Mehanički debridman u liječenju kroničnih rana

master's thesis

• Title (english): Mechanical debridement in chronic wound treatment
• Author: Frane Markulić
• Mentor: Srećko Budi (mentor)
• Committee member: Rado Žic (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Srećko Budi (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2016-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Debridement je jedan od ključnih postupaka u liječenju kroničnih rana. Postupak se izvodi u cilju odstranjivanja nekrotičnog i devitaliziranog tkiva, te fibrinskih naslaga, a sav taj biološki teret na rani usporava cijeljenje i blokira autosomne mehanizme koji bi u slučaju akutne rane u više faza proveli cijeljenja rane i vraćanje integriteta tkivu.
Tako samim debridementom pripremamo dno rane i potičemo prijelaz procesa u rani iz kroničnih u one akutne, a akutni procesi su nam potrebni za cijeljenje. Debridement može biti raznih vrsta, od onih najmanje zahtjevnih i kratkotrajnih kao što su oštri i mehanički pa do kirurškog, biološkog i enzimatskog debridementa koji zahtijevaju stručno osoblje i dugotrajniji su postupci.
Mehanički debridement je jedan od najviše korištenih vrsta zbog svoje cijene i lakoće primjene, a možemo razlikovati klasičnu vrstu debridementa sa suhim, vlažnim i parafinskim gazama, te novijim metodama mehaničkog debridementa kao što je upotreba jastučića s monofilamentnim vlaknima i terapija tehničkim aparatima koji koriste vodene ili ultrazvučne valove.
Upotreba klasičnih oblika mehaničkog debridementa nije sasvim selektivna za nekrotično tkivo i fibrinske naslage i može uzrokovati bol kod pacijenta, dok novije metode mehaničkog debridementa su selektivnije i ne uzrokuju bol kod pacijenata.
Ne postoji savršena metoda debridementa; svaka ima svoje prednosti i nedostatke, te se svaka i koristi ovisno o tipu rane, dobi i statusu pacijenta i njegovim komorbiditetima, dostupnosti postupaka i naravno same hitnosti, ali za svaki debridement mora postojati rezultat dobre pripreme dna rane i odstranjivanje staništa za bakterije koji sa nekrotičnim tkivom tvore biofilm koji usporava cijeljenje i uzrokuje daljnje zdravstvene probleme. Potrebna su daljnja istraživanja i inovacije za pronalazak najbolje metode debridementa.

Abstract (english)

Wound debridement is one of the main procedures in the treatment of chronic wounds. The main goal of wound debridement is the removal of necrotic, devitalised tissue and slough. It is very important because all the bioburden in the wound is blocking the wound healing processes and causing the bacteria to grow in the wound and form biofilm.
Debridement is also called wound bed preparation and it helps the processes in the wound to reverse to acute ones and promote healing, because chronic conditions are blocking the normal epithelisation and recovering the integrity of tissue. Debridement consists of different types of procedures, from least time consuming and smaller needs for skilled staff like sharp and mechanical debridement, to more time consuming ones and specialist-requiring types like enzymatic, biological and surgical debridement.
Mehanical debridement is one of the most used types because of its low requirements for staff and relatively cheap price. We can divide it into several categories, whether it is done with dry-to-wet gauze, paraffin tulle or new gauzes with monofilament fibres. We also have debridement with automatic machines that use water or ultrasound waves.
Usage of dry-to-wet gauze and paraffin tulle is older method and it's not very selective and can cause pain in patient, while newer methods cause less or no pain and are very selective for necrotic tissue and slough.
There is no perfect method for wound debridement, each one has its own benefits and disadvantages, so we use all types of debridement depending on the situation, patient age and comorbidites or emergency of the patient. The goal of every debridement should be good wound bed preparation and removal of the bioburden in which bacteria grow and form biofilm that slows the healing process. There is a necessity for further research and innovation for finding the best derbidement method.

• Keywords: mehanički debridman; kronična rana; biofilm; cijeljenje rane
• Keywords (english): mechanical debridement; chronic wound; biofilm; wound healing
• Language: croatian
• URN:NBN: urn:nbn:hr:105:737282
• 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: 2017-07-03 07:31:52