Przewlekła rana pourazowa. Opis przypadku.

Among many types of chronic wounds there is a place for traumatic wounds. The circumstances in which they appeared influence their nature. Traumatic wounds are often very deep and a fight to save the wounded parts of the body such as the upper limb requires medical and nursing actions. Proceedings in accordance with the applicable recommendation of scientific societies guarantee a success in the form of restoration of continuity of the skin. A case of 23 years old- man, whose accident at the workplace caused a deep loss for the dorsum of left hand, is presented in the study. Interdisciplinary and local actions based on the latest recommendations in line with the foundation’s strategy resulted in a T.I.M.E strategy have been appliedWśród wielu rodzajów ran przewlekłych szczególne miejsce zajmują rany urazowe. Na ich zróżnicowany charakter bardzo często mają wpływ okoliczności, w jakich doszło do jej powstania. Niejednokrotnie rany urazowe są bardzo rozległe, głębokie i „walka” o uratowanie okaleczonej części ciała np. kończyny górnej, wymaga podejmowania wielokierunkowych i zespołowych działań lekarsko-pielęgniarskich. Postępowanie zgodne z obowiązującymi rekomendacjami towarzystw naukowych gwarantuje sukces w postaci odtworzenia ciągłości skóry. W pracy zaprezentowano opis przypadku 23- letniego mężczyzny, u którego w wyniku wypadku w miejscu pracy powstał głęboki ubytek na dłoni kończyny górnej lewej. Interdyscyplinarne, zespołowe działania i postępowanie miejscowe oparte na najnowszych rekomendacjach, zgodne z założeniami strategii T.I.M.E, wpłynęło na uzyskanie postawionego wspólnie celu w postaci przygotowania łożyska rany do przeszczepu skórnego

Chronic traumatic wound. A case report

Among many types of chronic wounds there is a place for traumatic wounds. The circumstances in which they appeared influence their nature. Traumatic wounds are often very deep and a fight to save the wounded parts of the body such as the upper limb requires medical and nursing actions. Proceedings in accordance with the applicable recommendation of scientific societies guarantee a success in the form of restoration of continuity of the skin. A case of 23 years old- man, whose accident at the workplace caused a deep loss for the dorsum of left hand, is presented in the study. Interdisciplinary and local actions based on the latest recommendations in line with the foundation’s strategy resulted in a T.I.M.E strategy have been appliedWśród wielu rodzajów ran przewlekłych szczególne miejsce zajmują rany urazowe. Na ich zróżnicowany charakter bardzo często mają wpływ okoliczności, w jakich doszło do jej powstania. Niejednokrotnie rany urazowe są bardzo rozległe, głębokie i „walka” o uratowanie okaleczonej części ciała np. kończyny górnej, wymaga podejmowania wielokierunkowych i zespołowych działań lekarsko-pielęgniarskich. Postępowanie zgodne z obowiązującymi rekomendacjami towarzystw naukowych gwarantuje sukces w postaci odtworzenia ciągłości skóry. W pracy zaprezentowano opis przypadku 23- letniego mężczyzny, u którego w wyniku wypadku w miejscu pracy powstał głęboki ubytek na dłoni kończyny górnej lewej. Interdyscyplinarne, zespołowe działania i postępowanie miejscowe oparte na najnowszych rekomendacjach, zgodne z założeniami strategii T.I.M.E, wpłynęło na uzyskanie postawionego wspólnie celu w postaci przygotowania łożyska rany do przeszczepu skórnego

Evaluation of the effectiveness of new polyurethane foam dressings in the treatment of heavily exudative venous ulcers

