The role of orthopedic’s in multidisciplinary approach to diabetic foot wounds

Objective: Owing to management of diabetic foot wounds (DFW) need severe and long-term treatment protocol that concerns many departments; diabetic foot ulcers necessitate multidisciplinary approach. Therefore a council was constituted that called “Wound Council”, included five deparments (endocrinology, infectious diseases, dermatology, orthopedics and plastic surgery) in Sisli Etfal Research an Training Hospital. The purpose of this study was to inform about the wound council and to emphasise the role of orthopedic approach to DFW.
Methods: A total of 42/154 patients (29 male and 13 female; mean age: 66) who had DFW, were evaluated on “Sisli Etfal Research and Training Hospital - Wound Council” and were decided to be treated by 1. Orthopaedics and Traumatology Clinic were included in this study. Patients’ demographic findings such as gender, age, location and duration of wound, wound culture, results of angiography, presence of vascular pathology, blood sugar levels, wound stages according to Wagner classificaion, surgical prosedures, complications and period of hospitalization were noted.
Results: Fifty one meeting were done in “Sisli Etfal Research and Training Hospital - Wound Council” between 2007-2009 and 154 patients were assessed. 120 of patients (76 male, 44 female and mean age: 58.6) had diabetes (type 1/2=3/117). Wound durations were changing between 2 weeks and 18 years. 42 of these patients who were hospitalized to 1. Orthopedics and Traumatology Clinic had tipe 2 diabetes mellitus (DM) and their mean wound durations were 3.4 month. Staphylococcus aerius were the more spawning microorganism. According to
Wagner classification; more half of patients were stage 4 and 5 (55.7%). 59.5% of patients had lower knee and 23.8% of patients had upper knee amputations. In addition debridement and drainage were applied to five of them, hyperbaric oxygen therapy (HBO) were added 3 of them and vacumm assisted closure (VAC) were added in 3 of them each. Reamputation precedure were applied to 9 of patients who had infection on postoperative follow-up period. Period of hospitalization period were 4-22 days (mean: 13.2).
Conclusion: Consultation traffic of necessary departments for the patients who have DFW decreases with mutidisciplinary approach. We’ve understant that orthopedic practice has an important place in this team. According to our study; for effective treatment of this DFW patients, multi clinical assessement can increase the success instead of single approach.

Diyabetik ayak yarasý olan hastalara multidisipliner yaklaþýmda ortopedinin yeri

Amaç: Diyabetik ayak yarasý uzun süreli ve ciddi tedavilere gereksinim göstermesi ve tedavinin birçok bölümü ilgilendirmesi nedeniyle multidisipliner bir yaklaþýmý gerekli kýlmaktadýr. Bu nedenle Þiþli Etfal Eðitim ve Araþtýrma Hastanesi’nde (ÞEAH) beþ bölümün (endokrinoloji, enfeksiyon hastalýklarý, dermatoloji, ortopedi ve plastik cerrahi) katýlýmý ile oluþturulan yara konseyi hakkýnda bilgi verilmesi ve deðerlendirilen diyabetik ayak yarasý (DAY) olan hastalara ortopedik açýdan yaklaþýmýn vurgulanmasý amaçlandý.
Gereç ve Yöntem: ÞEAH yara konseyinde deðerlendirilen 154 hastadan 1.Ortopedi ve Travmatoloji Kliniði’de yatarak tedavi görmesine karar verilen 42’si (29 erkek, 13 kadýn; yaþ ort: 66) çalýþmaya dahil edildi. Hastalarýn cinsiyeti, yaþý, yara lokalizasyonu gibi demografik bulgularý, yara kültür ve anjiografi sonuçlarý, damarsal patoloji varlýðý, kan þekeri düzeyleri, Wagner sýnýflamasýna göre yara evreleri, yapýlan cerrahi iþlemler, komplikasyonlar, hastanede yatýþ süreleri not edildi ve irdelendi.
Bulgular: 2007-2009 tarihleri arasýnda ÞEAH’de 51 kez yara konseyi yapýlarak 154 hasta deðerlendirildi. Hastalardan 120’si (76 erkek, 44 kadýn yaþ ort: 58.6) diyabetikti (tip 1/2=3/117). Yara süreleri 2 hafta-18 yýl arasýnda deðiþmekteydi. Bunlardan 1.Ortopedi ve Travmatoloji Kliniði’ne yatýrýlarak tedavi edilen 42 olgunun tamamý tip 2 diyabetes mellitustu (DM) ve ortalama yara süreleri 3.4 ay idi. Lezyonlar distal yerleþimli ve enfekte idi. Damar patolojisi olarak distalde daha fazla týkanýklýk saptandý. Kültürlerde ise en fazla stafilokokus aureus üredi. Wagner sýnýflamasýna göre; olgularýn yarýsýndan fazlasý evre 4 ve üzeri (%55.7) idi. Olgulara %59.5’ine diz altý, %23.8’ine diz üstü amputasyon yapýldý. Beþ hastaya debridman ve drenaj, 3’üne hiperbarik oksijen (HBO) tedavisi, 3’üne vakum yardýmlý yara kapama sistemi (VAC; vacumm assisted closure) eklendi. Ameliyat sonrasý takiplerde enfeksiyon geliþen 9 olguya reamputasyon yapýldý. Hastalarýn hastanede yatýþ süreleri ise 4-22 gün (ort: 13.2 gün) olarak belirlendi.
Sonuç: DAY olan hastalar için multidisipliner yaklaþým ile hastalarýn klinikler arasý görüþ alýþveriþi trafiði oldukça azalmaktadýr. Çalýþmamýz ile ortopedinin bu ekipte önemli bir yeri olduðu ve DAY olan hastalarýn tedavisi için tek bir bölüm dýþýnda, diðer kliniklerle beraber yapýlan deðerlendirmelerin yara tedavisindeki baþarýyý artýracaðý sonucuna ulaþtýk.