Badanie rany obejmuje ocenę jej brzegów, łożyska, wysięku oraz tkanek okalających. Objawy takie jak obecność przetoki, nadmierny wysięk lub maceracja tkanek mogą świadczyć o zaburzeniach procesu gojenia – zakażeniu czy stanie zapalnym.
Ocenę rany przeprowadza się w trakcie pierwszej wizyty zgodnie z tzw. trójkątem rany – badaniu podlegają więc brzegi i łożysko rany oraz tkanki okalające znajdujące się w odległości do 5 cm od brzegów rany. W trakcie badania rany bierze się pod uwagę jedynie widoczne albo badane narzędziem uszkodzenia tkanek. Nie stosuje się oceny intuicyjnej.
Ocena brzegów rany
Określenie kształtu rany pozwala ustalić jej etiologię. Na podłoże żylne wskazuje owalny lub nieregularny kształt rany, jeśli jej brzegi charakteryzuje łagodny spadek w kierunku dna. O pochodzeniu niedokrwiennym świadczy natomiast okrągły lub owalny kształt rany, której brzegi są ostro wycięte z pionowym spadkiem w kierunku dna.
Brzegi uniesione, wałowate lub wywinięte mogą być z kolei oznaką głębokiego stanu zapalnego lub zmian nowotworowych, do których doszło w obrębie rany. Innym powodem takiego wyglądu brzegów rany może być zapalenie kości w dnie rany.
Ocena łożyska rany
Jeżeli po oczyszczeniu rany widać różową ziarninę w dnie, świadczy to o etiologii żylnej rany. Blade dno pokryte martwicą rozpływną to typowa oznaka hipoksji lub rany niedokrwiennej.
Obecność przetoki to symptom głębokiego stanu zapalnego. Jeżeli w dnie jest wyczuwalna lub widoczna kość, może oznaczać to zapalenie tkanki kostnej. Z kolei dno grudkowe z ziarniną przerastającą ponad skórę wskazuje na stan zapalny lub rozwój nowotworu w dnie.
Pokryte włóknikiem dno może świadczyć o zakażeniu. Objaw ten może także wynikać z niedożywienia lub odwodnienia.
Ocena wysięku rany
Podczas oceny wysięku bierze się pod uwagę jego ilość, barwę, przejrzystość, zapach oraz konsystencję. Za stan prawidłowy uznawana jest lekko wilgotna rana z towarzyszącym średnim wysiękiem.
Brak wysięku lub jego zbyt mała ilość może być skutkiem odwodnienia lub niedożywienia. Z kolei nadmierna ilość wydzieliny wskazuje na postępujące zakażenie rany. O infekcji mogą świadczyć również kolor i konsystencja wysięku – w przypadku prawidłowego procesu gojenia wysięk barwą i konsystencją zbliżony jest do wody.
Jeśli wydzielina nie jest klarowna, mogło dojść do nadkażenia. Zielony kolor wysięku jest charakterystyczny dla zakażeń gronkowcem. Z kolei niebieskozielonkawy kolor, któremu towarzyszy słodkawy zapach, może być oznaką zakażenia pałeczką ropy błękitnej. Brązowy wysięk o zapachu przypominającym kał to konsekwencja zakażenia pałeczką okrężnicy.
Ocena tkanek okalających ranę
Zaczerwienienie i obrzęk tkanek okalających ranę wskazują na rozwój stanu zapalnego. Suchość i łuszczenie tkanek może być następstwem odwodnienia i przesuszenia. Napięte i błyszczące tkanki wynikają natomiast z niedokrwienia.
O nieprawidłowym zaopatrzeniu rany świadczy maceracja objawiająca się rozmoczeniem i białym zabarwieniem tkanek oraz uszkodzeniem naskórka. Bliznowate i przebarwione tkanki mogą wystąpić wskutek przewlekłej niewydolności żylnej. Jeśli tkanki sączą się i pokrywa je wyprysk, oznacza to, że doszło do stanu zapalnego o podłożu alergicznym.
Źródło: „Algorytmy i wytyczne postępowania terapeutycznego w ranach trudno gojących się” w: „Forum Leczenia Ran”, 2020;1(3):95-116.
Przeczytaj także: Fazy gojenia rany niepowikłanej
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