{"id":449,"date":"2022-01-12T14:00:07","date_gmt":"2022-01-12T11:00:07","guid":{"rendered":"https:\/\/tatd.org.tr\/tatdtravma\/?p=449"},"modified":"2022-02-23T16:48:30","modified_gmt":"2022-02-23T13:48:30","slug":"cerrahi-dikis-hakkinda-genel-bilgiler","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/travma\/genel\/cerrahi-dikis-hakkinda-genel-bilgiler\/","title":{"rendered":"Cerrahi Diki\u015f Hakk\u0131nda Genel Bilgiler"},"content":{"rendered":"<p>\u0130lk yaz\u0131m\u0131zda cerrahi diki\u015f hakk\u0131nda genel bilgiler ve temel tekniklerden bahsedece\u011fiz. Diki\u015fin tarih\u00e7esinden k\u0131saca bahsedip, iplerin \u00f6zellikleri, s\u0131k kullan\u0131lan ipler, i\u011fne \u00f6zellikleri ve temel diki\u015f tekniklerinden de g\u00f6rseller ile destekleyerek yaz\u0131m\u0131z\u0131 tamamlayaca\u011f\u0131z.<\/p>\n<p><img decoding=\"async\" class=\"alignnone size-medium wp-image-465\" src=\"https:\/\/tatd.org.tr\/tatdtravma\/wp-content\/uploads\/sites\/32\/2021\/12\/Picture1-300x133.gif\" alt=\"\" width=\"300\" height=\"133\" srcset=\"https:\/\/tatd.org.tr\/travma\/wp-content\/uploads\/sites\/32\/2021\/12\/Picture1-300x133.gif 300w, https:\/\/tatd.org.tr\/travma\/wp-content\/uploads\/sites\/32\/2021\/12\/Picture1-768x340.gif 768w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/p>\n<p>&nbsp;<\/p>\n<p><b>1. Diki\u015f nedir?<\/b><\/p>\n<ul>\n<li>Farkl\u0131 materyaller kullanarak uygulanan,<\/li>\n<li>Tek d\u00fc\u011f\u00fcm\/ d\u00fc\u011f\u00fcm s\u0131ralar\u0131 ile,<\/li>\n<li>Dokular\u0131n yakla\u015ft\u0131r\u0131lmas\u0131na verilen add\u0131r.<\/li>\n<\/ul>\n<p><b>2. Neden At\u0131l\u0131r?\u00a0<\/b><\/p>\n<ul>\n<li>Homeostazisi korumak,<\/li>\n<li>Doku b\u00fct\u00fcnl\u00fc\u011f\u00fcn\u00fc sa\u011flamak,<\/li>\n<li>Dokuda katater, stoma, atel gibi teknik enstr\u00fcmanlar\u0131n stabil kaymas\u0131n\u0131 sa\u011flamak ve yer de\u011fi\u015ftirmesini engellemek,<\/li>\n<li>A\u011fr\u0131y\u0131 azaltmak,<\/li>\n<li>Vital doku ekspozisyonunu, enfeksiyonu \u00f6nlemek,<\/li>\n<li>\u0130zi azaltmak.<\/li>\n<\/ul>\n<h4>Tarih\u00e7e<\/h4>\n<ul>\n<li>M\u00d6 1800-mumyalama esnas\u0131nda insan derisine ilk diki\u015fin at\u0131ld\u0131\u011f\u0131 d\u00fc\u015f\u00fcn\u00fcl\u00fcyor.<\/li>\n<li>Sushruta(M\u00d6 500): yara s\u00fct\u00fcrasyonu ve diki\u015f materyalleri tarif edilmi\u015f<\/li>\n<li>Galen(MS200) -hemostazis i\u00e7in ipek kullanm\u0131\u015f<\/li>\n<li>Andreas Vesalius-(MS 200) tendon ve sinir onar\u0131m\u0131 i\u00e7in diki\u015f kullan\u0131m\u0131.<\/li>\n<\/ul>\n<h4>\u0130deal diki\u015f materyali nas\u0131l olmal\u0131?<\/h4>\n<ul>\n<li>G\u00fc\u00e7l\u00fc olmal\u0131 \u2013 Diki\u015f at\u0131lan dokuda amaca uygun gerilim kuvvetini sa\u011flamal\u0131.<\/li>\n<li>\u0130nert- Doku ile en fazla uyum,en az yabanci cisim reaksiyonu olu\u015fmal\u0131.<\/li>\n<li>Esnek-Kullan\u0131m kolay, D\u00fc\u011f\u00fcm g\u00fcvenli\u011fi y\u00fcksek olmal\u0131.<\/li>\n<li>Atravmatik olmal\u0131 &#8211; kolayl\u0131kla dokulardan ge\u00e7erken dokuda tahribat yaratmamal\u0131.<\/li>\n<li>Ucuz olmal\u0131.<\/li>\n<\/ul>\n<p>Diki\u015f ipliklerini materyal kompozisyonu, dokuda erime \u00f6zellikleri ve iplik yap\u0131s\u0131na g\u00f6re s\u0131n\u0131fland\u0131rabiliriz (\u015eekil 1).<\/p>\n<p>&nbsp;<\/p>\n<div id=\"attachment_450\" style=\"width: 310px\" class=\"wp-caption aligncenter\"><img fetchpriority=\"high\" decoding=\"async\" aria-describedby=\"caption-attachment-450\" class=\"size-medium wp-image-450\" src=\"https:\/\/tatd.org.tr\/tatdtravma\/wp-content\/uploads\/sites\/32\/2021\/12\/Screen-Shot-2021-12-18-at-14.16.16-300x195.png\" alt=\"\" width=\"300\" height=\"195\" srcset=\"https:\/\/tatd.org.tr\/travma\/wp-content\/uploads\/sites\/32\/2021\/12\/Screen-Shot-2021-12-18-at-14.16.16-300x195.png 300w, https:\/\/tatd.org.tr\/travma\/wp-content\/uploads\/sites\/32\/2021\/12\/Screen-Shot-2021-12-18-at-14.16.16.png 431w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><p id=\"caption-attachment-450\" class=\"wp-caption-text\">\u015eekil 1. Materyal kompozisyonu, dokuda erime \u00f6zellikleri ve iplik yap\u0131s\u0131na g\u00f6re diki\u015f iplikleri s\u0131n\u0131fland\u0131rmas\u0131.<\/p><\/div>\n<p>Tablo 1&#8217;de ise, en s\u0131k kullan\u0131lan diki\u015f materyalleri g\u00f6r\u00fclmektedir.