Kronik Yarada TIME Yaklaşımı: Yara Kenarının Değerelendirilmesi ve Yara Yönetimindeki Önemi
Özet
Yaraların büyük çoğunluğu normal bir süreçte iyileşirken, bir kısmı kronik yaraya dönüşerek morbidite ve yüksek maliyete yol açar. Kronik yaraların yönetiminde sistematik bir değerlendirme sunan TIME (Doku, Enfeksiyon, Nem dengesizliği, Epitelyal kenar ilerlemesi) kısaltmasına 2004 yılında dördüncü bir bileşen olarak yara veya epidermal kenar değerlendirmesi eklenmiştir. Kronik yara kenarlarındaki hücrelerde hiperproliferasyon ve hücresel yaşlanma gibi anormallikler normal hücresel göçü ve iyileşmeyi engellemektedir. Klinisyenler yara bakımını optimize ettikten sonra epidermal hücre göçünün durumuna göre aselüler dermal matrisler, kök hücreler, epidermal hücre toplama veya negatif basınçlı yara tedavisi gibi yardımcı tedavi yöntemlerini değerlendirmelidir. Ayrıca, yara kenarı değerlendirmesinde göz ardı edilmemesi gereken önemli bir durum da cilt maligniteleridir. İyileşmeyen yaralarda yara skarı zemininde gelişen ve Marjolin Ülseri olarak bilinen cilt kanseri akılda bulundurulmalıdır. Kronik yara zemininde en sık agresif seyirli Skuamöz hücreli kanser gelişimi görülür. Bu tür bir malign transformasyon şüphesinde çoklu biyopsilerle histopatolojik değerlendirme yapılmalı, tanı sonrası geniş cerrahi eksizyon gibi multidisipliner tedavi yöntemleri uygulanmalıdır.
While the majority of wounds heal normally, some turn into chronic wounds, leading to morbidity and high costs. To provide a systematic approach in managing chronic wounds, the evaluation of the wound edge or epidermal edge was added in 2004 as the fourth component to the TIME (Tissue, Infection, Moisture, Edge) acronym. Abnormalities such as hyperproliferation and cellular senescence in chronic wound edges hinder normal cellular migration and healing. After optimizing local wound care, clinicians should consider advanced auxiliary therapies including acellular dermal matrices, stem cells, epidermal cell harvesting, or negative pressure wound therapy based on the status of epidermal migration. Furthermore, skin malignancies represent a critical aspect that must not be overlooked during wound edge evaluation. Skin cancer developing on the basis of a wound scar, known as Marjolin's Ulcer, must be kept in mind for non-healing wounds. Aggressive squamous cell carcinoma is the most common cancer type arising from chronic wounds. If such malignant transformation is suspected, histopathological evaluation via multiple biopsies must be performed, followed by multidisciplinary treatment modalities such as wide surgical excision once the diagnosis is confirmed.
Referanslar
Harries RL, Bosanquet DC, Harding KG. Wound bed preparation: TIME for an update. Int Wound J 2016; 13 (suppl. S3):8–14
Schultz GS, Sibbald RG, Falanga V, Ayello EA, Dowsett C, Harding K, Romanelli M, Stacey MC, Teot L, Vanscheidt W. Wound bed preparation: a systematic approach to wound management. Wound Repair Regen 2003;11:S1–28.
Schultz GS, Barillo DJ, Mozingo DW, Chin GA. Wound bed preparation and a brief history of TIME. Int Wound J 2004;1:19–32.
Bosanquet DC, Harding KG.Wound duration and healing rates: cause or effect? Wound Repair Regen 2014;22:143–50.
Schultz GS, Barillo DJ, Mozingo DW, Chin GA; Wound Bed Advisory Board Members. Wound bed preparation and a brief history of TIME. Int Wound J. 2004 Apr;1(1):19-32. doi: 10.1111/j.1742-481x.2004.00008.x. PMID: 16722894; PMCID: PMC7951422
Falanga V. Classifications for wound bed preparation and stimulation of chronic wounds. Wound Repair Regen 2000;8:347—52.
Rogers AA, Harding KG, Chen WYJ. The epidermis at the edge of venous leg ulcers exhibits proliferative rather than differentiation markers and is associated with basement membrane disruption. Wound Repair Regen 2003;11:A15.
