Kalça kırıkları sonrasında oluşan presakral bası yaralarının önlenmesinde en etkili topikal yöntem hangisidir
Öz
Bası yarası, kalça kırığı nedeniyle hastanede yatan hastalarda sıklıkla görülmektedir. Bu durum, cilt ve cilt altı dokudaki basınç, makaslama kuvveti ve sürtünmenin etkisiyle oluşmaktadır. Ameliyata kadar geçen preoperatif hazırlık sürecinde hastalar ağrı nedeniyle hareketsiz kalmakta ,supin pozisyonda yatmakta, tuvatet ihtiyacını karşılayamadıkları için alt bezi kullanmak zorunda kalmaktadırlar. Hasta alt bezi kullanan hastalarda inkontinans kaynaklı dermatit gözlemlenmektedir. Bu durum bası yaraları oluşumunda temel nedenleri oluşturmaktadır. Kalça kırıkları genelde yaşlı popülasyonda görüldüğüden İleri yaş, beslenme bozuklukları, nemli deri, enfeksiyon ve metabolik hastalıklar (örn; diyabet, böbrek yetmezliği) sık görülmektedir bu ek hastalıklar bası yarası oluşumunu kolaylaştıran diğer faktörlerdir. Bası yarası bir kez geliştikten sonra tedavisi uzun ve maliyetlidir. Önleme ve tedavi açısından basıncı azaltma ve risk faktörlerinin giderilmesi çok önemlidir. Yaranın şiddetine göre uygulanabilecek tedavi yöntemleri değişkendir,sistemik tedavilere ek olarak, lokal topical tedavi; basınç ve makaslama kuvvetinin giderilmesi, yara bakımı, inkontinans kaynaklı dermatitin önlenmesi , beslenmenin düzenlenmesi önemlidir. İleri olgularda ise cerrahi tedavi prosedürleri gerekmektedir.
Cerrahi tedavi öncesinde uygulanabilecek olan lokal topikal tedavi alternatiflerinin karşılaştırılması literatürde henüz yapılmamıştır. Kliniğimizde uygulanmış olan 3 farklı malzeme ve kontrol grubu karşılaştırılarak bu önemli probleme karşı en etkili yöntemin bulunması amaçlanmıştır.
Bu çalışma özellikle kalça kırıgı sonrasında oluşan presakral bası yaralarının topikal tedavisi üzerine odaklanmış literatürdeki ilk ve tek çalışmadır
Kalça kırıklarında presakral bası yaraları sıklıkla görülmekte olup oluşumunun ve maserasyonun önlenmesinde ve en etkili yöntem izotonikle yıkama sonrasında Bariyer kremli ped uygulaması ve bariyer sprey uygulaması ile destrüktif sıvılardan korunmasıdır.
Anahtar Kelimeler
Bası yarası Kalça kırığı Lokal tedavi inkontinans kaynaklı dermatit
Kaynakça
- 1.Simunovic N, Devereaux PJ, Sheila S, et al. Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. CMAJ, 2010; 182(15): 1609-16. https://doi.org/10.1503/cmaj.092220
- 2.Jaul E. Assessment and management of pressure ulcers in the elderly: current strategies. Drugs Aging, 2010; 27(4): 311-25. https://doi.org/10.2165/11318340-000000000-00000
- 3.Kottner J, Cuddigan J, Carville K et al. Prevention and treatment of pressure ulcers/injuries: The protocol for the second update of the international Clinical Practice Guideline 2019. J Tissue Viability, 2019; 28(2): 51-8. https://doi.org/10.1016/j.jtv.2019.01.001
- 4.Wei R, Chen HL, Li M, et al. Diabetes and pressure ulcer risk in hip fracture patients: a meta-analysis. J Wound Care, 2017;26(9): 519-27. https://doi.org/10.12968/jowc.2017.26.9.519
- 5.Mervis JS, Phillips TJ. Pressure ulcers: Prevention and management. J Am Acad Dermatol, 2019; 81(4): 893-902. https://doi.org/10.1016/j.jaad.2018.12.068
- 6.Kucisec-Tepes N, Characteristic Features of Pressure Ulcer Infection. Acta Med Croatica, 2016;70 Suppl 1: 45-51.
