Yara Yönetiminde Güncel Yaklaşımlar
Yara herhangi bir fiziksel hasar sonucunda dokubütünlüğünün bozulmasıdır. Toplumda diyabet,periferik damar hastalıkları gibi kronik hastalıklarınartmasıyla birlikte deri bütünlüğünü bozan akut ya dakronik yaraların görülme sıklığı da yükselmiştir. Budurum yeni yara tedavi yöntemleri ve seçenekleriniçoğaltmıştır. Son yıllarda gelişen tıp ve teknolojiyeparalel olarak ortaya çıkan modern yara örtüleri tedaviseyrini olumlu yönde değiştirmiştir. Yara tedavisindeyapışmayan, nemi koruyan, kokuyu önleyen ve toksikolmayan yara örtüleri idealdir. Negatif basınçlı yaratedavisi, hiperbarik oksijen tedavisi, kök hücretedavisi, büyüme faktörleri, topikal ajanlar, elektrikstimülasyonu, ultrason, lazer, maggot terapi, ozontedavisi, bal gibi uygulamalar yara tedavisindekialternatif yaklaşımlardandır. Uzmanlık gerektiren buuygulamalar ile kronik yara tedavisinde olumlusonuçlar elde edilmiştir. Yara iyileşmesi sistemik velokal faktörlerden etkilenmektedir. Bu nedenle etkinbir yara tedavisi için hasta tüm yönleriyledeğerlendirilmeli ve tedavinin planlanması bireyeözgü yapılmalıdır. İdeal tedavi yöntemi için hücreyenilenmesine olanak sağlayan, hastaya ağrı vermeyenve en kısa sürede iyileşmeyi sağlayan uygulamalarseçilmelidir.
Current Approaches in Wound Management
Wound is the deterioration of tissue integrity as a result of any physical damage. With the increase of chronic diseases such as diabetes and peripheral vascular diseases, there is an increase in the incidence of acute or chronic wounds that disrupt the skin integrity. This situation has increased the number of new wound treatment methods and options. Modern dressings that have emerged in parallel with the developing medicine and technology have changed the course of treatment in a positive way. Non-adherent, moisture-proof, odor-free and non-toxic dressings are ideal for wound treatment. In parallel with the developing medicine and technology, wound treatment has increased in recent years. Applications such as negative pressure wound therapy, hyperbaric oxygen therapy, electrical stimulation and ultrasound are frequently used. With these applications that require expertise, positive results have been obtained in chronic wound treatment. Wound healing is affected by systemic and local factors. Therefore, patients should be evaluated for all aspects of wound healing and effective treatment planning should be made specific to the individual. Ideal treatment method allows cell renewal, not pain to patient and provide recovery as soon as possible.
___
- 1. Drosou, A, Falabella, A, Kirsner, RS. (2003). "Antisptics on
Wounds: An Area of Controversy." Wounds, 15 (5), 149- 166.
- 2. Güneş, YÜ, Eşer, İ. (2006). "Nemli Yara İyileşmesi ve
Oklusif Pansumanların Nemli Yara İyileşmesindeki Önemi."
C.Ü. Hemşirelik Yüksekokulu Dergisi, 10 (2), 57-65.
- 3. Türsen, Ü. (2013). "Ülser Tedavisinde Yara Örtüleri."
Turkish Journal of Dermatology, 7, 61-71.
- 4. Kurtoğlu, AH, Karataş, A. (2009). "Yara Tedavisinde
Güncel Yaklaşımlar: Modern Yara Örtüleri." Ankara Eczacılık
Fakültesi Dergisi, 38 (3), 211-132.
- 5. Mendez-Eastman, S. (2005). "Wound Dressing Categories."
Plastic Surgery Nursing, 25 (2), 95-99.
- 6. Dumville, JC, Deshpande, S, O’Meara, S, Speak, K. (2012).
"Hydrocolloid Dressing for Healing Diabetic Foot Ulcers."
Cochrane Database Systematic Review, 15 (2), CD009099.
- 7. Blacburn J,Ousey K,Stephenson J. (2019). "Nurses' Education,
Confidence, and Competence in Appropriate Dressing
Choice."Adv Skin Care, 9, 1-7.