Indian J Plast Surg. 2012 May-Aug; 45(2): 193–202. doi: 10.4103/0970-0358.101277: 10.4103/0970-0358.101277 PMCID: PMC3495367 PMID: 23162216 Wound bed preparation from a clinical perspective A. S. Halim, T. L. Khoo, and A. Z. Mat Saad
Dowsett C. Exudate management: a patient-centred approach. JWound Care 2008;17:249–52.
Iorio ML, Shuck J, Attinger CE. Wound healing in the upper and lower extremities: a systematic review on the use of acellular dermal matrices. Plast Reconstr Surg 2012;130:232S–41.
Reyzelman AM, Bazarov I. Human acellular dermal wound matrix for treatment of DFU: literature review and analysis. J Wound Care 2015;24:128–34.
Richmond NA, Lamel SA, Braun LR, Vivas AC, Serena T, Kirsner RS. Epidermal grafting using a novel suction blister-harvesting system for the treatment of pyoderma gangrenosum. JAMA Dermatol 2014;150:999–1000.
Kirsner RS, Bernstein B, Bhatia A, Lantis J, Le L, Lincoln K, Liu P, Rodgers L, Shaw M, Young D. Clinical experience and best practices using epidermal skin grafts on wounds. Wounds 2015;27:282–92.
Aziz Z, Bell-Syer SE. Electromagnetic therapy for treating pressure ulcers. Cochrane Database Syst Rev 2015;9:CD002930.
Aziz Z, Cullum N. Electromagnetic therapy for treating venous leg ulcers. Cochrane Database Syst Rev 2015;7:CD002933.
Flemming K, Cullum N. Laser therapy for venous leg ulcers. Cochrane Database Syst Rev 2000;2:CD001182.
Chen C, HouWH, Chan ES,Yeh ML, LoHL. Phototherapy for treating pressure ulcers. Cochrane Database Syst Rev 2014;7:CD009224.
Cullum NA, Al-Kurdi D, Bell-Syer SE. Therapeutic ultrasound for venous leg ulcers. Cochrane Database Syst Rev 2010;6:CD001180.
Baba-Akbari Sari A, Flemming K, Cullum NA, Wollina U. Therapeutic ultrasound for pressure ulcers. Cochrane Database Syst Rev2006;3:CD001275.
Londahl M. Hyperbaric oxygen therapy as adjunctive treatment of diabetic foot ulcers. Med Clin North Am 2013;97:957–80.
O’Reilly D, Pasricha A, Campbell K, Burke N, Assasi N, Bowen JM, Tarride JE, Goeree R. Hyperbaric oxygen therapy for diabetic ulcers: systematic review and meta-analysis. Int J Technol Assess Health Care 2013;29:269–81.
Game FL, Hinchliffe RJ, Apelqvist J, Armstrong DG, Bakker K, HartemannA, Londahl M, Price PE, Jeffcoate WJ.Asystematic review of interventions to enhance the healing of chronic ulcers of the foot in diabetes. Diabetes Metab Res Rev 2012;28:119–41.
Chambers AC, Leaper DJ. Role of oxygen in wound healing: a review of evidence. J Wound Care 2011;20:160–4.
Health Research Authority. Topical oxygen and diabetic foot ulcers 2 (TODFU2). London: Health Research Authority, 2015. URL http://www.hra.nhs.uk/news/research-summaries/topical-oxygen-anddiabetic-foot-ulcers-2-todfu2/ [accessed on 25 May 2016].
(Kartika RW, Alwi I, Suyatna FD, Yunir E, Waspadji S, Immanuel S, Silalahi T, Sungkar S, Rachmat J, Reksodiputro MH, Bardosono S. The role of VEGF, PDGF and IL-6 on diabetic foot ulcer after Platelet Rich Fibrin + hyaluronic therapy. Heliyon. 2021 Sep 7;7(9):e07934. doi: 10.1016/j.heliyon.2021.e07934. PMID: 34585000; PMCID: PMC8455691.)
Blumberg SN, Berger A, Hwang L, Pastar I,Warren SM, Chen W. The role of stem cells in the treatment of diabetic foot ulcers. Diabetes Res Clin Pract 2012;96:1–9.
Carter MJ, Fylling CP, Parnell LK. Use of platelet rich plasma gel on wound healing: a systematic review and meta-analysis. Eplasty 2011;11:e38.
Dumville JC, Hinchliffe RJ, Cullum N, Game F, Stubbs N, Sweeting M, Peinemann F. Negative pressure wound therapy for treating foot wounds in people with diabetes mellitus. Cochrane Database Syst Rev 2013;10:CD010318.