<\/p>\n<div class=\"pcrstb-wrap\"><table style=\"width: 473px\" width=\"321\">\n<tbody>\n<tr>\n<td style=\"width: 90px\" width=\"73\"><\/td>\n<td style=\"width: 138px\" width=\"129\"><strong>Monofilaman<\/strong><\/td>\n<td style=\"width: 245px\" width=\"118\"><strong>Multifilaman<\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 90px\" width=\"73\"><strong>Emilebilir<\/strong><\/td>\n<td style=\"width: 138px\" width=\"129\"><span style=\"text-decoration: underline\">KATG\u00dcT<\/span><\/p>\n<p><span style=\"text-decoration: underline\">KOLLAJEN<\/span><\/p>\n<p>POL\u0130GLEKAPRON<\/p>\n<p>POL\u0130D\u0130OKSANON<\/td>\n<td style=\"width: 245px\" width=\"118\">POL\u0130GL\u0130KOL\u0130K AS\u0130T<br \/>\nPOL\u0130GALAKT\u0130N<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 90px\" width=\"73\"><strong>Emilmez<\/strong><\/td>\n<td style=\"width: 138px\" width=\"129\">NAYLON<br \/>\nPOL\u0130PROP\u0130LEN<\/td>\n<td style=\"width: 245px\" width=\"118\"><span style=\"text-decoration: underline\">\u0130PEK<\/span><\/p>\n<p>POLYESTER<\/td>\n<\/tr>\n<\/tbody>\n<\/table><\/div>\n<p>Tablo 1: En s\u0131k kullan\u0131lan diki\u015f materyallerinin emilebilirlik ve filaman yap\u0131s\u0131na g\u00f6re s\u0131n\u0131flamas\u0131.\u00a0Do\u011fal yap\u0131da iplikler alt\u0131 \u00e7izili g\u00f6sterilmi\u015ftir.<\/p>\n<h4>Emilebilir s\u00fct\u00fcrler<\/h4>\n<ul>\n<li>Emilebilir s\u00fct\u00fcrler, v\u00fccutta enzimatik veya hidroliz reaksiyonlar\u0131yla degrade olan (eriyen) gerilim kuvvetlerini zaman i\u00e7erisinde kaybeden diki\u015flerdir.<\/li>\n<li>Geleneksel olarak derin dokularda kullan\u0131lsa da, pediyatrik vakalarda cilt kapat\u0131m\u0131 i\u00e7in de tercih edilebilir.<\/li>\n<\/ul>\n<p><span style=\"text-decoration: underline\">\u0130deal \u015fartlarda;<\/span><\/p>\n<ul>\n<li>D\u00fc\u015f\u00fck doku reaksiyonu,<\/li>\n<li>Y\u00fcksek gerilim kuvveti,<\/li>\n<li>Yava\u015f emilim,<\/li>\n<li>D\u00fc\u011f\u00fcm g\u00fcvenli\u011fi sa\u011flarlar.<\/li>\n<\/ul>\n<p><span style=\"text-decoration: underline\">Kullan\u0131ld\u0131\u011f\u0131 alanlar:<\/span><\/p>\n<ul>\n<li>Derin yumu\u015fak dokularda<\/li>\n<li>Ok\u00fcler cerrahide<\/li>\n<li>Mukoza onar\u0131m\u0131nda<\/li>\n<li>Pediatrik cilt onar\u0131m\u0131nda<\/li>\n<\/ul>\n<h5>Emilebilen do\u011fal yap\u0131da s\u00fct\u00fcrler:<\/h5>\n<p><span style=\"text-decoration: underline\">Monofilaman s\u00fct\u00fcrler\u2013 v\u00fccut enzimleriyle par\u00e7alan\u0131r<\/span><\/p>\n<ul>\n<li>Katg\u00fct &#8211; Koyunlar\u0131n ba\u011f\u0131rsak submukozas\u0131 veya s\u0131\u011f\u0131rlar\u0131n ba\u011f\u0131rsak serozas\u0131ndan elde edilir. Krom tuzlar\u0131 ile kaplanarak emilme s\u00fcresi uzat\u0131labilir. Ucuz olmas\u0131 ve h\u0131zl\u0131 erimesi sebebiyle a\u011f\u0131z i\u00e7i gibi mukoza diki\u015flerinde ve pediatrik olgularda \u00f6zellikle tercih edilmektedir. Avrupa\u2019daki Prion hastal\u0131\u011f\u0131 salg\u0131n\u0131 sonras\u0131 kullan\u0131m\u0131 yasaklanm\u0131\u015f, ancak ABD ve uzak do\u011fuda kullan\u0131lmaya devam etmektedir.<\/li>\n<li>Gerilme direncinde %75 azalmaya;\n<ul>\n<li style=\"list-style-type: none\"><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&#8211; Normal katg\u00fctde 7 g\u00fcnde,<\/p>\n<p>&#8211; Krome katg\u00fctde 14 g\u00fcnde ula\u015f\u0131l\u0131r.<\/p>\n<h5>Emilebilen sentetik yap\u0131da s\u00fct\u00fcrler<\/h5>\n<p>Do\u011fal yap\u0131da diki\u015flerden farkl\u0131 olarak, hidrolizle par\u00e7alan\u0131r. Bunun sonucunda, degradasyon s\u00fcreci, daha az doku reaksiyon olu\u015fturur.<\/p>\n<ul>\n<li>Monofilamanlar :\n<ul>\n<li>Poliglekapron (Monocryl, Tekmon)<\/li>\n<li>Polidioksanon (PDS-2, Pedesente)<\/li>\n<li>Poliglukonat (Maxon)<\/li>\n<li>Glikomer (Biosyn)<\/li>\n<\/ul>\n<\/li>\n<li>Multifilaman\n<ul>\n<li>Poliglikolik asit (Pegesorb, Dexon)<\/li>\n<li>Poligalaktin 910 (Pegelak, Vicryl)<\/li>\n<li>Polisorb<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h4>S\u0131k kullan\u0131lan sentetik emilebilir s\u00fct\u00fcrler<\/h4>\n<p><strong><u>Poliglekapron 25 -\u201cMONOCRYL, TEKMON<\/u>\u201d<\/strong><\/p>\n<p><img decoding=\"async\" class=\"wp-image-451 alignleft\" src=\"https:\/\/tatd.org.tr\/tatdtravma\/wp-content\/uploads\/sites\/32\/2021\/12\/monocril.jpg\" alt=\"\" width=\"92\" height=\"201\" \/><\/p>\n<ul>\n<li>Antijenik ve pirojenik de\u011fil.<\/li>\n<li>\u00c7ok az doku reaksiyonu var .<\/li>\n<li>Gerilme direnci 2 haftada %30\u2019a d\u00fc\u015fer, 3 haftada kaybolur.<\/li>\n<li>90-120 g\u00fcnde hidrolize olur.<\/li>\n<\/ul>\n<blockquote><p>Ciltalt\u0131 diki\u015fler, mukoza, subkutik\u00fcler onar\u0131mlar i\u00e7in idealdir.