{"id":16958,"date":"2023-04-17T20:21:07","date_gmt":"2023-04-17T18:21:07","guid":{"rendered":"http:\/\/old.institutcataladelpeu.com\/?p=16958"},"modified":"2023-05-29T10:30:17","modified_gmt":"2023-05-29T08:30:17","slug":"les-ulceres-classificacio","status":"publish","type":"post","link":"https:\/\/old.institutcataladelpeu.com\/ca\/les-ulceres-classificacio\/","title":{"rendered":"Les \u00falceres d’extremitats inferiors: classificaci\u00f3"},"content":{"rendered":"\r\n

Les \u00falceres s\u00f3n lesions deprimides que apareixen als peus amb afectaci\u00f3 variable, que poden arribar des de la capa m\u00e9s superficial de la pell (epidermis)fins a estructures \u00f2ssies en un proc\u00e9s necr\u00f2tic, amb una caracter\u00edstica comuna: dificultat de cicatritzaci\u00f3 o cura espont\u00e0nia.<\/p>\r\n

\r\n

Classificaci\u00f3 segons la seva etiopatog\u00e8nia<\/b><\/p>\r\n

– \u00dalcera neurop\u00e0tica (45-60%).<\/p>\r\n

– \u00dalcera neuroisqu\u00e8mica (40-55%).<\/p>\r\n

– \u00dalcera isqu\u00e8mica:<\/p>\r\n

\u2022 Obstrucci\u00f3 arterial cr\u00f2nica (arterioesclerosi) 90-95%.<\/p>\r\n

\u2022 Tromboange\u00eftis obliterant (malaltia deBuerger) 5%.<\/p>\r\n

\u2022 Malalties vasoesp\u00e0stiques (malaltia de Raynaud) 10%.<\/p>\r\n

– \u00dalcera infectada (neurop\u00e0tica o neuroisqu\u00e8mica) (cel\u00b7lulitis, infecci\u00f3 necrosant i osteomielitis).<\/p>\r\n

 <\/p>\r\n

Grups de risc<\/b><\/p>\r\n

– Antecedents d’ulceracions pr\u00e8vies.<\/p>\r\n

– Amb neuropatia perif\u00e8rica.<\/p>\r\n

– Amb malaltia vascular isqu\u00e8mica.<\/p>\r\n

– Amb deformitats \u00f2ssies \u00b7 cirurgies preventives<\/p>\r\n

– Antecedents d’alcoholisme.<\/p>\r\n

– Amb a\u00efllament social.<\/p>\r\n

Tipus d’\u00falceres<\/b><\/p>\r\n

– \u00dalceres vasculars: Constitueixen solucions de continu\u00eftat amb p\u00e8rdues de subst\u00e0ncies epiteli-conjuntives, degudes a un proc\u00e9s tissular patol\u00f2gic d’origen vascular i d’evoluci\u00f3 cr\u00f2nica.<\/p>\r\n

Dos tipus: isqu\u00e8miques o arterials est\u00e0siques o venoses. S\u00f3n sempre resultat d’una patologia vascular, de car\u00e0cter cr\u00f2nic i recidivant. Les venoses o d\u2019estasi s\u00f3n les m\u00e9s freq\u00fcents, representen entre 60 i 80%. Les arterials representen entre 10 i 25% encara que poden ser mixtes. Les venoses s\u00f3n m\u00e9s freq\u00fcents en dones i les arterials en homes.<\/p>\r\n

\u2022 Factors de risc: tabac, diabetis, hipertensi\u00f3, obesitat, sedentarisme.<\/p>\r\n

\u2022 La cl\u00ednica de les \u00falceres venoses inclou aparici\u00f3 en regi\u00f3 supramaleolar interna; de grand\u00e0ria variable, poden ser \u00faniques o m\u00faltiples; de formes arrodonides o ovalades; amb vores suaus, una mica elevades, color vermell violaci i brillant; el fons t\u00e9 diferents caracter\u00edstiques. Depenent de l’estat de l’\u00falcera pot ser vermell o groc o presentar secreci\u00f3 purulenta. Dolor moderat o inexistent, quan apareix \u00e9s a causa de la infecci\u00f3.<\/p>\r\n

– La cl\u00ednica de les \u00falceres arterials, en canvi, inclou dolor produ\u00eft per la isqu\u00e8mia i per l’\u00falcera, punyent i ben localitzat, exacerbat per embenatges i el dec\u00fabit. S’alleuja amb cama posici\u00f3 pendulant; fredor per disminuci\u00f3 de l’aportaci\u00f3 sangu\u00ednia; pal\u00b7lidesa que en passar el temps evoluciona a cianosi; claudicaci\u00f3 intermitent, dolor muscular; impot\u00e8ncia funcional; oclusi\u00f3 arterial aguda per obstrucci\u00f3 brusca i abs\u00e8ncia de pols. Localitzaci\u00f3 de l’\u00falcera: entre els dits dels peus o en la punta d’aquests, caps articulars de les falanges, tal\u00f3, mal\u00e8ol extern. En diab\u00e8tics, zona de caps metatarsals, planta del peu. Caracter\u00edstiques de l’\u00falcera: grand\u00e0ria petita, vores ben definides, gran profunditat (es veu l’os), teixit negr\u00f3s o necr\u00f2tic, no t\u00e9 hemorr\u00e0gies, s\u00f3n seques. Canvis associats a la cama o peu: pell prima, brillant i seca, ungles engrossides, abs\u00e8ncia de borrissol, variacions de temperatura, pal\u00b7lidesa, edema periulcer\u00f3s.<\/p>\r\n

