ETHEM GÜNEREN, Selahattin YAMAN, Mithat ULAY, Lütfi BAŞ

Diabetik ayaktaki doku defektlerinin tedavisinde hiperbarik oksijenin yeri

Diabetik hastalarda alt ekstremite yaralarının tedavisinde amputasyon gibi morbidite ile sonuçlanan bir seçeneğin yüksek oranda olması, yeni yöntemlerin aranmasını teşvik eder. Hiperbarik oksijen tedavisi (HBO2T) doku düzeyinde oksijenin parsiyel basıncını arttırıp hümoral savunma sisteminin aerobik fazını indükleyerek yara iyileşmesini hızlandırır. Bu çalışmada diabetik ayak hastalarında adjuvan HBO 2T'nin etkisi araştırıldı. Diabeti ve alt ekstremitede yarası bulunan 27 hastadan geleneksel yöntemlerle iyileşmeyen 10 hastaya adjuvan HBO 2T uygulandı. Tedavi rejimi 2.4 atm basınç altında %100 oksijen inhalasyonu şeklinde günde 1 kez 90 dakika süre ile ameliyat öncesi 20 seans ameliyat sonrası 10 seans uygulandı. Bir hasta radikal cerrahi girişime gerek duymadan iyileşti. 6 hasta radikal cerrahi girişimle iyileşti. 2 hasta diz altı amputasyonla iyileşti, 1 hastamızı tedavi sırasında diabetin sistemik komplikasyonlarından kaybettik. Hastalarımızın hiçbirinde HBO2T'ne bağlı komplikasyon görülmedi. Bu çalışmanın sonucunda adjuvan HBO 2T'nin diabetik ayakta noninvazif ve morbiditesi olmayan bir yöntem olarak tedaviye eklenebileceği düşünüldü.

Anahtar Kelimeler:

Hiperbarik oksijenleme, Cerrahi işlemler, operatif, Tedavi sonucu, Diabetik ayak

The state of hyperbaric oxygen therapy in the treatment of diabetic foot

Treatment of lower extremity wounds in diabetic patients is generally unsatisfactory. Morbidity is huge, and significant percentage of patients undergo high level amputation. We wanted to promote wound healing in these patients by increasing oxygen delivery through the defective microcirculation by the use of hyperbaric oxygen (HBO). Ten diabetic patients with lower limb injuries were treated with HBO which 100 %O <sub>2</sub> inhalation in a pressurised chamber at 2.4 ATA. This treatment was carried out daily for 90 minutes for 20 days pre-operatively, and 10 days post-operatively. One of our 10 patients healed secondarily, 6 patients were treated with surgery, 2 patients underwent below-knee amputation and 1 patient died from systemical complications of diabetes mellitus. According to this study, we observed the morbidity rate was decreased in comparison of traditional expectations.

Keywords:

Hyperbaric Oxygenation, Surgical Procedures, Operative, Treatment Outcome, Diabetic Foot,

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