Promoción de la cicatrización de heridas después de la gangrena de Fournier

PROTOCOLO FOCAL

Valores del protocolo focal

Aplicación: Distribuida sobre los bordes de la herida
Densidad de energía: EFD: 0,10 - 0,25 mJ/mm², dependiendo de la tecnología del dispositivo y de la percepción del dolor por parte del paciente.
Frecuencia: 3-5 Hz
Impulsos: 2000-4000
Nº de sesiones: 2-3 veces por semana
Duración del tratamiento: 6-12 semanas

Información médica

A principios de la década de 1990, Gerald Haupt ya demostró que las ondas de choque de baja energía favorecen la cicatrización de heridas. Desde entonces, se han publicado numerosos informes sobre el efecto positivo de la aplicación de ondas de choque en heridas de difícil cicatrización (por ejemplo, úlceras diabéticas). Esto llevó al primer autor de este capítulo a utilizar la terapia extracorpórea de ondas de choque (ESWT) para la cicatrización de heridas tras una gangrena de Fournier, tanto con cobertura plástica mediante colgajos rotatorios como sin ella.

La gangrena de Fournier representa una fascitis necrosante en la zona de los genitales externos y el periné. Requiere una escisión radical inmediata de la piel afectada y de las áreas subcutáneas, así como un tratamiento intensivo del paciente. Tras un tratamiento primario exitoso, se utilizan diferentes técnicas para cubrir los defectos cutáneos (injertos de piel parcial, colgajos rotatorios), las cuales conllevan un riesgo de cicatrización secundaria.

Basándose en la buena experiencia con la terapia extracorpórea de ondas de choque de baja intensidad (Li-ESWT) en el tratamiento de úlceras cutáneas crónicas, recientemente se informó sobre un tratamiento adyuvante en tres casos con cicatrización secundaria después de cirugía con colgajo rotatorio. Posteriormente, se logró el cierre completo del defecto mediante crecimiento tisular localizado inducido por las ondas de choque.

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