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Krwiak podpaznokciowy – kiedy wymaga leczenia w strategii TIME?

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Krwotok podpaznokciowy to schorzenie występujące najczęściej w następstwie urazu mechanicznego. W przypadku rozległych krwotoków konieczna może być awulsja płytki paznokciowej. Prowadzi to do powstania ran pourazowych, które należy leczyć zgodnie ze strategią TIME. Jak przebiega terapia tego rodzaju ran?

Do powstania krwotoku podpaznokciowego dochodzi na skutek urazów takich jak uderzenie, nadmierny ucisk, stłuczenie. Krwiak podpaznokciowy ma jednorodne żółte, brązowe, ciemnoczerwone lub sine zabarwienie, które ulega przesuwaniu się od części proksymalnej do dystalnej płytki paznokciowej. W okolicy urazu stwierdza się podwyższoną ciepłotę tkanek, możliwa jest również obecność stanu zapalnego. Krwiak powoduje dolegliwości bólowe.

Leczenie krwiaków podpaznokciowych

W leczeniu krwiaków podpaznokciowych każdorazowo należy stosować zasady antyseptyki. Wysięk nagromadzony pod płytką paznokciową powinien zostać usunięty poprzez perforację (nakłucie lub nawiercenie) płytki. Zabieg powinien się odbyć w ciągu doby od stwierdzenia urazu. Uszkodzone miejsce należy następnie poddać odciążeniu.

Krwiaki podpaznokciowe a strategia TIME

W przypadku rozległych urazów, które oprócz płytki obejmują również wał okołopaznokciowy, nie stosuje się perforacji. Jeżeli stwierdzony zostanie brak przyczepności płytki paznokciowej do warstwy onychodermalnej i łożyska z macierzą, przeprowadza się awulsję płytki paznokciowej. Powstałą w ten sposób ranę należy leczyć zgodnie ze schematem TIME, co zapobiegnie nadkażeniu bakteryjnemu lub grzybiczemu i umożliwi ponowny wzrost prawidłowej płytki paznokciowej.

Miejsce urazu po usunięciu płytki paznokciowej należy oczyścić z resztek martwych tkanek i przemyć płynem antyseptycznym. Wskazane jest stosowanie na dno rany hydrożelu, który zapewni odpowiednie środowisko gojenia i będzie stymulował procesy regeneracyjne. Rana powinna następnie zostać zabezpieczona opatrunkiem specjalistycznym, który zapewni ochronę przed czynnikami zewnętrznymi i odciąży miejsce urazu. Łożysko rany powinno być regularnie oczyszczane i nawilżane podczas zmian opatrunków.

Po zakończeniu postępowania w kierunku leczenia rany należy wdrożyć odpowiednio dobraną terapię podologiczną. Właściwy dobór metod terapeutycznych zmniejsza ryzyko trwałego uszkodzenia aparatu paznokciowego i nadkażenia bakteryjnego lub grzybiczego.

Źródło:

M. Wolska-Jachimowska, „Rany pourazowe w przebiegu wynaczynienia podpaznokciowego u pacjentów podologicznych. Opis przypadków”, „Forum Leczenia Ran” 2020, 1(4): 171-174.

Przeczytaj także: Czy warto stosować manualny drenaż limfatyczny w terapii ran trudno gojących się?

Przeczytaj bezpłatnie pokrewny artykuł w czasopiśmie „Forum Leczenia Ran”:

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