Diyabetik Ayakta Minör Cerrahiler
Özet
Diyabetes Mellitus, kapiller dolaşımı ve sinir sistemini etkileyerek ayaklarda duyu kaybı, deformite ve iyileşmeyen ülserlere yol açan küresel bir sağlık sorunudur. Diyabetik ayak yaraları (DAY), yüksek tedavi maliyetleri, hastanede uzun kalış süreleri ve non-travmatik alt ekstremite amputasyonlarının en önemli nedenleri arasında yer almaktadır. Etkin bir yara yönetimi için glike hemoglobin (HbA1c) seviyelerinin hastanın klinik durumuna göre optimize edilmesi ve enfeksiyon kontrolü amacıyla doku biyopsisi veya küretaj ile bakteriyolojik inceleme yapılması kritik önem taşır. Tedavinin temel taşını, etkilenen uzvun yükünün bireysel boşaltma bandajları veya ortezlerle hafifletilmesi ile cansız dokuların cerrahi olarak tamamen uzaklaştırılması (radikal debridman) oluşturur. Klasik cerrahi debridmana ek olarak; larva tedavisi, enzimatik, ultrasonik, basınçlı su ve negatif basınçlı yara tedavisi (NBT) gibi yenilikçi minör cerrahi yöntemler süreci desteklemektedir. İskemik olgularda acil revaskülarizasyon ve anjiyo cerrahi konsültasyonu gerekirken, osteomiyelit varlığında kemik rezeksiyonu ve uzun süreli antibiyotik tedavisi uygulanır. Multidisipliner bir yaklaşım, sürekli podiatrik bakım, hastanın eğitimi ve özel ortopedik ayakkabı kullanımı, yaraların tekrarlamasını ve amputasyon riskini önlemede hayati bir rol oynamaktadır.
Diabetic Mellitus is a global health issue that affects capillary circulation and the nervous system, leading to sensory loss, deformities, and non-healing ulcers in the feet. Diabetic foot ulcers (DFUs) are major causes of high treatment costs, prolonged hospitalizations, and non-traumatic lower extremity amputations. For effective wound management, optimizing glycated hemoglobin (HbA1c) levels based on the patient's clinical status and performing bacteriological examination via tissue biopsy or curettage for infection control are critical. The cornerstone of treatment includes offloading the affected limb using individual pressure-relief bandages or orthoses, combined with the complete surgical removal of non-viable tissues (radical debridement). In addition to conventional surgical debridement, innovative minor surgical methods such as maggot-larva therapy, enzymatic, ultrasonic, hydrosurgery, and negative pressure wound therapy (NPWT) support the process. Ischemic cases require urgent revascularization and angiosurgical consultation, while bone resection and prolonged antibiotic therapy are applied in the presence of osteomyelitis. A multidisciplinary approach, continuous podiatric care, patient education, and the use of specialized orthopedic footwear play a vital role in preventing recurrence and amputation risks.
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