Yara Yönetiminde Yenilikçi Yaklaşımlar

Yara herhangi bir fiziksel hasar sonucunda doku bütünlüğünün bozulmasıdır. Toplumda diyabet, periferik damar hastalıkları gibi kronik hastalıkların artmasıyla birlikte deri bütünlüğünü bozan akut ya da kronik yaraların görülme sıklığı da yükselmiştir. Bu durum yeni yara tedavi yöntemleri ve seçeneklerini çoğaltmıştır. Yara tedavisinde son yıllarda gazlı bezin yerine geçen modern yara örtüleri tedavi seyrini olumlu yönde değiştirmiştir. Yara tedavisinde yapışmayan, nemi koruyan, kokuyu önleyen ve toksik olmayan yara örtüleri idealdir. Son yıllarda gelişen tıp ve teknolojiye paralel olarak yara tedavisinde de çeşitlilik artmıştır. Negatif basınçlı yara tedavisi, hiperbarik oksijen tedavisi, elektrik stimülasyonu ve ultrason gibi uygulamalar sık olarak kullanılmaktadır. Uzmanlık gerektiren bu uygulamalar ile kronik yara tedavisinde olumlu sonuçlar elde edilmiştir. Yara iyileşmesi sistemik ve lokal faktörlerden etkilenmektedir. Bu nedenle etkili yara tedavisi için hasta tüm yönleriyle değerlendirilmeli ve tedavinin planlanması da bireye özgü yapılmalıdır. İdeal tedavi yöntemi için hücre yenilenmesine olanak sağlayan, hastaya ağrı ve zarar vermeyen ve en kısa sürede iyileşmeyi sağlayan uygulamalar seçilmelidir. 

Innovative 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. In recent years, modern dressings that replaced the gauze in the treatment of wounds changed the course of treatment positively. 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 and do not harm to patient and provide recovery as soon as possible.

___

  • 1. Drosou, A., Falabella, A., Kirsner, R.S. (2003). Antisptics on Wounds: An Area of Controversy. Wounds, 15 (5), 149- 166.2. Güneş, Y.Ü., 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, A.H., 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. Yazar, H., Karaca, İ.R. (2016). Yumuşak Dokuda Yara İyileşmesi, Etkileyen Faktörler ve Skar Revizyonu. Atatürk Üniversitesi Diş Hekimliği Fakültesi Dergisi, 15, 152-161.7. Dowsett, C. (2002). The Role of the Nurse in Wound Bed Preparation. Nursing Standard, 16 (44), 69-76.8. Gürsoy, A. (2007). Yara Örtüsü Seçimi. HEAD, 4 (1), 6-9.9. Calianno, C. (2003). How to Choose the Right Treatment and Dressing for the Wound. Nursing Management, 6 (10), 12-14.10. 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), 185-206.11. Kim, J.O., Park, J.K., Kim, J.H., Jin, S.G., Yong, C.S., Li, D.X., 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. 12. Chin, G.A., Diegelmann, R.F., Schultz, G.S. (2005). Cellula and Molecular Regulation of Wound Healing. Wound Healing. (s.17-39). Boca Raton: Taylor&Francis Group.13. Altay, P., Başal, G. (2010). Yara örtüleri. Tekstil Teknolojileri Elektronik Dergisi, 4 (1), 109-121.14. Yalçın, Atar, N. (2014). Basınç Yaraları. Erişkin Yoğun Bakım Hastalarında Temel Sorunlar ve Hemşirelik Bakımı. (s. 149-164). İstanbul: Nobel Tıp Kitapevi.15. Dumville, J.C, O’Meara, S., Deshpande, S. (2011). Hydrogel dressing for Healing Foot Ulcers. Cochrane Database Systematic Review, 7 (9), CD009101.16. Stashak, T.S, Farstvedt, E., Othic, A. (2004). Update on Wound Dressings: Indications and Best Use. Clinical Techniques in Equine Practice, 3 (2), 148-163.17. Dumville, J.C, Deshpande, S., O’Meara, S., Speak, K. (2012) Hydrocolloid Dressing For Healing Diabetic Foot Ulcers. Cochrane Database Systematic Review, 15 (2), CD009099.18. Pott, F.S, Meier, M.J, 