Yara Pansumanı: Negatif Basınçlı Yara Tedavisi
Özet
Negatif basınçlı yara tedavisi (NBYT), kronik ve akut yaraların iyileşmesinde subatmosferik basınç uygulayarak sekresyonları emen, periferal kan akımını ve lokal oksijenizasyonu artıran multifaktöryel bir yöntemdir. İlk olarak 1995 yılında FDA onayı alan sistem; sünger, membran, hortum, cihaz ve toplama kabından oluşur. Uygulama öncesinde canlı doku görülene kadar debridman yapılması başarı için kritiktir ve pansumanlar genellikle 2-3 günde bir değiştirilir. Zamanla taşınabilir ve yarayı antiseptik veya salin sıvılarla irrige eden yıkamalı-instilasyonlu sistemler ile gümüş iyonlu süngerler geliştirilmiş, böylece bakteriyel yükün ve biyofilm tabakasının azaltılmasında daha yüksek etkinlik sağlanmıştır. NBYT, dokuda makro ve mikrodeformasyonlar yaratarak ödemi azaltır, hücre bölünmesini, VEGF ve PDGF gibi lokal büyüme hormonlarını uyararak granulasyon dokusunu artırır. Ayrıca oluşan geçici hipoksi, vazodilatasyon yoluyla kanlanmayı destekler. Geniş bir kullanım alanına sahip olan NBYT; venöz ülserler, diyabetik ayak yaraları, açık karın, greftlenmiş alanlar ve kompleks kemik kırıklarına eşlik eden yumuşak doku yaralanmalarında endikedir. Ancak açık organ yaralanmalarında, drene edilmemiş abselerde ve akut iskemik yaralarda kullanılması kontrendikedir.
Negative pressure wound therapy (NPWT) is a multifactorial method used in chronic and acute wound healing that applies subatmospheric pressure to aspirate secretions and increase peripheral blood flow and local oxygenation. First receiving FDA approval in 1995, the system consists of a foam, membrane, tubing, device, and collection canister. Performing debridement until viable tissue is visible before application is critical for success, and dressings are typically changed every 2-3 days. Over time, portable models and instillation-NPWT systems that irrigate the wound with antiseptic or saline solutions, as well as silver-ion infused foams, have been developed, providing higher efficacy in reducing bacterial load and biofilm layers. NPWT creates macro and microdeformations in the tissue to reduce edema, stimulates cell division, and increases granulation tissue by elevating local growth hormones such as VEGF and PDGF. Additionally, the induced temporary hypoxia supports blood perfusion through vasodilation. Having a wide range of indications, NPWT is applied in venous ulcers, diabetic foot wounds, open abdomen, grafted areas, and soft tissue injuries accompanying complex bone fractures. However, its use is contraindicated in open and unprotected organ injuries, undrained abscesses, and acute ischemic wounds.
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