Skin tears flap management in patient affected by dermatoporosis
Dermatoporosis is the chronic cutaneous atrophy syndrome that makes the skin particularly fragile and it is the main risk factor in the onset of skin tears (ST). The syndrome is still little known in our country and the particularity acquired by affected skin and its difficulty in regeneration is often ignored. STs, which are often underestimated both by the patient and by the medical staff, have, in the patient with dermatoporosis, an evolution towards the most difficult healing, in which the management of the free skin flap (FSF) is fundamental. If the management of the FSF is inadequate, the evolution of the injury goes towards chronicity, which leads to greater patient suffering and waste of resources.
Following the spontaneous observation of the evolution of ST in patients with dermatoporosis from 2009 to date (about 150) it is clear that the preservation and the combination of vital FSF following an unsuitable cleansing or non-vital FSF, affects the reparative process even if you use appropriate advanced medications.
Based on the gained experience, a series of practical recommendations are defined in the immediate and late intervention for the management of the FSF on: the cleansing of the fund of the lesion and of the internal part of the vital flap, the preservation of the flap during cleansing, the primary dressing and the importance of maintaining the right humidity gradient in the interval between dressings.
To illustrate this, it is brought into vision the evolution of ST in some clinical cases with FSF treated differently with the first two-hour to twenty-day intervention in patients with: age >80 years, Barthel Index from 0 to 100, dermatoporosis stage IIb-IV, ST type T2-T3, FSF >2 cm. Healing times from five to one hundred days, compared to the state and treatment of the flap.
The presence and condition of the flap directly affect the healing of ST, the phenomenon is to be explored through clinical studies. With adequate management of the FSF even in the patient with dermatoporosis the STs can reach healing within 15 days. The process lends itself to standardization for the resemblance of the patient's condition.