- 8. Yazar, H, Karaca, İR. (2016). "Yumuşak Dokuda Yara
İyileşmesi, Etkileyen Faktörler ve Skar Revizyonu." Atatürk
Üniversitesi Diş Hekimliği Fakültesi Dergisi, 15, 152-161.
- 9. Dowsett, C. (2002). "The Role of the Nurse in Wound Bed
Preparation." Nursing Standard, 16 (44), 69-76.
- 10. Gürsoy, A. (2007). "Yara Örtüsü Seçimi." HEAD, 4 (1), 6-9.
- 11. Calianno, C. (2003). "How to Choose the Right Treatment
and Dressing for the Wound." Nursing Management, 6 (10), 12-14.
- 12. Fonder, E. (2008). "Treating the Chronic Wound: A Practical
Approach to the Care of Nonhealing Wounds and Wound Care
Dressings." Journal of the American Academy of Dermatology,
58 (2), 185-206.
- 13. Kim, JO, Park, JK, Kim, JH, Jin, SG, Yong, CS, Li, DX, et al.
(2008)." Development of Polyvinyl Alcohol-Sodium Alginate
Gel-Matrix Based Wound Dressing System Containing
Nitrofurazone." International Journal of Pharmaceutics, 359 (1-2), 79–86.
- 14. Chin, GA, Diegelmann, RF, Schultz, GS. (2005). Cellula and
Molecular Regulation of Wound Healing. Wound Healing. Boca
Raton: Taylor&Francis Group, 17-39.
- 15. Altay, P, Başal, G. (2010). "Yara Örtüleri." Tekstil Teknolojileri
Elektronik Dergisi, 4 (1), 109-121.
- 16. Yalçın, Atar, N. (2014). "Basınç Yaraları. Erişkin Yoğun Bakım
Hastalarında Temel Sorunlar ve Hemşirelik Bakımı. İstanbul:
Nobel Tıp Kitapevi, 149-164.
- 17. Dumville, JC, O’Meara, S, Deshpande, S. (2011). "Hydrogel
dressing for Healing Foot Ulcers." Cochrane Database
Systematic Review, 7 (9), CD009101.
- 18. Stashak, TS, Farstvedt, E, Othic, A. (2004). "Update on Wound
Dressings: Indications and Best Use."Clinical Techniques in
Equine Practice, 3 (2), 148-163.
- 19. Pott, FS, Meier, MJ, Stocco, JG, Crozeta, K, Ribas, JD. (2014).
"The Effectiveness of Hydrocolloid Dressings Versus other
Dressings in the Healing of Pressure Ulcers in Adults and Older
Adults: A Systematic Review and Meta-Analysis." Revista
Latino-Americana de Enfermagem, 22 (3), 511-520.
- 20. Qaseem, A, Humphrey, LL, Forciea, MA, Starkey, M, Danberg,
TD. (2015). "Treatment of Pressure Ulcers: A Clinical Practice
Guideline from the American College of Physicians." Annals of
Internal Medicine, 162 (5), 370-379.
- 21. Qaseem, A, Mir, TP, Starkey, M, Danberg, TD. (2015). "Risk
Assessment and Prevention of Pressure Ulcers: A Clinical
Practice Guideline from the American College of Physicians."
Annals of Internal Medicine, 162 (5), 359-369.
- 22. Dreifke, MB, Jayasuriya, AA, Jayasuriya, AC. (2015). "Current
Wound Healing Procedures and Potential Care." Material
Science and Engineer C: Material for Biological Applicatons,
48, 651–662.
- 23. Sezer, AD, Hatipoğlu, F, Cevher, E, Oğurtan, Z, Baş, AL,
Akbuğa, J. (2007). "Chitosan Film Containing Fucoidan as a
Wound Dressing for Dermal Burn Healing: Preparation and in
Vitro/İn Vivo Evaluation." An Official Journal of the American
Association of Pharmaceutical Scientists, 8 (2), 1-8.
- 24. Uppal, R, Ramaswamy, GN, Arnold, C, Goodband, R, Wang, Y.
