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DİABETİK AYAKTA TEDAVİ YAKLAŞIMLARI VE WAGNER SINIFLAMASININ TEDAVİYİ YÖNLENDİRMEDEKİ ROLÜ

Amaç: Diabetik ayak enfeksiyonları alt ekstremite amputasyonlarının 2/3 ünden sorumludur. Diabetik ayak yaralarının toplumlara maliyetide çok yüksektir. Bizim bu çalışmadaki amacımız diyabetik hastalarda oluşan ayak problemlerinin derecelendirmesini yaparak uygulanacak en uygun tedavi şeklini seçmek ve buna bağlı olarak hastanın yaşam kalitesini, ruhsal durumunu bozan travmatik bir işlem olan amputasyon oranını azaltmaktır. Yöntem: xxxxxxx Genel Cerrahi Kliniğine diabetik ayak nedeniyle yatmış 49 hasta çalışma kapsamına alınmıştır. Bulgular: 49 hastadan 30’u (% 61.2) erkek 19’u (% 38.8) kadındı. Yaş ortalaması 61,4 (39-80) idi. Hastaların hepsinde tip 2 DM mevcut idi. Hastalar Wagner sınıflamasına göre değerlendirildiğinde 4 (%8,25) hasta grup 1, 19 (%38,7) hasta grup 2, 13 (%26,5) hasta grup 3, 9 (%18,3) hasta grup 4 ve 4 (%8,25) hasta grup 5 olarak tespit edildi. Wagner sınıflaması ve amputasyonlar ile yaş, cinsiyet, açlık kan şekeri, üre, kreatinin değerleri arasında anlamlı fark saptanmamıştır. Sonuç: Diabetik ayak infeksiyonları komplikasyonların oldukça ağır olması, amputasyon ve hatta mortalite ile sonuçlanması nedeniyle ekonomik ve sosyal kayıplara neden olan önemli bir sağlık problemidir. Bu yüzden diabetik ayak oluşumunun önlenmesi hem toplumsal hem de ekonomik açıdan önemlidir. Bunun için hastalığın risk faktörlerinin belirlenmesi ve buna göre risk altındaki hastaların belirlenip bilinçlendirilmesi gerekmektedir. Hekimlerin de bu risk faktörlerini bilerek daha dikkatli davranmaları sonucunda yeterli ve zamanında tedaviye başlanması ile amputasyon oranlarının düşürülmesi söz konusudur. Multidisipliner bir yaklaşımla diabetik ayak infeksiyonlarının tedavisinin başarıyla yapılabilmesi ve ampütasyon oranlarının düşürülmesi mümkündür.

Anahtar Kelimeler:

Diabetik ayak, Wagner sınıflaması

THE TREATMENT APPROACHES IN DIABETIC FOOT AND THE ROLE OF WAGNER CLASSIFICATION IN THE GUIDANCE OF TREATMENT

Aim: Diabetic foot infections are responsible from the 2/3 of the lower extremity amputations. The cost of diabetic foot ulcers is significantly high for the society. The aim of the present study was to select the best treatment module by performing the staging of the foot problems in diabetic patients, and decrease the rate of amputation which is a traumatic procedure that decrease the quality of life, and the mental health of the patient. Methods: Fourty-nine patients diagnosed as having diabetic foot who presented to the General Surgery Clinic of xxxxxxx were included in the study. Results: Thirty patients (61.2%) out of 49 were men, and 19 (38.8%) were mean. The mean age was 61.4 years (ranging, 39-80 years). All patients were diagnosed with type 2 diabetes. The evaluation in accordance with the Wagner classification showed that 4 (8.25%) patients were in Group 1, 19 (38,7%) were in Group 2, 13 patients (26.5%) were in Group 3, 9 (18.3%) were in Group 4, and 4 (8.5%) patients were in Group 5. No significant difference was detected between the Wagner classification, and amputations with the age, sex, fasting blood glucose, urea, creatinine levels. Conclusion: Diabetic foot infections are significant health problems which resulted with economic, and social burden because the complications are severe, and resulted with amputation and even with mortality. Therefore, the prevention of the occurrence of diabetic foot is important for the social and economic perspective.The identification of the risk factors of the disease, and educating the patients who are under risk are required. Amputation rates may be decreased with the initiation of the adequate treatment in proper time with the attentive approach of the physicians who are informed of the risk factors. The treatment of the diabetic foot infections may be accomplished, and the amputation rates may be decreased with a multidisciplinary approach.

Keywords:

Diabetic foot, Wagner classification,

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