 <\/p>\r\n

– \u00dalceres neurop\u00e0tiques: produ\u00efdes per un d\u00e8ficit de sensibilitat que produir\u00e0 la ulceraci\u00f3 en punts de fricci\u00f3 o deformaci\u00f3 del peu. Es localitza en qualsevol punt en la planta del peu, on hi hagi una pressi\u00f3 extr\u00ednseca mantinguda. S\u00f3n ulceracions de forma rodona que presenten hiperqueratosis periulcerals. S\u00f3n indolores.<\/p>\r\n

 <\/p>\r\n

– \u00dalceres per pressi\u00f3: S\u00f3n zones localitzades de necrosis que tendeixen a apar\u00e8ixer quan el teixit tou est\u00e0 comprimit entre dos plans. La pressi\u00f3 normal en els capil\u00b7lars cutanis oscil\u00b7la entre 16-33mm Hg, quan el pes excedeix a aquesta pressi\u00f3 es presenta isqu\u00e8mia local i erosi\u00f3 de la pell i produeix l’\u00falcera. Els factors de risc que n\u2019afavoreixen l\u2019aparici\u00f3 s\u00f3n lesions cut\u00e0nies; trastorns en el transport d’oxigen; defici\u00e8ncies nutricionals; trastorns immunol\u00f2gics; alteracions de l’estat de consci\u00e8ncia; defici\u00e8ncies motores i defici\u00e8ncies sensorials<\/p>\r\n

\u2022 La seva etiopatog\u00e8nia inclou:<\/p>\r\n

\u2022 Pressi\u00f3: \u00c9s una for\u00e7a que actua perpendicular a la pell a conseq\u00fc\u00e8ncia de la gravetat, provocant un aixafament entre dos plans.<\/p>\r\n

\u2022 Fricci\u00f3: \u00c9s una for\u00e7a tangencial que actua paral\u00b7lelament a la pell, produint-se frecs, per moviments o arrossegaments.<\/p>\r\n

\u2022 For\u00e7a de pin\u00e7ament vascular: Combina els efectes de pressi\u00f3 i fricci\u00f3.<\/p>\r\n

 <\/p>\r\n

Tractament<\/b><\/p>\r\n

El tractament \u00e9s multidisciplinari, prolongat i dif\u00edcil, per la qual cosa ser\u00e0 fonamental establir un diagn\u00f2stic diferencial entre els diferents tipus d’\u00falceres. La cura local ha d’anar acompanyada de la correcci\u00f3 de la causa productora, crucial en la curaci\u00f3, aix\u00ed com a evitar la recidiva (plantilles de desc\u00e0rrega). \u00c9s molt necessari mantenir ben neta i hidratada la pell perilesional. Hem d\u2019evitar l’ab\u00fas d’antis\u00e8ptics agressius sobre la pell ja que la ressequen molt.<\/p>\r\n<\/div>\r\n

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\"Les<\/figure>","protected":false},"excerpt":{"rendered":"

Les \u00falceres s\u00f3n lesions deprimides que apareixen als peus amb afectaci\u00f3 variable, que poden arribar des de la capa m\u00e9s superficial de la pell (epidermis)fins a estructures \u00f2ssies en un proc\u00e9s necr\u00f2tic, amb una caracter\u00edstica comuna: dificultat de cicatritzaci\u00f3 o cura espont\u00e0nia. Classificaci\u00f3 segons la seva etiopatog\u00e8nia – \u00dalcera neurop\u00e0tica (45-60%). – \u00dalcera neuroisqu\u00e8mica (40-55%). […]<\/p>\n","protected":false},"author":3,"featured_media":16952,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[276,346,306,307],"tags":[],"class_list":["post-16958","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-alteracions-dermatologiques","category-icp-ca","category-patologia-ca","category-peu-diabetic"],"yoast_head":"\nLes \u00falceres d'extremitats inferiors: classificaci\u00f3 - Institut Catal\u00e0 del Peu<\/title>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"ca_ES\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Les \u00falceres d'extremitats inferiors: classificaci\u00f3 - Institut Catal\u00e0 del Peu\" \/>\n<meta property=\"og:description\" content=\"Les \u00falceres s\u00f3n lesions deprimides que apareixen als peus amb afectaci\u00f3 variable, que poden arribar des de la capa m\u00e9s superficial de la pell (epidermis)fins a estructures \u00f2ssies en un proc\u00e9s necr\u00f2tic, amb una caracter\u00edstica comuna: dificultat de cicatritzaci\u00f3 o cura espont\u00e0nia. Classificaci\u00f3 segons la seva etiopatog\u00e8nia – \u00dalcera neurop\u00e0tica (45-60%). – \u00dalcera neuroisqu\u00e8mica (40-55%). 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