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Diabetik Ayak Sağaltımında Vakum Destekli Kapama (VAC) Metodu ve Debridmanın Birlikte Etkinliği

The Combined Effectiveness of Debridement and Vacuum-Asisted Closure (VAC) Method in the Management of Diabetic Foot

Journal Name:

  • İnönü Üniversitesi Tıp Fakültesi Dergisi

Publication Year:

  • 2012

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Objectives: Diabetic foot ulcerscause infections and tissue loss as a result of a vicious circle including peripheral neuropathy, vascular insufficiency, and immune disorders. This destructive period restrict the reconstruction options and highlights skin graft repair option. The success of the graft depends on the adequate granulation tissue without infection. Vacuum assisted closure system therapy is very successful and effective for providing of this dual effect. In this study, we analyzed the effectiveness of the VAC applications combined with debridement in 20 cases with diabetic foot ulcer retrospectively. Materials and Methods: VAC treatment was applied for 7 sessions meanly for 36 h under 125-150 mm Hg intermittently and waiting period for 12h combining with recurrent debridement. Decreasing in the wound dimensions by contractions and evident increasing the granulation tissue in the wounds were observed just from the second session of the VAC therapy. Results: After the sufficient thickness granulation tissue formation, the wounds were repaired by split thickness skin grafts. No recurrence was seen except of two patients with heel ulcers. Distal transmetatarsal reamputation was performed to 3 patients after 6 months. Conclusion: VAC treatment is very safe and effective in wound healing including the improvement of granulation tissue, drainage of infection, and wound contraction. The determining factor on the effectiveness of VAC treatment is debridement which is performing effectively on time.
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Abstract (Original Language): 
Amaç: Diabetik ayak ülserleri periferik nöropati, vasküler yetmezlik ve immün sistem bozukluklarından oluşan kısır döngünün sonucu olup enfeksiyon ve doku kayıplarına neden olmaktadır. Bu yıkıcı süreç cerrahi onarım seçeneklerini oldukça kısıtlamakta ve greftle onarım seçeneğini öne çıkarmaktadır. Greftlerin başarısı enfeksiyondan arındırılmış yeterli granülasyon dokusunun varlığına bağlıdır. Vakum yardımlı yara kapama sistemi (VAC) tedavisi bu iki etkiyi aynı anda sağlamada oldukça etkili ve başarılıdır. Bu çalışmamızda debritmanlarla birlikte VAC tedavisi uygulamalarının etkinliğini, 20 diabetik ayak ülserli olguda, geriye dönük olarak inceledik. Gereç ve Yöntem: VAC tedavisi mükerrer debridmanlarla birlikte ortalama 7 seans uygulandı. 36 saat 125-150 mm Hg intermittan basınç altında uygulandı. Seanslar arasında 12 saat bekleme süresi vardı. VAC tedavi uygulamasının ikinci seansından itibaren yaralarda belirgin granülasyon dokusu artışı ve kontraksiyonla yara boyutlarında küçülme gözlendi. Bulgular: Yeterli kalınlıkta granülasyon dokusu oluşturulduktan sonra yaralar kısmi kalınlıkta deri grefti ile onarıldı. Ayak topuğuna lokalize yarası olan 2 hasta dışında nüks görülmedi. 3 hastaya 6 ay sonra distal seviye transmetatarsal reamputasyon yapıldı. Sonuç: VAC tedavisi, yara enfeksiyonunun drenajında, yaranın kontraksiyonunda ve granülasyon dokusunun artmasında oldukça güvenli ve etkili bir yöntemdir. VAC tedavisinin bu etkinliğinde belirleyici olan uygun zaman aralıklarında yapılan etkili debridmanlardır.
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  • 3
132-137
  • Turkish

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