- 7.Langer G, Fink A, Nutritional interventions for preventing and treating pressure ulcers. Cochrane Database Syst Rev, 2014; 2: 32-36. https://doi.org/10.1002/14651858.CD003216.pub2
- 8.Edlich R, Winters KL, Woodard CR, et al. Pressure ulcer prevention. J Long Term Eff Med Implants, 2004;14(4): 285-304. https://doi.org/10.1615/JLongTermEffMedImplants.v14.i4.20
- 9.Stechmiller JK, Understanding the role of nutrition and wound healing. Nutr Clin Pract, 2010; 25(1): 61-8. https://doi.org/10.1177/0884533609358997
- 10.Rich SE, Shardell M, Hawkes WG, et al. Pressure-redistributing support surface use and pressure ulcer incidence in elderly hip fracture patients. J Am Geriatr Soc, 2011; 59(6): 1052-9. https://doi.org/10.1111/j.1532-5415.2011.03446.x
- 11.Beers EH. Palliative Wound Care: Less Is More. Surg Clin North Am, 2019; 99(5): 899-919. https://doi.org/10.1016/j.suc.2019.06.008
- 12.Andrade CCD, Almeida CFDSC, Pereira WE, et al., Costs of topical treatment of pressure ulcer patients. Rev Esc Enferm USP, 2016; 50(2): 295-301. https://doi.org/10.1590/S0080-623420160000200016
- 13.Baumgarten M, Margolis DJ, Orwig DL, et al. Pressure ulcers in elderly patients with hip fracture across the continuum of care. J Am Geriatr Soc, 2009; 57(5): 863-70. https://doi.org/10.1111/j.1532-5415.2009.02245.x
- 14.Ratliff CR, Rodeheaver GT, Pressure ulcer assessment and management. Lippincotts Prim Care Pract, 1999; 3(2): 242-58.
- 15.Forni C, D'Alessandro F, Gallerani P, et al. Effectiveness of using a new polyurethane foam multi-layer dressing in the sacral area to prevent the onset of pressure ulcer in the elderly with hip fractures: A pragmatic randomised controlled trial. Int Wound J, 2018; 15(3): 383-90. https://doi.org/10.1111/iwj.12875
- 16.Gorse GJ, Messner RL, Improved pressure sore healing with hydrocolloid dressings. Arch Dermatol, 1987; 123(6): 766-71. https://doi.org/10.1001/archderm.1987.01660300088018
What is the most effective topical method for preventing presacral pressure sores that occur after hip fractures?
Öz
Pressure sores are frequently observed in patients hospitalized due to hip fractures. This condition is caused by pressure, shearing forces, and friction on the skin and subcutaneous tissues. During the preoperative preparation period leading up to surgery, patients often remain immobile due to pain, lie in a supine position, and must use incontinence products because they cannot meet their toileting needs. Incontinence-related dermatitis is observed in patients using incontinence products, which constitutes a fundamental cause for pressure sore development. Since hip fractures are generally seen in the elderly population, advanced age, nutritional disorders, moist skin, infection, and metabolic diseases (e.g., diabetes, kidney failure) are frequently associated, serving as additional factors that facilitate pressure sore formation. Once a pressure sore develops, its treatment is lengthy and costly. Therefore, reducing pressure and addressing risk factors is crucial for prevention and treatment. The choice of treatment methods may vary according to the severity of the wound. In addition to systemic treatments, local topical treatments, including alleviating pressure and shearing forces, wound care, prevention of incontinence-related dermatitis, and nutritional regulation, are essential. Surgical treatment procedures may be necessary in advanced cases.
Comparison of local topical treatment alternatives that can be applied before surgical treatment has not been conducted in the literature. This study aims to find the most effective method to address this significant problem by comparing three different materials and a control group applied in our clinic.
This study particularly focuses on the topical treatment of presacral pressure sores occurring after hip fractures and is the first and only study in the literature.
Presacral pressure sores are frequently observed in hip fractures, and the most effective method for preventing their formation and maceration is the application of barrier cream pads and barrier spray after isotonic cleansing.
Anahtar Kelimeler
Pressure sore Hip fracture Local treatment incontinence-related dermatitis
Etik Beyan
çalışmamız etik kurul onayı alınarak , etik kurallar çerçevesinde yapılmıştır.