<\/p><\/blockquote>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><u><strong>Polidioksanon-\u201cPDS II, Pedesente\u201d<\/strong> <\/u><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-452 alignleft\" src=\"https:\/\/tatd.org.tr\/tatdtravma\/wp-content\/uploads\/sites\/32\/2021\/12\/pedesente-139x300.jpg\" alt=\"\" width=\"89\" height=\"192\" srcset=\"https:\/\/tatd.org.tr\/travma\/wp-content\/uploads\/sites\/32\/2021\/12\/pedesente-139x300.jpg 139w, https:\/\/tatd.org.tr\/travma\/wp-content\/uploads\/sites\/32\/2021\/12\/pedesente.jpg 198w\" sizes=\"(max-width: 89px) 100vw, 89px\" \/><\/p>\n<ul>\n<li>Pirojenik \/antijenik etkisi, doku reaksiyonu minimaldir.<\/li>\n<li>D\u00fc\u011f\u00fcm emniyeti a\u00e7\u0131s\u0131ndan az g\u00fcvenilirdir.(En az 4 kez d\u00fc\u011f\u00fcm atmak gerekir.)<\/li>\n<li>Gerilme direnci 2. haftada %75, 4 haftada %60\u2019a d\u00fc\u015fer.<\/li>\n<li>Tam emilim: 6-7 ay s\u00fcrer.<\/li>\n<\/ul>\n<blockquote><p>Kranyofasyal cerrahide kemiklerin aras\u0131nda semi-rigid tespit olu\u015fturmak i\u00e7in, kas\/tendon onar\u0131m\u0131nda, mukozalarda kullan\u0131l\u0131r.<\/p><\/blockquote>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><strong><u>Poligalaktin 910 -:\u201dV\u0130CRYL, PEGALAK\u201d<\/u><\/strong><\/p>\n<ul>\n<li>Glikolid ve laktid\u2019in kopolimeridir.<img loading=\"lazy\" decoding=\"async\" class=\"wp-image-453 alignright\" src=\"https:\/\/tatd.org.tr\/tatdtravma\/wp-content\/uploads\/sites\/32\/2021\/12\/vicryl.png\" alt=\"\" width=\"110\" height=\"186\" \/><\/li>\n<li>D\u00fc\u015f\u00fck molek\u00fcl a\u011f\u0131rl\u0131\u011f\u0131: rapid form<\/li>\n<li>TRICLOSAN kaplama: antibakteriyel \u00f6zellik kazand\u0131r\u0131r. plus form olarak bilinir.<\/li>\n<li>\u00d6r\u00fclm\u00fc\u015f, yani multifilamand\u0131r. Bu \u00f6zelli\u011fi sayesinde d\u00fc\u011f\u00fcm g\u00fcvenli\u011fi olduk\u00e7a iyi iken,\u00a0\u00f6te yanda dokulardan ge\u00e7erken bir miktar hasar olu\u015fturur.<\/li>\n<li>Gerilme direnci 2 haftada %65\u2019e d\u00fc\u015fer,4 haftada kaybolur.<\/li>\n<li>60-70 g\u00fcnde hidrolize olur.<\/li>\n<\/ul>\n<blockquote><p>&nbsp;<\/p>\n<p>Mukoza, yumu\u015fak doku onar\u0131mlar\u0131nda, abdominal ve oftalmik cerrahide kullan\u0131l\u0131r.<\/p><\/blockquote>\n<h4><\/h4>\n<h4>Emilemeyen s\u00fct\u00fcrler<\/h4>\n<ul>\n<li>Emilmeyen diki\u015fler, do\u011fal veya sentetik yap\u0131da olup, gerilim kuvvetlerini kaybetmeyen diki\u015f materyalleridir. Cilt \u00fczerine uyguland\u0131\u011f\u0131nda al\u0131nmas\u0131 gereklidir. Ancak derin dokularda al\u0131namayacaklar\u0131 i\u00e7in \u00e7ok uzun s\u00fcre kal\u0131r.<\/li>\n<li>\u0130pek, \u00e7elik, poliamid ve polipropilen en s\u0131k tercih edilen, emilemeyen diki\u015f materyalleridir.<\/li>\n<\/ul>\n<h5>Emilemeyen do\u011fal yap\u0131da s\u00fct\u00fcrler<\/h5>\n<ul>\n<li>\u0130pek s\u00fct\u00fcrler, tarihsel olarak en \u00e7ok kabul g\u00f6rm\u00fc\u015f ve kullan\u0131lan diki\u015f materyalidir. \u00d6rg\u00fcl\u00fc, multiflaman yap\u0131dad\u0131r ve m\u00fckemmel d\u00fc\u011f\u00fcm g\u00fcvenli\u011fi sa\u011flar.<\/li>\n<li>Her ne kadar emilmeyen diki\u015fler aras\u0131nda kabul edilse de, yava\u015f ve uzun s\u00fcren enzimatik bir y\u0131k\u0131ma u\u011frayarak g\u00fcc\u00fcn\u00fc zamanla kaybetmektedir.Bu durum, hidrolizle y\u0131k\u0131ma u\u011frayan Vikril, Dexon, PDS\u2019ye g\u00f6re \u00e7ok daha fazla reaksiyon olu\u015fmas\u0131n\u0131n nedenidir.<\/li>\n<li>2 y\u0131ldan sonra tamamen rezorbe oldu\u011fu kabul edilmektedir.Yava\u015f emilen diki\u015f malzemesi denmesi daha uygundur.<\/li>\n<li>Olu\u015fturdu\u011fu doku reaksiyonu ve \u00f6rg\u00fcl\u00fc yap\u0131s\u0131ndan kaynakl\u0131 olarak doku ge\u00e7i\u015finde yaratt\u0131\u011f\u0131 tahribat nedeniyle g\u00fcn\u00fcm\u00fczde cilt diki\u015fi olarak kabul g\u00f6rmemektedir.<\/li>\n<li>G\u00fcn\u00fcm\u00fczde damar ligasyonu, dren fiksasyonu gibi cerrahi i\u015flemlerde hala tercih edilmesinin birincil sebebi ucuz ve g\u00fcvenli olmas\u0131d\u0131r.<\/li>\n<\/ul>\n<h5>Emilmeyen Sentetik S\u00fct\u00fcrler :<\/h5>\n<ul>\n<li>Bu diki\u015f materyali ailesi, emilme \u00f6zelli\u011fi g\u00f6stermedi\u011fi ve doku ile reaksiyona girmedi\u011fi i\u00e7in \u00f6zellikle k\u00fctan\u00f6z diki\u015flerde tercih edilirken, tensil kuvvetlerini kaybetmemeleri nedeniyle de damar, fasya ve tendon gibi derin doku onar\u0131mlar\u0131nda zaman zaman tercih edilirler.