Yara Tedavisinde Kullanılan Pasif Kapama Yöntemleri ve Yara Bakım Materyalleri
Özet
Yara bakım örtüleri, yara ile dış ortam arasında fiziksel bir bariyer oluşturarak enfeksiyonları önleyen, doku hasarını asgariye indiren ve kollajen sentezini artırıp yeniden epitelizasyon sağlayarak iyileşme sürecini hızlandıran kritik materyallerdir. İdeal bir yara örtüsünün nemli bir ortam sağlaması, eksüdayı düzenlemesi, uygun sıcaklığı koruması ve yarayı bakterilerden koruması gerekmektedir. Doğru örtü seçimi; yaranın lokalizasyonu, boyutu, doku tipi, bakteriyel yükü ve eksüda seviyesi gibi spesifik parametrelerin düzenli olarak değerlendirilmesine dayanır. Ülkemizde sıklıkla Yara Bakım Derneği'nin sınıflaması kabul görmekte olup yara örtüleri pasif ve aktif kapamalar olarak adlandırılmaktadır. Klinik uygulamalarda nem dengesini yönetmek, otolitik debridmanı kolaylaştırmak ve enfeksiyonu kontrol etmek amacıyla hidrokolloid, hidrojel, yarı geçirgen film, köpük, kalsiyum aljinat, hidrofiber ve kollajen örtüler kullanılmaktadır. Ayrıca gümüş, bal ve iyot içeren antimikrobiyal sistemler ile koku giderici kömür örtüler de yönetime katkı sağlar. Son yıllarda geliştirilen doku mühendisliği ürünleri, akıllı polimerler ve suni deriler ise özellikle iyileşmesi güç diyabetik ayak ve venöz bacak ülserleri gibi kronik yaralarda epitelizasyonu uyarmaktadır. Etkin bir yara yönetimi için hemşirelerin tüm bu ürünlerin endikasyon ve kontrendikasyonlarını bilmesi şarttır.
Wound dressings are critical materials that prevent infections, minimize tissue damage, and accelerate the healing process by increasing collagen synthesis and providing re-epithelization by establishing a physical barrier between the wound and the external environment. An ideal wound dressing must provide a moist environment, properly regulate exudate, maintain optimum temperature, and protect the wound against bacterial contamination. Selecting the appropriate dressing relies on regular assessments of specific parameters including wound localization, size, tissue type, bacterial load, and exudate levels. In our country, the classification established by the Wound Care Association is widely accepted, dividing wound dressings into passive and active closures. In clinical practice, hydrocolloid, hydrogel, semi-permeable film, foam, calcium alginate, hydrofiber, and collagen dressings are utilized to manage moisture balance, facilitate autolytic debridement, and control infection. Additionally, antimicrobial systems containing silver, honey, or iodine, along with odor-absorbing charcoal dressings, contribute to wound management. Recently developed tissue engineering products, smart polymers, and artificial skins stimulate epithelization, particularly in hard-to-heal chronic wounds such as diabetic foot and venous leg ulcers. For effective wound management, nurses must thoroughly understand the indications and contraindications of all these products.
Referanslar
Boateng JS, Matthews KH, Stevens HN, Eccleston, GM. Wound healing dressings and drug delivery systems: a review. Journal of Pharmaceutical Sciences, 2008; 97 (8):2892-2923. doi: 10.1002/jps.21210.
Ghomi ER, Khalili S, Khorasani SN, et. al. Wound dressings: Current advances and future directions. Journal of Applied Polymer Science,2019; 136(27): 47738. DOI: 10.1002/app.47738
Jones V, Grey JE, Harding KG. Wound dressings, BMJ, 2006; 332(7544): 777-780. 10.1136/ bmj.332.7544.777
Zhang M, Zhao X. Alginate hydrogel dressings for advanced wound management. International Journal of Biological Macromolecules,2020;162:1414–1428. doi.org/10.1016/j. ijbiomac.2020.07.311
Weir D, BrindleT. Wound Dressings. In: Hamm RL (eds.) Text and Atlas of Wound Diagnosis and Treatment. United States: McGraw-Hill Education; 2015.p.343-384. ISBN: 978-0-07-180721-0.
Kumar PTS, Abhilash S, Manzoor SK, et. al. Preparation and characterization of novel beta-chitin/nanosilver compositescaffolds for wound dressing applications. Carbohydrate Polymers. 2010: 761-767. doi.org/10.1016/j.carbpol.2009.12.024.
Ying W, Tan J, Chen C, et.al. Biofabrication of silver nanoparticles and its application for development of wound dressing system in nursing care for burn injuries in children. Journal of Drug Delivery Science and Technology, 2019;54: 101236. doi.org/10.1016/j.jddst.2019.101236
Santhanam R, Rameli MAP, Jeffri AA, Wan Ismail WI. Bovine based collagen dressings in wound care management. Journal of Pharmaceutical Research International.2020; 32(33): 48-63. DOI: 10.9734/JPRI/2020/v32i3330949
Erdoğan B. Yara Bakım Ürünleri. Topalan M, Aktaş Ş (Ed.), Güncel Yönleriyle Kronik Yara içinde 1. Baskı. Ankara: Aygül Ofset Matbaacılık San. Tic. Ltd. Şti; 2010. p.143-171.
