Diyabetik Ayakta Anatomik Değişiklikler

Amaç: Diyabetik hastaların, amputasyon gerektiren, kangreni geliştirme olasılığı 15 kat daha fazladır. Travmatik olmayan uzuv amputasyonlarının çoğu, diyabetin komplikasyonlarından kaynak-lanmaktadır.Bu çalışmanın amacı diyabetik ayak ülseri olan has-talarda meydana gelen çeşitli anatomik değişiklikleri analiz etmek-tir.Materyal ve Metod: Hindistan BHDC Profesör ve Cerrahi Ana-bilim Dalı Başkanı yönetimindeki üçüncü basamak hastanesinde Diyabet Kliniğine başvuran 70 hastanın ayak lezyonunun doğası, yerleşim yeri, büyüklüğü, ayak lezyonlarının etiyolojisi ve yara bezlerinin hassasiyet ve kültürü konusunda prospektif bir çalışma yürütüldü.Bulgular: En sık görülen lezyonlar nasır, kuru cilt, fissür, hiper-trofik ve kırılgan tırnak formlarında cilt ve tırnak değişiklikleri (47 hasta,% 67.1) görülmüştür. 20 hastada (% 28,5) ülser mevcuttu ve 3 hastada (% 4,2) kangren vardı. 56 hasta (% 80) çoklu yara de-bridmanları ile tedavi edildi ve seri pansumanlar yapıldı.11 has-tadan (% 15.7) yara iyileşmesi için cilt grefti istedi. 3 hasta için (% 4.2) bir çeşit amputasyon gerektirdi.Sonuç: Kesin diyabetik kontrol, günlük pansumanlar, yeterli, agresif ve zamanında debridman ve kültüre özgü antibiyotikler şeklinde cerrahi müdahale ile diabetik ayak yaralarının iyileştiği tespit edildi. Uygun seviyelerde amputasyon, septisemiyi önlemek için şiddetli enfeksiyonlarda hayat kurtarıcı önlemler olarak yapılmalı ve hayat kurtarıcı, kol ve ayak tasarrufundan daha önce-liklidir.

Anahtar Kelimeler:

Amputasyon, ayak lezyonları, nöropati, yara debridmanı

Anatomical Changes in Diabetic Foot

Objective: Diabetic patients are 15 times more likely to develop gangrene, requiring amputation. Most of the non-traumatic limb amputations are due to complications of diabetes. The aim of this study was to analyse the various anatomical changes occurring in patients with diabetic foot ulcers.Materials and Methods: A prospective study was carried out in 70 patients presenting to the Diabetic Clinic at a tertiary care hospi-tal in Delhi, India under the Professor and Head of Department Surgery BHDC India, regarding the site, size, nature of foot le-sion, etiology of foot lesions and culture and sensitivity patterns of the wound swabs.Results: Most common lesions were noticed to have skin and nail changes (47 patients,67.1%) in the form of corns, callosities, dry skin, fissures, hypertrophied and brittle nails.20 patients (28.5%) presented with ulcers and 3 patients (4.2%) had gangrene. 56 patients (80%) were managed by multiple wound debridements and serial dressings.11 patients (15.7%) required skin grafting for wound healing.3 patients (4.2%) required some form of amputa-tion.Conclusion: It was found that with strict diabetic control, daily dressings, surgical intervention in the form of adequate, aggressive and timely debridement and culture specific antibiotics, the diabetic foot wounds healed well. Amputation at appropriate levels should be performed as life-saving measures in severe infections to pre-vent septicaemia and lifesaving takes precedence over limb / toe saving.

Keywords:

Amputation, foot lesions, neuropathy, wound debridement,

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