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), 511-520.19. Qaseem, A., Humphrey, L.L., Forciea, M.A., Starkey, M., Danberg, T.D. (2015). Treatment of Pressure Ulcers: A Clinical Practice Guideline from the American College of Physicians. Annals of Internal Medicine, 162 (5), 370-379.20. Qaseem, A., Mir, T.P., Starkey, M., Danberg, T.D. (2015). Risk Assessment and Prevention of Pressure Ulcers: A Clinical Practice Guideline from the American College of Physicians. Annals of Internal Medicine, 162 (5), 359-369.21. Dreifke, M.B., Jayasuriya, A.A., Jayasuriya, A.C. (2015). Current Wound Healing Procedures and Potential Care. Material Science and Engineer C Material for Biological Applicatons, 48, 651–662. 22. Purner, S.K, Babu, M. (2000). Collagen Based Dressings-A Review. Burns, 26 (1), 54–62.23. Brett, D.A. (2008). Review of Collagen and Collagen Based Wound Dressings. Wounds, 20 (12), 347-356.24. Chen, R.N., Wang, G.M., Chen, C.H., Ho, H.O., Sheu, M.T. (2006). Development of Chitosan/Collagen Matrixes as a Wound Dressing. Biomacromolecules, 7 (4), 1058–1064.25. Sezer, A.D., Hatipoğlu, F., Cevher, E., Oğurtan, Z, Baş, A.L., 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), 1-8.26. Uppal, R., Ramaswamy, G.N., Arnold, C., Goodband, R., Wang, Y. (2011). Hyaluronic Acid Nanofiber Wound Dressing—Production, Characterization, and in Vivo Behavior. Journal of Biomedical Materials Research, 97 (1), 20-29. 27. Supp, D.M., Boyce, S.T. (2005). Engineered Skin Substitutes: Practices and Potentials. Clinics in Dermatology, 23 (4), 403-12.28. Özkayın, N., Erdem, M., Tiftikçioğlu, Y.Ö. (2017). Negatif Basınçlı Yara Tedavisi ve Ortopedi Pratiğinde Kullanımı. TOTBİD Dergisi, 16, 203–208.29. Aktaş, Ş. (2012). Kronik Yarada Lokal Faktörler ve Yardımcı Tedaviler. ANKEM Dergisi, 26 (2), 217-222.30. 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), CD009261.31. Ubbink, D.T., Westerbos, S.J., Evand, D., Land, L.,Vermeılen, H. (2008). Topical Negative Pressure for Treating Chronic Wounds. Cochrane Database Systematc Review, 16 (3), CD001898.32. Dumville, J.C., Hinchliffe, R.J., 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), CD010318.33. Hingorani, A., Lamuraglia, G.M., Henke, P., Meissner, M.H., Loretz, L., Zinszer, K.M., 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), 3-21.34. 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), 176–182.35. Sahni, T., Singh, P., John, M.J. (2003). Hyperbaric Oxygen Therapy: Current Trends and Applications. Journal of Association Physicians India, 51, 280–284.36. Mehta, Vandana, De., Abhishek, Balachandran, C. (2009). Hyperbaric Oxygen Therapy. Journal of Pakistan Association of Dermatologists, 19 (3), 164–167.37. Thom, S.R. (2011). Hyperbaric Oxygen: its Mechanisms and Efficiency. Plastic and Reconstrictive Surgery, 127 (1), 131–141.38. Stoekenbroek, R.M., Santema, T.B., Legemate, D.A., Ubbink, D.T., Brink, A., Koelemay, M.J.W. (2014). Hyperbaric Oxygen for the Treatment of Diabetic Foot Ulcers. Department of Surgery, Academic Medical Center. Systematic Review, 47 (6), 647-655.39. 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), 166-175.40. 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), 998-1003.41. Öztopalan, D.F., Işık, R., Durmuş, A.S. (2017). Yara İyileşmesinde Büyüme Faktörleri ve Sitokinlerin Rolü. Dicle Üniversitesi Veteriner Fakültesi Dergisi, 10 (1), 83-88.42. 