NB Kadiköy Hastanesi

Treatment of Chronic Wound

Your solution for treatment of chronic wound is at NB Kadikoy Hospital!

Non-healing wound is not a destiny!

Wounds that do not heal in a long time due to diabetes are a very important problem for both patients and those around them.
These wounds may not heal for months and may cause limb loss. In fact, the formation of these wounds is not only due to high blood glucose, but also o other disorders caused by it.

As a vision holder clinic, we apply the most modern and effective treatment methods to our patients with a multidisciplinary approach and aim quick recovery, considering both the wounds and factors causing wounds.

We are always there for you with our modern and multidisciplinary Chronic Wound Care Clinic.

What Is a Chronic Wound?

Chronic wounds are long-term wounds that do not heal in 3 months. It is possible to reduce this period to 1 month. Skin ulcers, meaning chronic wounds, are wounds that involve the entire layer of the skin and heal slowly or do not heal.

Having a long-term (chronic) wound is a condition that deeply affects the patients, their environment and the society. The increase in the elderly population generally shows parallelism with the increase in chronic wounds. Chronic (long-term) wounds can cause pain, loss of function and mobility, inability to work, being confined to home or even bed, depression, stress, anxiety, undesired malodor, shyness, social isolation, financial burden, long-term hospitalization and even death.

Complications, or in other words, undesired side effects may occur during the long healing period of chronic wounds. These are as follows:

Cellulitis (skin infection)
Eczema
Bleeding
Gangrene
Amputation.

Chronic wounds can cause long-term disability, that is, unfitness for work, which in turn can cause the wound to heal more difficultly like a vicious circle.

Diabetes Wounds Can Heal, too!

There are Wound Care Centers in the developed countries that deal only with this issue for the treatment and care of chronic wounds. At Wound Care Centers, it is aimed to treat patients with appropriate medical materials, dressings, radiological imaging, minimal intervention, and surgical methods. The main purpose here is to treat this very important condition that negatively affects patients, their environment and society in the best possible way. Our Chronic Wound Care Clinic at our hospital is at your service with its professional healthcare staff in accordance with this purpose.

Treatment is provided at our hospital with patients practicing all modern methods and using high-tech devices already used in the world.

What Are Chronic Wounds?

Chronic wounds occur in 4 main types depending on the causes:

Pressure sores or decubitus wounds
Diabetic wounds
Wounds due to venous insufficiency
Wounds due to arterial insufficiency

(It should also be kept in mind that skin cancer can also manifest itself with skin ulcers or wounds that do not heal in a long time.)

Chronic Wound Types

What Is Pressure Sore?

Pressure sores (decubitus ulcer) occur when a certain part of the body is exposed to long-term pressure in patients with limited mobility. Circulation in this area begins to deteriorate and the amount of blood coming to this area decreases. Then the cells begin to die, and as a result, pressure sores develop. It usually occurs in patients who are bedridden, paralyzed or have undergone major surgery.

Factors such as malnutrition, inadequate care, emaciation or obesity, presence of anemia, diabetes, and weak body resistance are factors facilitating the development of pressure sores. Pressure sores, also known as bedsore, can usually be seen in middle and lateral zones of the hip and on the heels.

What Is Diabetic Wound?

Diabetic wounds develop as a result of poorly managed long-term diabetes mellitus causing arterial blood circulation insufficiency and decreased sensation due to nerve involvement. These wounds are generally seen on the feet, toe tips and areas with bone pressure.

Diabetes mellitus unmanaged for many years damages vascular and nerve tissues and easily causes wounds on the feet. It is a very important to keep blood glucose under control and eliminate the infection for healing of the wound while treating it.

What Is Venous Ulcer?

Venous ulcers occur as a result of increased blood pressure in the veins. When blood clot formation, also called deep vein thrombosis, develops in the leg veins, the valves deteriorate, blood flow is restricted or valves being to dysfunction for many reasons. As a result, such wounds develop. Venous ulcers are generally seen on inner sides of ankles and are difficult to treat. This type of wound absolutely requires a special care.

What Is Arterial Ulcer?

Arterial ulcers occur due to occlusions in arteries that carry clean blood. These sores are usually seen on the tips of toes and fingers or in other areas.

What Is Skin Cancer?

Skin cancers, the most common cancer type, can occur anywhere in the body. They manifest themselves as non-healing wounds or a change in an existing mole.

What Are Types of Skin Cancer?

There are many types of skin cancer, the most common types are respectively listed below:

Basal Cell Cancer

Basal cell cancers tend to recur in the area where they develop and do not spread to distant organs.

Squamous Cell Cancer

Squamous cell cancers show a similar course; however, they can spread to distant organs and lymph nodes.

Melanoma

Melanoma is a deadly type of skin cancer. If not treated at early stage, they can spread to lymph nodes and distant organs.
In a country with a population of 70 million, approximately 2.500 people die each year due to skin cancers, 75% of this ratio caused by melanoma while the remaining 25% caused by other types of skin cancers.

Treatment of Varicose Veins

What Is Varicosis?

Varicose veins are the enlargement of the veins that carry blood back to the heart. It is a very common disease, occurring in approximately 20% of all adults and 50% of people at the age of over 50. On the other hand, it is more common in women.

