Rana głęboka? Przetoka? Terapia na wagę złota!
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Rana głęboka? Przetoka? Terapia na wagę złota!

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Terapia owrzodzeń i ran trudno gojących się wymaga regularnego postępowania terapeutycznego, zgodnego ze strategią TIME. Podstawą terapii owrzodzeń, zwłaszcza tych z przetokami, jest regularne oczyszczanie łożyska rany (etap T; Tissue debridement), kontrola obciążenia mikrobiologicznego, infekcji i zapalenia (etap I; Infection and inflammation control), zarzadzanie raną w optymalnie wilgotnym środowisku (M; moisture balance) oraz pielęgnacja brzegów rany i wspieranie procesu naskórkowania (E; Edges, epidermization).

 

 

Szczególnie ważnym aspektem w terapii ran oraz przetok/tuneli z cechami infekcji jest płukanie ich bezpiecznym produktem o działaniu bójczym wobec drobnoustrojów (np. Granudacyn) i stosowanie specjalistycznych opatrunków do wypełnień (np. ze srebrem). Zgodnie z Konsensusem prof. Axela Kramera14 opublikowanym w 2018 roku, podchloryny (m.in. Granudacyn) są jedyną bezpieczną substancją, którą można stosować do ran głębokich bez odpływu, bez konieczności wypłukania czy neutralizacji.

Podchloryny to bezpieczny i skuteczny środek pierwszego wyboru w dekontaminacji ran ostrych i przewlekłych, jak również do irygacji ran głębokich, przetok, ropni i jam ciała (np. jamy otrzewnej). Granudacyn® to otrzymywany drogą elektrolizy stabilny i bezpieczny roztwór kwasu podchlorawego i podchlorynu sodu, który wykazuje działanie bójcze wobec bakterii Gram+ i Gram-, w tym MRSA, ORSA, VRSA, VRE, wirusów, grzybów i przetrwalników np. Clostridium14. Działa na drobnoustroje poprzez penetrację ściany i błony komórkowej oraz poprzez osmolizę.

Oczyszczona i wypłukana rana głęboka lub przetoka powinna następnie zostać zaopatrzona opatrunkiem o wysokiej chłonności i retencji, który odpowiednio zabezpieczy brzegi rany głębokiej i ochroni skórę wokół niej przed maceracją. Jest to niezwykle ważne, szczególnie w owrzodzeniach i przetokach/tunelach na podeszwie stopy. Opatrunkiem, który spełni te wymagania, a dodatkowo ma działanie przeciwbakteryjne jest żelujący opatrunek włóknisty Exufiber Ag+, który zawiera siarczan srebra.

Działanie bójcze siarczanu srebra ma miejsce już w 30. minucie i potwierdzone jest nawet w 7. dobie wobec bakterii Gram-dodatnich, Gram-ujemnych, w tym szczepów opornych na antybiotyki. Należy zaznaczyć, iż Exufiber Ag+ jest zalecany przez międzynarodowe grupy eksperckie, jako element postępowania przeciwbiofilmowego, uzupełniającego strategię TIME. Opatrunek włóknisty Exufiber Ag+ cechuje spójna struktura, dzięki której jest on łatwy do wyjęcia w jednym kawałku, nawet z głębokiej przetoki. Co więcej, opatrunek ten wykazuje, potwierdzone badaniami in vitro, właściwości przekazywania wysięku do opatrunku wtórnego.

 

 

Rany głębokie, tunele, przetoki wymagają szczególnej uwagi

Poza oczyszczaniem mechanicznym i usunięciem struktury biofilmu, ważnym aspektem w procesie leczenia rany jest stała kontrola obciążenia mikrobiologicznego. Wykonuje się ją właśnie poprzez regularne płukanie bezpiecznym produktem o działaniu bójczym i stosowanie opatrunków specjalistycznych do wypełnień.

Oprócz wspomnianych już właściwości, takich jak wysoka absorpcja i retencja, opatrunki te charakteryzują się optymalnym zarządzaniem obciążenia białkowego, tj. wysięk i wydzieliny. Ponadto niezwykle ważnym czynnikiem terapii ran głębokich i przetok jest stosowanie rozwiązań łatwych do aplikacji i wyjęcia z rany. Pamiętajmy również, że rana z cechami infekcji wymaga postępowania zgodnego z obowiązującym protokołem, a w przypadku pogorszenia stanu rany, natychmiastowej konsultacji z wykwalifikowanym personelem medycznym.

Źródła:

  1. Dissemond J et al. Evidence for silver in wound care, meta-analysis of clinical studies from 2000–2015. J Dtsch Dermatol Ges. 2017 May;15(5):524-535.
  2. Gee Kee E et al Randomized controlled trial of three burns dressings for partial thickness burns in children. Burns. 2015 Aug;41(5):946-55
  3. Meaume S. et al. A study to compare a new self adherent soft silicone dressing with a self adherent polymer dressing in stage II pressure ulcers. Ostomy Wound Management, 2003.
  4. Wiberg A.B. et al. Preventing maceration with a soft silicone dressing: in-vitro evaluations. Poster presented at the 3rd Congress of the WUWHS, Toronto, Canada, 2008.
  5. Dhataryija K et al. An open, non comperative multicentre evaluation of performance and safety using an antimicrobial exudate transfer dressing on diabetic foot ulcers. A case series. J. Wound Care 2016; 25(5): 256–265.
  6. Chadwick P, Taherinejad F, Hamberg K, Waring M. Clinical and scientific data on a silver-containing soft-silicone foam dressing: an overview. Journal of Wound Care 2009;18(11):483-491.
  7. White R. et al. Evidence for atraumatic soft silicone wound dressing use. Wounds UK, 2005.
  8. Gee Kee E et al. Cost-effectiveness of silver dressings for paediatric partial thickness burns: An economic evaluation from a randomized controlled trial. Burns. 2017 Jun;43(4):724-732.
  9. Silverstein P. et al. Anopen, parallel, randomized, comparative, multicenter study to evaluate the cost-effectiveness, performance, tolerance, and safetyof a silver contain in soft silicone foam dressing vs silver sulfadiazine cream. J BurnCareRes. 2011 Nov-Dec; 32(6).
  10. Zurcher S, Krapfl L, Burds A. Reducing postoperative surgical site infections in coronary artery bypass graft patients. Poster presentation at the 45th Annual Conference of the Wound Ostomy and Conti¬nence Nurses Society, Seattle, WA, US 2013.
  11. Davis, S. C., Li, J. , Gil, J., Head, C., Valdes, J., Glinos, G. D., Solis, M. , Higa, A. and Pastar, I. (2019), Preclinical evaluation of a novel silver gelling fiber dressing on Pseudomonas aeruginosa in a porcine wound infection model. Wound Rep Reg, 27: 360-365
  12. Gil et at. 2017. Evaluation of a Gelling Fiber Dressing with Silver to Eliminate MRSA Biofilm Infec¬tions and Enhance the Healing. Poster presented at the Symposium on Advanced Wound Care Spring meeting/Wound Healing Society (WHS) Annual Meeting 2017, Apr 05 – 09, 2017, San Diego, CA, USA.
  13. Surgical Materials Testing Laboratory. BS EN 13726-1:2002: Test methods for primary wound dressings. Mölnlycke Health Care. Data on file. (2014).
  14. Kramer et al. Consensus on Wound Antisepsis: Update 2018, Skin Pharmacol Physiol 2018; 31:28-58

Artykuł powstał we współpracy z firmą Mölnlycke.

 

Przeczytaj także: Leczenie owrzodzeń żylnych goleni ze średnim wysiękiem – zasady postępowania

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