Opracowane przez European Pressure Ulcer Advisory Panel definicja i klasyfikacja odleżyn to pomocne narzędzie w terapii tego rodzaju ran. Dzięki wykorzystaniu kluczowych dla leczenia ran parametrów system pozwala na precyzyjną ocenę stanu odleżyny i wdrożenie właściwego leczenia.
Stworzony przez Europejski Panel Doradczy ds. Odleżyn (European Pressure Ulcer Advisory Panel, EPUAP) system klasyfikacji odleżyn obejmuje cztery poziomy.
Stopień pierwszy obejmuje przypadki, w których skóra jest nieuszkodzona, występuje miejscowe zaczerwienienie nieblednące, zlokalizowane zwykle nad wyniosłością kostną. Skóra w tym obszarze może sprawiać ból, możliwe są także miejscowe zmiany temperatury (skóra chłodniejsza lub cieplejsza od sąsiadujących tkanek). Zmiany na tym poziomie mogą sprawiać trudności diagnostyczne u osób o ciemnej karnacji.
Stopień drugi oznacza częściową utratę grubości skóry właściwej. Występują płytkie, otwarte owrzodzenia z czerwonoróżowym dnem rany lub pęcherze z płynem surowiczym bądź surowiczo-krwistym. Na tym poziomie nie obserwuje się natomiast występowania tkanki martwiczej wilgotnej oddzielającej się od tkanki zdrowej oraz zasinień, które wskazywałyby na uszkodzenie tkanek głębokich.
Autorzy systemu klasyfikacji zwracają uwagę, by różnicować uszkodzenia odleżynowe z tego poziomu od podrażnień spowodowanych stosowaniem przylepców medycznych, maceracji naskórka wynikającej z kontaktu skóry z wilgocią (np. z powodu nietrzymania moczu), a także niewielkich urazów (rozdarć i otarć).
Na stopniu trzecim obserwuje się pełną utratę grubości tkanki. Możliwe jest odsłonięcie podskórnej tkanki tłuszczowej, ale nie dochodzi do odsłonięcia kości, mięśni i ścięgien. Może wystąpić tkanka martwicza wilgotna, a także podminowanie i tunelowanie rany.
Stopień czwarty to pełna utrata grubości tkanki. Może dojść do odsłonięcia kości, mięśnia lub ścięgna. Jeżeli odleżyna sięga w głąb mięśnia lub struktur podtrzymujących (np. powięzi, torebki stawu), istnieje ryzyko wystąpienia zapalenia szpiku lub kości.
Na tym etapie rozwoju odleżyny często występuje podminowanie i tunelowanie rany. Może się pojawić oddzielająca się tkanka martwicza lub strup.
Źródła: https://www.epuap.org/
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