Diyabetik Ayakta Ampütasyon
Özet
Diyabetik ayak ülserleri, diyabetin psiko-sosyal açıdan en yıkıcı komplikasyonlarından biri olup vakaların yaklaşık %15'i ampütasyonla sonuçlanmaktadır. Islak kangrenle neticelenen enfeksiyonlar ile sensoriyal nöropati ve periferik damar hastalığı kaynaklı kuru kangren, ampütasyonun başlıca nedenleridir. Calcaneusun distalinden yapılanlar minör, proksimalinden yapılanlar ise majör ampütasyon olarak sınıflandırılır. Yapılan araştırmalar, özellikle erkek hastalarda ve on yılı aşkın süredir diyabeti olan bireylerde ampütasyon riskinin daha yüksek olduğunu göstermektedir. Minör ampütasyonlarda enfeksiyon ve reampütasyon oranları majör olanlara kıyasla daha yüksek seyretmektedir. Cerrahi seviye belirlenirken hastanın genel sağlık durumu, beslenmesi, glukoz seviyeleri ve doku perfüzyonu dikkate alınmalı; güdüğü kapatacak derinin gergin olmamasına özen gösterilmelidir. Diyabetik ampütasyon cerrahisi; özel insizyon teknikleri, doku zedelenmesini önlemek adına dikkatli elektrokoter kullanımı ve flep hazırlığı gibi unsurlarla diğer cerrahi yöntemlerden ayrışır. Morbiditeyi en aza indirmek için öncelikle parmak, ray ve transmetatarsal gibi parsiyel ayak ampütasyonları tercih edilirken, ilerlemiş vakalarda Lisfranc, Chopart ve Syme gibi daha proksimal seviyedeki dezartikülasyon ve ampütasyon prosedürleri uygulanmaktadır.
Diabetic foot ulcers are among the most psychosocially devastating complications of diabetes, with approximately 15% of cases resulting in amputation. Infections leading to wet gangrene, alongside ischemic ulcers and dry gangrene caused by sensory neuropathy and peripheral vascular disease, constitute the primary causes of amputation. Amputations performed distal to the calcaneus are classified as minor, whereas those proximal to it are considered major. Research indicates that the risk of amputation is higher particularly in male patients and individuals who have had diabetes for over ten years. Minor amputations exhibit higher rates of infection and reamputation compared to major ones. When determining the surgical level, the patient's overall health status, nutrition, glucose levels, and tissue perfusion must be considered, ensuring that the skin closing the stump is not under tension. Diabetic amputation surgery differs from other surgical techniques through elements such as specific incision techniques, careful use of electrocautery to prevent tissue devitalization, and precise flap preparation. To minimize morbidity, partial foot amputations like toe, ray, and transmetatarsal amputations are preferred initially, while more proximal disarticulations and amputation procedures such as Lisfranc, Chopart, and Syme are utilized in advanced cases.
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