<\/li>\n<\/ul>\n<p><strong>S\u0131k kullan\u0131lan emilmeyen sentetik s\u00fct\u00fcrler<\/strong><\/p>\n<p><span style=\"text-decoration: underline\"><strong>P<\/strong><strong>olipropilen<\/strong><strong>\u00a0&#8220;<\/strong><strong>PROPILEN, PROLENE, SURGILENE,SURGIPRO&#8221;<\/strong><\/span><\/p>\n<ul>\n<li><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-454 alignright\" src=\"https:\/\/tatd.org.tr\/tatdtravma\/wp-content\/uploads\/sites\/32\/2021\/12\/prolen-131x300.jpg\" alt=\"\" width=\"62\" height=\"142\" srcset=\"https:\/\/tatd.org.tr\/travma\/wp-content\/uploads\/sites\/32\/2021\/12\/prolen-131x300.jpg 131w, https:\/\/tatd.org.tr\/travma\/wp-content\/uploads\/sites\/32\/2021\/12\/prolen.jpg 136w\" sizes=\"(max-width: 62px) 100vw, 62px\" \/>Monofilaman yap\u0131dad\u0131r.<\/li>\n<li>Y\u00fcksek gerilim kuvveti vard\u0131r.<\/li>\n<li>Doku reaksiyonu en az olan materyallerdendir.<\/li>\n<li>Dokudan ge\u00e7i\u015fi \u00e7ok kolayd\u0131r.<\/li>\n<li>En az g\u00fc\u00e7 kaybeden monofilamand\u0131r.<\/li>\n<\/ul>\n<blockquote><p>Cilt onar\u0131mlar\u0131, Tendon onar\u0131mlar\u0131, kardiyovask\u00fcler, mikrovask\u00fcler onar\u0131mlarda yayg\u0131n olarak kullan\u0131l\u0131r.<\/p><\/blockquote>\n<p><span style=\"text-decoration: underline\"><strong>Polyester<\/strong><strong> \u201c<\/strong><strong>ETH<\/strong><strong>I<\/strong><strong>BOND,POL<\/strong><strong>I<\/strong><strong>TER<\/strong><strong>\u201d<img loading=\"lazy\" decoding=\"async\" class=\"wp-image-455 alignright\" src=\"https:\/\/tatd.org.tr\/tatdtravma\/wp-content\/uploads\/sites\/32\/2021\/12\/ethibond.jpg\" alt=\"\" width=\"60\" height=\"136\" \/><\/strong><\/span><\/p>\n<ul>\n<li>Sentetik, multiflamand\u0131r.<\/li>\n<li>5-6 d\u00fc\u011f\u00fcmden sonra d\u00fc\u011f\u00fcm g\u00fcvenli\u011fi iyidir.<\/li>\n<li>Gerilim kuvvetlerini s\u00fcresiz olarak korurlar.<\/li>\n<li>Silikon veya teflon kaplanarak dokudan daha kolay ge\u00e7i\u015f sa\u011flanm\u0131\u015ft\u0131r.<\/li>\n<li>Ancak bu yolla d\u00fc\u011f\u00fcmlerin kayma riski artmaktad\u0131r ve d\u00fc\u011f\u00fcm g\u00fcvenli\u011fi azalmaktad\u0131r.<\/li>\n<\/ul>\n<p><span style=\"text-decoration: underline\"><strong>3-Poliamid (Naylon)<\/strong><strong> \u201c<\/strong><strong>ETH<\/strong><strong>I<\/strong><strong>LON, DAYLON<\/strong><strong>\u201d<\/strong><\/span><\/p>\n<p><span style=\"text-decoration: underline\"><strong> <img loading=\"lazy\" decoding=\"async\" class=\" wp-image-456 alignright\" src=\"https:\/\/tatd.org.tr\/tatdtravma\/wp-content\/uploads\/sites\/32\/2021\/12\/ethilon-138x300.jpg\" alt=\"\" width=\"85\" height=\"185\" srcset=\"https:\/\/tatd.org.tr\/travma\/wp-content\/uploads\/sites\/32\/2021\/12\/ethilon-138x300.jpg 138w, https:\/\/tatd.org.tr\/travma\/wp-content\/uploads\/sites\/32\/2021\/12\/ethilon.jpg 150w\" sizes=\"(max-width: 85px) 100vw, 85px\" \/><\/strong><\/span><\/p>\n<ul>\n<li>Sentetik,monofilaman, emilmeyen bir materyaldir.<\/li>\n<li>Gerilme direnci ilk y\u0131lda %20 kay\u0131p verirken, 2. Y\u0131l\u0131n sonunda gerilme direncinin %75\u2019ini hala korumaktad\u0131r.<\/li>\n<li>Doku reaksiyonu \u00e7ok azd\u0131r.<\/li>\n<li>Polipropilene g\u00f6re biraz daha pahal\u0131d\u0131r.<\/li>\n<\/ul>\n<blockquote><p>Deri, mikrocerrahi, oftalmik cerrahide tercih edilir.<\/p><\/blockquote>\n<h4><\/h4>\n<h4>S\u00fct\u00fcr kal\u0131nl\u0131klar\u0131<\/h4>\n<p>\u0130lk iplikler kal\u0131nl\u0131klar\u0131na g\u00f6re 1-6 aras\u0131nda numaraland\u0131r\u0131lm\u0131\u015f olup, 6 numara en kal\u0131n\u0131, 1 numara en inceyi temsil etmekteydi. Zaman i\u00e7erisinde, teknolojinin geli\u015fmesiyle daha ince iplikler \u00fcretilmesi m\u00fcmk\u00fcn olunca, 1 numaradan daha ince olan ilk materyal 0 (#0) olarak numaraland\u0131r\u0131lm\u0131\u015f. \u00a0Ancak daha sonra daha ince iplikler \u00fcretildik\u00e7e, \u201c-\u201c veya ondal\u0131kl\u0131 rakamlar\u0131 kullanmak yerine, yeni ve daha ince iplikler, incelik artt\u0131k\u00e7a, \u201c0\u201d rakam\u0131n\u0131n say\u0131s\u0131n\u0131n artt\u0131r\u0131lmas\u0131yla,\u00a0 00, 000, 0000 olarak numaraland\u0131r\u0131lmaya devam edilmi\u015f. Bunun \u00fczerine g\u00fcn\u00fcm\u00fczde kulland\u0131\u011f\u0131m\u0131z iplik kal\u0131nl\u0131klar\u0131 da b\u00f6ylelikle isimlendirilmi\u015f. USP s\u0131n\u0131flamas\u0131na g\u00f6re diki\u015f iplerinin kal\u0131nl\u0131klar\u0131 tablo 2\u2019de verilmi\u015ftir.