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KABG Sonrası Safen İnsizyon Yaralarının Primer ve Vakum Yardımlı Kapama Sonuçları

Year 2020, Volume: 2 Issue: 2, 31 - 35, 23.06.2020

Abstract

Amaç: Endoskopik minimal invaziv yöntemle ven
çıkarılması kullanılmasına rağmen kalp merkezlerinin çoğunda halen
konvansiyonel açık yöntemle ven çıkarılması standart bir uygulamadır. Yara yeri
enfeksiyonları nadir olmakla birlikte sıklıkla sistemik hastalığa sahip obez ve
yaşlı kadınlarda görülmektedir. Enfekte ve nekrotik dokuların debridmanı
gerekli olmasına rağmen yaranın primer mi yoksa Vakum Yardımlı Kapama (VYK)
tekniğiyle mi kapatılması tartışma konusudur.



Gereç ve yöntem: Retrospektif olarak iki farklı merkezden 43
hastada toplam 54 bacak insizyon yarasını değerlendirdik. Dizüstü, diz ve dizin
altında olmak üzere sırasıyla 20, 29 ve 5 bacak yarası incelenmiştir.  20 yaranın 12 si (dizüstündeki), 29 yaranın
18’i (dizaltındaki) ve diz bölgesi üzerindeki bütün yaralar 7,2±0,8 günlük
vakum yardımlı kapama tedavisi kullanıldıktan sonra dikiş atılarak
kapatılmıştır. Diğer yaralar ise debridman sonrasında primer olarak
kapatılmıştır. Bütün hastalara yara yerinden alınan kültür sonucuna göre
duyarlı antibiyotik tedavisi başlanmıştır.



Bulgular: Bütün hastalar kullanılan tekniklerle tamamen
iyileşmiştir. Primer yara kapama yapılan 2 hastada tekrar debridman ve
sonrasında vakum yardımlı kapama cihazı kullanma gereksinimi olmuştur.  Pürülan akıntı sadece dizaltı yarası olan 3
hastada görülmüştür.



Sonuç: Safen ven koroner arter bypass cerrahisinde en sık
kullanılan otolog greft olmakla beraber bacak yaraları cerrahi sonrasında
görülen can sıkıcı komplikasyonlardır. Bu yaraların tedavisinde her iki metot
da etkili olmalarına rağmen vakum yardımlı kapama cihazı tekniğinin diz
altındaki yaralar için daha başarılı olduğu görülmektedir.  Bu bulgular diz altında daha az cilt altı
doku olmasına veya eşlik eden mikroanjiopatilere bağlı olabilmekle birlikte
daha ileri çalışmalar için adres teşkil etmektedir. 

Supporting Institution

yok

Project Number

yok

Thanks

Hitit Üniversitesi Kalp ve Damar Cerrahisi Sorumlu Hemşiresi Kelime Özşen'e bu zorlu hasta grubuna karşı gösterdikleri yakın ilgi ve özverileri nedeniyle teşekkür ederiz.

References

  • D.D. Wipke-Tevis, N.A. Stotts, P. Skov, V. Carrieri-Kohlman Frequency, manifestations, and correlates of impaired healing of saphenous vein harvest incisions Heart Lung, 1996;25:108-116
  • P.B. L'Ecuyer, D. Murphy, J.R. Little, V.J. Fraser The epidemiology of chest and leg wound infections following cardiothoracic surgery Clin Infect Dis, 1996;22: 424-429
  • Allen KB, Heimansohn DA, Robison RJ et al. Risk factors for leg wound complications following endoscopic versus traditional saphenous vein harvesting. The Heart Surgery Forum, 01 Jan 2000, 3(4):325-330
  • Fleischmann W, Strecker W, Bombelli M, Kinzl L. Vacuum sealing as treatment of soft tissue damage in open fractures Unfallchirurg. 1993;96(9):488–492.
  • Banwell P, Withey S, Holten I. The use of negative pressure to promote healing. Br J Plast Surg. 1998;51(1):79.
  • Philbeck TE, Whittington KT, Millsap MH, Briones RB, Wight DG, Schroeder WJ. The clinical and cost effectiveness of externally applied negative pressure wound therapy in the treatment of wounds in home healthcare Medicare patients. Ostomy Wound Manage. 1999;45(11):41–50.
  • Moues CM, van den Bemd GJ, Meerding WJ, Hovius SE. An economic evaluation of the use of TNP on full thickness wounds. J Wound Care. 2005;14(5):224–227.
  • Atkins BZ, Wooten MK, Kistler J, Hurley K, Hughes GC, Wolfe WG. Does negative pressure wound therapy have a role in preventing post‐sternotomy wound complications? Surg Innov 2009; 16: 140– 6.
  • Gulack BC, Kirkwood KA, Shi W et al Secondary surgical-site infection after coronary artery bypass grafting: A multi-institutional prospective cohort study The Journal of Thoracic and Cardiovascular Surgery 2018;155(4): 1555-1562
  • Paletta CE, Huang DE, Fiore AC, Swartz MT, Rilloraza FL, Gardner JE Major leg wound complications after saphenous vein harvest for coronary revascularization The Annals of Thoracic Surgery 2000;70(2): 492-497
  • Lee AJ, Sheppard CE, Kent WDT, Mewhort H, Sikdar KC, Fedak PWM Safety and efficacy of prophylactic negative pressure wound therapy following open saphenous vein harvest in cardiac surgery: a feasibility study Interactive CardioVascular and Thoracic Surgery, 2017;24(3):324–328

Primary or Vacuum Assisted Closure For The Leg Incision Wound Infections Following CABG

Year 2020, Volume: 2 Issue: 2, 31 - 35, 23.06.2020

Abstract

Objective: Although minimally invasive endoscopic techniques
were in use for the harvesting of the vein, conventional open harvesting
technique is almost standard in most heart centers. Infections of the wound may
be seen rarely, especially in older obese females with accompanying systemic
diseases. Debridement of the infected and necrotized tissue is essential
however closure of the wound either primarily or after vacuum assisted closure
(VAC) is of debate.

