Abordaje de una persona con úlceras venosas infectadas / Approach of a person with infected venous ulcers

Las personas con heridas venosas infectadas precisan que se solucione el problema agudo (infección), para posteriormente tratar la causa de base (hipertensión venosa). Mediante una correcta valoración de la persona se puede establecer un tratamiento integral. En el caso expuesto se consigue la curación de una úlcera venosa de 12 años de evolución en 11 semanas de tratamiento, con el consiguiente ahorro para el Sistema de Salud, mejora de la calidad de vida de la persona y su entorno, y disminución de las cargas asistenciales(AU)

People infected with venous wounds need to solve the acute problem (infection), later to treat the underlying cause (venous hypertension). By a proper assessment of the person can establish a comprehensive treatment. In the case above is achieved healing a venous ulcer 12 years of evolution in 11 weeks of treatment, with consequent savings for the health system, improving the quality of life of the person and the environment and cut red tape care (AU)

[Approach of a person with infected venous ulcers]. / Abordaje de una persona con ulceras venosas infectadas.

People infected with venous wounds need to solve the acute problem (infection), later to treat the underlying cause (venous hypertension). By a proper assessment of the person can establish a comprehensive treatment. In the case above is achieved healing a venous ulcer 12 years of evolution in 11 weeks of treatment, with consequent savings for the health system, improving the quality of life of the person and the environment and cut red tape care.

[Local control treatment of bacteria found present in an infected bed sore by means of a hydropolymer dressing with ionic silver]. / Control local de la carga bacteriana en una úlcera por presión infectada. Mediante un apósito hidropolimérico con plata iónica.

Every chronic wound has microorganisms present on its surface and therefore, its contamination is universal and unavoidable, but the majority of these wounds are not infected. It is important, therefore, to refine the diagnosis of infection indentifying the microorganisms which have succeeded in gaining access to the submarginal tissues in order to be able to prevent unnecessary or inappropriate antibiotic treatment and to lessen possible complications. A high level of bacteria present, close to 105 "UFC" per gram of tissue, even though this does not manifest a clinical infection, might interfere with the repair mechanisms and impede cicatrization of the wound. Due to this difficulty to identify in a precise manner the microorganisms which cause an infection, those patients who have sepsis related to bed sores are habitually treated empirically with wide spectrum range antibiotics, potentially more toxic and often more expensive. But it is important to restrict the use of local antibiotics when treating chronic wounds and to prioritize the use of cleaning methods and diverse debridement methods in order to lower the presence of bacteria. The use of systemic antibiotics should be limited to precise indications, considering that today we have at our disposal alternate treatments with topical antibiotics, principally dressings which contain silver.

Preventing pressure ulcers on the heel: a Canadian cost study.

An adaptation of a clinical study of 130 patients at risk of developing a pressure ulcer on the heels was performed using Canadian costs. The aim of the study was to compare the cost effectiveness of a specially shaped hydrocellular dressing (Allevyn Heel) versus that of a protective heel bandage (Soffban and gauze) in pressure ulcer prevention over an 8-week period.

Control local de la carga bacteriana en un úlcera por presión infectada. Mediante un apósito hidropolimérico con plata iónica / Local control treatment of bacteria found present in an infected bed sore by means of a hydropolymer dressing with ionic silver

Todas las heridas crónicas presentan microorganismos en su superficie y, por ello, su contaminación es universal e inevitable, pero la mayoría no está infectada. Es importante, entonces, afinar el diagnóstico de infección identificando los microorganismos que han conseguido profundizar en tejidos submarginales, con el fin de prevenir tratamientos antibióticos innecesarios o inadecuados y minimizar las posibles complicaciones. Una carga bacteriana elevada, próxima a los 105 UFC por gramo de tejido, aunque no produzca manifestaciones clínicas de infección, puede interferir con los mecanismos reparadores impidiendo la cicatrización de la herida. A causa de esta dificultad para identificar de manera exacta los microorganismos causantes de la infección, los pacientes con sepsis relacionada con UPP son habitualmente tratados de manera empírica con antibióticos de amplio espectro, potencialmente más tóxicos y a menudo más caros. Pero es importante restringir el uso de antibióticos locales en el tratamiento de las heridas crónicas y priorizar la utilización de la limpieza y los diversos métodos de desbridamiento para reducir la carga bacteriana. El uso de antibióticos sistémicos debe limitarse a las indicaciones precisas, dado que hoy en día disponemos de alternativas al tratamiento con antibióticos tópicos, principalmente los apósitos que contienen plata(AU)

