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      Cronificación de una herida traumática por diversos factores Translated title: Traumatic wound chronification through various factors

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          Abstract

          RESUMEN Exponemos un caso clínico que nos puede servir como ejemplo y análisis de varios factores que observamos en nuestra práctica diaria. Las diversas circunstancias ocurridas tras el tratamiento inicial, además de las propias dificultades intrínsecas de la herida, hacen que observemos el proceso de curación como un tratamiento sistémico y holístico, además de local. Reseñaremos un caso en el que, tras un accidente fortuito, se produce una herida compleja. El tratamiento inicial fue realizado mediante técnicas convencionales, pero circunstancias como las creencias religiosas y la mala relación enfermera-paciente desencadenó una mala adhesión al tratamiento, además del uso de alternativas terapéuticas populares. Todo esto acabó en una mala evolución de la herida y la cronificación de la misma. La oportuna derivación a la Unidad de Heridas Crónicas encauzó el tratamiento y la posterior resolución del caso.

          Translated abstract

          ABSTRACT We present a case report that serves as an example and analysis of several factors that we observe in our daily practice. The different conditions that occurred after the initial treatment, in addition to the intrinsic difficulties of the wound, make us observe the healing process as a systemic and holistic treatment, as well as a local one. We will review a case of a complex wound, after a fortuitous accident. The initial treatment was performed using conventional techniques, but religious beliefs and the poor nurse-patient relationship, triggered a bad adherence to treatment and the use of popular therapeutic alternatives. All this ended in a bad evolution and chronification of the wound. Referral to Chronic Wounds Unit, directed the treatment and the resolution of the case report.

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          Angiosomes of the leg: anatomic study and clinical implications.

          In 1987, Taylor and Palmer introduced the angiosome concept. This anatomical study defined the three-dimensional vascular territories supplied by source arteries and veins to each tissue layer between the skin and the bone. This report, however, was an overview investigation and did not study each region of the body in fine detail. In 1996, Inoue and Taylor studied the angiosomes of the forearm in much greater detail. They showed, among other findings, that the zone between the angiosomes, formed by reduced caliber (choke) vessels or similar caliber (true) anastomotic arteries, occurred usually within tissues, especially the muscles, not between them. This study focuses on the same region in the lower limb to draw a comparison and to fill certain voids in our knowledge--the leg. Twelve lower limbs from fresh cadavers were investigated over a 2-year period after perfusing each with a mixture containing radio-opaque lead oxide. The anatomy of the arterial supply to the skin, the muscles, and the periosteum of the bones of the leg was examined. The contribution to each tissue was defined by dissection, by metal clip tagging of vessels, by radiography, and by mapping the branches with colored pins, coded to match the respective source arteries. A subtraction technique was used to study the muscles whereby the bones of the limb were replaced with radiolucent balloons to obtain an unobscured picture of the vasculature of the leg. The muscles were then segregated one by one from the muscle mass and x-rayed again. Next, cross-section studies were made in two legs to complete the three-dimensional picture, tracing the branches from the source arteries to each layer. Finally, the contribution to each tissue from the popliteal, sural, anterior tibial, posterior tibial, and peroneal vessels were color coded to match these source arteries, thus defining the angiosomes of the leg. Results, as in the forearm, showed that in most cases the connections between adjacent angiosomes occurred within tissues, not between them. The skin, the bones, and most muscles received branches from two or more angiosomes, thus revealing one of the important anastomotic pathways through which the circulation is reconstituted when a source artery is interrupted by disease or trauma. Notably, however, the muscles of the anterior compartment of the leg were supplied from one angiosome. This finding, coupled with the anatomy of the rigid fascial compartments of the leg, helps explain the variable clinical pictures and syndromes seen in cases in which the circulation is compromised or interrupted. Finally, this anatomical study adds further information to help design or redesign flaps in the leg for local or free transfer. Similarly, the information reveals the pathways through which the supply to the remaining tissues is reconstituted when one of the source arteries is harvested with a free flap, especially when multiple tissues are included in the transplant.
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            Métodos alternativos para el tratamiento de pacientes con heridas infectadas

            Se revisó la bibliografía médica disponible sobre el uso de algunas sustancias de origen natural, utilizadas desde la antigüedad para tratar a personas lesionadas, inicialmente por traumatismos. Con el transcurso del tiempo, los conocimientos trasmitidos de una generación a otra condujeron a emplearlas para desinfectar heridas quirúrgicas y curar o cicatrizar úlceras, escaras y quemaduras, entre otras lesiones. La miel, el azúcar y los peloides, específicamente el limo, han devenido eficaces medicamentos para eliminar infecciones y reparar heridas, con mejores resultados que los derivados de productos industriales y otros métodos alternativos, puesto que además de ser menos costosos y de fácil aplicación, ejercen su acción beneficiosa sin tener que combinarse con antibióticos o compuestos cicatrizantes.
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              Hipergranulación en heridas crónicas: un problema ocasional pero no infrecuente

              La hipergranulación es un problema ocasional, pero a la vez no infrecuente, con el que se enfrentan muchos clínicos responsables del tratamiento de heridas en su práctica diaria. Este fenómeno ocurre en un amplio abanico de heridas que incluyen las incisiones y heridas posquirúrgicas, los estomas (gastrostomías, traqueostomías, etc.) y las heridas crónicas. El objetivo del presente artículo es cuantificar y analizar la evidencia generada en torno al tema de la hipergranulación en las heridas crónicas, mediante la búsqueda bibliográfica en diversas bases de datos. Tras el análisis y revisión de los diferentes documentos recuperados se evidencia, tanto cuantitativa como cualitativamente hablando, una escasez importante de investigación en torno a la hipergranulación en heridas crónicas. Esto hace que el problema no se halle lo suficientemente explicado y que no existan evidencias sólidas que justifiquen el uso de un tratamiento sobre otro.
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                Author and article information

                Journal
                geroko
                Gerokomos
                Gerokomos
                Sociedad Española de Enfermería Geriátrica y gerontológica (Barcelona, Barcelona, Spain )
                1134-928X
                2020
                : 31
                : 1
                : 51-54
                Affiliations
                [4] orgnameHospital General San Jorge orgdiv1Servicio de Dermatología España
                [3] orgnameHospital General San Jorge orgdiv1Unidad de Enfermería Cirugía General España
                [5] orgnameHospital Sagrado Corazón de Jesús orgdiv1Enfermería España
                [1] orgnameHospital General San Jorge orgdiv1Servicio de Urgencias España
                [2] orgnameHospital Sagrado Corazón de Jesús orgdiv1Unidad de Heridas Crónicas
                Article
                S1134-928X2020000100010 S1134-928X(20)03100100010
                0cf047c6-c6d3-4c2b-b0d6-502af8ac0052

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 09 November 2018
                : 11 October 2018
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 10, Pages: 4
                Product

                SciELO Spain

                Categories
                Helcos

                herida aguda cronificada,relación enfermera-paciente,acute chronic wound,Herida traumática,Traumatic wound,nurse-patient relationship,mala adhesión al tratamiento,poor treatment adherence

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