Epitelializacja ważnym etapem strategii TIME – jak przyspieszyć naskórkowanie rany?
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Epitelializacja ważnym etapem strategii TIME – jak przyspieszyć naskórkowanie rany?

Ten tekst przeczytasz w 3 min.

Zgodnie z opracowaną przez specjalistów European Wound Managment Association strategią TIME epitelializacja, czyli ostatnia faza gojenia rany jest niezwykle ważnym, ale i najdłuższym procesem w terapii. O tym, jak temu procesowi pomóc i jak go przyspieszyć opowiada pielęgniarka z wieloletnim doświadczeniem w opiece nad raną, mgr Elżbieta Szkiler.

Co to jest epitelializacja?

Epitelializacja jest procesem, który zachodzi równocześnie z tworzeniem ziarniny. Polega na przesuwaniu się komórek naskórka z obwodu rany do jej środka. Jako podłoże wykorzystywana jest utworzona ziarnina.

Pierwszym etapem epitelializacji jest migracja keratynocytów

Stymulują ją czynniki znajdujące się w macierzy pozakomórkowej: kolagen, fibronektyna, uwalniane czynniki wzrostu FGF, TGF α, EGF, a także wytwarzany przez fibroblasty czynnik wzrostu keratynocytów (KGF). To one powodują, że komórki naskórka ulegają fenotypowym zmianom, które mają za zadanie umożliwić im przemieszczanie się.

Dochodzi wówczas do zaniku łączących je z sąsiednimi komórkami i błoną podstawną desmosomów i hemidesmosomów oraz formułowania pseudopodii. Jeżeli nastąpiło całkowite przykrycie powierzchni rany pojedynczą warstwą nabłonka, zaczyna się faza proliferacji. Czas epitelializacji zależy od prawidłowego stosowania się do zasad w poprzednich fazach gojenia rany.

Jak przyspieszyć naskórkowanie rany?

W opiece nad raną trudno gojącą się doskonale sprawdzi się preparat, który będzie w stanie utworzyć warstwę ochronną, która ułatwi i przyspieszy gojenie rany.

– Maść SutriHeal ma jedną bardzo ważną właściwość – drobnoustroje nie wykazują na nią oporności – mówi pielęgniarka, mgr Elżbieta Szkiler. Obecne w maści lignany działają przeciwzapalnie, redukują wszystkie metaloproteinazy (które uszkadzają tkanki), wolne rodniki, cytokiny prozapalne, leukocyty prozapalne oraz wszystkie inne niekorzystne czynniki, które zachodzą w ranie – tłumaczy pielęgniarka.

Jak dodaje mgr Szkiler, ważne jest także umiejętne stosowanie preparatu.

– Przed zastosowaniem maści SutriHeal należy pamiętać, że najpierw należy pozbyć się martwicy i biofilmu z rany. Po usunięciu biofilmu, maść można zastosować nawet na ranę zakażoną. Preparat ten może być również założony w kieszeń lub do przetoki. Jest preparatem bardzo bezpiecznym i naturalnym, dlatego można go zaaplikować w tkankę głęboką, dzięki czemu kieszenie przetoki bardzo szybko się zamykają – zwróciła uwagę Elżbieta Szkiler.

 

Istota działania przeciwdrobnoustrojowego i przeciwzapalnego

W ranach onkologicznych, odleżynach, owrzodzeniach podudzi i innych potrzebne jest wsparcie nie tylko w kwestii działania przeciwdrobnoustrojowego i przeciwzapalnego, ale również w kwestii ułatwienia procesu wtórnego nabłonkowania.

– Dzięki tej maści wyleczyłam przesuszoną, uszkodzoną kość piszczelową w przebiegu mięsaka goleni, oparzenie klatki piersiowej po wielotygodniowym leczeniu szpitalnym i w poradniach chirurgicznych oraz drobne uszkodzenia w przebiegu piodermii – wyliczyła pielęgniarka. SutriHeal sprawdził się również w leczeniu bardzo głębokiej, trudnej do leczenia odleżyny, która miała tak głęboką kieszeń i głęboką przetokę w tej kieszeni, że łyżeczka stomatologiczna wchodziła mi w całości i nie czułam dna. Po założeniu maści SutriHeal z opatrunkiem biodegradowalnym, przetoka zamknęła się w ciągu 48 godzin – zaznaczyła.

Jak podkreśliła Elżbieta Szkiler, maść tą można stosować do każdego rodzaju rany, od otarć, skaleczeń do tych trudno gojących się, takich jak odleżyny, owrzodzenia czy oparzenia.

Dlaczego nie należy stosować maści z antybiotykiem?

Zgodnie z najnowszym konsensusem dotyczącym antyseptyki ran z 2018 r. „należy unikać miejscowego stosowania antybiotyków do ograniczonych lokalnie zakażeń ran i kolonizacji, nie tylko z powodu pobudzania rozwoju oporności, lecz także z powodu trudnej oceny ich mikrobiostatycznego trybu działania i stężenia”.

Jak uniknąć powikłań w procesie gojenia ran?

Wśród najczęstszych powikłań w procesie gojenia ran wyróżnia się zakażenie w ranie, niedostateczne ukrwienie tkanek, wysuszenie rany, nadmierny wysięk z rany lub uraz rany. W procesie epitelializacji należy dbać o wszystkie te czynniki, jednak szczególnie o to, by uniknąć zakażenia rany takimi drobnoustrojami, jak m.in. Staphylococcus aureus, gronkowce koagulazo-ujemne i enterokoki.

Aby się przed tym uchronić, niezbędne będzie zastosowanie preparatu o działaniu przeciwbakteryjnym.

 

Artykuł powstał we współpracy z firmą Verco S.A.

 

Źródła:

[1] Stanirowski P., Sawicki W., Nowoczesne metody terapii trudno gojących się położniczo-ginekologicznych ran pooperacyjnych – analiza przydatności i skuteczności stosowania, Borgis – Postępy Nauk Medycznych 7/2013, s. 475-487

[2] Olszyna J., Zastosowanie poliheksanidy i żywicznych kwasów świerku norweskiego w oparzeniach pośredniej grubości skóry twarzy u dzieci, Chirurgia Plastyczna i Oparzenia 2019;7(4):175-179

[3] Materiały prasowe Verco S.A.

 

Przeczytaj także: Czas leczyć rany – strategia TIMES w dobie epidemii COVID-19

Przeczytaj bezpłatnie pokrewny artykuł w czasopiśmie „Chirurgia Plastyczna i Oparzenia”:

Zastosowanie poliheksanidu i żywiczych kwasów świerku norweskiego w oparzeniach pośredniej grubości skóry twarzy u dzieci

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