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Samenvatting Hoofdstuk 1: Diagnostiek en classificatie wonde $5.93
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Samenvatting Hoofdstuk 1: Diagnostiek en classificatie wonde

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Wondclassificatie volgens het TIME-concept

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  • October 3, 2023
  • 12
  • 2023/2024
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VD&I 3: Heelkunde
Hoofdstuk 1: Diagnostiek en classificatie wonde
1.1 Inleiding
- 3 huidlagen
 Epidermis
 Vernieuwt om de maand
 Relatief dode laag -> schilfert continu af
 Dermis
 Levende laag -> bevat bloedvaten, zenuwen, bindweefsel, collageen
(stevigheid), elastine, zweetklieren, haarfollikels
 Epitheelcellen migreren naar wondoppervlak
 Eerste belemmerende factoren verwijderen (geel weefsel, …)
 Volledig rood weefsel (granulatieweefsel)  epitheelcellen
kunnen te werk gaan
 Hypodermis
 Bevat vetweefsel, bindweefsel, …

- 4 fase van wondheling
 Stollingsfase
 1ste instantie bloeding -> bloedplaatjes zorgen voor stolling -> ontstaan
van fibrinenetwerk (gele/etterige kleur)
 Ontstekingsfase
 Warmte, rood, zwelling, pijn
 Duurt niet vrij lang, i.t.t. bij immuungecompromiteerde patiënten
 Proliferatie fase
 Aanmaak nieuw bindweefsel
 Duur afhankelijk van soort wonde (chirurgisch <-> vuil)
 Remodeling/herstelfase
 Duur: +/- 1 jaar

1.2 Wondclassificatie!!
Etiologie (= oorzaak van de wonde)
- Acute wonde
 Duur: 4 à 6 weken
 Iatrogeen: heelkundige incisie, amputatie, wonde na biopsie, donorsite, …
 Niet-iatrogeen (trauma): scheur, blaar, brandwonde, steekwonde
- Chronische wonde
 Duur: > 8 weken
 Ulcus cruris = beenzweer (=vasculair probleem)
 Oorzaken: slechte doorbloeding, OL, ouderdom, trauma
 Diabetische voet
 Decubitus wonde
- Oncologische wonde (zien we volgend jaar)
 VB: tumor die de huid doorboort, bestralingswonde
Uniforme beoordeling

, - Belangrijk voor genezing op te volgen + overdrachten te kunnen communiceren

TIME(DH)-concept
- Doel: WBP
 = gezond maken van wondbodem
 = wound bed preparation
- Acute <-> chronische wonde
 Hetzelfde mechanisme qua heling
 MAAR: genezing chronische wonde is verstoord door necrose, bacteriën,
exsudaat, onderliggende aandoeningen, …
 Acute, normale wondgenezing
 Genezing binnen 4 weken of duidelijk kleiner (> 30-50%)
 Vertraagde wondgenezing
 Genezing: 4 - 8 weken
 Chronische wonde
 Wondgenezing valt stil na 8 weken

- T: tissue management
- I: inflammation and infection control
- M: moisture balance
- E: epithelial (edge) advancement

- D: disease/diagnosis
- H: healing

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