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. 43. Lee, A.R.C., Leem, H., Jaegwan, L., Park, K.C. (2005). Reversal of Silver Sulfadiadine-İmpaired Wound Healing by Epidermal Growth Factor. Biomaterials, 26 (10), 4670-4676.44. Greer, N., Foman, N.A., 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, 532-542.45. Ulma, R.M., Aghaloo, T.L., Freymiller, E.G. (2013). Wound Healing. Oral and Maxillofacial Trauma. (S. 9-29). Philadelphia: Saunders.46. 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), CD001177.47. Saydam, İ.M, 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), 113-120.48. Lakshmipathy, U., Verfaillie, C. (2005). Stem Cell Plasticity. Blood Reviews, 19 (1), 29-38. 49. Ding, D.C., Shyu, W.C., Lin, S.Z. (2011). Mesenchymal Stem Cells. Cell Transplantation 20 (1), 5-14. 50. Jackson, W.M., Nesti, L.J., Tuan, R.S. (2012). Concise Review: Clinical Translation of Wound Healing Therapies Based on Mesenchymal Stem Cells. Stem cells Translational Medicine, 16 (1), 44-50.51. Marx, R.E. (2001). Platelet-Rich Plasma (PRP): What is PRP and What is not PRP? Implant Dentistry, 10 (4), 225-228. 52. Dhillon, R.S, Schwarz, E.M., Maloney, M.D. (2012). Platelet-Rich Plasma Therapy-Future or Trend? Arthritis Research and Theraphy, 14 (4), 219.53. Carter, M.J, Fylling, C.P., Parnell, L. (2011). Use of Platelet Rich Plasma Gel on Wound Healing: A Systematic Review and Meta-Analysis. Eplasty, 11, 382-410.54. Zapata, M.J, Carvajal, A.J.M., Sola, I., Exposito, J.A., Bolibar, I., Rodrigez, L., et al. (2013). Autologous Platelet Rich Plasma for Treating Chronic Wounds. Cochrane Database Systematic Review, 25 (5), CD006899.55. Demir, A., Kelahmetoğlu, O., Keleş, M.K. (2010). Yara İyileşmesinde Elektrik Stimulasyonu Uygulaması. Journal of Experimental and Clinical Medicine, 27, 160-163.56. Aksoy, G. (2012). Cerrahi infeksiyonlar. Cerrahi hemşireliği I (s. 165-168), İstanbul: Nobel Tıp Kitapevi. 57. 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), 1-22.58. Sebastian, A., Iqbal, J., Colthurst, S.W., Volk, A. (2015). Electrical Stimulation Enhances Epidermal Proliferation in Human Cutaneous Wounds by Modulating. Journal of Investigative Dermatology, 135 (4), 1166-1174.59. 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), 185–195.60. Robertson, V.J., Baker, K.G. (2001). A review of Therapeutic Ultrasound: Effectiveness Studies. Physical Theraphy, 81 (7), 1339–1350.61. Ennis, W.J, Valdes, W., Gainer, M., Patricio, M. (2006). Evaluation of Clinical Effectiveness of MIST Ultrasound Therapy for the Healing of Chronic Wounds. Advances in Skin and Wound Care, 19 (8), 437-446.62. 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. 63. Vickie, R., Driver, M.S., Min Yao, M.D., Cristopher, J., Miller, B.A. (2011). Noncontact low Frequency Ultrasound Therapy in the Treatment of Chronic Wounds: A Meta Analysis. Wound Repair and Regeneration, 19, 4-20.64. Yaghoobi, R., Kazerouni, A., Kazerouni, O. (2013). Evidence for Clinical Use of Honey in Wound Healing as an Anti-Bacterial, Anti-İnflammatory Anti-Oxidant and Anti-Viral Agent: A Review. Jundishapur Journal of Natural Pharmaceutical Products, 8 (3), 100-104.65. 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. 66. Eddy, J.J., Gideonsen, M.D., Mack, G.P. (2008). Practical Considerations of using Topical Honey for Neuropathic Diabetic Foot Ulcers: A Review. Wisconsin Medical Society Journal, 107 (4), 187-190.