(2011). "Hyaluronic Acid Nanofiber Wound DressingProduction, Characterization, and in Vivo Behavior." Journal of
Biomedical Materials Research, 97 (1), 20-29.
- 25. Chen, RN, Wang, GM, Chen, CH, Ho, HO, Sheu, MT. (2006).
"Development of Chitosan/Collagen Matrixes as a Wound
Dressing." Biomacromolecules, 7 (4), 1058–1064.
- 26. Purner, SK, Babu, M. (2000). "Collagen Based Dressings-A
Review." Burns, 26 (1), 54–62.
- 27. Brett, DA. (2008). "Review of Collagen and Collagen Based
Wound Dressings." Wounds, 20 (12), 347-356.
28. Supp, DM, Boyce, ST. (2005). "Engineered Skin Substitutes:
Practices and Potentials." Clinics in Dermatology, 23 (4), 403-412.
- 29. Boateng, JS, Matthew, KH, Stevens, HNE, Eccleston, GM.
(2007). “Wound Healing Dressings and Drug Delivery Systems:
A Review” J. Pharm. Sci, 97(8), 2892-2923.
- 30. Lu, MM, Bai, J, Shao, D, Qiu, J, Li, M, Zheng, X, et al. (2018).
"Antibacterial And Biodegradable Tissue Nano-Adhesives For
Rapid Wound Closure."International Journal Nanomedicine, 13,
5849–5863.
- 31. Özkayın, N, Erdem, M, Tiftikçioğlu, YÖ. (2017). "Negatif
Basınçlı Yara Tedavisi ve Ortopedi Pratiğinde Kullanımı."
TOTBİD Dergisi, 16, 203–208.
- 32. Aktaş, Ş. (2012). "Kronik Yarada Lokal Faktörler ve Yardımcı
Tedaviler." ANKEM Dergisi, 26 (2), 217-222.
- 33. Webster, J, Scuffham, P, Stankievicz, M, Chaboyer, W. (2014).
"Negative Pressure Wound Therapy for Skin Grafts and Surgical
Wounds Healing By Primary Intention." Cochrane Systematic
Review, 18 (4), CD009261.
- 34. Ubbink, DT, Westerbos, SJ, Evand, D, Land, L,Vermeilen, H.
(2008). "Topical Negative Pressure for Treating Chronic
Wounds." Cochrane Database Systematc Review, 16 (3),
CD001898.
- 35. Dumville, JC, Hinchliffe, RJ, Cullum, N, Game, F, Stubbs, N,
Sweeting, M, et al. (2013). "Negative Pressure Wound Therapy
for Treating Foot Wounds in People with Diabetes Mellitus."
Cochrane Database Systematc Review, 17 (10), CD010318.
- 36. Hingorani, A, Lamuraglia, GM, Henke, P, Meissner, MH,
Loretz, L, Zinszer, KM, et al. (2016). "The Management of
Diabetic Foot: A Clinical Practice Guideline by the Society for
Vascular Surgery in Collaboration with the American Podiatric
Medical Association and the Society for Vascular Medicine."
Journal of Vascular Surgery, 63 (2), 3-21.
- 37. Aydın, F, Aktaş, Ş, Olgaç, V, Mezdeği, A, Karamülsel, S.
(2003). "Deneysel Kompartman Sendromunda Cerrahi
Dekompresyonla Kombine Edilen Hiperbarik Oksijen
Tedavisinin Etkinliği. "Ulusal Travma Acil Cerrahi Dergisi, 9
(3), 176–182.
- 38. Sahni, T, Singh, P, John, MJ. (2003). "Hyperbaric Oxygen
Therapy: Current Trends and Applications." Journal of
Association Physicians India, 51, 280–284.
- 39. Mehta, Vandana, De, Abhishek, Balachandran, C. (2009).
"Hyperbaric Oxygen Therapy." Journal of Pakistan Association
of Dermatologists, 19 (3), 164–167.
- 40. Thom, SR. (2011). Hyperbaric Oxygen: its Mechanisms and
Efficiency." Plastic and Reconstrictive Surgery, 127 (1), 131–141.
