Ali Erdal GÜNEŞ, Mehmet Ali EREN, Tevfik SABUNCU

Negatif Basınçlı Yara Tedavisinin Diyabetik Ayak Ülseri İyileşmesi Üzerine Etkileri: Tek Merkez deneyimi

Amaç:Diyabetik hastaların %15’inde hayatının bir döneminde diyabetik ayak ülseri (DAÜ) gelişmekte olup, bunların %3 kadarı alt ekstremite amputasyonu ile sonuçlanmaktadır. Negatif basınçlı yara tedavisi (NBYT) modern, invaziv olmayan bir yardımcı tedavi sistemidir. Bu çalışmanın amacı DAÜ olan hastalarımızda NBYT’nin kullanımı ile ilgili tecrübelerimizi paylaşmak ve iyileşme üzerine olan etkilerini vurgulamaktır. Materyal ve metod:DAÜ nedeniyle kliniğe yatan ve tedavisi sırasında NBYT kullanılan hastalar retrospektif olarak incelendi.NBYT öncesi ve sonrası yaranın durumu daha önce çekilen fotoğraflara bakılarak değerlendirildi. Yaraların iyileşme durumu iki farklı doktorun gözlemine dayanarak “tamamen iyileşti”, “büyük oranda iyileşti”, “kısmen iyileşti”, “iyileşme olmadı” ve “kötüleşti” şeklinde sınıflandırıldı.Bulgular:Çalışmamıza 8’i kadın 5’i erkek olmak üzere 13 hasta dâhil edildi. Tüm hastalarımıza 6 seans NBYT uygulandı. Hastaların yaş ortalaması 61,2±5,3 olup Wagner sınıfı beş hastada 2 iken, yedi hastada 3, bir hastada ise 4 olarak değerlendirilmiştir. Hastaların %54’ünde kısmen iyileşme, %39’unda büyük oranda iyileşme, %8’inde ise iyileşme olmadı. NBYT ile birlikte C-reaktif protein (∆%:-88,9±70,3) (p<0.007), sedimentasyon hızı (∆%:-40,7±13,4) (p<0.005) ve beyaz kan hücrelerinde (∆%:-40.6±35,3) (p<0.007) anlamlı şekilde azalma olmuştur.Sonuç: Klinik tecrübelerimize göre seçilmiş hastalarda NBYT etkin kullanımı ile DAÜ ülserlerinde kan akımının artışını sağlayarak, proinflamatuar belirteçleri ve eksüdayı azaltarak iyileşme oranlarının artırabileceğini ve ampütasyon oranlarının azalabileceğini düşünüyoruz.

Anahtar Kelimeler:

Diyabetik Ayak, Negatif-Basınçlı Yara Terapisi, Yara iyileşmesi

The Effects of Negative Pressure Wound Therapy on Diabetic Foot Ulcer Healing: Single Center Experience

Background:Diabetic foot ulcer (DFU) is developing in 15% of diabetic patients and 3% of them have lower extremity amputation. Negative pressure wound treatment (NPWT) is a modern, noninvasive adjunctive therapy system. The aim of this study is to share our experience with the use of NPWT in our patients with DFU and to emphasize its impact on healing. Methods:Patients who were admitted to the clinic due to DFU and who used NPWT during their treatment were retrospectively reviewed. The status of the injury before and after NPWT was evaluated by looking at the photographs taken before. The recovery status of the wounds was classified as "complete improvement", "large improvement", "partial improvement", "no improvement" and "worsening" based on the observation of two different specialists. Results:We enrolled 13 patients to our study, whom of 8 were female and 5 were male. All our patients were treated six NBYT sessions. The mean age of the patients was 61.2 ± 5.3 years and the Wagner class was 2 in five patients, 3 in seven patients and 4 in one patient. Fifty four % of the patients had partial improvement, 39% had a significant improvement, and 8% had no improvement. With NBYT, C-reactive protein (±%: - 88,9 ± 70,3) (p <0.007), sedimentation rate (±%: - 40,7 ± 13,4) (p <0.005) and white blood cells (hücr%: - 40.6 ± 35.3) (p <0.007) levels was significantly reduced.Conclusions: According to our clinical experience we believe that effective use of NPWT will increase blood flow in DFU ulcers and may improve recovery rates by reducing proinflammatory markers and exudates and reduce amputation rates in selected patients.

Keywords:

Diabetic Foot, Negative-Pressure Wound Therapy, Wound Healing,

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