Nuri ÇAKIR, Ayhan KARAKOÇ, Alev ALTINOVA, Müjde AKTÜRK, Göksun AYVAZ, Hüseyin DEMİRCİ, Füsun TÖRÜNER, İlhan YETKİN, Metin ARSLAN

Wagner sınıflamasına göre evre 3 ve 4 olan diabetik ayak olgularında alt ekstremite amputasyon sıklığı

Amaç: Diabetes Mellitus hastalarında diabetik ayak gelişimi yaşam kalitesinin kötüleşmesine, alt ekstremite amputasyonlarına ve mortalite artı¬şına neden olabilen önemli bir komplikasyondur. Diabetik ayale gelişmiş olan hastalarda enfeksiyon (özellikle derin doku enfeksiyonu) varlığı, alt ekstremitenin amputasyon riskini arttırdığı için özel önem taşır. Çalışma¬mızda uygun antibiyotik ve yara bakımı uygulanan, Wagner sınıflamasına göre evre 3 ve 4 olan diabetik hastalarda amputasyon sıklığının değerlen¬dirilmesi amaçlandı. Metod: GÜTF Diabetik Ayak Polikliniği'nde, 2002 Ocak- 2003 Haziran dönemi içinde takip edilen, Wagner sınıflamasına göre evre 3 ve 4 olan hastalar, retrospektif olarak değerlendirildi. Dermografik özellikleri kay¬dedildi. Hastalarda MR ve kemik sintigrafisi ile osteomyelit varlığı araştı¬rıldı. Alt ekstremite amputasyonlan ayak bileği seviyesine göre major ve minör amputasyon olarak sınıflandırıldı. Sonuç: 2002 Ocak - 2003 Haziran dönemi içerisinde Diabetik Ayak Polikliniği'ne başvuran toplam 78 hastanın 33'ünde osteomyelit ve derin doku enfeksiyonu saptandı (%42,30). Wagner sınıflamasına göre 30 hasta evre 3, 3 hasta evre 4 olarak değerlendirildi. 12 hasta kadın (%36,4), 21 hasta erkekdi (%63,6). Hastaların yaş ortalamaları 60,0±ll,2, diabet süre¬leri 15,8±9,8 yıl olarak saptandı. Takiplerde amputasyonu kabul etmeyen 1 hasta exitus oldu (%3,03). 3 hastaya minör, 2 hastaya major amputasyon uygulandı. Toplam amputasyon oranı % 15,62 olarak bulundu. Yorum: Derin doku enfeksiyonu gelişmiş olan diabetik ayaklı hastalarda multidisipliner yaklaşım, uygun yara bakımı ve antibiyotik tedavisi ile amputasyon oranlarının geçmiş ülkemiz verilerine göre azaldığı görül¬müştür.

Amputation rate in diabetic foot patients with Wagner classification 3 and 4

Aim: Diabetic foot causes morbidity and mortality and reduces the quality of life. The presence and treatment of infections in diabetic foot is espe¬cially important as they may increase the amputation risk. In our study we evaluated the amputation rate in diabetic foot patients with Wagner Classification 3 and 4. Method: Diabetic patients diagnosed with diabetic foot ulcers (Wagner Class 3 and 4) were evaluated retrospectively between January 2002 and June 2003. The presence of osteomyelitis was investigated by bone scin-tigraphy and MRI. Amputations were classified as major or minor accor¬ding to the ankle. Results: Thirty-three of 78 (42.3%) patients with diabetic foot ulcers had osteomyelitis. Twelve patients (36.4%) were women and 21 were men (63.6%). Mean age was 60.0Ü1.2 years, and mean diabetes duration was 15.8±9.8 years. Thirty patients were classified as Wagner class 3 and 3 as class 4. In the follow-up period one patient who did not agreed to the amputation died. Three patients had minor and 2 patients had major am¬putations. The total amputation rate was 15.6%. Conclusion: Amultidisciplinary approach and appropriate therapy reduce the amputation rates in diabetic foot patients.

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