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Jak rozpoznać i ocenić ranę? Część IV – rany neuropatyczne [ZDJĘCIA]

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Rany neuropatyczne najczęściej są objawem zespołu stopy cukrzycowej, ale mogą wystąpić również w przebiegu innych chorób, np. naczyniowych. Wdrożenie leczenia powinno być poprzedzone prawidłową oceną urazu. Jak ocenić ranę neuropatyczną?

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 neuropatycznych.

 

Przypadki kliniczne – rany neuropatyczne

Przypadek nr 1 – Rana neuropatyczna w przebiegu ZSC (CT1)

Stan zapalny stawu śródstopno-paliczkowego 5 palca – obrzęk, zaczerwienienie i zwiększona miejscowo temperatura.
Skala kolorowa
: rana zielona
Diagnoza: zapalenie kości w zespole stopy cukrzycowej

Przypadek nr 2 – Owrzodzenie neuropatyczne bez cukrzycy

Prawdopodobnie pourazowe uszkodzenie nerwu. Głęboki ubytek tkanek pięty bez kieszeni w dnie rany. W teście metalowej sondy wyczuwalna jest kość.
Skala kolorowa
: rana zielono-czerwona

Przypadek nr 3 – Owrzodzenie śródstopia w ZSC (CT1)

Okalające tkanki: obrzęknięte, zwiększona miejscowo temperatura
Brzegi rany: pokryte hiperkeratozą
Łożysko: pokryte martwicą czarną suchą
Skala kolorowa: rana zielono-czarna
Diagnoza: stopa Charcota

Przypadek nr 4 – Owrzodzenie okolicy ścięgna Achillesa (CT1)

Okalające tkanki: obrzęknięte i zaczerwienione, zwiększona miejscowo temperatura
Brzegi rany: pokryte martwicą czarną
Łożysko: suche, pokryte martwicą żółtą, w badaniu testem sondy metalowej wyczuwalna jest kość
Skala kolorowa: rana zielono-czarno-żółta
Diagnoza: staw (stopa) Charcota

Przypadek nr 5 – Owrzodzenie śródstopia w ZSC (CT2)

Zmieniony kształt stopy, obniżenie łuku podłużnego stopy, palce szponiaste, podeszwowa część stopy podobna do kołyski.
Brzegi rany: pokryte hiperkeratozą
Łożysko: pokryte biofilmem z małą ilością wysięku
Skala kolorowa: rana zielono-czerwona
Diagnoza: stopa Charcota

Przypadek nr 6 – Owrzodzenie pięty i kostki przyśrodkowej

Owrzodzenie pięty poniżej kostki i od strony podeszwowej odsłaniające kość piętową oraz owrzodzenie kostki przyśrodkowej z widocznymi ścięgnami.
Skala kolorowa
: rana zielono-czerwono-siwa
Diagnoza: owrzodzenie neuropatyczno-niedokrwienne z zapaleniem kości

 

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

Pobierz poradnik w formie PDF:

1 487 thoughts on “Jak rozpoznać i ocenić ranę? Część IV – rany neuropatyczne [ZDJĘCIA]

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