COMPREHENSIVE CARE OF OBESITY PATIENT WITH CHRONIC LEG WOUNDS AND LYMPHEDEMA - CASE REPORT

U procesu cijeljenja rane događaju se brojni procesi kojima se, čak i u idealnim prilikama, stvara funkcionalno manje vrijedno tkivo uz strukturne i funkcionalne promjene. Brojni su čimbenici rizika za nastanak kronične i teško cijeleće rane. Prisutnost rane kao i dugotrajnost liječenja utječu na sve sfere života bolesnika te dovode do pada kvalitete života. Prikazom pretilog bolesnika s ranama potkoljenica, limfedemom i otežanim kretanjem uz bolove radi osteoartritisa kuka te pareze peronealnog živca uz kljenut stopala, opisan je model skrbi prema principu sveobuhvatne individualizirane skrbi uz biopsihosocijalni pristup. Necijeleće rane i pretilost bile su zapreka za neophodan operativni zahvat ugradnje totalne endoproteze kuka. Dijagnostički postupci uključivali su procjenu bolesnika i čimbenika cijeljenja, procjenu vaskularnog statusa nogu obojenim doplerom i mjerenjem pedobrahijalnog indeksa, procjenu edema, rana kao i psihosocijalnog statusa bolesnika. U terapiji su primjenjena pomagala za kompresivnu terapiju, lokalni postupci obrade rane uz pokrivala i njega kože. Provedena je edukacija bolesnika i člana obitelji o kompresivnoj terapiji, uz davanje savjeta i savjetovanja o prehrani i vježbanju kao i suportivna psihoterapija. Kronične rane na desnoj potkoljenici zacijelile su za dva tjedna, a na lijevoj za 11 tjedana, bez recidiva od dvije godine. U vremenu od 20 mjeseci bolesnik je postigao preporučenu tjelesnu težinu te je podvrgnut planiranoj operaciji koja je polučila dobar terapijski rezultat u vidu nestanka bolova i dobrog hodanja, bez ikakvih komplikacija zahvata. Partnerski odnos s bolesnikom uz visok nivo motiviranosti i suradljivosti, poglavito u primjeni kompresivne terapije, utjecali su ne samo na cijeljenje rana, što je bio primarni cilj, već i na podizanje ukupne kvalitete bolesnikova života. Za takav opseg skrbi potrebna su dodatna specifična znanja i vještine zdravstvenih djelatnika kao i dodatna oprema ordinacija koja skrbi za bolesnika s ranama. In the process of wound healing, numerous processes occur that, even under ideal circumstances, create functionally less valuable tissue with structural and functional changes. There are numerous risk factors for the development of chronic and so called hard to heal wounds. The presence of a wound, as well as long duration of treatment, affect all spheres of the patient\u27s life and lead to a decline in the quality of life. A model of care according to the principle of comprehensive individualized care with a biopsychosocial approach is described in the presentation of an obese patient with lower leg wounds, lymphedema and difficult, painful moving due to hip os-teoarthritis and peroneal nerve paresis with clubfoot. Non-healing wounds and obesity were an obstacle to the necessary surgical total hip endoprosthesis implantation procedure. Diagnostic procedures included assessment of the patient and healing factors, assessment of the vascular status of the legs by ultrasound color doppler im-aging and measurement of the ankle brachial index, assessment of edema, wounds, and psychosocial status of the patient. In the ther-apy, compression therapy devices, local wound therapy and dress-ings and skin care were used. The patient and family member were educated on compression therapy, along with advice and counseling on diet and exercise, as well as supportive psychotherapy. Chronic wounds on the right lower leg healed in two weeks, and on the left in 11 weeks, without recurrence for two years. In a period of 20 months, the patient reached the recommended body weight and underwent a planned operation, which obtained a good therapeutic result in the form of disappearance of pain and good walking, with-out any complications from the procedure. The partner relationship with the patient with a high level of motivation and adherence, es-pecially in compression therapy, influenced not only the healing of wounds, which was the primary goal, but also the improvement of the overall quality of the patient\u27s life. Such a scope of care requires additional specific knowledge and skills of healthcare professionals, as well as additional equipment of medical institutions that care for patients with wounds