- 41. Stoekenbroek, RM, Santema, TB, Legemate, DA, Ubbink, DT,
Brink, A, Koelemay, MJW. (2014). "Hyperbaric Oxygen for the
Treatment of Diabetic Foot Ulcers. Department of Surgery,
Academic Medical Center." Systematic Review, 47 (6), 647-655.
- 42. Liu, R, Ling, Li, Mengliu, Y, Guenther, B, Ganghi, Y. (2013).
"Systematic Review of the Effectiveness of Hyperbaric
Oxygenation Therapy in the Management of Chronic Diabetic
Foot Ulcers." Mayo Clinic Proceeding, 88 (2), 166-175.
- 43. Löndahl, M, Katzman, P, Nillson, A, Hammarlund, C. (2010).
"Hyperbaric Oxygen Therapy Facilitates Healing of Chronic
Foot Ulcers in Patients with diabetes." Diabetes Care, 33 (5),
998-1003.
- 44. Öztopalan, DF, Işık, R, Durmuş, AS. (2017). "Yara
İyileşmesinde Büyüme Faktörleri ve Sitokinlerin Rolü." Dicle
Üniversitesi Veteriner Fakültesi Dergisi, 10 (1), 83-88.
- 45. Martí-Carvajal, AJ, Gluud, C, Nicola, S. (2015). "Growth
Factors For Treating Diabetic Foot Ulcers." Cochrane Database
Syst Rev, 1, 8548.
- 46. Zhang, L, Chen, J, Han, C. (2009). "A Multicenter Clinical Trial
Of Recombinant Human GM-CSF Hydrogel For The Treatment
Of Deep Second-Degree Burns." Wound Repair Regen, 17, 685.
- 47. Cruciani, M, Lipsky, BA, Mengoli, C, de Lalla F. (2013).
"Granulocyte-Colony Stimulating Factors As Adjunctive
Therapy For Diabetic Foot İnfections." Cochrane Database Syst
Rev, 17;(8), 810.
- 48. Bao, P, Kodro, A, Michael, S., Paul, H. (2008). “The Role of
Vascular Endothelial Growth Factor in Wound Healing.” Journal
of Surgical Research, 153 (2), 347-358.
- 49. Lee, ARC, Leem, H, Jaegwan, L, Park, KC. (2005). "Reversal
of Silver Sulfadiadine-Impaired Wound Healing by Epidermal
Growth Factor." Biomaterials, 26 (10), 4670-4676.
- 50. Greer, N, Foman, NA, MacDonald, R, Dorrian, J, Fitzgerald, P,
Rutks, I, et al. (2013). "Advanced Wound Care Therapies for
Nonhealing Diabetic, Venous, and Arterial Ulcers." Annals of
Internal Medicine, 159, 532-542.
- 51. Ulma, RM., Aghaloo, TL, Freymiller, EG. (2013). Wound
Healing. Oral and Maxillofacial Trauma. Philadelphia: Saunders,
9-29.
- 52. Brrigs, M., Nelson, E.A., Martyn, S., James, M. (2012). "Topical
Agents or Dressings for Pain in Venous Leg Ulcers." Cochrane
Database Systematic Review, 14 (11), CD001177.
- 53. Saydam, İM, Yılmaz, S, Seven, E. (2005). "Topikal Olarak
Uygulanan Nitrofurazon ve Rifamisin’in Tam Kalınlıkta Yara
İyileşmesi Üzerine Etkileri." C. Ü. Tıp Fakültesi Dergisi, 27 (3),
113-120.
- 54. Lakshmipathy, U, Verfaillie, C. (2005). "Stem Cell Plasticity."
Blood Reviews, 19 (1), 29-38.
- 55. Ding, DC, Shyu, WC, Lin, SZ. (2011). "Mesenchymal Stem
Cells." Cell Transplantation, 20 (1), 5-14.
- 56. Jackson, WM, Nesti, LJ, Tuan, RS. (2012). "Concise Review:
Clinical Translation of Wound Healing Therapies Based on
Mesenchymal Stem Cells." Stem Cells Translational Medicine,
16 (1), 44-50.
