Terapia rany trudno gojącej się wymaga w wielu przypadkach zastosowania więcej niż jednego opatrunku. Najnowsze badania wskazują, że odpowiednie połączenie opatrunków ma duży wpływ na gojenie rany2. Kluczem do skuteczności terapii jest dobór produktów, które będą wykazywały pełną kompatybilność i synergię działania.
Zapewnienie maksymalnej skuteczności leczenia ran wymaga doboru odpowiedniego opatrunku. W ranach obficie sączących oraz ranach głębokich opatrunek stosowany samodzielnie może nie odpowiadać w pełni potrzebom terapeutycznym. W takim przypadku w celu utrzymania higieny rany konieczne jest połączenie dwóch opatrunków, które razem zapewnią odpowiednią opiekę nad raną. Aby osiągnąć możliwie najlepszy efekt terapeutyczny, należy wybrać w tym celu opatrunki, które skutecznie i optymalnie ze sobą współpracują. Przykład takiego skutecznego połączenia w leczeniu ran stanowią opatrunki AQUACEL® Ag+ Extra™ oraz AQUACEL® Foam. Oba opatrunki wykonane są w technologii Hydrofiber®, co zapewnia idealne współdziałanie.
Optymalne połączenie technologii Hydrofiber®
W badaniu obserwacyjnym pt. „PARTNER obserwational study: First results on the benefits of two synergic dressings in the management of acute and chronic wounds in community setting” sprawdzono w praktyce klinicznej skuteczność połączenia w terapii rany opatrunków w technologii Hydrofiber® – opatrunku pierwotnego (AQUACEL® Extra™) z wtórnym opatrunkiem piankowym (AQUACEL® Foam).
Badanie trwające od października 2018 roku do czerwca 2019 roku objęło 1502 pacjentów z ranami przewlekłymi (849 pacjentów) i ostrymi (653 pacjentów). 314 uczestników badania cierpiało na cukrzycę, natomiast 585 pacjentów miało zaburzenia sercowo-naczyniowe. 20 proc. wszystkich przypadków stanowiły rany niegojące się od ponad 3 miesięcy. W 81 proc. przypadków występował umiarkowany lub obfity wysięk, natomiast u 63 proc. pacjentów stwierdzono zmiany na skórze wokół rany.
W badaniu na przestrzeni 2 tygodni oceniano, czy stan rany uległ poprawie, pogorszeniu czy też został ustabilizowany. Ewaluacji poddano również ilość wysięku, komfort pacjenta podczas zmiany opatrunku oraz ogólną jakość życia.
Wyniki badania wskazały, że połączenie opatrunków w technologii Hydrofiber® zapewnia widoczną poprawę efektów leczenia w ranach trudno gojących się.
Rola synergii w leczeniu ran
Jak wskazują autorzy badania, uzyskanie pozytywnych efektów terapeutycznych było możliwe dzięki pełnej synergii działania obu opatrunków. W strukturze opatrunków AQUACEL® Extra™ i AQUACEL® Foam wykorzystano technologię Hydrofiber®, która umożliwia swobodny transfer wysięku pomiędzy obydwoma opatrunkami.
Skuteczne zarządzanie wysiękiem pozwala na osiągnięcie pozytywnych efektów terapeutycznych. Dzięki optymalnemu połączeniu opatrunków ograniczone zostaje ryzyko maceracji skóry wokół rany, natomiast w samym łożysku rany powstaje optymalne środowisko gojenia. Dzięki temu poprawie ulegają zarówno wyniki terapii, jak i komfort życia pacjenta. Potwierdzają to wyniki przedstawianego badania[1],[2].
Jak wykazano w ewaluacji po 14 dniach terapii wyleczenie lub poprawę stanu rany uzyskano w 89 proc. przypadków. W przypadku ran niegojących się od ponad 3 miesięcy poprawę odnotowano w 79 proc. przypadków.
Jak wykazały inne badania[3],[4] w przypadku połączenia opatrunku AQUACEL® Extra™ wykonanego w technologii Hydrofiber® z silikonowym opatrunkiem piankowym* efekty współdziałania opatrunków były znacznie gorsze. Przepływ wysięku pomiędzy opatrunkami był ograniczony. Pomiędzy opatrunkiem pierwotnym i wtórnym uzyskano jedynie 18% styczności, co w sposób istotny wpływa na efektywność kontrolowania wysięku z rany. Wskazuje to wyraźnie, że tylko w pełni dopasowane, wykazujące pełną synergię opatrunki mogą znacząco usprawnić proces leczenia ran.
