IS NEGATIVE PRESSURE WOUND CLOSURE SYSTEM EFFECTIVE IN DIABETIC FOOT INFECTION? A COMPARATIVE RETROSPECTIVE STUDY

Öz

OBJECTIVE: More than half percent of nontraumatic foot amputation seen on diabetic patients. Our aim in this study is to evaluate the use of negative pressure wound closure device (NBYT), which has been used in recent years, in the treatment of patients with diabetic foot.

MATERIAL AND METHODS: 40 patients who were followed for diabetic foot wound was divided into two group. 20 patients were followed-up with debridement and dressing (NBYT-) and 20 patients with vacuum assisted closure system and debridement (NBYT +).

RESULTS: According to the Wagner classification of patients with NBYT; 2 were in stage 2, 8 were stage 3, 9 were stage 4 and 1 was stage 5. According to Pedis classification 10 were stage 3, 1 were stage 4. In the NBYT (-) group according to Wagner classification 4 patients were stage 2, 7 were stage 3, 8 were stage 4 and 1was stage 5. Debridement was performed on 16 of NBYT + patients, amputation was performed on 3, and epidermal growth factor (EGF) was applied on 3. Fourteen of NBYT (-) patients were debrided and 7 were amputated. There was a statistically significant difference in terms of hospitalization duration and wound size according to the patients who were applied NBYT (p <0.05).

CONCLUSIONS: NBYT has been shown to reduce the length of hospitalization and amputation rate. More extensive prospective, randomized, multidisciplinary studies are needed on this topic.

Anahtar Kelimeler

• Diabetic Foot,Negative-Pressure Wound Therapy,Antibiotic

DİYABETİK AYAK YARALARINDA NEGATİF BASINÇLI YARA KAPAMA SİSTEMİ ETKİLİ MİDİR ? RETROSPEKTİF KARŞILAŞTIRMALI ÇALIŞMA

Öz

AMAÇ: Travmaya bağlı olmayan ayak ampütasyonlarının yarısından fazlası diyabetik hastalarda görülmektedir. Bu çalışmadaki amacımız, son yıllarda kullanımı artan nega-tif basınçlı yara kapama cihazı (NBYT) uygulamasının di-yabetik ayaklı hastaların tedavisinde kullanım sonuçlarını değerlendirmektir.

GEREÇ VE YÖNTEM: Diyabetik ayak yarası nedeni ile takip edilen 40 hastanın 20 tanesi debridman ve pansuman ile (NBYT-), 20 tanesi ise Basınçlı Yara Kapama cihazı ve debridman(NBYT+) ile takip edilmiştir.

BULGULAR: NBYT(+) gruptaki hastaların Wagner evrelemesine göre; 2'si evre 2, 8’i evre 3, 9 ‘u evre 4 ve 1'i evre 5 idi. Pedis evresine göre 10’u evre 3, 1’i evre 4 idi. NBYT(-) grupta ise Wagner evrelemesine göre: 4’ evre 2, 7’si evre 3, 8’i evre 4 ve 1’i evre 5 idi. NBYT + hastaların 16’sına debridman, 3’üne ampütasyon, 3’üne (epidermal growth factor) EGF uygulaması yapılmıştır. NBYT(-) hastaların 14 ‘üne debridman, 7’sine ampütasyon uygulanmıştır. Yapılan çalışmada NBYT uygulanan hastalarda, uygulanmayan hastalara göre yaş, cinsiyet, hastane yatış süresi ve yara boyutu açısından anlamlı farklılık bulundu (p<0.05).

SONUÇ: NBYT’nin yatış süresini ve ampütasyon oranını azalttığı görülmüştür. Bu konuyla ilgili daha geniş prospektif ,randomize, multidisipliner çalışmalara ihtiyaç duyulmaktadır.

Anahtar Kelimeler

• Diyabetik Ayak,Negatif-Basınçlı Yara Terapisi,Antibiotik

Kaynakça

1. Aydoğan Ü, Akbulut H DY. Diyabetik Ayak. TAF Prev Med Bull. 2010;9:375–82.
2. Wukich DK, Hobizal KB, Sambenedetto TL, Kirby K, RosarioBL. Outcomes of Osteomyelitis in Patients Hospitalized With Diabetic Foot Infections. Foot ankle Int. 2016;37(12):1285–91.
3. Bozkurt F, Tekin R, Çelen MK Ayaz C. Diyabetik Ayakİnfeksiyonlarında Tedavi Yaklaşımı. Konuralp Tıp Derg. 2012;4(2):15–9.
4. Özkayın N, Erdem M, Tiftikcioğlu YÖ. Negatif basınçlı yaratedavisi ve ortopedi pratiğinde kullanımı. TOTBID Derg. 2017;16(3):203–8.
5. Scherer SS, Pietramaggiori G, Mathews JC, Prsa MJ, HuangS, Orgill DP. The mechanism of action of the vacuum-assisted closure device. Plast Reconstr Surg. 2008;122(3):786–97.
6. Konya, Petek; Demirtük N. The evalution of diabetic Footinfection followed in our clinic for last three years. Acta Medica Alanya. 2017;1(1):11–4.
7. Vaidhya N, Panchal A, Anchalia MM. A New Cost-effectiveMethod of NPWT in Diabetic Foot Wound. Indian J Surg. 2013;77:1–5.
8. Magnus E, Houtum WH van. The value of debridement andVacuum-Assisted Closure (V.A.C.) Therapy in diabetic foot ulcers. Diabetes Metab Res Rev [Internet]. 2008;24(Suppl 1):76–80. Available from: http://libweb.anglia.ac.uk/

9. Glass GE, Murphy GRF, Nanchahal J. Does negative-pressure wound therapy influence subjacent bacterial growth? A systematic review. J Plast Reconstr Aesthetic Surg. 2017;70(8):1028–37.
10. Pellino G, Sciaudone G, Candilio G, De Fatico GS, LandinoI, Della Corte A, et al. Preventive NPWT over closed incisions in general surgery: Does age matter? Int J Surg. 2014;12(S2):S64–8.
11. Fleischmann W, Strecker W, Bombelli M, Kinzl L. Vacuumsealing as treatment of soft tissue damage in open fractures. Unfallchirurg. 1993;96(9):488–92.
12. Fleischmann W, Lang E, Russ M. Treatment of infection byvacuum sealing. Unfallchirurg. 1997;100(4):301–4.
13. Dzieciuchowicz L, Espinosa G, Grochowicz L. Vacuumassisted closure (VAC) in the treatment of advanced diabetic foot. Cirugía Española (English Ed. 2009;86(4):213–8.
14. Armstrong DG, Lavery LA. Negative pressure woundtherapy after partial diabetic foot amputation: a multicentre, randomised controlled trial. Lancet. 2005;366(9498):1704–10.
15. Rutherford RB, Baker JD, Ernst C, Johnston KW, Porter JM,Ahn S, et al. Recommended standards for reports dealing with lower extremity ischemia: Revised version. J Vasc Surg. 1997;26(3):517–38.
16. Demir A, Demirtaş Y, Çiftçi M, Öztürk N, Karacalar A. TopikalNegatif Basınç ( Vakum Yardımlı Kapama [ Vac ]) Uygulamalarımız. Türk Plast Rekonstruktif Cer Der. 2006;14(3):171–7.