Kirurška obrada akutne kožne rane

master's thesis

• Title (english): Surgical management of acute cutaneous wound
• Author: Josip Jaman
• Mentor: Krešimir Martić (mentor)
• Committee member: Rado Žic (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Krešimir Martić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2019-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Tehnike za zbrinjavanje rane rođene su i kaljene iz umijeća ratnih kirurga, a svoju renesansu doživljavaju u moderno doba. Danas su akutne rane jedno od najčešćih stanja koje zahtijevaju zbrinjavanje u hitnom prijemu. Rana se u kirurgiji definira kao anatomski i funkcionalni prekid cjelovitosti tkiva ili organa. Pacijenti koji su zadobili akutnu traumatsku ranu navode kako je najvažniji ishod liječenja, odnosno obrade akutne traumatske rane, sprječavanje infekcije. S liječničke strane bitno je procijeniti koje vrste rana, odnosno njezine karakteristike, ili stanja pacijenta, povećavaju rizik za razvoj infekcije. Kako bi se rana mogla detaljno pregledati, učiniti adekvatan debridman iste te kako bi pacijentu smanjili bolnost i nelagodu, potrebno je ranu učiniti bezbolnom primjenom lokalnih anestetika. Indikacije za korištenje antiseptika u cilju smanjena mikrobiološke kontaminacije u akutnoj kožnoj rani ostaju nejasne u usporedbi s čišćenjem rane sterilnom fiziološkom otopinom. Glavni razlog za izbjegavanje korištenja antiseptika u rani može biti njihova dokazana in vitro citotoksičnost, dok in vivo primjeni nedostaju sigurni dokazi za određene antiseptike. Rana se u kirurškoj praksi najčešće zatvara šivanjem korištenjem različitih kirurških konaca, dok su tkivna ljepila i adhezivne trake rjeđe korištene tehnike. Često podcijenjeni, ali prijeko potrebni koraci u zbrinjavanju akutnih rana su prevoj rane nakon obrade i njega rane nakon otpusta iz hitnog bolničkog prijema. Neadekvatan prevoj rane ili neadekvatna njega iste mogu, unatoč najboljoj obradi, dovesti do puno lošijeg ishoda cijeljenja. Svrha ovog diplomskog rada je dati uvid u umijeća obrade rane temeljenih na znanstvenim dokazima i ukazati na ustaljena kirurška pravila (dogme) u tom području.

Abstract (english)

Techniques for wound management were born from the arts of war surgeons, today these techniques are having a new renaissance in the era of modern medicine. Acute wounds are one of the most common conditions requiring treatment in
the emergency departments. Wounds are in surgery defined as an anatomical and functional disruption of tissue or organ integrity. Patients sustaining acute traumatic wounds reported prevention of wound infection as the single most important treatment outcome. For a physician, it is important to identify the characteristics of wound and patient conditions that will interfere with wound healing by increasing the risk for developing infection. In order to inspect the wound in detail, make an appropriate debridement, and alleviate the patient’s pain and discomfort, the wound should be anesthetized using local anesthetics. Indications for the use of antiseptics to reduce microbiological contamination in the acute cutaneous wound are still unclear in comparison with wound cleansing using a sterile saline solution. The main reason to avoid usage of antiseptics in wounds is probably their proven in vitro cytotoxicity, whereas, in vivo evidence is lacking for certain antiseptics. In surgical practice, the wounds are most often closed by suturing using various surgical sutures, while tissue adhesives and adhesive tapes are less commonly used techniques. Often underestimated but necessary steps in the management of an acute wound are wound dressings, wound bandaging and wound aftercare proceeding discharge from an emergency department. Inadequate wound dressing or inadequate wound aftercare may worsen, despite the best surgical management, wound healing outcomes. This graduate thesis aims to provide an overview of evidence-based wound management techniques and to point out established surgical rules (dogma) in the field of wound management.

• Keywords: akutna rana; kirurgija; primarna obrada rane; kirurška obrada rane; traumatska rana
• Keywords (english): acute wound; surgery; primary wound management; surgical wound management; traumatic wound
• Language: croatian
• URN:NBN: urn:nbn:hr:105:454089
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-03-01 09:38:53