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Najważniejsze elementy procesu zaopatrywania rany

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Wśród najważniejszych czynników w procesie zaopatrywania rany są pierwotne wycięcie rany, szew pierwotny, szew pierwotny odroczony, szew wtórny, wtórne wycięcie rany, unieruchomienie rany, a także sączkowanie lub drenowanie rany.

Głównym celem pierwotnego wycięcia rany jest chirurgiczne wyjałowienia rany, które polega na usunięciu z niej skrzepów krwi, tkanek uszkodzonych, zmiażdżonych brzegów rany, ciał obcych. Wszystkie te czynniki mogą wpływać negatywnie na proces gojenia, jak również być źródłem zakażenia. Biorąc pod uwagę świeże rany cięte, nie ma konieczności wycinania ich brzegów. Należy również zwrócić uwagę, aby oszczędnie wycinać rany umiejscowione na dłoniach i twarzy.

Kolejną czynnością w opracowaniu ran świeżych, ciętych lub pierwotnie wyciętych będzie założenie szwu pierwotnego. Polega ono na zbliżeniu brzegów rany szwami chirurgicznymi, metalowymi zszywkami, paskami przylepca bądź klejami tkankowymi. Co szczególnie ważne, szwu pierwotnego nie zakłada się na rany, które powstały więcej niż 8-12 godzin wcześniej, rany potencjalnie zakażone lub zakażone. Będą to zazwyczaj rany miażdżone, kąsane, szarpane oraz zabrudzone ziemią czy odchodami. Wówczas można zastosować luźne zszycie po szczegółowym opracowaniu rany i założeniu sączka.

W procesie zaopatrywania rany stosuje się również szew pierwotny odroczony, który zakłada się w czasie pierwszego wycinania rany. Co ważne, jest on niezwiązany, a dopiero po kilku dniach, jeżeli wystąpiły objawy zakażenia rany, jest on dociągany.

W przypadku niezszytej rany zakażonej, która zostanie oczyszczona i będzie wypełniała się ziarniną, zakłada się szew wtórny.

Jeżeli w niezszytej ranie ziarnina pokryła ranę nierówno i bliznowacieje wówczas niezbędne będzie wtórne wycięcie rany.

W procesie zaopatrywania rany stosuje się również unieruchomienie rany, w celu dokładnego umocowania opatrunku oraz miejsca urazu.

Stosowane także w zaopatrywaniu ran sączkowanie lub drenowanie wykonuje się, aby umożliwić odprowadzenie z rany krwi, wysięku czy chłonki.

Źródło: Noszczyk W., Chirurgia Repetytorium, Wydanie II uaktualnione Warszawa 2019, s. 253-254

Przeczytaj także: Badania pokazały, że tkanka tłuszczowa śródskórna u seniorów pozytywnie wpływa na proces gojenia ran

Przeczytaj bezpłatnie pokrewny artykuł w czasopiśmie „Pielęgniarstwo w Anestezjologii i Intensywnej Opiece”:

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