Niezgoda JA, Baranoski S, Ayello EA, McIntosh A, Montoya L, Ostler M. Wound Treatment Options. In. Baranoski S, Ayello EA (eds.) Wound Care Essentials Practice Principles. 5th ed. China: Wolters Kluwer;2020. P.536-683.
Kamińska MS, Cybulska AM, Skonieczna-Żydecka K, et al. Effectiveness of Hydrocolloid Dressings for Treating Pressure Ulcers in Adult Patients: A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health. 2020;17:7881; doi:10.3390/ijerph17217881.
Dhivyaa S, Padma VV, Santhini E. Wound dressings – a review. BioMedicine,2015;5(4):24-28. DOI 10.7603/s40681-015-0022-9
Kennedy JF, Bunko K. The use of ‘smart’ textiles for wound care. In: Rajendran S (eds.) Advanced Textiles for Wound Care, 2nd ed Sawton, Cambridge, UK: Woodhead Publishing; 2019. pp. 289-311.
Weller C. Interactive dressings and their role in moist wound management. In: Rajendran S (eds.) Advanced Textiles for Wound Care. 2nd ed Sawton, Cambridge, UK: Woodhead Publishing; 2019. pp. 105–134.
Weller CD, Team V, Sussman G. First-Line Interactive Wound Dressing Update: A Comprehensive Review of the Evidence. Front. Pharmacol. 2020;11:155. doi: 10.3389/fp-har.2020.00155.
Vowden K, Vowden P. Wound dressings: principles and practice. Surgery, 2017; 35 (9), 489–494. doi: 10.1016/j.mpsur.2017.06.005
Ezzelarab MH, Nouh O, Ahmed AN, et.al. A Randomized Control Trial Comparing Transparent Film Dressings and Conventional Occlusive Dressings for Elective Surgical Procedures, Macedonian Journal of Medical Sciences. 2019, 15;7(17):2844-2850.
Dumville JC, Deshpande S, O’Meara S, Speak K. Foam dressings for healing diabetic foot ulcers. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD009111. DOI: 10.1002/14651858.CD009111.pub3.
Nielsen J, Fogh K. Clinical utility of foam dressings in wound management: a review. Chronic Wound Care Management and Research. 2015;2:31–38.
Augustin M, Herberger K, Kroeger K, et.al. Cost-effectiveness of treating vascular leg ulcers with UrgoStart® and UrgoCell® Contact. International Wound Journal, 2016;13(1):82–87. doi: 10.1111/iwj.12238
Abdelrahman T, Newton H. Wound dressings: Principles and Practice. Surgery 2011;29(10):491–495. doi.org/10.1016/j.mpsur.2011.06.007
Mirasoğlu B. Yara bakım ürünleri. TOTBİD Dergisi, 2015; 14:456–461 doi: 10.14292/totbid. dergisi.2015.65
Dabiri G, Damstetter E, Phillips T. Choosing a wound dressing based on common wound characteristics. Adv. Wound Care, 2016; 5 (1):32–41. doi: 10.1089/wound.2014.0586
Vachhrajani V, Khakhkhar P. Science of Wound Healing and Dressing Materials. Singapore: Springer Nature; 2020.p. 73-84. ISBN 978-981-32-9236-9 (eBook)
Holloway S, Enoch S, Grey JE. Dressings and Devices. In: Price A, Grey JE, Patel GK, Harding KG (eds.) ABC of Wound Healing. 2nd ed. Hoboken: John Wiley & Sons Ltd; 2022.p.85-94.
Sood A, Kogan S, Granick MS. Wound Dressings and Comparative Effectiveness Data. In: Shiffman MA, Low M (eds.) Chronic Wounds, Wound Dressings and Wound Healing. Switzerland: Springer Nature; 2021.p.185-205.
Sorushanova A, Delgado ALM, Wu Z, et. al. The collagen suprafamily: from biosynthesis to advanced biomaterial development, Adv. Mater. 2019; 31, 1801651. https://doi. org/10.1002/adma.201801651.
Koehler J, Brandl FP, Goepferich AM. Hydrogel wound dressings for bioactive treatment of acute and chronic wounds. European Polymer Journal.2018;100:1-11. doi.org/10.1016/j. eurpolymj.2017.12.046
Rodríguez-Cabelloa JC, de Torre IG, Ibañez-Fonzeca, et.al. Bioactive scaffolds based on elastin-like materials for wound healing. Advanced Drug Delivery Reviews, 2018;129:118- 133. doi.org/10.1016/j.addr.2018.03.003
Borda LJ, Macquhae FE, Kirsner RS. Wound Dressings: A Comprehensive Review. Curr Derm Rep. 2016;5:287–297. DOI 10.1007/s13671-016-0162-5
Mutlu S, Yılmaz E. (2019). Yara Yönetiminde Yenilikçi Yaklaşımlar. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, 2019; 8(4):481-494.
Öztaş P. Yara iyileşmesi, bakımı ve tedavisi. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi, 2021; 54(2):341-351. DOI: 10.20492/aeahtd.931499
Peate I, Glencross W. Wound Care at a Glance. (1st ed). Chichester, UK: John Wiley & Sons Ltd; 2015. p. 54-57.