Destekleyen Kurum
çalışmamızda destek ve maddi yardım yoktur
Kaynakça
- 1.Simunovic N, Devereaux PJ, Sheila S, et al. Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. CMAJ, 2010; 182(15): 1609-16. https://doi.org/10.1503/cmaj.092220
- 2.Jaul E. Assessment and management of pressure ulcers in the elderly: current strategies. Drugs Aging, 2010; 27(4): 311-25. https://doi.org/10.2165/11318340-000000000-00000
- 3.Kottner J, Cuddigan J, Carville K et al. Prevention and treatment of pressure ulcers/injuries: The protocol for the second update of the international Clinical Practice Guideline 2019. J Tissue Viability, 2019; 28(2): 51-8. https://doi.org/10.1016/j.jtv.2019.01.001
- 4.Wei R, Chen HL, Li M, et al. Diabetes and pressure ulcer risk in hip fracture patients: a meta-analysis. J Wound Care, 2017;26(9): 519-27. https://doi.org/10.12968/jowc.2017.26.9.519
- 5.Mervis JS, Phillips TJ. Pressure ulcers: Prevention and management. J Am Acad Dermatol, 2019; 81(4): 893-902. https://doi.org/10.1016/j.jaad.2018.12.068
- 6.Kucisec-Tepes N, Characteristic Features of Pressure Ulcer Infection. Acta Med Croatica, 2016;70 Suppl 1: 45-51.
- 7.Langer G, Fink A, Nutritional interventions for preventing and treating pressure ulcers. Cochrane Database Syst Rev, 2014; 2: 32-36. https://doi.org/10.1002/14651858.CD003216.pub2
- 8.Edlich R, Winters KL, Woodard CR, et al. Pressure ulcer prevention. J Long Term Eff Med Implants, 2004;14(4): 285-304. https://doi.org/10.1615/JLongTermEffMedImplants.v14.i4.20
- 9.Stechmiller JK, Understanding the role of nutrition and wound healing. Nutr Clin Pract, 2010; 25(1): 61-8. https://doi.org/10.1177/0884533609358997
- 10.Rich SE, Shardell M, Hawkes WG, et al. Pressure-redistributing support surface use and pressure ulcer incidence in elderly hip fracture patients. J Am Geriatr Soc, 2011; 59(6): 1052-9. https://doi.org/10.1111/j.1532-5415.2011.03446.x
- 11.Beers EH. Palliative Wound Care: Less Is More. Surg Clin North Am, 2019; 99(5): 899-919. https://doi.org/10.1016/j.suc.2019.06.008
- 12.Andrade CCD, Almeida CFDSC, Pereira WE, et al., Costs of topical treatment of pressure ulcer patients. Rev Esc Enferm USP, 2016; 50(2): 295-301. https://doi.org/10.1590/S0080-623420160000200016
- 13.Baumgarten M, Margolis DJ, Orwig DL, et al. Pressure ulcers in elderly patients with hip fracture across the continuum of care. J Am Geriatr Soc, 2009; 57(5): 863-70. https://doi.org/10.1111/j.1532-5415.2009.02245.x
- 14.Ratliff CR, Rodeheaver GT, Pressure ulcer assessment and management. Lippincotts Prim Care Pract, 1999; 3(2): 242-58.
- 15.Forni C, D'Alessandro F, Gallerani P, et al. Effectiveness of using a new polyurethane foam multi-layer dressing in the sacral area to prevent the onset of pressure ulcer in the elderly with hip fractures: A pragmatic randomised controlled trial. Int Wound J, 2018; 15(3): 383-90. https://doi.org/10.1111/iwj.12875
- 16.Gorse GJ, Messner RL, Improved pressure sore healing with hydrocolloid dressings. Arch Dermatol, 1987; 123(6): 766-71. https://doi.org/10.1001/archderm.1987.01660300088018
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Ortopedi |
| Bölüm | Makaleler |
| Yazarlar | |
| Yayımlanma Tarihi | 31 Aralık 2023 |
| Gönderilme Tarihi | 13 Ekim 2023 |
| Kabul Tarihi | 21 Ekim 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 6 Sayı: 3 |
