Uso de sistema de presión negativa (VAC) para tratamiento de herida compleja en dorso de mano y antebrazo derecho
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Fecha
2021
Autores
Perilla Escorcia, Claudia
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Ediciones Universidad Simón Bolívar
Facultad de Ciencias de la Salud
Facultad de Ciencias de la Salud
Resumen
Introducción: en el presente trabajo se podrá apreciar el caso clínico, con la utilización
del método de cierre asistido de heridas con presión negativa, como tratamiento
alternativo a la amputación de la extremidad afectada.
Objetivo: aplicar sistema de presión negativa (VAC) para tratamiento de herida
compleja en dorso de mano y antebrazo derecho.
Método y materiales: paciente femenina de 44 años sin antecedentes patológicos;
hospitalizada por el servicio de ginecología con diagnóstico de embarazo tardío de 41
semanas con realización de cesárea de urgencia por sufrimiento fetal. Dada la lesión
de difícil manejo y la inestabilidad hemodinámica fue necesaria la realización de una
escarectomía tangencial temprana y un desbridamiento escisional del tejido necrótico y
lavados quirúrgicos del área cruenta con la colocación de apósitos de sistema de
presión negativa.
Resultados: tras los procedimientos hubo exposición de los tendones extensores, y
delimitación del área comprometida con una gran herida con exposición de estructuras
vitales para la funcionalidad de la mano y los dedos. Con preservación de estructuras
funcionales y reconstrucción de partes blandas conservando estética y funcionalidad de
la mano.
Conclusiones: la utilidad de este protocolo es una alternativa útil de salvamento de
miembros en pacientes quienes por sus condiciones no son candidatos a otro tipo de
procedimientos quirúrgicos, con un riesgo inminente de amputación de la extremidad
comprometida, además de su efectividad en el tratamiento simultaneo de patologías
infecciosas cáusales del deterioro sistémico del paciente.
Introduction: in this work we will be able to appreciate the clinical case, with the use of the method of assisted closure of wounds with negative pressure, as an alternative treatment to the amputation of the affected limb. Objective: to apply a negative pressure system (VAC) to treat complex wounds on the back of the hand and right forearm. Method and materials: 44-year-old female patient with no pathological history; hospitalized by the gynecology service with a diagnosis of a late pregnancy of 41 weeks with an emergency cesarean section due to fetal distress. Given the difficult-to-manage lesion and hemodynamic instability, it was necessary to perform an early tangential scarectomy and excisional debridement of the necrotic tissue and surgical washings of the bloody area with the placement of negative pressure system dressings. Results: after the procedures there was exposure of the extensor tendons, and delimitation of the area involved with a large wound with exposure of vital structures for the functionality of the hand and fingers. With preservation of functional structures and reconstruction of soft tissues, preserving aesthetics and functionality of the hand. Conclusions: the usefulness of this protocol is a useful alternative for limb salvage in patients who, due to their conditions, are not candidates for other types of surgical procedures, with an imminent risk of amputation of the compromised limb, in addition to its effectiveness in simultaneous treatment of infectious pathologies causal of the systemic deterioration of the patient.
Introduction: in this work we will be able to appreciate the clinical case, with the use of the method of assisted closure of wounds with negative pressure, as an alternative treatment to the amputation of the affected limb. Objective: to apply a negative pressure system (VAC) to treat complex wounds on the back of the hand and right forearm. Method and materials: 44-year-old female patient with no pathological history; hospitalized by the gynecology service with a diagnosis of a late pregnancy of 41 weeks with an emergency cesarean section due to fetal distress. Given the difficult-to-manage lesion and hemodynamic instability, it was necessary to perform an early tangential scarectomy and excisional debridement of the necrotic tissue and surgical washings of the bloody area with the placement of negative pressure system dressings. Results: after the procedures there was exposure of the extensor tendons, and delimitation of the area involved with a large wound with exposure of vital structures for the functionality of the hand and fingers. With preservation of functional structures and reconstruction of soft tissues, preserving aesthetics and functionality of the hand. Conclusions: the usefulness of this protocol is a useful alternative for limb salvage in patients who, due to their conditions, are not candidates for other types of surgical procedures, with an imminent risk of amputation of the compromised limb, in addition to its effectiveness in simultaneous treatment of infectious pathologies causal of the systemic deterioration of the patient.
Descripción
Palabras clave
Sepsis, Necrosis cutánea, Sshock séptico, Necrosis isquemia, Desbridamiento, Skin necrosis, Septic shock, Ischemic necrosis, Debridement