Diyabetik Ayak Cerrahisi
Özet
Diyabetik ayak ülserleri, yaşam boyu karşılaşma riski yüzde 34'e varan, yüksek morbidite ve amputasyon oranları ile seyreden ciddi bir sağlık sorunudur. Türkiye'de erişkin diyabet prevalansı %11.1 olup, bu hastalarda amputasyon riski normal popülasyona göre 15-20 kat artış göstermektedir. Yara gelişiminde nöropati, anjiyopati ve immünopati birlikte rol oynar; his kaybı ve inflamasyon bulgularının fark edilmemesi enfeksiyonun derin dokulara ve tendonlar boyunca yayılmasına yol açar. Erken, agresif ve çok basamaklı cerrahi müdahaleler, selülit aşamasında bile en hızlı ve uygun tedavi seçeneğidir. Cerrahi tedavinin ana hedefleri; apselerin drenajı, nekrotik dokuların ameliyathanede etkin debridman ile uzaklaştırılması, derin doku ve kemik kültürleri alınarak patojene özgü antibiyotik tedavisinin düzenlenmesi ve fonksiyonel bir ayak yapısı sağlanarak nükslerin önlenmesidir. Multidisipliner yaklaşımların amputasyon oranlarını anlamlı derecede azalttığı kanıtlanmıştır. Sebsis gibi yaşamı tehdit eden durumlarda kısmi ayak amputasyonları (Ray, Transmetatarsal vb.) son çare olarak uygulanırken, iyileşme sonrası nüksü engellemek adına mekanik offloading ve gerektiğinde ileri podiatrik veya vasküler cerrahi prosedürler tercih edilmektedir.
Diabetic foot ulcers are a serious health problem with a lifetime risk of up to 34 percent, characterized by high morbidity and amputation rates. The prevalence of adult diabetes in Turkey is 11.1%, and the risk of amputation in these patients increases 15-20 times compared to the normal population. Neuropathy, angiopathy, and immunopathy play a role together in ulcer development; loss of sensation and the absence of neuroinflammatory response cause infections to spread along tendons and deep tissues without being noticed. Early, aggressive, and multistep surgical interventions are the fastest and most appropriate treatment modality even in the case of cellulitis. The primary goals of surgical treatment are the drainage of abscesses, removal of necrotic tissues through effective debridement in the operating room, management of pathogen-specific antibiotic therapy by obtaining deep tissue and bone cultures, and prevention of recurrence by ensuring a functional foot structure. Multidisciplinary approaches have been proven to significantly reduce amputation rates. In life-threatening conditions such as sepsis, partial foot amputations (Ray, Transmetatarsal, etc.) are performed as a last resort, while mechanical offloading and, if necessary, advanced podiatric or vascular surgical procedures are preferred to prevent recurrence after healing.
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