Dörr S, Lucke-Paulig L, Vollmer C, Lobmann R. Malignant Transformation in Diabetic Foot Ulcers-Case Reports and Review of the Literature. Geriatrics (Basel). 2019 Nov 7;4(4):62. doi: 10.3390/geriatrics4040062. PMID: 31703431; PMCID: PMC6961039
Mast, B.A.; Schultz, G.S. Interactions of cytokines, growth factors and proteases in acute and chronic wounds. Wound Repair Regen. 1996, 4, 411–420.
Bazalínski, D.; Pryzbek-Mita, J.; Baranska, B.; Wiech, P. Marjolin0s ulcer in chronic wounds—Review of available literature. Contemp. Oncol. 2017, 21, 197–202.
Pekarek, B.; Buck, S.; Osher, L. A comprehensive review on Marjolin0s ulcers: Diagnosis and treatment. J. Am. Coll. Certif. Wound Spec. 2011, 3, 60–64.
Cavalière, R.; Mercado, D. Squamous cell carcinoma from Marjolin0s ulcer of the foot in diabetic patient: Case study. J. Foot Ankle Surg. 2018, 57, 838–843.
Potter, B.; Pitcher, J.D., Jr.; Adams, S.C.; Temple, H.T. Squamous cell carcinoma of the foot. Foot Ankle Int. 2009, 30, 517–523
Harries RL, Bosanquet DC, Harding KG. Wound bed preparation: TIME for an update. Int Wound J 2016; 13 (suppl. S3):8–14
Schultz GS, Sibbald RG, Falanga V, Ayello EA, Dowsett C, Harding K, Romanelli M, Stacey MC, Teot L, Vanscheidt W. Wound bed preparation: a systematic approach to wound management. Wound Repair Regen 2003;11:S1–28.
Schultz GS, Barillo DJ, Mozingo DW, Chin GA. Wound bed preparation and a brief history of TIME. Int Wound J 2004;1:19–32.
Bosanquet DC, Harding KG.Wound duration and healing rates: cause or effect? Wound Repair Regen 2014;22:143–50.
Schultz GS, Barillo DJ, Mozingo DW, Chin GA; Wound Bed Advisory Board Members. Wound bed preparation and a brief history of TIME. Int Wound J. 2004 Apr;1(1):19-32. doi: 10.1111/j.1742-481x.2004.00008.x. PMID: 16722894; PMCID: PMC7951422
Falanga V. Classifications for wound bed preparation and stimulation of chronic wounds. Wound Repair Regen 2000;8:347—52.
Rogers AA, Harding KG, Chen WYJ. The epidermis at the edge of venous leg ulcers exhibits proliferative rather than differentiation markers and is associated with basement membrane disruption. Wound Repair Regen 2003;11:A15.
Indian J Plast Surg. 2012 May-Aug; 45(2): 193–202. doi: 10.4103/0970-0358.101277: 10.4103/0970-0358.101277 PMCID: PMC3495367 PMID: 23162216 Wound bed preparation from a clinical perspective A. S. Halim, T. L. Khoo, and A. Z. Mat Saad
Dowsett C. Exudate management: a patient-centred approach. JWound Care 2008;17:249–52.
Iorio ML, Shuck J, Attinger CE. Wound healing in the upper and lower extremities: a systematic review on the use of acellular dermal matrices. Plast Reconstr Surg 2012;130:232S–41.
Reyzelman AM, Bazarov I. Human acellular dermal wound matrix for treatment of DFU: literature review and analysis. J Wound Care 2015;24:128–34.
Richmond NA, Lamel SA, Braun LR, Vivas AC, Serena T, Kirsner RS. Epidermal grafting using a novel suction blister-harvesting system for the treatment of pyoderma gangrenosum. JAMA Dermatol 2014;150:999–1000.
Kirsner RS, Bernstein B, Bhatia A, Lantis J, Le L, Lincoln K, Liu P, Rodgers L, Shaw M, Young D. Clinical experience and best practices using epidermal skin grafts on wounds. Wounds 2015;27:282–92.
Aziz Z, Bell-Syer SE. Electromagnetic therapy for treating pressure ulcers. Cochrane Database Syst Rev 2015;9:CD002930.
Aziz Z, Cullum N. Electromagnetic therapy for treating venous leg ulcers. Cochrane Database Syst Rev 2015;7:CD002933.
