Kronik Yara Tedavisinde Dermis İskletelerinin Yeri
Özet
Dermis iskeletleri, açık deri yaralarının geçici veya kalıcı kapatılmasını sağlayan biyolojik, sentetik veya biyosentetik ürünlerdir. Amacı, normal derinin özelliklerini taklit ederek yara iyileşmesini ve rejenerasyonunu optimum hızda sağlamaktır. Akut veya kronik yaralarda ve rekonstrüksiyon prosedürlerinde kullanılırlar. Her ürünün kendine özgü avantaj ve dezavantajları bulunmakta; kullanım kararı yaranın tipine, etiyolojisine ve etkilenen cilt katmanına göre değişmektedir. İdeal bir dermis iskeleti, sıvı kaybını ve enfeksiyonu önlemeli, stabil ve biyolojik olarak parçalanabilir bir yapı sunmalıdır. Evrensel bir sınıflandırma sistemi olmasa da Kumar sınıflaması gibi katman sayısına ve hücre içeriğine dayalı sistemler mevcuttur. Bu materyaller ilk olarak geniş yanıkların tedavisinde kullanılmaya başlanmış, ardından diyabetik ayak ülserleri, kronik venöz ülserler ve dekübit yaraları gibi kronik vakalarda da başarıyla uygulanmıştır. İnsan amniyon zarı, dermal rejenerasyon matriksleri ve aselüler dermal matriksler sıkça tercih edilen ticari ve biyolojik türevlerdir. Akılcı kullanım için yara yatağının nekrotik dokulardan ve enfeksiyondan tamamen arındırılması kritik bir önkoşuldur. Sağlık maliyetlerini ilk aşamada artırsa da yara kapanma süresini kısaltarak genel maliyeti düşürürler.
Dermal templates are biological, synthetic, or biosynthetic products that provide temporary or permanent closure of open skin wounds. Their purpose is to mimic the properties of normal skin to ensure wound healing and regeneration at optimum speed and conditions. They are utilized in the treatment of acute or chronic wounds and in reconstruction procedures. Each product has its own advantages and disadvantages, and their use varies according to the type of wound, its etiology, and the affected skin layer. An ideal dermal template should form a barrier layer that prevents fluid loss and infection, and provide a stable, biodegradable scaffold. Although there is no universally accepted classification system, methods like the Kumar classification exist based on layer count and cellular content. Initially used for extensive burns, they are now successfully applied in chronic wounds such as diabetic foot ulcers, chronic venous ulcers, and pressure sores. Human amniotic membrane, dermal regeneration matrices, and acellular dermal matrices are frequently preferred derivatives. For rational use, clearing the wound bed of all necrotic tissues and infections is a critical prerequisite. Although they increase healthcare costs initially, they reduce overall costs by shortening the wound closure time.
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