Diyabetik ayak yarası olan hastalara multidisipliner yaklaşımda ortopedinin yeri
The role of orthopedic's in multidisciplinary approach to diabetic foot wounds
Yazar: YAVUZ ARIKAN
Danışman: PROF. DR. ÜNAL KUZGUN
Sağlık Bakanlığı / İstanbul Şişli Hamidiye Etfal Eğitim ve Araştırma Hastanesi / Ortopedi ve Travmatoloji Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2010
Konu: Ortopedi ve Travmatoloji = Orthopedics and Traumatology

Özet:
ÖZET:
     Diyabetik ayak yarası olan hastalara multidisipliner yaklaşımda ortopedinin yeri 
Diabetik ayak yarası  uzun süreli ve ciddi tedavilere gereksinim göstermesi ve tedavinin birçok bölümü ilgilendirmesi nedeniyle multidisipliner bir yaklaşımı gerekli  kılmaktadır. Hastanemizde 2007 yılında oluşturulan Yara Konseyi'nde diabetik ayak hastaları multidisipliner bir yaklaşımla değerlendirildi.
     Şişli etfal eğitim ve araştırma hastanesi yara konseyi tarafından değerlendirilen ve 1. Ortopedi ve travmatoloji kliniğinde yatarak tedavi gören 46  hastamız çeşitli değerleri göz önüne alınarak incelendi. Hastaların 28'i erkek 18'i kadındı. Hastaların hepsi tip 2 diabetti. Olguların %38.7 si Wagner sınıflamasına göre %8.6 sı grup 1, % 32.6 sı grup 2,  % 34.7 si grup 3,  % 13 ü grup 4, % 10.8 i grup 5 olarak saptandı. Hastalardaki lezyonların enfekte supüre ve distal yerleşimli olduğu dikkati çekti. Yapılan fizik muayenede ve anjiografilerinde  tıkanmış arter seviyelerinin distalde daha fazla olduğu görüldü. Hastaların Yapılan kültür antibiogramlarda en fazla üreyen mikroorganizmanın stafilokokus aerus üredi.   
      Hastalara çeşitli cerrahi müdahaleler yapıldı. Bunlar debritman +drenaj(6),
metphalangial amp.(2), transmetatarsal amp(3), lisfrac amp.(3), chopart amp(2), syme
amp(4),piregoff amp (1), diz altı amp.(19), diz üstü amp.(6) ve bilateral diz üstü
amputasyondu(1).Hastaların 6 'sına debridman+grefonaj, 6 hastaya HBO, 8 hastaya 
VAC uygulandı. Opere edilen hastalardaki 15 ekstremite bir üst seviyeden tekrar 
ampute edildi.
       Diabetik ayak yarası olan hastalar için multidisipliner yaklaşım ile hastaların mağduriyeti ortadan kalkmaktadır. Çalışmamız ile ortopedinin bu ekipte önemli bir yeri olduğunu

Abstract:
ABSTRACT:
The role of orthopedic's in multidisciplinary approach to diabetic foot wounds 
Objective:
 Owing to management of diabetic foot wounds (DFW) need severe and long-term treatment protocol 
that concerns many departments; diabetic foot ulcers necessitate multidisciplinary approach. Therefore a coun
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cil was constituted that called "Wound Council", included five deparments (endocrinology, infectious diseases, 
dermatology, orthopedics and plastic surgery) in Sisli Etfal Research an Training Hospital. The purpose of this 
study was to inform about the wound council and to emphasise the role of orthopedic approach to DFW.
Methods:
 A total of 42/154 patients (29 male and 13 female; mean age:66) who had DFW, were evaluated on 
"Sisli Etfal Research and Training Hospital - Wound Council" and were decided to be treated by 1. Orthopaedics 
and Traumatology Clinic were included in this study. Patients' demographic findings such as gender, age, loca
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tion and duration of wound, wound culture, results of angiography, presence of vascular pathology, blood sugar 
levels, wound stages according to Wagner classificaion, surgical prosedures, complications and period of hos
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pitalization were noted.
Results:
 Fifty one meeting were done in "Sisli Etfal Research and Training Hospital - Wound Council" between 
2007-2009 and 154 patients were assessed. 120 of patients (76 male, 44 female and mean age:58.6) had diabe
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tes (type 1/2=3/117). Wound durations were changing between 2 weeks and 18 years. 42 of these patients who 
were hospitalized to 1. Orthopedics and Traumatology Clinic had tipe 2 diabetes mellitus (DM) and their mean 
wound durations were 3.4 month. Staphylococcus aerius were the more spawning microorganism. According to 
Wagner classification; more half of patients were stage 4 and 5 (55.7%). 59.5% of patients had lower knee and 
23.8% of patients had upper knee amputations. In addition debridement and drainage were applied to five of 
them, hyperbaric oxygen therapy (HBO) were added 3 of them and vacumm assisted closure (VAC) were added 
in 3 of them each. Reamputation precedure were applied to 9 of patients who had infection on postoperative 
follow-up period. Period of hospitalization period were 4-22 days (mean:13.2).
Conclusion: 
Consultation traffic of necessary departments for the patients who have DFW decreases with muti
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disciplinary approach. We've understant that orthopedic practice has an important place in this team. According 
to our study; for effective treatment of this DFW patients, multi clinical assessement can increase the success 
instead of single approach.