There are valves providing blood flow towards the heart and acting as a pump in veins located in legs. If their function is impaired, the pumping process towards the heart becomes deteriorated, and the blood begin to accumulate in veins, causing them to enlarge and become visible. This condition is called “venous insufficiency.”

Small veins within the skin are identified as “capillary varices” (telangiectasias or spider veins) whereas large veins beneath the skin are described as “varicose veins.”

One of the first signs of venous insufficiency is the emergence of varicose veins. According to CEAP Classification of Venous Disorders, appearance of capillary vessels indicates the stage 1 of venous insufficiency whereas appearance of larger varicose veins indicates stage 2. If not treated, the disease can progress due to accumulation of blood in legs. As a result,

Swelling in legs (stage 3)
Hardening of the skin
Color change and dermatitis (stage 4)
Hardly healing wounds (stage 5)
Non-healing wounds (stage 6) can develop.

In this sense, treatment of varicosis is very important.

The purpose of the treatment is to ensure blood to return to the heart through intact veins and prevent the disease by treating the dysfunctional veins.

What Is Varicosis Treated?

In treatment of varicosis, the following methods are performed:

Laser therapy
Intravenous laser therapy
Sclerotherapy (injection of a medication into the varicose vein)
Phlebectomy (removal of varicose veins through small incisions)
Varicose vein stripping (surgical removal of entire varicose vein).
Also, compression socks are beneficial for patients suffering this disease. The compression socks increase the return of blood through intact veins. They also prevent the progression of varicose veins; however, they do not provide treatment for existing varicose veins.

For the treatment of varicose veins, it is recommended to avoid standing for a long time and raise the legs while sitting.

What Is Endovenous Laser Therapy (EVLT)?

Endovenous Laser Therapy (EVLT) is the process of closing large varicose veins with the help of laser beam. This method has been developed in recent years as an alternative to the Varicose Vein Stripping, which is a surgical intervention, performed under anesthesia at the operating room and has a longer recovery period.

In the stripping method, varicose veins are surgically removed under anesthesia through the incisions made over the inguinal area and ankle level. On the other hand, in the EVLT method, the vein is closed using a laser beam with the help of a thin catheter applied from the lower thigh area. The EVLT can be performed at the physician's room without the need for general anesthesia. The success rate of EVLT is around 97%.

How Is Endovenous Laser Therapy Applied (EVLT)?

A thin laser catheter is inserted into the varicose vein in the lower thigh area.
Then, the laser beam is applied to internal area of the vein for closure.
Catheter insertion during the procedure is performed under ultrasonography guidance.
The EVLT is usually applied in 30-45 minutes under local anesthesia.

Recovery Period After Endovenous Laser Therapy (EVLT)

One of the most important benefits of EVLT is that the recovery period is comfortable and short-term. After the EVLT, patients can walk and continue to normal daily activities. The bandage applied to therapy area is removed following about 2-3 days. Then, patients are asked to wear compression socks for 7 days. Post-procedure pain can be taken under control with aspirin-free pain killers if patients feel any pain. The patients can begin to do exercise or sport and have a hot shower within 2 weeks.

What Are the Risks?

The EVLT has some risks, too, like any intervention. These include bruising, pain, itching and decreased skin sensation, which usually subside within two weeks.

What Is Sclerotherapy?

It is the process used in treatment of small varicose veins and capillary varicose veins.
The enlarged veins are closed with the help of different drugs injected into them thanks to this treatment.

What Is Laser Therapy?

It is the treatment of capillary varicose veins with the laser therapy applied over the skin. It is applied over the skin to smaller varicose veins at the skin level while the laser therapy is applied through the enlarged vein beneath the skin in EVLT. It can be performed with or after the sclerotherapy.

What Is the Laser Therapy Used For?

Visible capillary vessels in face and other areas of body
Congenital vascular lesions
Psoriasis
Pityriasis rosea
Active acnes
Age-associated skin spots and wrinkles
Removal of unwanted hair

What Is Phlebectomy?

It is the process of removing the large varicose veins in pieces through small incisions made over them.

What Is Varicose Vein Stripping?

It is the surgical removal of large varicose veins.

In this method, incisions are made over the inguinal and wrist areas, and a stripper tool is inserted into the varicose vein. After that, the vein is removed along its entire length. It is performed under anesthesia at an operating room.

Treatment of Capillary Varicose Veins

Capillary varicose veins are the enlargement of the thin veins in the skin of the face and legs, becoming visible in purple-blue-red colors. Sclerotherapy and laser therapies are used for treatment.

In sclerotherapy, a medication is injected into the capillary vessel to close the vessel by means of using a thin needle. In laser therapy, on the other hand, laser beam is applied to the capillary vessel from external surface of the skin. These methods can be practiced alone or in combination. At our hospital, laser therapy is preferred for smaller capillary vessels by following the treatment of the vessel feeding the capillary vessels with sclerotherapy. Because in sclerotherapy, it is difficult to insert a needle into very small vessels and the laser therapy applied over the skin is more effective on small vessels.

Sclerotherapy and laser therapy over skin are the procedures performed at the physician's office, which take 15-30 minutes and do not require anesthesia. Patients can get back to work immediately after a laser therapy and in 3 days after a sclerotherapy. Also, patients can can do heavy exercises in 2-3 days after the laser therapy and in 2-4 weeks after the sclerotherapy.