- 57. Marx, RE. (2001). "Platelet-Rich Plasma (PRP): What is PRP
and What is not PRP?" Implant Dentistry, 10 (4), 225-228.
- 58. Dhillon, RS, Schwarz, EM, Maloney, MD. (2012). "PlateletRich Plasma Therapy-Future or Trend?" Arthritis Research and
Theraphy, 14 (4), 219.
- 59. Carter, MJ, Fylling, CP, Parnell, L. (2011). "Use of Platelet Rich
Plasma Gel on Wound Healing: A Systematic Review and MetaAnalysis." Eplasty, 11, 382-410.
- 60. Zapata, MJ, Carvajal, AJM, Sola, I, Exposito, JA, Bolibar, I,
Rodrigez, L, et al. (2013). "Autologous Platelet Rich Plasma for
Treating Chronic Wounds." Cochrane Database Systematic
Review, 25 (5), CD006899.
- 61. Demir, A, Kelahmetoğlu, O, Keleş, MK. (2010). "Yara
İyileşmesinde Elektrik Stimulasyonu Uygulaması." Journal of
Experimental and Clinical Medicine, 27, 160-163.
- 62. Aksoy, G. (2012). Cerrahi İnfeksiyonlar. Cerrahi Hemşireliği I.
İstanbul: Nobel Tıp Kitapevi, 165-168.
- 63. Sebastian, A, Iqbal, J, Colthurst, SW, Volk, A. (2015).
"Electrical Stimulation Enhances Epidermal Proliferation in
Human Cutaneous Wounds by Modulating." Journal of
Investigative Dermatology, 135 (4), 1166-1174.
- 64. Ud-Din, S, Sebastian, A, Giddings, P, Colthurst, J, Whiteside, S,
Morris, J, et al. (2015). "Angiogenesis is Induced and Wound
Size is Reduced by Electrical Stimulation in an Acute Wound
Healing Model in Human Skin." Plos One, 10 (4), 1-22.
- 65. Mostafa, J, Ali, Y, Zohre, R, Samaneh, R. (2015).
"Electromagnetic Fields and Ultrasound Waves in Wound
Treatment: A Comparative Review of therapeutic outcomes."
Biosciences Biotechnology Research Asia, 12 (1), 185–195.
- 66. Robertson, VJ, Baker, K.G. (2001). "A review of Therapeutic
Ultrasound: Effectiveness Studies." Physical Theraphy, 81 (7),
1339–1350.
- "Evaluation of Clinical Effectiveness of MIST Ultrasound
Therapy for the Healing of Chronic Wounds." Advances in Skin
and Wound Care, 19 (8), 437-446.
- 68. Voigt, J, Wendelken, M, Driver, V. (2011). "Low-Frequency
Ultrasound (20-40 kHz) as an Adjunctive Therapy for Chronic
Wound Healing: A Systematic Review of the Literature and
Meta-Analysis of Eight Randomized Controlled Trials." The
Internal Journal of Lower Extremity Wounds, 10 (4), 1-15.
- 69. Vickie, R, Driver, MS, Min Yao, MD, Cristopher, J, Miller, BA.
(2011). "Noncontact low Frequency Ultrasound Therapy in the
Treatment of Chronic Wounds: A Meta Analysis." Wound
Repair and Regeneration, 19, 4-20.
- 70. Boyraz, İ, Yıldız, A. (2016)."Lazer Çeşitleri ve Yüksek
Yoğunluklu Lazer Kullanımı. "Contemp Med,6,104-109.
- 71. Alan, H, Güler, Ç, Yolcu, Ü, Koparal, M, Çakır, E, Demir, P.
(2018). "Biostimulatory Effects of Diode Laser and Ozone on
Wound Healing in Rats. " Meandros Med Dent J, 19, 7-106.
- 72. Rocha, JCT, Tim, CR, Avo, L, Filho, LR, Kido, HW, Hamblin,
HW, et al. (2018). "Mitochondrial Dynamics (Fission And
Fusion) And Collagen Production İn A Rat Model Of Diabetic
Wound Healing Treated By Photobiomodulation: Comparison
Of 904 Nm Laser And 850 Nm Light-Emitting Diode (LED).