Materials and methods: We retrospectively evaluated 54 leg incision wounds
in 43 patients from two different centers. 20, 29 and 5 wounds were observed
below on and above the knee respectively. 12 of 20 (below the knee), 18 of 29
(above the knee) and all of knee region wounds were sutured after vacuum
assisted closure treatment which had been lasted for mean 7.2 ±0.8 days. The
remaining wounds were primarily sutured following debridement. All patients had
antimicrobial therapy associated with the wound culture microorganism
sensitivity results.

Results: All patient were treated well with the ongoing
technique. 2 patients in primary closure group were re-debredated and VAC
treatment was initiated. Purulent discharge was observed only in 3 patients who
had below knee wounds.







Conclusion: Saphenous vein is the most common autologous venous
graft material that was used during coronary artery bypass grafting surgery and
wounds on the leg is a bothersome complication after surgery. Treatment of
these wounds with both methods is effective however VAC assisted treatment
seems more successful in wounds below the knee. This finding may be related of
less subcutaneous tissue or accompanying micro-angiopathy which should be addressed
in further studies.

Project Number

yok

References

  • D.D. Wipke-Tevis, N.A. Stotts, P. Skov, V. Carrieri-Kohlman Frequency, manifestations, and correlates of impaired healing of saphenous vein harvest incisions Heart Lung, 1996;25:108-116
  • P.B. L'Ecuyer, D. Murphy, J.R. Little, V.J. Fraser The epidemiology of chest and leg wound infections following cardiothoracic surgery Clin Infect Dis, 1996;22: 424-429
  • Allen KB, Heimansohn DA, Robison RJ et al. Risk factors for leg wound complications following endoscopic versus traditional saphenous vein harvesting. The Heart Surgery Forum, 01 Jan 2000, 3(4):325-330
  • Fleischmann W, Strecker W, Bombelli M, Kinzl L. Vacuum sealing as treatment of soft tissue damage in open fractures Unfallchirurg. 1993;96(9):488–492.
  • Banwell P, Withey S, Holten I. The use of negative pressure to promote healing. Br J Plast Surg. 1998;51(1):79.
  • Philbeck TE, Whittington KT, Millsap MH, Briones RB, Wight DG, Schroeder WJ. The clinical and cost effectiveness of externally applied negative pressure wound therapy in the treatment of wounds in home healthcare Medicare patients. Ostomy Wound Manage. 1999;45(11):41–50.
  • Moues CM, van den Bemd GJ, Meerding WJ, Hovius SE. An economic evaluation of the use of TNP on full thickness wounds. J Wound Care. 2005;14(5):224–227.
  • Atkins BZ, Wooten MK, Kistler J, Hurley K, Hughes GC, Wolfe WG. Does negative pressure wound therapy have a role in preventing post‐sternotomy wound complications? Surg Innov 2009; 16: 140– 6.
  • Gulack BC, Kirkwood KA, Shi W et al Secondary surgical-site infection after coronary artery bypass grafting: A multi-institutional prospective cohort study The Journal of Thoracic and Cardiovascular Surgery 2018;155(4): 1555-1562
  • Paletta CE, Huang DE, Fiore AC, Swartz MT, Rilloraza FL, Gardner JE Major leg wound complications after saphenous vein harvest for coronary revascularization The Annals of Thoracic Surgery 2000;70(2): 492-497
  • Lee AJ, Sheppard CE, Kent WDT, Mewhort H, Sikdar KC, Fedak PWM Safety and efficacy of prophylactic negative pressure wound therapy following open saphenous vein harvest in cardiac surgery: a feasibility study Interactive CardioVascular and Thoracic Surgery, 2017;24(3):324–328
There are 11 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Research Articles
Authors

Utku Alemdaroğlu 0000-0002-9123-7403

Sertan Özyalçın This is me 0000-0003-3390-3655

İzzet Hafez This is me 0000-0002-8521-1389

Emin Erol This is me 0000-0002-7679-3575

Adnan Yalçınkaya 0000-0002-0752-6553

Hüseyin Tünel 0000-0003-1175-1961

Adem İlkay Diken 0000-0002-8782-7603

Project Number yok
Publication Date June 23, 2020
Submission Date March 26, 2020
Acceptance Date May 2, 2020
Published in Issue Year 2020 Volume: 2 Issue: 2

Cite

AMA Alemdaroğlu U, Özyalçın S, Hafez İ, Erol E, Yalçınkaya A, Tünel H, Diken Aİ. KABG Sonrası Safen İnsizyon Yaralarının Primer ve Vakum Yardımlı Kapama Sonuçları. Hitit Medical Journal. June 2020;2(2):31-35.