Every chronic wound has microorganisms present on its surface and therefore, its contamination is universal and unavoidable, but the majority of these wounds are not infected. It is important, therefore, to refine the diagnosis of infection indentifying the microorganisms which have succeeded in gaining access to the submarginal tissues in order to be able to prevent unnecessary or inappropriate antibiotic treatment and to lessen possible complications. A high level of bacteria present, close to 105 «UFC» per gram of tissue, even though this does not manifest a clinical infection, might interfere with the repair mechanisms and impede cicatrization of the wound. Due to this difficulty to identify in a precise manner the microorganisms which cause an infection, those patients who have sepsis related to bed sores are habitually treated empirically with wide spectrum range antibiotics, potentially more toxic and often more expensive. But it is important to restrict the use of local antibiotics when treating chronic wounds and to prioritize the use of cleaning methods and diverse debridement methods in order to lower the presence of bacteria. The use of systemic antibiotics should be limited to precise indications, considering that today we have at our disposal alternate treatments with topical antibiotics, principally dressings which contain silver(AU)

Recomendaciones sobre la utilización de antisépticos en el cuidado de heridas crónicas / Guideliness on the antisepsis for chronic wounds care

No disponible

Apósitos de colágeno en polvo en la cicatrización de heridas por segunda intención / Collagene powder dressings use for cicatrisation over wounds during follow up treatment

Las heridas significan no sólo un importante problema bio-psico-social para el paciente que las padece, sino también un importante gravamen económico para el sistema sanitario. Una de las muchas clasificaciones sobre heridas nos permite diferenciar entre agudas (traumatismos leves, heridas quirúrgicas...) y crónicas (úlceras por presión, ulceras vasculares...); esta diferenciación nos permite distinguir entre cicatrización por primera intención (aquella que se da en las heridas agudas) y que se caracteriza por no necesitar el relleno de ninguna cavidad. Y la cicatrización por segunda intención (por la que normalmente se resuelven las heridas crónicas), que constituye un proceso largo en el tiempo dado que necesita el relleno de la cavidad mediante tejido de neoformación, el tejido de granulación.En el presente artículo describimos la utilización de un nuevo apósito de colágeno exógeno (Catrix®) en la cicatrización de heridas por segunda intención, así como las acciones del mismo en las diferentes fases de la cicatrización. Para todo ello, nos apoyamos en un caso clínico tratado en nuestra unidad que corresponde a la cicatrización por segunda intención de una herida post-quirúrgica secundaria a un desbridamiento por una hidrosadenitis supurativa, que ingresó en nuestra unidad en espera de injerto cutáneo (AU)

[Collagen powder dressings in the healing of secondary intention wounds. Report of a case]. / Apósitos de colágens en polvo en la cicatrización de heridas por segunda intención. A propósito de un caso.

The wounds mean not only an important bio-psico-social problem for the patient who suffers them, but also an important economic burden for the sanitary system. One of the many wounds classifications allows us to differentiate between acute wounds (slight traumatism, surgical wounds...) and chronic wounds (pressure ulcers, vascular ulcers...), this differentiation allows us to distinguish between wound healing by primary intention (that occurs in acute wounds where filling of cavity is not needed). And wound repair by secondary intention (the way by which chronic wounds are normally solved), a long process in time that needs the filling of the cavity with a neoformation tissue, the granulation tissue. In the present article we described the use of a new dressing of exogenous collagen (Catrix) in the healing of wounds by secondary intention, as well as the actions of this dressing in the different phases of healing. For all it, we supported by a clinical case treated in our unit that corresponds to the healing by second intention of a post-surgical wound secondary to debride by a suppurative hydrosadenitis, that was admitted to our unit waiting for skin graft.