"Journal of Photochemistry and Photobiology, 187,41-47.
- 73. Aktürk, AŞ, Bayramgürler, D. (2016). "Yara İyileşmesinde
Lazer Tedavisi. " Turkiye Klinikleri J Dermatol-Special Topics,
9 (1), 9-46.
- 74. Gray, M. (2008). " Is Larval (Maggot) Debridement Effective
For Removal Of Necrotic Tissue From Chronic Wounds? "
Journal of wound, ostomy, and continence nursing : official
publication of The Wound, Ostomy and Continence Nurses
Society / WOCN, 35(4), 378-84.
- 75. Back, DA, Scheuermann-Poley, C, Willy, C. (2013).
"Recommendations On Negative Pressure Wound Therapy With
İnstillation And Antimicrobial Solutions-When, Where And
How To Use: What Does The Evidence Show? " International
wound journal, 10 (1),32- 42.
- 76. Coşkun, Ö, Uzun, G, Dal, D, Yıldız, Ş, Sönmez, YA, Yurttaş, Y,
et al. (2016). "Kronik Yarada Tedavi Yaklaşımları. " Gülhane
Tıp Dergisi, 58, 207-228.
- 77. Zarchi, K, Jemec, GB. (2012). "The Efficacy Of Maggot
Debridement Therapy--A Review Of Comparative Clinical
Trials." International wound journal, 9(5), 469-77.
- 78. Tian, X, Liang, XM, Song, GM, Zhao, Y, Yang, XL. (2013).
"Maggot Debridement Therapy For The Treatment Of Diabetic
Foot Ulcers: A Meta-Analysis. " Journal Of Wound Care, 22(9),
9-426.
- 79. Zhang, J, Guan, M, Xie, C, Luo, X, Zhang, Q, Xue, Y. (2014).
"Increased Growth Factors Play A Role İn Wound Healing
Promoted By Noninvasive Oxygen-Ozone Therapy İn Diabetic
Patients With Foot Ulcers." Oxidative Medicine And Cellular
Longevity, 10,110.
- 80. Wainstein, J, Feldbrin, Z, Boaz, M, Harman-Boehm, I. (2011).
"Efficacy of Ozone-Oxygen Therapy For The Treatment Of
Diabetic Foot Ulcers. " Diabetes technology & therapeutics,
13(12), 60-1255.
- 81. Mutluoğlu, M, Karabacak, E, Karagoz, H, Uzun, G, Ay, H.
(2012). " Topical Ozone And Chronic Wounds: İmproper Use Of
Therapeutic Tools May Delay Wound Healing. "North American
Journal of Medical Sciences, 4 (11), 6-615.
- 82. Yaghoobi, R, Kazerouni, A, Kazerouni, O. (2013). "Evidence
for Clinical Use of Honey in Wound Healing as an AntiBacterial, Anti-Inflammatory Anti-Oxidant and Anti-Viral
Agent: A Review." Jundishapur Journal of Natural
Pharmaceutical Products, 8 (3), 100-104.
- 83. Iftikhar, F, Arshad, M, Rasheed, F, Amraiz, D, Amwar, P,
Gulfraz, M. (2010). “Effects of Acacia Honey on Wound
Healing in Various Rat Models." Phytotheraphy Research, 24
(4), 583-586.
- 84. Eddy, JJ, Gideonsen, MD, Mack, GP. (2008). "Practical
Considerations of using Topical Honey for Neuropathic Diabetic
Foot Ulcers: A Review." Wisconsin Medical Society Journal,
107 (4), 187-190.
- 85. Mayer, A, Slezak, V, Takac, P, Olejnik, J, Majtan J. (2014).
"Treatment Of Non-Healing Leg Ulcers with Honeydew
Honey." Journal Of Tissue Viability, 23 (3), 7-94.
- 86. Kamaratos, AV, Tzirogiannis, KN, Iraklianou, SA,
Panoutsopoulos, GI, Kanellos, IE, Melidonis, AI. "Manuka
Honey-Impregnated Dressings in The Treatment of Neuropathic
Diabetic Foot Ulcers. "International Wound Journal, 11 (3), 63-259.