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Przyczyny powstawania i leczenie trudno gojących się ran chirurgicznych

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Rany chirurgiczne wymagają specyficznego zaopatrzenia, bez którego może dojść do komplikacji skutkujących zaburzeniem procesu gojenia. Aby zminimalizować ryzyko kolejnych uszkodzeń tkanek, niezbędne będzie wdrożenie odpowiedniego leczenia.

Rana chirurgiczna powstaje podczas operacji lub wykonywania procedur medycznych w gabinecie zabiegowym. Zazwyczaj tego typu rany goją się szybko, ale w wyniku pojawienia się komplikacji w postaci rozejścia szwów lub zakażenia, proces gojenia zostaje spowolniony. Na ponowne otwarcie się rany wpływ mogą mieć zarówno błędy popełnione przez lekarza np. nieprawidłowe założenie szwów, jak i czynniki mechaniczne w postaci kaszlu lub odruchu wymiotnego.

Najczęstszą przyczyną niegojących się ran pooperacyjnych jest śródoperacyjne zastosowanie niewłaściwych powierzchniowo czynnych antyseptyków i pozostawienie ich w jamach ciała. Należą do nich: 0,05% i 0,1% dwuchlorowodorek oktenidyny, 0,1% poliheksanid (PHMB), 0,04% PHMB i jodyna powidonowa. Antyseptyki traktowane są przez tkanki jak białko obcogatunkowe, co wywołuje stan zapalny.

Drugim czynnikiem utrudniającym gojenie się ran chirurgicznych jest zakażenie objawiające się bolesnością rany, zaczerwieniem jej okolic, wysiękiem, podwyższoną temperaturą tkanek wokół rany. Warto zaznaczyć, że w pierwszych dniach po przeprowadzeniu zabiegu mogą się pojawić objawy sugerujące zakażenie, jednak ich obecność wynika z uszkodzeń tkanek powstałych podczas zabiegu, a nie z infekcji.

Sposoby leczenia ran chirurgicznych

Podstawą w trakcie leczenia trudno gojących się ran jest ich odpowiednie zabezpieczenie oraz higiena. Ważną rolę odgrywają tu zarówno zastosowane opatrunki, jak i środki służące do dezynfekcji. Nie można też zapominać o odpowiednim nawilżeniu rany, aby nadmiernie nie wysychała. Istotne jest też powstrzymanie wysięku i ograniczenie rozwoju drobnoustrojów w obrębie rany.

Rana powinna być oczyszczana przy każdej zmianie opatrunku przy użyciu antyseptyków oraz poprzez usunięcie martwej tkanki. Dodatkowo w przypadku rozpoznania zakażenia zaleca się korzystanie z dwóch środków zawierających inne substancje czynne. Wysięk z rany kontrolowany jest przy użyciu nieprzywierających opatrunków.

W leczeniu trudno gojących się ran skuteczna jest też metoda podciśnieniowa. Wykorzystuje się w niej specjalne urządzenie połączone z raną przy pomocy rurek i samego opatrunku. Maszyna wytwarzając podciśnienie oczyszcza ranę z wysięku, ogranicza liczebność drobnoustrojów, a także stymuluje powstawanie nowych naczyń włosowatych. Nie można jej jednak stosować przy wszystkich ranach. Aby wykorzystać terapię podciśnieniem, należy zabezpieczyć ranę hemostatycznie. Oznacza to, że nie może występować żadne krwawienie. Muszą też zostać usunięte wszelkie obumarłe tkanki. Całkowite oczyszczenie tkanek z wydzieliny i bakterii uzyskuje się po 7-10 dniach. Czas ten wydłuża się u chorych na cukrzycę z zespołem stopy cukrzycowej i wynosi 14 dni.

Źródło: M. Kucharzewski, E. Szkiler „Niegojące się rany chirurgiczne. Rozejście się rany chirurgicznej i zakażenie miejsca operowanego”, Forum Leczenia Ran 2020;1(4), str. 143-151

 

Przeczytaj także: Zakażenie rany trudno gojącej się – kiedy wdrożyć leczenie antybiotykami?

Przeczytaj bezpłatnie pokrewny artykuł w czasopiśmie „Forum Leczenia Ran”: Rany przewlekłe stopy – rosnący problem kliniczny i społeczny?

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