Abstract | Uvod: Karcinom dojke je najčešći maligni karcinom kod žena. Od ove bolesti u Hrvatskoj godišnje oboli oko 3000 žena. Liječenje karcinoma dojke uključuje kirurške zahvate, kemoterapiju, zračenje, hormonsku terapiju i terapiju tzv. pametnim lijekovima. Kirurško liječenje je potrebno provesti u većeg broja bolesnica s karcinomom dojke. Kod liječenja karcinoma dojke potrebno je napraviti rezove na dojci i pazuhu ako se radi o poštednim operacijama dojke te veće rezove na dojci i torakalnoj stijenci ako se radi o radikalnim operacijama ili rekonstrukicjama dojke. Briga o kirurškom rezu počinje već u operacijskoj dvorani i nastavlja se tijekom boravka na odjelu te po otpustu iz bolnice u kućnoj njezi. Kod šivanja rane na dojci najčešće se koriste resorptivni potkožni šavi kojima se postiže rasterećenje napetosti na šavnoj liniji, a rubovi kože se dovedu u bliski kontakt. Dalje se jednim resorptivnim produžnim šavom dermis i epidermis dovedu u bliski kontakt. Na kraju šivanja rana ima minimalno sekrecije na šavnoj liniji. Tradicionalni i najčešći način njege rane na dojci sličan je kao i na drugim mjestima na tijelu, upotrebom kompresa koje se stavljaju u operacijskoj dvorani na ranu. Prevoj rane i zamjena kompresa vrši se prvi ili drugi postoperacijski dan. Nakon kirurškog zahvata na dojci, pažljiva briga o ranama postaje ključna komponenta procesa oporavka pacijentica, pri čemu je važno odabrati optimalno vrijeme za započinjanje aktivnosti poput tuširanja i fizikalne terapije, uzimajući u obzir stanje rane i odabranu metodu njege. Rane koje su suhe i bez sekrecije kod previjanja mogu se već nakon 48h sati ostaviti otvorene i može se započeti s tuširanjem. U novije vrijeme poseže se za oblogama za rane ili se koriste posebni flasteri za pokrivanje rana.
Cilj: usporediti različite metode pokrivanja rana. Usporediti tradicionalni način pokrivanja rane samo kompresom, pokrivanje rane posebnim flasterima za rane tzv. „steri strip“ suturama i pokrivanje rane s običnim flasterom “micropore”.
Metode: Kod 30 bolesnica u operacijskoj dvorani na tek sašivenu ranu postavili smo samo sterilne komprese. Na drugih 30 „steri strip“ suture, a kod 30 bolesnica postavili smo samo flaster „micropore“. Izgled ožiljka pratili smo kod previjanja na odjelu, kod previjanja u poliklinici te na kontroli nakon mjesec dana od operacije. Bilježeni su znaci sekrecije iz rane prvi ili drugi postoperacijski dan, znakovi infekcije u postoperacijskom tijeku, te zadovoljstvo bolesnica s
izgledom ožiljka nakon mjesec dana. Sve bolesnice bile su upoznate s istraživanjem i imaju potpisan informirani pristanak.
Rezultati: ustanovljeno je da rane pokrivene flasterom/microporem imaju značajno manje krvarenja ili sekrecije iz rane prvi postoperativni dan. Nema značajnih razlika u raspodjeli načina pokrivanja kirurške rane, prevoju nakon 7 do 10 dana, infekciji, zaprekama u fizikalnoj terapiji ili u estetskom izgledu ožiljka mjesec dana nakon operacije.
Zaključak: Istraživanje je pokazalo da bolesnice čije su rane prekrivene steri strip suturama i microporom imaju manje krvarenje i sekreciju iz rane prvi postoperativni dan, za razliku od rana koje su prekrivene samo kompresama. |
Abstract (english) | Introduction: Breast cancer is the most common malignant cancer in women. Around 3000 women are diagnosed with this disease annually in Croatia. Treatment for breast cancer includes surgical procedures, chemotherapy, radiation therapy, hormone therapy, and targeted therapy with so-called "smart drugs." Surgical intervention is necessary for a significant number of breast cancer patients. Depending on the type of surgery, incisions are made on the breast and armpit for breast-conserving surgeries, or larger incisions on the breast and thoracic wall for radical surgeries or breast reconstructions. Care for the surgical incision begins in the operating room and continues during the hospital stay and upon discharge into home care. Resorbable subcutaneous sutures are commonly used for suturing the wound on the breast, providing relief from tension on the suture line and bringing the skin edges into close contact. Further, a single resorbable continuous suture brings the dermis and epidermis into close contact. Minimal secretion is expected at the suture line at the end of wound closure. The traditional and most common method of wound care on the breast is similar to other areas of the body, using compresses applied in the operating room. Wound dressing changes are performed on the first or second postoperative day. After breast surgery, careful wound care becomes a crucial component of patient recovery, where choosing the optimal time to initiate activities such as showering and physical therapy is essential, considering the wound condition and chosen method of care. Dry wounds without secretion can be left open after 48 hours of dressing, and showering can commence. Recently, there has been a trend towards using wound dressings or special adhesive dressings for wound coverage.
Aim: compare different wound dressing methods. Compare the traditional way of covering the wound with only a compress, covering the wound with special plasters for wounds, the so-called "steri strip" sutures and covering the wound with an ordinary "micropore" patch.
Methods: In the case of 30 patients, only sterile compresses were applied to the freshly sutured wound in the operating room. On the other 30, "steri strip" sutures were applied, and in 30 patients, only a patch was placed on the sutured wound. We monitored the appearance of the
scar during dressings in the ward, during dressings in the polyclinic, and at the check-up one month after the operation. Signs of secretion from the wound were recorded on the first or second postoperative day. Signs of infection in the postoperative course, and the patients satisfaction with the appearance of the scar one month after procedure. All patients were informed about the research and have signed informed consent.
Results: it was found that wounds covered with patch/micropore had significantly less bleeding or secretions from the wound on the first postoperative day. There are no significant differences in the distribution of surgical wound coverage, dressings after 7 to 10 days, infection, physical therapy delay, or the aesthetic appearance of the scar one month after surgery.
Conclusion: Research has shown that patients whose wounds are covered with plaster and micropore have less bleeding and secretion from the wound on the first postoperative day, in contrast to wounds that are covered only with compresses. |