ayub Med Coll Abbottabad 2003; 15(3):39-42.