Usunięcie martwych tkanek ma kluczowe znaczenie w przebiegu leczenia ran oparzeniowych. Wczesne zastosowanie nekrektomii zmniejsza ryzyko zgonu pacjenta i przyspiesza jego powrót do zdrowia.
Nekrektomia jest jedną z metod opracowywania rany oparzeniowej. Polega na usunięciu tkanek martwiczych. Przeprowadzenie nekrektomii jest istotne pod kątem profilaktyki zakażeń i przyspieszenia procesu gojenia. Jednocześnie nekrektomia jest zabiegiem poprzedzającym wykonanie przeszczepu skóry.
Ze względu na sposób wykonywania zabiegu wyróżnia się nekrektomię mechaniczną i enzymatyczną.
Metody nekrektomii mechanicznej
Do mechanicznych sposobów usuwania martwych tkanek z ran oparzeniowych należą nekrektomia styczna i dopowięziowa.
Zabieg wykonuje się przy pomocy takich narzędzi jak nóż wodny, nóż Humby’ego, dermatom elektryczny czy skalpel i nożyczki preparacyjne. Wadą tego rozwiązania jest uszkodzenie zdrowych tkanek podczas zabiegu, co spowalnia dalszy proces leczenia. Zabieg nekrektomii obarczony jest dużym ryzykiem krwawienia, a szczególne zagrożenie zaobserwowano przy operacjach przeprowadzanych u dzieci z obszernymi poparzeniami.
Nekrektomia enzymatyczna
W procesie oczyszczania rany z tkanek martwiczych z wykorzystaniem nekrektomii enzymatycznej wykorzystuje się preparaty zawierające enzymy proteolityczne, których zadaniem jest upłynnianie tkanki martwiczej. Metoda ta jest stosowana przy małych, ale głębokich ranach oparzeniowych, które są leczone w warunkach ambulatoryjnych. Preparatów enzymatycznych nie należy łączyć z opatrunkami zawierającymi składniki hamujące działanie enzymów, takie jak srebro lub jod. Zaletą nekretomii enzymatycznej jest usunięcie tkanki martwiczej bez uszkadzania zdrowych tkanek.
Dlaczego nekrektomia jest ważna w leczeniu oparzeń?
Nekrektomia jako działanie służące oczyszczeniu rany zapobiega rozwojowi infekcji i umożliwia wykonanie przeszczepu skóry na obszar oparzenia. Istotne jest dążenie do możliwie najwcześniejszego wykonywania zabiegu usuwania martwicy w ranach oparzeniowych. Drobne nekrektomie mogą być również stosowane jako metoda zmniejszania powierzchni oparzenia, pod warunkiem, że są wykonywane wcześnie i z dużą częstotliwością. Usuwanie martwicy z łożyska rany skraca proces leczenia i zwiększa szanse pacjenta na przeżycie.
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Przeczytaj także: Doustny TXA skuteczny w zapobieganiu utracie krwi w chirurgii ortopedycznej, Ocena wyników leczenia zachowawczego i wczesnego
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