Akut yanýklarýn tedavisinde negatif basýnçlý yara terapisinin etkinliði

AMAÇ: Bu çalýþmada, amacýmýz negatif basýnçlý yara terapisinin (NBYT) akut yanýklarýn tedavisindeki sonuçlarý ve etkinliðinin araþtýrýlmasýydý.
GEREÇ VE YÖNTEM: Bu çalýþmaya, Ocak 2014 ile Aralýk 2015 tarihleri arasýnda Kartal Dr. Lütfi Kýrdar Eðitim ve Araþtýrma Hastanesi Yanýk Merkezi’nde yanýk yarasý sebebiyle NBYT uygulanan hastalar dâhil edildi. Hasta verileri ileriye yönelik olarak tutulan bir veritabaný kullanýlarak geriye dönük olarak toplandý. Olgularýn; yaþ, cinsiyet, yanýk etiyolojileri, yara lokalizasyonlarý, VAC uygulama süreleri, genel tedavi süreleri, yara kapatma teknikleri geriye dönük olarak deðerlendirildi.
BULGULAR: Çalýþmaya alýnan toplam 35 olgunun 32’si (%91.6) erkek, üçü (%8.4) kadýndý. Hastalarýn genel yaþ ortalamalarý 49.5±16 (13–79) idi. Etiyolojik faktörler sýrasýyla 19 (%54.3) olguda elektrik çarpmasý, yedi (%20) olguda temas yanýðý, altý (%17.2) olguda alev yanýðý, üç (%8.6) olguda sýcak su þeklindeydi. Uygulama yapýlan yaralarýn tümünde yanýklar 3. veya 4. derece idi. NBYT uygulama süremiz en az üç, en çok 16 gün olmak üzere ortalama 10.1±3.9 gündü. Hastalarýn hiçbirinde uygulamaya baðlý komplikasyon geliþmedi. Bir hastamýzda standart basýnçta uygulama sýrasýnda lokal aðrý geliþmesi üzerine uygulamaya düþük basýnç ile (75 mmHg) devam edilerek basýnç kademeli olarak artýrýldý. Uygulama sonucu tüm hastalarýn yara alanlarýnda küçülme, granülasyon dokusunda ve kanlanmada artma, ödem ve yara sekresyonunda azalma gözlemlendi. Hastalarýn hiçbirinde uygulama bölgesinde bakteriyal üreme tespit edilmedi. Tüm hastalarýn yaralarý cerrahiye uygun olarak deðerlendirilerek ortalama 11.2±3.7 günün sonunda greft veya flep yöntemlerinin biri kullanýlarak kapatýldý. Hastalarýn hiçbirinde greft ya da flebe sekonder komplikasyon görülmedi. Hastalar ameliyat sonrasý ortalama 6.7±2.1 (5–9 gün) günde taburcu edildi.
TARTIÞMA: Çalýþmamýzýn bulgularý ýþýðýnda, NBYT’nin iyileþmesi zor, derin, tendon ve kemik ekspoze olmuþ yanýklarda yaranýn kýsa sürede greft ya da flepler ile kapatýlmasýna olanak vererek, pansuman sayýsýný ve hastanede yatýþ süresini azaltabilecek yardýmcý bir tedavi seçeneði olabileceði söylenebilir. Ancak, halen daha literatürde NBYT’nin yanýkta kullanýmý ile ilgili kanýt düzeyi yüksek ileriye yönelik, randomize, kontrollü çalýþma eksikliðinin de mevcut olduðu vurgulanmalýdýr.

Efficacy of negative pressure wound therapy in the management of acute burns

BACKGROUND: The aim of the present study was to evaluate the outcomes and efficacy of negative pressure wound therapy in the management of acute burns.
METHODS: Patients with acute burns who have received negative pressure wound therapy at the Dr. Lutfi Kýrdar Kartal Research and Training Hospital Tertiary Burn Care Center between January 2014 and December 2015 were included in the study. Patient data were retrospectively reviewed by analyzing data from our prospective patient database.
RESULTS: A total of 38 patients were evaluated for the study. Three patients were excluded due to mortality prior to the completion of the treatment course. There were 32 (91.6%) male and 3 (8.4%) female patients. The mean age of the patients was 49.5±16 years. The etiological factors included electrical burn injury in 19 (54.3%), chemical burn injury in 7 (20%), flame burn injury in 6 (17.2%), and hot water burns in 3 (8.4%) patients. The severity of the burns was grade 3 or 4 in all of the patients included in the study. The mean duration of negative pressure wound therapy was 10.1±3.9 days. There were no procedure-related complications throughout the duration of the study. During the standard application of the device, one patient experienced local pain; therefore, low pressure (75 mmHg) was applied during therapy, and pressure was steadily increased. As a result of the application of this therapy, a decrease in the surface area, edema, and secretion of the wound and an increase in the granulation tissue and perfusion of the wound were observed in all treated patients. Wound cultures revealed no bacterial growth in any of the patients. The mean duration of surgical wound closure was 11.2±3.7 days. No complication was observed related to wound closure. The mean duration of hospital discharge in the postoperative period was 6.7±2.1 days.
CONCLUSION: Well-designed, randomized control studies showing the efficacy of negative pressure wound therapy in patients with burns are lacking. The results of the present study showed that negative pressure wound therapy may reduce the number of wound debridement sessions, time of wound closure, and hospitalization in major burn injuries exposing the underlying tendons and bones.