<\/p>\n<p><strong>\u00d6rnek :<\/strong><\/p>\n<p>#0<\/p>\n<p>#00 -&gt; 2-0 (2\/0)<\/p>\n<p>#000 -&gt; 3-0 (3\/0)<\/p>\n<div class=\"pcrstb-wrap\"><table style=\"width: 431px\" width=\"330\">\n<tbody>\n<tr>\n<td style=\"width: 86px\" width=\"71\">USP<br \/>\ndesignation<\/td>\n<td style=\"width: 72px\" width=\"60\">sentetik emilebilir \u00e7ap (mm)<br \/>\ndiameter (mm)<\/td>\n<td style=\"width: 273px\" width=\"199\">emilmeyen \u00e7ap (mm)<br \/>\ndiameter (mm)<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 86px\" width=\"71\">11-0<\/td>\n<td style=\"width: 72px\" width=\"60\"><\/td>\n<td style=\"width: 273px\" width=\"199\">0.01<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 86px\" width=\"71\">10-0<\/td>\n<td style=\"width: 72px\" width=\"60\">0.02<\/td>\n<td style=\"width: 273px\" width=\"199\">0.02<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 86px\" width=\"71\">9-0<\/td>\n<td style=\"width: 72px\" width=\"60\">0.03<\/td>\n<td style=\"width: 273px\" width=\"199\">0.03<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 86px\" width=\"71\">8-0<\/td>\n<td style=\"width: 72px\" width=\"60\">0.04<\/td>\n<td style=\"width: 273px\" width=\"199\">0.04<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 86px\" width=\"71\">7-0<\/td>\n<td style=\"width: 72px\" width=\"60\">0.05<\/td>\n<td style=\"width: 273px\" width=\"199\">0.05<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 86px\" width=\"71\">6-0<\/td>\n<td style=\"width: 72px\" width=\"60\">0.07<\/td>\n<td style=\"width: 273px\" width=\"199\">0.07<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 86px\" width=\"71\">5-0<\/td>\n<td style=\"width: 72px\" width=\"60\">0.1<\/td>\n<td style=\"width: 273px\" width=\"199\">0.1<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 86px\" width=\"71\">4-0<\/td>\n<td style=\"width: 72px\" width=\"60\">0.15<\/td>\n<td style=\"width: 273px\" width=\"199\">0.15<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 86px\" width=\"71\">3-0<\/td>\n<td style=\"width: 72px\" width=\"60\">0.2<\/td>\n<td style=\"width: 273px\" width=\"199\">0.2<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 86px\" width=\"71\">2-0<\/td>\n<td style=\"width: 72px\" width=\"60\">0.3<\/td>\n<td style=\"width: 273px\" width=\"199\">0.3<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 86px\" width=\"71\">0<\/td>\n<td style=\"width: 72px\" width=\"60\">0.35<\/td>\n<td style=\"width: 273px\" width=\"199\">0.35<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 86px\" width=\"71\">1<\/td>\n<td style=\"width: 72px\" width=\"60\">0.4<\/td>\n<td style=\"width: 273px\" width=\"199\">0.4<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 86px\" width=\"71\">2<\/td>\n<td style=\"width: 72px\" width=\"60\">0.5<\/td>\n<td style=\"width: 273px\" width=\"199\">0.5<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 86px\" width=\"71\">3<\/td>\n<td style=\"width: 72px\" width=\"60\">0.6<\/td>\n<td style=\"width: 273px\" width=\"199\">0.6<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 86px\" width=\"71\">4<\/td>\n<td style=\"width: 72px\" width=\"60\">0.6<\/td>\n<td style=\"width: 273px\" width=\"199\">0.6<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 86px\" width=\"71\">5<\/td>\n<td style=\"width: 72px\" width=\"60\">0.7<\/td>\n<td style=\"width: 273px\" width=\"199\">0.7<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 86px\" width=\"71\">6<\/td>\n<td style=\"width: 72px\" width=\"60\"><\/td>\n<td style=\"width: 273px\" width=\"199\">0.8<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 86px\" width=\"71\">7<\/td>\n<td style=\"width: 72px\" width=\"60\"><\/td>\n<td style=\"width: 273px\" width=\"199\"><\/td>\n<\/tr>\n<\/tbody>\n<\/table><\/div>\n<p>Tablo 2. Diki\u015f iplerinin kal\u0131nl\u0131klar\u0131n\u0131n USP s\u0131n\u0131flamas\u0131na g\u00f6re kar\u015f\u0131l\u0131\u011f\u0131<\/p>\n<h4>\u0130\u011fneler<\/h4>\n<p>Diki\u015f materyalleri tek ba\u015flar\u0131na dokudan penetre olma \u00f6zelli\u011fine sahip olmad\u0131klar\u0131ndan, dokuyu penetre edici bir i\u011fne ile kullan\u0131lmalar\u0131 \u015fartt\u0131r.<\/p>\n<p>&nbsp;<\/p>\n<p>S\u00fct\u00fcr i\u015fleminde kullan\u0131lacak olan i\u011fneler ideal olarak;<\/p>\n<p>&nbsp;<\/p>\n<ol>\n<li>Korozyona\u00a0 diren\u00e7li olmal\u0131,<\/li>\n<li>Dokuya penetre olabilmesi i\u00e7in yeterli sertlikte olmal\u0131,<\/li>\n<li>K\u0131r\u0131lmadan, deforme olabilme ve \u015fekil alabilmeli<\/li>\n<li>Dokuda minimal travma yapacak yeterlikte inceli\u011fe sahip olmal\u0131,<\/li>\n<li>\u0130pi \u00e7ekerken dokuda a\u015f\u0131r\u0131 abrazyon yapmamal\u0131,<\/li>\n<li>Keskin k\u0131sm\u0131 dokuyu kolayca ge\u00e7ebilmeli,<\/li>\n<li>Enstr\u00fcman ve elle tutuldu\u011funda kullan\u0131m\u0131 kolay olmal\u0131d\u0131r.