Erkan ORHAN, Enver ARPACI

Negatif Basınçlı Terapinin Diyabetik Hastalardaki Ayak Dorsumu Defektlerini Deri Grefti Rekonstrüksiyonuna Uygun Hale Getirmesi

Amaç: Diyabetik ayak ülserlerinin rekonstrüksiyonunda amaç, hastanın yürümesine olanak sağlayacak şekilde yaraların, uygun kalınlık ve genişlik- teki yumuşak doku ile kapatılmasıdır. Uygun incelikte doku ile ayak dorsumu rekonstrüksiyonu greftler ile sağlanabilir. Fakat, çoğu zaman ayak dorsumu defektlerinde kemik ve tendonlar ekspoze olmakta ve deri grefti ile rekonstruksiyon mümkün olamamaktadır. Negatif basınçlı terapi (NBT) ile ekspoze tendon ve greflerin üzeri granülasyon dokusu ile kaplanabilmektedir. Bu çalışmada, kemik ve tendonların üzerinin NBT yardımı ile ta- mamen granülasyon dokusu ile kaplandığı ve bu şekilde greft ile uygun şekilde yaraların rekonstruke edildiği, ayak dorsumu defekti olan diyabetik hastaları sunmaktayız. Gereç ve Yöntem: Bu çalışmaya, 2013 ile 2016 yılları arasında kemik ve tendonların ekspoze olduğu ayak dorsumu defekti olan ve NBT ile tedavi edilen hastalar dahil edilmiştir. Bulgular: NBT bu dönemde 18 hastada kullanılmıştır. Hastalar ortalama 25.28 cm2 yara alanına sahiplerdi ve ortalama 28.7 gün yatarak tedavi gördürerek ortalama 5.9 seans NBT ile tedavi edildiler. Tüm hastaların yaraları greft ile kapatıldı. Bir yıllık takiplerinde herhangi bir problem izlen- medi ve tüm hastaların rahatlık ile ayakkabı giyip yürüyebildiler. Sonuç: Biz ayak dorsumu defekti olan diyabetik hastalarda NBT ile beraber greft ile rekonstrüksiyonunun iyi bir seçenek olduğu kanaatindeyiz.

Negative Pressure Therapy Makes Diabetic Foot Dorsum Defects Suitable for Skin Graft Reconstruction

Objective: The aim of diabetic foot ulcer reconstruction is to close wounds with a soft tissue of appropriate width and thickness that allows the pa- tient to walk. Tissue reconstruction of appropriate fineness in foot dorsum is ensured with skin grafts. However, since tendon and bony tissues are often exposed in foot dorsum defects, it is normally not possible to perform reconstruction with a skin graft. By negative pressure therapy (NPT) exposed tendons and bone will be covered with granulation tissue. In this study, we describe patient who had diabetic foot dorsum defects with ex- posed tendons and bone, which were completely covered with the granulation tissue after NPT and this made it possible to perform extremely fine graft reconstructions. Material and Method: The study included diabetic patients with foot dorsum defects with exposed tendons and bones who were treated with NPT between 2013 and 2016. Results: In that period 18 diabetic patients with foot dorsum defects with exposed tendons and bones who were treated with NPT. On average, pa- tients’ wounds were 25.28 cm2 and they underwent 5.9 NBT sessions during 28.7 hospital days. The defects of all patients were reconstructed with grafts. In the one-year postoperative follow-ups, there were no problems; all patients were mobile and could wear comfortable shoes. Conclusion: Graft reconstruction after NBT is a reliable treatment option for foot dorsum defects in diabetic patients.

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