Background. The aim of the study was to evaluate the effectiveness of polyurethane dressings in the treatment of venous ulcers and the assessment of wound pain. Material and methods. The study was conducted in 2005 in the Venous Ulcers Outpatient Clinic of the Chair and the Clinic of Surgery of Biziel Hospital in Bydgoszcz, Poland. Twenty patients with venous ulcers participated in the study; all of them had indications for foam dressing use. Depending on wound state and periwound skin, polyurethane dressing Biatain adhesive (14 patients) or non-adhesive (6 patients) was used. During the dressing changes, hydrotherapy and mechanical debridement were used. Two-layer compression therapy was also used. Results. Initial mean surface area of ulcers was 18.55 cm2. Large ulcers (> 20 cm2) were characterized by a seven times longer duration than smaller ulcers (< 10 cm2) (5.7 months vs. 39.5 months). Statistically significant changes of surface area during six weeks of treatment were observed (p < 0.05). All patients complained of significant pain. Pain intensity was lower during the treatment time. Conclusions. Polyurethane foam dressings have a high absorption potential; they influence the treatment of heavily exudative ulcers in a positive way, improve healing progress and reduce surface area.Wstęp. Celem badań była ocena skuteczności opatrunków poliuretanowych Biatain w leczeniu owrzodzeń żylnych goleni oraz ocena dolegliwości bólowych rany. Materiał i metody. Badania przeprowadzono w 2005 roku w Poradni Leczenia Owrzodzeń Żylnych Katedry i Kliniki Chirurgii Ogólnej Szpitala Wojewódzkiego im. dr. J. Biziela w Bydgoszczy. W badaniu uczestniczyło 20 chorych z owrzodzeniem żylnym, u których występowały wskazania do zastosowania opatrunku chłonnego. W zależności od stanu rany i otaczającej skóry stosowano opatrunek poliuretanowy Biatain nieprzylepny (14 chorych) lub przylepny (6 chorych). Podczas zmiany opatrunku prowadzono hydroterapię i oczyszczanie mechaniczne. Stosowano kompresjoterapię dwuwarstwową. Wyniki. Początkowa średnia powierzchnia owrzodzeń wynosiła 18,55 cm2. Owrzodzenia duże, o powierzchni powyżej 20 cm2 trwały 7-krotnie dłużej niż owrzodzenia o małej powierzchni poniżej 10 cm2 (5,7 miesiąca vs. 39,5 miesiąca). Obserwowano znamienne statystycznie zmiany średnich pola powierzchni (p < 0,05) w 6-tygodniowym okresie leczenia. U wszystkich chorych stwierdzono występowanie silnych dolegliwości bólowych. Ich natężenie zmniejszało się podczas leczenia. Wnioski. Pianki poliuretanowe należą do opatrunków chłonnych o dużej sile absorpcji. Pozytywnie wpływają na leczenie mocno sączących się owrzodzeń żylnych, przyczyniają się do postępu w gojeniu i zmniejszenia powierzchni rany

Microbiological Status of Venous Leg Ulcers and Its Predictors: A Single-Center Cross-Sectional Study

Venous leg ulcers are frequently colonized by microbes. This can be particularly devastating if the ulcer is infected with alert pathogens, i.e., highly virulent microorganisms with well-developed mechanisms of antibiotic resistance. We analyzed the microbiological status of venous leg ulcers and identified the clinicodemographic predictors of culture-positive ulcers, especially in ulcers with colonization by alert pathogens. Methods: This study included 754 patients with chronic venous leg ulcers. Material for microbiological analysis was collected by swabbing only from patients who did not receive any antibiotic treatment. Results: A total of 636 (84.3%) patients presented with culture-positive ulcers. Alert pathogens, primarily Pseudomonas aeruginosa, were detected in 28.6% of the positive cultures. In a logistic regression model, culture-positive ulcers were predicted independently by age &gt; 65 years, current ulcer duration &gt; 12 months, and ulceration area greater than 8.25 cm2. Two of these factors, duration of current ulcer &gt; 12 months and ulceration area &gt; 8.25 cm2, were also identified as the independent predictors of colonization by alert pathogens. Conclusions: Colonization/infection is particularly likely in older persons with chronic and/or large ulcers. Concomitant atherosclerosis was an independent predictor of culture-negative ulcers

Healing Process, Pain, and Health-Related Quality of Life in Patients with Venous Leg Ulcers Treated with Fish Collagen Gel: A 12-Week Randomized Single-Center Study

The aim of the study was to assess the effectiveness of fish skin collagen and its impact on healing, pain intensity, and quality of life in patients with venous leg ulcers (VLUs). This study included 100 adults with VLUs. Eligible patients were randomized to either tropocollagen gel treatment (group A, n = 47) or placebo alone (group B, n = 45). We applied the gel to the periwound skin for 12 weeks. All groups received standard wound care, including class 2 compression therapy and wound hygiene procedures. We assessed the healing rate (cm2/week) and quality of life (QoL) using the Skindex-29 and CIVIQ scales. In group A, more ulcers healed, and the healing rate was faster. In both study groups, patients showed a significant improvement in quality of life after the intervention, but there was a greater improvement in the tropocollagen group. In group A, the greatest improvement was related to physical symptoms and the pain dimension. This study showed that the application of fish collagen gel to the periwound skin improves the healing process and QoL in patients with VLUs. The 12-week treatment with collagen reduced the severity of physical complaints, pain, and local skin symptoms, which determined the quality of life in patients with VLUs to the greatest extent