<\/li>\n<\/ol>\n<h4>\u0130\u011fnelerin yap\u0131sal \u00f6zellikleri :<\/h4>\n<p><strong><u>\u0130\u011fne ucu <\/u><u>:<\/u> <\/strong><\/p>\n<ul>\n<li>Diki\u015f materyalinin kullan\u0131lmas\u0131n\u0131n planland\u0131\u011f\u0131 dokunun \u00f6zelliklerine g\u00f6re se\u00e7ilir.<\/li>\n<li>Keskin, sivri, k\u00f6r, yuvarlak, kesici-sivri, ters kesici gibi s\u0131n\u0131fland\u0131r\u0131l\u0131r.<\/li>\n<li>Cilt gibi rijid dokular ancak keskin u\u00e7lu i\u011fneler ile penetre edilebilirken, bu u\u00e7lar derin-yumu\u015fak dokularda travmaya yol a\u00e7abildi\u011finden, bu dokularda yuvarlak i\u011fne u\u00e7lu i\u011fneler tercih edilir.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong><u>\u0130\u011fne g<\/u><u>\u00f6vdesi <\/u><u>:<\/u> <\/strong><\/p>\n<ul>\n<li>Porteg\u00fcn\u00fcn kavrad\u0131\u011f\u0131 orta k\u0131s\u0131md\u0131r. Yuvarlak,k\u00fct,diamond, taper, ters keskin, keskin, spat\u00fcl tipleri vard\u0131r.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong><u>\u0130\u011fne boyu<\/u><u> :<\/u> <\/strong><\/p>\n<ul>\n<li>\u0130\u011fnenin ucundan ip olarak devam etti\u011fi son noktas\u0131na kadar olan uzunlu\u011fu g\u00f6sterir.<\/li>\n<li>Dar alanlarda, derin dokularda, mikrocerrahi i\u015flemlerde k\u0131sa i\u011fne boylar\u0131 tercih edilirken, kal\u0131n dokularda uzun i\u011fne boylar\u0131 tercih edilir.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong><u>\u0130\u011fne yar\u0131\u00e7ap\u0131 <\/u><u>:<\/u> <\/strong><\/p>\n<ul>\n<li>\u0130\u011fne formunun ve kavsin, i\u011fnenin olu\u015fturaca\u011f\u0131 bir dairenin \u00e7evresine oran\u0131n\u0131 g\u00f6sterir.<\/li>\n<li>En s\u0131k kullan\u0131lan formlar 3\/8 ve \u00bd iken, \u00bc ve 5\/8 gibi formlar da mevcuttur.<\/li>\n<li>Ayr\u0131ca daire kavsine uymayan d\u00fcz ve asimetrik i\u011fne formlar\u0131 da mevcuttur.<\/li>\n<li>Diki\u015f at\u0131lan dokunun ve \u00e7al\u0131\u015fma sahas\u0131n\u0131n \u00f6zelliklerine g\u00f6re se\u00e7ilir.<\/li>\n<\/ul>\n<h4><\/h4>\n<h4>Diki\u015f ambalaj\u0131n\u0131n okunmas\u0131 :<\/h4>\n<p>Yukar\u0131da bahsedilen iplik ve i\u011fne \u00f6zelliklerinin t\u00fcm\u00fc ve son kullanma tarihi gibi temel malzeme \u00f6zellikleri, ambalaj\u0131n \u00fczerinde a\u00e7\u0131k olarak okunur olmal\u0131d\u0131r. (Resim 1)<\/p>\n<div id=\"attachment_457\" style=\"width: 310px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-457\" class=\"size-medium wp-image-457\" src=\"https:\/\/tatd.org.tr\/tatdtravma\/wp-content\/uploads\/sites\/32\/2021\/12\/sutur-okuma-300x165.png\" alt=\"\" width=\"300\" height=\"165\" srcset=\"https:\/\/tatd.org.tr\/travma\/wp-content\/uploads\/sites\/32\/2021\/12\/sutur-okuma-300x165.png 300w, https:\/\/tatd.org.tr\/travma\/wp-content\/uploads\/sites\/32\/2021\/12\/sutur-okuma.png 468w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><p id=\"caption-attachment-457\" class=\"wp-caption-text\">Resim 1. Vicryl (ETHICON) marka bir diki\u015f ambalaj\u0131n\u0131n g\u00f6r\u00fcn\u00fcm\u00fc. Sol \u00fcst yuvarlak iplik \u00e7ap\u0131 (3-0) ve ip uzunlu\u011funu (70 cm) g\u00f6stermektedir.<br \/>Sol altta i\u011fne \u00f6zellikleri belirtilmektedir. Buna g\u00f6re, diki\u015f i\u011fnesi 26 mm uzunlukta, \u00bd kavis formunda ve taper u\u00e7ludur.<br \/>Sa\u011f \u00fcstte ise malzemenin son kullanma tarihi ile beraber seri numaralar\u0131 izlenmektedir.<\/p><\/div>\n<h4>Diki\u015f teknikleri<\/h4>\n<h5>Cilt diki\u015finde genel prensipler<\/h5>\n<ul>\n<li>Cilt diki\u015finin amac\u0131, derinde \u00f6l\u00fc bo\u015fluk b\u0131rakmadan ve dermal- epidermal yap\u0131lar\u0131 en uygun \u015fekilde yakla\u015ft\u0131rarak doku b\u00fct\u00fcnl\u00fc\u011f\u00fcn\u00fc olu\u015fturmakt\u0131r.<\/li>\n<li>Yara iyile\u015fmesi dinamikleri \u00f6ng\u00f6r\u00fcld\u00fc\u011f\u00fcnde, bir miktar kontraksiyon ka\u00e7\u0131n\u0131lmaz olup, bu kontraksiyon sonucunda diki\u015f hatt\u0131n\u0131n i\u00e7eriye g\u00f6m\u00fclmesi (inversiyon) s\u00f6z konusu olacakt\u0131r.<\/li>\n<li>Yara iyile\u015fmesi ve kozmezis a\u00e7\u0131s\u0131ndan istenmeyen bir durum olan inversiyonun engellenmesi amac\u0131yla diki\u015f hatt\u0131nda bir miktar eversiyon, yani yara kenarlar\u0131n\u0131n d\u0131\u015far\u0131ya \u00e7evrilmesi arzulan\u0131r.