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Zastosowanie iniekcji z kolagenu w leczeniu owrzodzeń [CASE STUDY]

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Kolagen to białko będące ważnym składnikiem macierzy zewnątrzkomórkowej, odgrywające kluczowa rolę w procesie gojenia ran. Badania wykazują, że zastosowanie kolagenu w formie iniekcji in-situ w brzegi rany może przynieść pozytywne efekty w terapii ran trudno gojących się o zróżnicowanej etiologii, w tym ran owrzodzeniowych.

Kolagen stanowi 25-30% wszystkich białek w ludzkim organizmie. Jest to podstawowy budulec skóry właściwej (stanowi 70% masy wszystkich białek w skórze), dlatego też odgrywa tak ważną rolę w procesie gojenia ran, szczególnie na etapach proliferacji i remodelingu.

W praktyce klinicznej leczenia trudno gojących się ran iniekcyjne podanie tropokolagenu typu I, czyli kolagenu w jego podstawowej postaci, tworzącej biorusztowanie dla dojrzałego kolagenu, budującego zdrowe i silne włókna, wspomaga stymulację procesu naskórkowania oraz obkurczania się rany, a także ziarninowania. 

Poniżej przedstawiamy case studies z zastosowaniem iniekcji kolagenu typu I pochodzenia wieprzowego w postaci tropokolagenu w terapii rozległych owrzodzeń.
W obu przypadkach podano pacjentom kolagenowe wyroby medyczne w iniekcjach z linii Collagen Medical Device włoskiej firmy GUNA (produkty MD-Tissue i MD-Matrix), około 1 cm od brzegów rany, w protokołach czasowych indywidualnie dobranych do możliwości i potrzeb pacjenta.

Dokumentacja pierwszego przypadku została przygotowana przez zespół specjalistów ze Świętokrzyskiego Centrum Onkologii w Kielcach w składzie: dr n. med. Przemysław Ciepiela, lek. Piotr Cieślicki, lek. Krzysztof Kaczmarczyk, mgr Małgorzata Gajek.

Przypadek drugi został przedstawiony przez lek. Katarzynę Osiak (Klinika Chirurgii Plastycznej CMKP, Samodzielny Publiczny Szpital Kliniczny im. prof. W. Orłowskiego CMKP) oraz dr. hab. n. med. Artura Pasternaka (Klinika Chirurgii Plastycznej CMKP, Samodzielny Publiczny Szpital Kliniczny im. prof. W. Orłowskiego CMKP; Katedra Anatomii, Uniwersytet Jagielloński Collegium Medicum).

Przypadek nr 1

Pacjent w wieku 67 lat, obciążony wielochorobowością: cukrzyca typu 2 leczona insuliną, małopłytkowość (stan po steroidoterapii), choroba niedokrwienna serca (stan po CABG), przewlekła choroba nerek, nadciśnienie tętnicze, nowotwór złośliwy okrężnicy (stan po opracji i chemioterapii).

Rana po urazie podudzia lewego. Na wizytę zgłosił się po około miesiącu od urazu, kiedy doszło do rozległego owrzodzenia podudzia z występującymi tkankami martwiczymi i włóknikiem.

Przypadek nr 2

Pacjent w wieku 40 lat. Rana po urazie zmiażdżeniowo-skalpacyjnym stopy lewej. Na ranę zastosowano wolne przeszczepy skóry pośredniej grubości, siatkowane. W okolicy piętowej przeszczepy nie wygoiły się. Nastąpiła liza, proces naskórkowania został zatrzymany. W dnie atoniczna ziarnina.

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