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Jak rozpoznać i ocenić ranę? Część VI – rany atypowe [ZDJĘCIA]

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Prawidłowa ocena rany wymaga uwzględnienia różnych czynników, takich jak m.in. stan brzegów, łożyska i tkanek okalających czy ilość wysięku. W przypadku ran atypowych diagnostyka może się wiązać ze szczególnymi trudnościami. Zapraszamy do zapoznania się z zebranymi przypadkami.

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 atypowych.

 

Przypadki kliniczne – rany atypowe

Przypadek nr 1 – Owrzodzenie goleni

Okalające tkanki: Gładkie, napięte, blade
Brzegi rany: Nieregularne, lekko uniesione, różowe
Łożysko: Częściowo pokryte martwicą rozpływną i biofilmem, bladoróżowe
Skala kolorowa: Rana zielono-żółto-szara
Diagnoza: Zapalenie małych naczyń i skóry (kapilar)

Przypadek nr 2 – Owrzodzenie goleni

Okalające tkanki: Napięte i błyszczące
Brzegi rany: Zasinione, nieregularne
Łożysko: Częściowo pokryte włóknikiem i martwicą żółtą rozpływną, różowo-żółte, wilgotne
Skala kolorowa: Rana zielono-czerwono-żółta
Diagnoza: Piodermia zgorzelinowa

Przypadek nr 3 – Owrzodzenie przedniej części goleni

Okalające tkanki: Napięte, błyszczące, o zmienionym kolorze, z pojedynczymi zmianami satelitarnymi
Brzegi rany: Niewidoczne
Łożysko: Niewidoczne, pokryte martwą szaro-czarną warstwą
Skala kolorowa: Rana zielono-czarna
Diagnoza: Piodermia zgorzelinowa

Przypadek nr 4 – Zapalenie skóry

Okalające tkanki: Niezmienione
Brzegi rany: Płaskie
Łożysko: Różowe, pozbawione naskórka
Skala kolorowa: Rana zielono-czarno-szara
Diagnoza: Zapalenie małych naczyń skóry

Przypadek nr 5 – Stan zapalny tkanek okolicy kostki

Okalające tkanki: Obrzęknięte i zaczerwienione
Brzegi rany: Pozbawione naskórka
Łożysko: Małe, pełnej grubości skóry, sączące się, zaczerwienione
Skala kolorowa: Rana zielono-czerwona
Diagnoza: Podejrzenie zapalenia kości stawu skokowego

Przypadek nr 6 – Owrzodzenie okolicy nadpiętowej

Okalające tkanki: Zaczerwienione, obrzęknięte
Brzegi rany: Nieregularne, ostro wycięte
Łożysko: Pokryte martwicą żółtą rozpływną
Skala kolorowa: Rana zielono-żółta
Diagnoza: Podejrzenie zapalenia kości

Przypadek nr 7 – Owrzodzenie goleni pełnej grubości skóry

Okalające tkanki: Napięte i błyszczące
Brzegi rany: Nieregularne, częściowo zmacerowane
Łożysko: Pokryte martwicą żółtą
Skala kolorowa: Rana zielono-czarna
Diagnoza: Zapalenie średnich naczyń skóry

Przypadek nr 8 – Oparzenie stopy przez rurę wydechową motocykla. Stan po odrzuceniu przeszczepu

Okalające tkanki: Zaczerwienione, obrzęknięte
Brzegi rany: Pokryte martwicą czarną, miejscami zmacerowane
Łożysko: Pokryte martwicą żółtą, z wysiękiem w dużej ilości
Skala kolorowa: Rana zielono-żółta

Przypadek nr 9 – Bliznowiec okalający ranę po radioterapii

Okalające tkanki: Bliznowate, zgrubiałe, zaczerwienione
Brzegi rany: Lekko uniesione, bliznowate
Łożysko: Czerwone, pokryte biofilmem
Skala kolorowa: Rana zielono-czerwona

Przypadek nr 10 – Owrzodzenie goleni w miejscu róży

Okalające tkanki: Lekko obrzęknięte, z niezmienionym kolorem
Brzegi rany: Obrzęknięte, częściowo wałowate, częściowo płaskie
Łożysko: Pokryte martwicą rozpływną i biofilmem
Skala kolorowa: Rana zielono-żółta
Diagnoza: Zakażona rana goleni

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

Pobierz poradnik w formie PDF:

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