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Jak rozpoznać i ocenić ranę? Część III – rany naczyniowe [ZDJĘCIA]

Karolina1 815 komentarzy
Ten tekst przeczytasz w 2 min.

By wdrożyć skuteczne leczenie rany, konieczne jest wcześniejsze przeprowadzenie badania uszkodzonych tkanek. Pod uwagę należy wziąć m.in. stan łożyska i brzegów rany oraz wysięk. W jaki sposób ocenia się ranę naczyniową?  

Oceny rany należy dokonać podczas pierwszej wizyty pacjenta w gabinecie. Podstawowym narzędziem, które należy wykorzystać do tego celu, jest tzw. trójkąt rany.

Więcej informacji na temat oceny rany znajdziesz tutaj

Następnie ranę należy ocenić w skali, która odpowiada etiologii rany:

W sporządzeniu charakterystyki rany pomaga kolorowa skala oceny rany.

Poniżej pokazujemy, jak zastosować te narzędzia w praktyce na przykładzie ran naczyniowych.

 

Przypadki kliniczne – rany naczyniowe

Przypadek nr 1 – Owrzodzenie kostki po wieloletnim stosowaniu hydrokoloidów

Okalające tkanki: niezmienione
Brzegi rany: nieregularne, bez cech epitelizacji
Łożysko: suche, grudkowe, blade, „uparzone”, ziarnina przerastająca poziom skóry
Skala kolorowa: rana zielono-czerwona
Diagnoza: głęboki stan zapalny tkanek lub rak

Przypadek nr 2 – Owrzodzenie grzbietu stopy

Okalające tkanki: obrzęknięte, napięte, blade, pozbawione naskórka z ranami satelitarnymi, palce obrzęknięte
Brzegi rany: nieregularne, blade, paznokcie żółte, wkręcające
Łożysko: ubytek tkanek pokryty martwicą żółtą
Skala kolorowa: rana zielono-szaro-żółta
Diagnoza: owrzodzenie niedokrwienne (miażdżycowe)

Przypadek nr 3 – Owrzodzenie przedniej części goleni

Okalające tkanki: blade, napięte, błyszczące
Brzegi rany: uniesione, pokryte naskórkiem
Łożysko: grudkowe, blade, pokryte martwicą żółtą rozpływną
Skala kolorowa: rana zielono-żółto-szara
Diagnoza: zakażone owrzodzenie niedokrwienne

Przypadek nr 4 – Owrzodzenie goleni kostki przyśrodkowej

Okalające tkanki: bliznowate (lipodermatoscleroza), przebarwione (hemosyderoza), aureola żylna na stopie
Brzegi rany: łagodne, pokryte wysuszonym wysiękiem
Łożysko: suche, pokryte włóknikiem
Skala kolorowa: rana zielono-żółta
Diagnoza: owrzodzenie żylne

Przypadek nr 5 – Owrzodzenie okalające goleni po zakrzepicy

Okalające tkanki: blade, suche
Brzegi rany: nieregularne, miejscami ostro wycięte
Łożysko: pokryte martwicą żółtą rozpływną
Skala kolorowa: rana zielono-szaro-żółta
Diagnoza: zakrzepowe zapalenie żył

Przypadek nr 6 – Owrzodzenie tyłu goleni

Okalające tkanki: obrzęk, zaczerwienienie, skóra zgrubiała, sucha
Brzegi rany: nieregularne
Łożysko: ubytek skóry, pokryte martwicą żółtą, suche 
Skala kolorowa: rana zielono-żółta
Diagnoza: owrzodzenie chłonne

Przypadek nr 7 – Owrzodzenie kostki przyśrodkowej

Okalające tkanki: bladoróżowe, wilgotne, napięte
Brzegi rany: okrągłe, zmacerowane, ostro wycięte, pokryte martwicą żółtą
Łożysko: pokryte biofilmem i częściowo martwicą czarną rozpływną
Skala kolorowa: rana zielono-szaro-żółta
Diagnoza: zakażone owrzodzenie niedokrwienne

Przypadek nr 8 – Owrzodzenie kostki zewnętrznej

Okalające tkanki: zaczerwienione, napięte, blade
Brzegi rany: ostro wycięte
Łożysko: częściowo pokryte martwicą czarną rozpływną
Skala kolorowa: rana zielono-szara
Diagnoza: owrzodzenie niedokrwienne (tętnicze)

 

Wszystkie przedstawione przypadki pochodzą z praktyki mgr Elżbiety Szkiler. Udostępnione za zgodą autorki.

Przeczytaj więcej:

Jak różnicować owrzodzenia żylne, niedokrwienne i neuropatyczne?

Owrzodzenia żylne – przyczyny i specyfika

Pobierz poradnik w formie PDF:

Pobierz

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