Influence of ulceration etiology on the global quality of life and its specific dimensions, including the control of pain, in patients with lower limb vascular insufficiency

Introduction : The results of previous studies suggest that the quality of life in patients with lower limb ulcerations is markedly poorer than in the general population – with regard to physical, mental and social spheres. This complex character of that parameter necessitates comprehensive analyses of its specific aspects, including the level of the acceptance of illness and associated pain symptoms. Aim : To compare the quality of life and its specific dimensions in patients with lower limb ulcerations of various etiology. Material and methods : Patients with the ulcerations resulting from venous (n = 101) or arterial pathologies (n = 98), or having mixed etiology (n = 99) were examined with the: 1) Skindex-29 instrument, 2) Acceptance of Illness Scale, 3) Beliefs about Pain Control Questionnaire, and 4) Coping Strategy Questionnaire. Results : The average quality of life related to physical symptoms was significantly higher in patients with venous ulcerations. Patients with ulcerations of arterial etiology more frequently used catastrophizing, and less often ignored pain sensations, used coping self-statements, and increased their activity levels; they were characterized by lower levels of control and poorer ability to decrease the pain. The internal locus of pain control increased proportionally to the global quality of life scores and levels of illness acceptance. Control over pain and ability to decrease the pain were more effective in individuals who used ignoring pain sensations, increasing the activity level, coping self-statements, and reinterpreting pain than in those using catastrophizing or praying and hoping strategies. Conclusions : Physical complaints seem to be the basic determinant of the quality of life in patients with the lower limb ulceration, irrespective of its etiology

Occurrence and Severity of Pain in Patients with Venous Leg Ulcers: A 12-Week Longitudinal Study

Background: The aim of the study was to analyze the dynamics of pain severity and its predictors in a group of patients with chronic venous leg ulcers. Methods: A 12-week longitudinal study included 754 patients with chronic venous leg ulcers. Subjective severity of pain was measured at weekly intervals with an 11-point visual analogue scale (VAS). Results: A significant decrease in VAS scores has been observed throughout the entire analyzed period. Higher severity of pain during follow-up was independently predicted by the presence of pus and/or unpleasant smell from the ulceration during the first visit, as well as by the occurrence of posterior and/or circumferential ulcers. The presence of ulcer redness during the first visit was associated with lesser pain severity; also, a significant interaction effect between the ulceration redness and warmth was observed. Conclusions: Implementation of complex holistic care may contribute to a substantial decrease in the occurrence and severity of pain in a patient with venous leg ulcers. Pain control seems to depend primarily on clinical parameters and topography of venous ulcers. The predictors of pain severity identified in this study might be considered during the planning of tailored care for patients with venous leg ulcers

ORIGINAL PAPER<br> Functional and biopsychosocial restrictions among patients with a venous ulcer

Introduction: The aim of the study was to assess physical and psychosocial problems of patients with a venous ulcer. Functioning, downfall risk, nutritional status and prevalence of depression were assessed. Relationships between the mentioned variables were also evaluated. Material and methods: The study was conducted in 2004 and 2005 among 77 patients (mean age 73.9, range 55-92), and included 37 patients from the Venous Ulcers Outpatient Clinic of the Chair and Clinic of Surgery and 40 patients from the Chair and Clinic of Geriatrics, Medical University in Bydgoszcz. A short form of the Tinetti test was used for downfall risk assessment, GDS (Geriatric Depression Scale), Mini Nutritional Assessment (MNA) form and III part of EASY-Care 1997-8 questionnaire were used. Results: Patients with an ulcer more often had the following problems: depression (z=5.002, p<0.05), downfall risk (z=3.43, p<0.05), malnutrition (z=3.15, p<0.05) and functional disorders (z=3.37, p<0.05). A higher risk of downfall was observed among patients with functional disorders. The presence of emotional disorders influenced also functioning and nutritional status. Conclusions: Chronic venous insufficiency and ulcers increase the risk of functional disorders in every sphere of patient’s activity – physical, psychological and emotional or social