Idealne połączenie dla ran z infekcją, biofilmem lub podejrzeniem obecności biofilmu
W ranach z cechami infekcji, biofilmem lub podejrzeniem jego obecności, konieczne jest zastosowanie opatrunku, który będzie miał działanie przeciwdrobnoustrojowe. Optymalnym będzie wówczas połączenie opatrunków: AQUACEL® Ag+ Extra™ oraz AQUACEL® Foam. Opatrunek o potwierdzonym badaniami działaniu antybiofilmowym[5],[6],[7]. AQUACEL® Ag+ Extra™ jest wykonany w technologii Hydrofiber® i dzięki temu idealnie współdziała z opatrunkiem AQUACEL® Foam. Zastosowana w AQUACEL® Ag+ Extra™ technologia Więcej Niż SrebroTM (łącząca działanie trzech składników: surfaktantu, chelatora metalu i jonów srebra) uszkadza strukturę biofilmu w ranie, a mikroorganizmy są lepiej wyeksponowane na przeciwdrobnoustrojowe działanie srebra jonowego.[8] Dzięki technologii Hydrofiber®, opatrunek reaguje w zetknięciu z wysiękiem, z rany tworząc koherentny żel, idealnie dopasowujący się do łożyska rany, dzięki czemu nie dochodzi do powstawania martwych przestrzeni, w których mogłyby namnażać się bakterie.[9],[10] Wysięk wraz z niekorzystnymi składnikami (nadmiar aktywnych metaloproteinaz i czynników zapalnych ), uszkodzona matryca pozakomórkowa i martwe mikroorganizmy, są zamykane w zżelowanej warstwie Hydrofiber® i usuwane wraz z opatrunkiem w trakcie jego zmiany.[11],[12] Nadmiar wysięku, tak jak w innych opatrunkach wykonanych w tej technologii, przekazywany jest do opatrunku wtórnego AQUACEL® Foam. Dzięki synergii ich działania otrzymujemy idealne rozwiązanie w przypadku ran z obfitym wysiękiem, głębokich, zakażonych lub zagrożonych infekcją (podejrzenie obecności biofilmu).
* silikonowy opatrunek piankowy to opatrunek z silikonową warstwą kontaktową (stykającą się z raną).
Źródła:
[1] PARTNER observational study: Preliminary results on the utility of the combination of two dressings in the management of acute and chronic wounds in private practice. TOMASI, J, Yvon, C, Lucas, A. P20, poster presented at Journees CiCATRISATIONS, Paris, France, 26-28 Jan 2020.
[2] Tomasti J., Yvon C., Lucas A., “PARTNER STUDY: First results on the benefits of two synergic dressings in the management of acute and chronic wounds in community setting” Abstract accepted at the WUWHS 2020 Congress
[3] Mixing Wound Dressings: Does it Affect Clinical Outcomes, Tickle. J. Poster presented at World Union of Wound Healing Societies, Florence, Italy 2016.
[4] Visual Assessment of Fluid Handling by AQUACEL® Extra covered by Different Foam Dressings WHRI5397 MS147. Data on file, ConvaTec Inc.
[5] Suleman L et al. Use of internally validated in vitro biofilm models to assess antibiofilm performance of silver-containing gelling fibre dressings. JOURNAL OF WOUND CARE VOL 29, NO 3, MARCH 2020 dostępne na: https://www.magonlinelibrary.com/doi/full/10.12968/jowc.2020.29.3.154
[6] Suleman L et al. Use of internally validated in vitro biofilm models to assess antibiofilm performance of silver-containing gelling fibre dressings. JOURNAL OF WOUND CARE VOL 29, NO 3, MARCH 2020 dostęne na: https://www.magonlinelibrary.com/doi/full/10.12968/jowc.2020.29.3.154
[7] THE COST-EFFECTIVENESS OF AQUACEL® AG+ DRESSINGS COMPARED WITH STANDARD CARE IN WOUND MANAGEMENT. SC-000565-GB. ConvaTec. Data on File. 2019
[8] Bowler PG, Parsons, D. Combatting wound biofilm and recalcitrance with a novel antibiofilm Hydrofiber™ wound dressing. Wound Medicine. 2016; 14: 6–11.
[9] Bishop SM, Walker M, Rogers AA, Chen WYJ. Moisture balance: optimising the wound-dressing interface. J Wound Care. 2003;12:125-128.
[10] Bowler P, Jones S, Towers V, Booth R, Parsons D, Walker M, 2010. Dressing conformability and silver-containing wound dressings. Wounds UK 6: 14-20.
[11] Newman GR, Walker M, Hobot JA, Bowler PG. Visualization of bacterial sequestration and bacterial activity within hydrating Hydrober™ wound dressings. Biomaterials. 2006; 27: 1129-1139.
[12] Walker M, Hobot JA, Newman GR, Bowler PG. Scanning electron microscopic examination of bacterial immobilization in a carboxymethyl cellulose (AQUACEL™) and alginate dressing. Biomaterials. 2003; 24: 883-890
Artykuł powstał we współpracy z firmą ConvaTec.
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