17. Traitement des lésions cutanées

Capsules pour l’action pour LM (2nd ed., 2013)

Le problème:Man using hand to brake wheelchair

Chez les personnes ayant une LM, environ 75 % des ulcères de décubitus sont de stade I ou II et peuvent être traitées de façon habituelle. Les 25 % restants, de stade III ou IV, exigent une prise en charge plus spécialisée. Les ulcères graves peuvent réduire la mobilité et l’autonomie, imposer une amputation et même causer des infections mortelles. Le traitement est plus efficace lorsque le diagnostic est précoce et le traitement instauré rapidement.

Capsule pour l’action

Stade I ou II : soins de plaies habituels. Stade III ou IV : intervention spécialisée ou approche chirurgicale.

 

Plus d´informations: International classification for wound care

Pratiques d’excellence fondées sur des preuves:

Le soin usuel des ulcères de stade I et II comprend nettoyage, débridement et pansement compressif. On a obtenu des résultats encourageants avec des produits pouvant être administrés à domicile par une équipe de soin des plaies : hydrocolloïde occlusif, stimulation électrique, poudre d’arginine et gel plaquettaire. On recommande d’offrir une intervention précoce, un enseignement des autosoins et une aide à la décision, ainsi qu’une consultation en réadaptation pour obtenir de l’aide en matière de siège et de prévention. Une consultation en diététique pourrait être utile, l’état nutritionnel pouvant affecter significativement la guérison (particulièrement l’apport en énergie et en protéines).

Pour les ulcères de stade III et IV, on recommande la chirurgie, puisqu’il est démontré qu’elle a des effets positifs importants sur la guérison des plaies et la qualité de vie. Les communications par télé ou visioconférence ont rendu les soins spécialisés plus accessibles, générant un bon niveau de concordance avec l’évaluation in situ.

Source clé:

    European Pressure Ulcer Advisory Panel & National Pressure Ulcer Advisory Panel (2009). Pressure Ulcer Prevention: Quick Reference Guide. Washington DC: National Pressure Ulcer Advisory Panel

Références supplémentaires:

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    Baker, L.L., et al. (1996). Effect of electrical stimulation waveform on healing of ulcers in human beings with spinal cord injury. Wound Repair & Regeneration, 4(1): 21-8.
http://dx.doi.org/10.1046/j.1524-475X.1996.40106.x
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