Hastanın Genel Değerlendirilmesi
Özet
Yara iyileşmesi, ardışık ve karmaşık fazlardan oluşan çok yönlü bir süreçtir. Yara yönetimi ve tedavisinde sadece yaraya odaklanmak yerine, hastanın ilk başvuru anından itibaren sistemik ve çevresel tüm faktörleriyle bir bütün olarak ele alınması, iyileşmeyi engelleyen risklerin tespiti açısından büyük önem taşır. Klinik değerlendirmede; mevcut ve önceki yara öyküsü, ağrı varlığı, diyabet, periferik arter hastalığı gibi kronik tıbbi durumlar, geçirilmiş cerrahiler ve sigara kullanımı ile sosyal destek ortamı detaylıca sorgulanmalıdır. Ayrıca obezite, ödem, yaşlanma, immobilizasyon, kemoterapi, steroid veya radyasyon gibi immünosupresif tedaviler yara iyileşmesini yavaşlatan ya da bozan temel etkenlerdir. Tanı ve takip sürecinde ekstremitelerin detaylı vasküler muayenesi, Doppler ultrason gibi noninvaziv testler, tam kan sayımı, metabolik paneller, yara kültürleri ve beslenme durumunun takibi için albümin/prealbümin seviyeleri içeren rutin laboratuvar çalışmaları eksiksiz yapılmalıdır. Sonuç olarak, saçlı deriden ayak tırnağına kadar yapılacak bütüncül bir fizik muayene ve psikososyal irdeleme, iyileşmeyen kronik yaraların tedavisinde başarının anahtarıdır.
Wound healing is a multifaceted process consisting of consecutive and complex phases. In wound management and treatment, rather than focusing solely on the wound itself, evaluating the patient as a whole with all systemic and environmental factors from the very first presentation is of great importance for identifying risks that impede healing. In the clinical evaluation; current and previous wound history, presence of pain, chronic medical conditions such as diabetes and peripheral arterial disease, past surgeries, smoking habits, and the social support environment must be thoroughly questioned. Furthermore, obesity, edema, aging, immobilization, and immunosuppressive therapies such as chemotherapy, steroids, or radiation are the primary factors that delay or impair wound healing. During the diagnosis and follow-up process, a detailed vascular examination of the extremities, noninvasive tests like Doppler ultrasound, and routine laboratory studies including complete blood count, metabolic panels, wound cultures, and albumin/prealbumin levels to monitor nutritional status must be fully performed. Consequently, a holistic physical examination spanning from the scalp to the toenails, combined with a psychosocial evaluation, is the key to success in treating non-healing chronic wounds.
Referanslar
Lindley LE, Stojadinovic O, Pastar I, Tomic-Canic M. Biology and Biomarkers for Wound Healing.Plast Reconstr Surg. 2016;138(3 Suppl):18S-28S.
Volmer-Thole M, Lobmann R. Neuropathy and Diabetic Foot Syndrome.Int J Mol Sci. 2016;17(6):917. Published 2016 Jun 10. doi:10.3390/ijms17060917
Armstrong DG, Boulton AJM, Bus SA. Diabetic Foot Ulcers and Their Recurrence. N Engl J Med. 2017 Jun 15;376(24):2367-2375. doi: 10.1056/NEJMra1615439. PMID: 28614678.
Sørensen LT. Wound healing and infection in surgery: the pathophysiological impact of smoking, smoking cessation, and nicotine replacement therapy: a systematic review. Ann Surg. 2012 Jun;255(6):1069-79. doi: 10.1097/SLA.0b013e31824f632d. PMID: 22566015
Schneider C, Stratman S, Kirsner RS. Lower Extremity Ulcers. Med Clin North Am. 2021 Jul;105(4):663-679. doi: 10.1016/j.mcna.2021.04.006. PMID: 34059244.
https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
Bonifant H, Holloway S. A review of the effects of ageing on skin integrity and wound healing. Br J Community Nurs. 2019 Mar 1;24(Sup3):S28-S33. doi: 10.12968/bjcn.2019.24.Sup3.S28. PMID: 3081719
Mervis JS, Phillips TJ. Pressure ulcers: Pathophysiology, epidemiology, risk factors, and presentation. J Am Acad Dermatol. 2019 Oct;81(4):881-890. doi: 10.1016/j.jaad.2018.12.069. Epub 2019 Jan 18. PMID: 30664905
Bus SA. The Role of Pressure Offloading on Diabetic Foot Ulcer Healing and Prevention of Recurrence. Plast Reconstr Surg. 2016 Sep;138(3 Suppl):179S-187S. doi: 10.1097/PRS.0000000000002686. PMID: 27556758
Bootun R. Effects of immunosuppressive therapy on wound healing. Int Wound J. 2013 Feb;10(1):98-104. doi: 10.1111/j.1742-481X.2012.00950.x. Epub 2012 Feb 24. PMID: 22364410; PMCID: PMC7950386
Zhang H, Huang Z, Zou X, Liu T. Bevacizumab and wound-healing complications: a systematic review and meta-analysis of randomized controlled trials. Oncotarget. 2016 Dec 13;7(50):82473-82481. doi: 10.18632/oncotarget.12666. PMID: 27756883; PMCID: PMC5347706
Wang AS, Armstrong EJ, Armstrong AW. Corticosteroids and wound healing: clinical considerations in the perioperative period. Am J Surg. 2013 Sep;206(3):410-7. doi: 10.1016/j.amjsurg.2012.11.018. Epub 2013 Jun 4. PMID: 23759697
Bray FN, Simmons BJ, Wolfson AH, Nouri K. Acute and Chronic Cutaneous Reactions to Ionizing Radiation Therapy. Dermatol Ther (Heidelb). 2016 Jun;6(2):185-206. doi: 10.1007/s13555-016-0120-y. Epub 2016 Jun 1. PMID: 27250839; PMCID: PMC4906114
Molnar JA, Vlad LG, Gumus T. Nutrition and Chronic Wounds: Improving Clinical Outcomes. Plast Reconstr Surg. 2016 Sep;138(3 Suppl):71S-81S. doi: 10.1097/PRS.0000000000002676. PMID: 27556777.