<\/li>\n<li>Bu ama\u00e7la, i\u011fnenin dokudan ge\u00e7erken derinde y\u00fczeyele g\u00f6re daha geni\u015f bir kavisle d\u00f6nd\u00fcr\u00fclmesi uygun olur ve yeterli eversiyon sa\u011flar.<\/li>\n<\/ul>\n<div id=\"attachment_458\" style=\"width: 210px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-458\" class=\" wp-image-458\" src=\"https:\/\/tatd.org.tr\/tatdtravma\/wp-content\/uploads\/sites\/32\/2021\/12\/dikis-genel-292x300.png\" alt=\"\" width=\"200\" height=\"206\" srcset=\"https:\/\/tatd.org.tr\/travma\/wp-content\/uploads\/sites\/32\/2021\/12\/dikis-genel-292x300.png 292w, https:\/\/tatd.org.tr\/travma\/wp-content\/uploads\/sites\/32\/2021\/12\/dikis-genel-613x630.png 613w, https:\/\/tatd.org.tr\/travma\/wp-content\/uploads\/sites\/32\/2021\/12\/dikis-genel.png 660w\" sizes=\"(max-width: 200px) 100vw, 200px\" \/><p id=\"caption-attachment-458\" class=\"wp-caption-text\">\u015eekil 2. Diki\u015fte temel unsurlar\u0131n \u015femas\u0131<\/p><\/div>\n<p>Diki\u015f at\u0131l\u0131rken kar\u015f\u0131l\u0131kl\u0131 dermal ve epidermal dokular birbiriyle en uygun \u015fekilde yakla\u015fmas\u0131 i\u00e7in i\u011fnenin \u0131s\u0131rma mesafesinin (yara kenar\u0131 ile i\u011fnenin cilde girdi\u011fi nokta aras\u0131ndaki mesafe) ve \u0131s\u0131rma kal\u0131nl\u0131\u011f\u0131n\u0131n (yara kenar\u0131 ile derin dokuda i\u011fnenin giri\u015f-\u00e7\u0131k\u0131\u015f yapt\u0131\u011f\u0131 nokta aras\u0131ndaki vertikal mesafe) her iki tarafta e\u015fit olmas\u0131na dikkat g\u00f6sterilmelidir (\u015eekil 2).<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<h4>Acil serviste kullan\u0131lan temel k\u00fctan\u00f6z diki\u015f teknikleri<\/h4>\n<h5>Basit aral\u0131kl\u0131 (\u015eekil 3)<\/h5>\n<ul>\n<li>5-7mm aral\u0131kla yerle\u015ftirilir.\n<div id=\"attachment_459\" style=\"width: 162px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-459\" class=\" wp-image-459\" src=\"https:\/\/tatd.org.tr\/tatdtravma\/wp-content\/uploads\/sites\/32\/2021\/12\/basit-aralikli.jpg\" alt=\"\" width=\"152\" height=\"212\" \/><p id=\"caption-attachment-459\" class=\"wp-caption-text\">\u015eekil 3. Basit aral\u0131kl\u0131 diki\u015f<\/p><\/div>\n<p>&nbsp;<\/li>\n<\/ul>\n<h5>Vertikal mattress (\u015eekil 4)<\/h5>\n<ul>\n<li>Erken al\u0131nmazsa \u00e7apraz ize neden olabilir.<\/li>\n<\/ul>\n<div id=\"attachment_460\" style=\"width: 268px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-460\" class=\" wp-image-460\" src=\"https:\/\/tatd.org.tr\/tatdtravma\/wp-content\/uploads\/sites\/32\/2021\/12\/vertikal-matris-300x245.jpg\" alt=\"\" width=\"258\" height=\"211\" srcset=\"https:\/\/tatd.org.tr\/travma\/wp-content\/uploads\/sites\/32\/2021\/12\/vertikal-matris-300x245.jpg 300w, https:\/\/tatd.org.tr\/travma\/wp-content\/uploads\/sites\/32\/2021\/12\/vertikal-matris.jpg 418w\" sizes=\"(max-width: 258px) 100vw, 258px\" \/><p id=\"caption-attachment-460\" class=\"wp-caption-text\">\u015eekil 4. Vertikal matress<\/p><\/div>\n<h5>Horizontal matress (\u015eekil 5)<\/h5>\n<ul>\n<li>Vertikal matrese g\u00f6re daha fazla doku hipoksisine neden olur.<\/li>\n<li>El ve ayakta avantajl\u0131.<\/li>\n<\/ul>\n<div id=\"attachment_461\" style=\"width: 263px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-461\" class=\" wp-image-461\" src=\"https:\/\/tatd.org.tr\/tatdtravma\/wp-content\/uploads\/sites\/32\/2021\/12\/horizontal-matris-300x272.jpg\" alt=\"\" width=\"253\" height=\"229\" srcset=\"https:\/\/tatd.org.tr\/travma\/wp-content\/uploads\/sites\/32\/2021\/12\/horizontal-matris-300x272.jpg 300w, https:\/\/tatd.org.tr\/travma\/wp-content\/uploads\/sites\/32\/2021\/12\/horizontal-matris.jpg 501w\" sizes=\"(max-width: 253px) 100vw, 253px\" \/><p id=\"caption-attachment-461\" class=\"wp-caption-text\">\u015eekil 5. Horizontal matress<\/p><\/div>\n<h5>Basit Devaml\u0131 (Over and Over) (\u015eekil 6)<\/h5>\n<ul>\n<li>Y\u00fcz b\u00f6lgesinde uygulanmaz.<\/li>\n<\/ul>\n<div id=\"attachment_462\" style=\"width: 219px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-462\" class=\"size-full wp-image-462\" src=\"https:\/\/tatd.org.tr\/tatdtravma\/wp-content\/uploads\/sites\/32\/2021\/12\/basit-devamli.jpg\" alt=\"\" width=\"209\" height=\"124\" \/><p id=\"caption-attachment-462\" class=\"wp-caption-text\">\u015eekil 6. Basit devaml\u0131.