Flemming K, Cullum N. Laser therapy for venous leg ulcers. Cochrane Database Syst Rev 2000;2:CD001182.
Chen C, HouWH, Chan ES,Yeh ML, LoHL. Phototherapy for treating pressure ulcers. Cochrane Database Syst Rev 2014;7:CD009224.
Cullum NA, Al-Kurdi D, Bell-Syer SE. Therapeutic ultrasound for venous leg ulcers. Cochrane Database Syst Rev 2010;6:CD001180.
Baba-Akbari Sari A, Flemming K, Cullum NA, Wollina U. Therapeutic ultrasound for pressure ulcers. Cochrane Database Syst Rev2006;3:CD001275.
Londahl M. Hyperbaric oxygen therapy as adjunctive treatment of diabetic foot ulcers. Med Clin North Am 2013;97:957–80.
O’Reilly D, Pasricha A, Campbell K, Burke N, Assasi N, Bowen JM, Tarride JE, Goeree R. Hyperbaric oxygen therapy for diabetic ulcers: systematic review and meta-analysis. Int J Technol Assess Health Care 2013;29:269–81.
Game FL, Hinchliffe RJ, Apelqvist J, Armstrong DG, Bakker K, HartemannA, Londahl M, Price PE, Jeffcoate WJ.Asystematic review of interventions to enhance the healing of chronic ulcers of the foot in diabetes. Diabetes Metab Res Rev 2012;28:119–41.
Chambers AC, Leaper DJ. Role of oxygen in wound healing: a review of evidence. J Wound Care 2011;20:160–4.
Health Research Authority. Topical oxygen and diabetic foot ulcers 2 (TODFU2). London: Health Research Authority, 2015. URL http://www.hra.nhs.uk/news/research-summaries/topical-oxygen-anddiabetic-foot-ulcers-2-todfu2/ [accessed on 25 May 2016].
(Kartika RW, Alwi I, Suyatna FD, Yunir E, Waspadji S, Immanuel S, Silalahi T, Sungkar S, Rachmat J, Reksodiputro MH, Bardosono S. The role of VEGF, PDGF and IL-6 on diabetic foot ulcer after Platelet Rich Fibrin + hyaluronic therapy. Heliyon. 2021 Sep 7;7(9):e07934. doi: 10.1016/j.heliyon.2021.e07934. PMID: 34585000; PMCID: PMC8455691.)
Blumberg SN, Berger A, Hwang L, Pastar I,Warren SM, Chen W. The role of stem cells in the treatment of diabetic foot ulcers. Diabetes Res Clin Pract 2012;96:1–9.
Carter MJ, Fylling CP, Parnell LK. Use of platelet rich plasma gel on wound healing: a systematic review and meta-analysis. Eplasty 2011;11:e38.
Dumville JC, Hinchliffe RJ, Cullum N, Game F, Stubbs N, Sweeting M, Peinemann F. Negative pressure wound therapy for treating foot wounds in people with diabetes mellitus. Cochrane Database Syst Rev 2013;10:CD010318.
Dörr S, Lucke-Paulig L, Vollmer C, Lobmann R. Malignant Transformation in Diabetic Foot Ulcers-Case Reports and Review of the Literature. Geriatrics (Basel). 2019 Nov 7;4(4):62. doi: 10.3390/geriatrics4040062. PMID: 31703431; PMCID: PMC6961039
Mast, B.A.; Schultz, G.S. Interactions of cytokines, growth factors and proteases in acute and chronic wounds. Wound Repair Regen. 1996, 4, 411–420.
Bazalínski, D.; Pryzbek-Mita, J.; Baranska, B.; Wiech, P. Marjolin0s ulcer in chronic wounds—Review of available literature. Contemp. Oncol. 2017, 21, 197–202.
Pekarek, B.; Buck, S.; Osher, L. A comprehensive review on Marjolin0s ulcers: Diagnosis and treatment. J. Am. Coll. Certif. Wound Spec. 2011, 3, 60–64.
Cavalière, R.; Mercado, D. Squamous cell carcinoma from Marjolin0s ulcer of the foot in diabetic patient: Case study. J. Foot Ankle Surg. 2018, 57, 838–843.
Potter, B.; Pitcher, J.D., Jr.; Adams, S.C.; Temple, H.T. Squamous cell carcinoma of the foot. Foot Ankle Int. 2009, 30, 517–523