<\/p><\/div>\n<h5>Subk\u00fctik\u00fcler Devaml\u0131<\/h5>\n<div id=\"attachment_463\" style=\"width: 169px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-463\" class=\"size-full wp-image-463\" src=\"https:\/\/tatd.org.tr\/tatdtravma\/wp-content\/uploads\/sites\/32\/2021\/12\/subkutik-devamli-.jpg\" alt=\"\" width=\"159\" height=\"136\" \/><p id=\"caption-attachment-463\" class=\"wp-caption-text\">\u015eekil 7. Subk\u00fctik\u00fcler devaml\u0131<\/p><\/div>\n<h4>Diki\u015f enstr\u00fcmanlar\u0131<\/h4>\n<p>Diki\u015f at\u0131lmas\u0131n\u0131 m\u00fcmk\u00fcn k\u0131lmak ve uygun diki\u015f atmak ancak do\u011fru enstr\u00fcmanlar\u0131n do\u011fru \u015fekilde kullan\u0131lmas\u0131 ile m\u00fcmk\u00fcnd\u00fcr. Cilt diki\u015fi atarken kullan\u0131lan en temel enstr\u00fcmanlar:<\/p>\n<ul>\n<li>Penset (forceps),<\/li>\n<li>Porteg\u00fc (needle holder) ve<\/li>\n<li>Makast\u0131r (scissors).(Foto 2)<\/li>\n<\/ul>\n<div id=\"attachment_464\" style=\"width: 310px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-464\" class=\"size-medium wp-image-464\" src=\"https:\/\/tatd.org.tr\/tatdtravma\/wp-content\/uploads\/sites\/32\/2021\/12\/dikis-aletleri-300x169.jpg\" alt=\"\" width=\"300\" height=\"169\" srcset=\"https:\/\/tatd.org.tr\/travma\/wp-content\/uploads\/sites\/32\/2021\/12\/dikis-aletleri-300x169.jpg 300w, https:\/\/tatd.org.tr\/travma\/wp-content\/uploads\/sites\/32\/2021\/12\/dikis-aletleri.jpg 512w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><p id=\"caption-attachment-464\" class=\"wp-caption-text\">Foto 2. Diki\u015f aletleri<\/p><\/div>\n<h4>Diki\u015fler ne zaman al\u0131nmal\u0131d\u0131r?<\/h4>\n<ul>\n<li>Diki\u015f al\u0131nma s\u00fcresi ile diki\u015f at\u0131lan dokunun kanlanmas\u0131 ters oranl\u0131d\u0131r.<\/li>\n<li>\u0130yi beslenen, kanlanmas\u0131 zengin dokularda yara iyile\u015fmesinin proliferasyon faz\u0131 h\u0131zl\u0131 ilerledi\u011finden, yara kenarlar\u0131n\u0131 tutarak ayr\u0131lmas\u0131n\u0131 engelleyecek fibrotik ba\u011f doku geli\u015fimi daha h\u0131zl\u0131 olur.<\/li>\n<li>Bu sebeple, bu dokularda diki\u015f gereksinimi daha k\u0131sa s\u00fcrede sonland\u0131r\u0131labilir.<\/li>\n<li>Diki\u015fin uzun kalmas\u0131 teknik olarak m\u00fcmk\u00fcn olsa da, daha uzun s\u00fcre dokuda b\u0131rak\u0131lan diki\u015fler daha fazla ize ve doku i\u00e7ine g\u00f6m\u00fclmeye ba\u011fl\u0131 olarak hasta konforunda azalmaya, enfeksiyona ve yabanc\u0131 cisim reaksiyonlar\u0131na (gran\u00fcloma) sebep olabilir.<\/li>\n<li>Bu sebeple, y\u00fczeyel dokulara at\u0131lan diki\u015fler en uygun zamanda al\u0131nmal\u0131d\u0131r.<\/li>\n<li>Her yara ayr\u0131 de\u011ferlendirilmeli ve yara kenarlar\u0131ndaki gerilim diki\u015f al\u0131nmas\u0131 \u00f6ncesi manuel olarak kontrol edilmelidir.<\/li>\n<li>Bununla birlikte, anatomik b\u00f6lgelere g\u00f6re ortalama diki\u015f al\u0131nma s\u00fcreleri a\u015fa\u011f\u0131daki gibidir:\n<ul>\n<li>Y\u00fcz: 3-4 g\u00fcn<\/li>\n<li>Sa\u00e7l\u0131 deri: 5 g\u00fcn<\/li>\n<li>G\u00f6vde: 7 g\u00fcn<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>Referanslar<\/strong><\/p>\n<ol>\n<li>Grabb and Smith&#8217;s Plastic Surgery 7th Edition<\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u0130lk yaz\u0131m\u0131zda cerrahi diki\u015f hakk\u0131nda genel bilgiler ve temel tekniklerden bahsedece\u011fiz. Diki\u015fin tarih\u00e7esinden k\u0131saca bahsedip, iplerin \u00f6zellikleri, s\u0131k kullan\u0131lan ipler, i\u011fne \u00f6zellikleri&hellip;<\/p>\n","protected":false},"author":883,"featured_media":464,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[1,10014],"tags":[10045,10044,10043],"class_list":["post-449","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-genel","category-akademik-blog-yazisi","tag-cerrahi","tag-dikis","tag-sutur"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/travma\/wp-json\/wp\/v2\/posts\/449","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/travma\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/travma\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/travma\/wp-json\/wp\/v2\/users\/883"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/travma\/wp-json\/wp\/v2\/comments?post=449"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/travma\/wp-json\/wp\/v2\/posts\/449\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/travma\/wp-json\/wp\/v2\/media\/464"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/travma\/wp-json\/wp\/v2\/media?parent=449"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/travma\/wp-json\/wp\/v2\/categories?post=449"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/travma\/wp-json\/wp\/v2\/tags?post=449"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}