褥瘡のラップ療法 eocities.jp.docVIP

褥瘡のラップ療法―開放性湿潤療法― Food-wrap-treatment of pressure ulcers; use of kitchen products such as food wrap and perforated polyethylene film as a non-adherent dressing たかせクリニック?顧問 鳥谷部 俊一 Director, Takase Clinic TORIYABE, Shunichi M.D. Key words:　褥瘡, ラップ療法, 開放性湿潤療法, OpWT. 要約 ラップ療法は褥瘡のドレッシング療法を簡便にした.1999年,筆者は食品用ラップを用いたⅢ-Ⅳ度褥瘡の処置法について報告した.穴あきポリエチレンフィルムと紙おむつを用いる処置法はその改良である.台所用穴あきポリエチレン袋と紙おむつで作った手製のドレッシングは患部や創の形状によく対応する.創に接するフィルムには,内径1mm,開口率5%の小さな穴が開いており,過剰な浸出液を処理しつつ創面の湿潤を保つ.ラップ療法は,ずり応力を打ち消し,ドレッシング処置を容易にする.ドレッシングが皮膚からずり上がる場合はフィルムが皺になって摩擦力を打ち消す. このドレッシング療法は閉鎖療法ではなく開放療法というものであり,筆者は開放性湿潤療法の用語を提唱している. ラップ療法に用いる材料は医療用に認可されたものではないが,臀部などの汚染域の使用に耐える台所用品である. 2010年3月,日本褥瘡学会理事会は,医師の責任のもとで行うことなどの条件付でラップ療法の実施を認める趣旨の見解を発表した. Abstract Food-wrap-treatment makes wound dressing of pressure ulcers simple and easy. The author reported in 1999 that cases of stages 3-4 pressure ulcers had been successfully treated by using a food wrap. In 2005, the author started using perforated plastic film as a dressing material and found it more effective than the previous food wrap treatment. The handmade dressing, consisting of a kitchen plastic bag made of perforated polyethylene film and a flat paper diaper, conforms well to the wound and the surrounding area regardless of the shape or depth of the wound. The wound-contact layer is made of non-adherent plastic film (pore-size 1mm, pore/film ratio in area 5%), which keeps wound surface wet and lets excessive wound fluid drained.　Use of plastic film makes “difficult-to-dress” wound “easy-to-dress” by reducing shear forces.　As the dressing rides up by friction, the film crumples between the skin and the diaper, and relieves shear forces incurred on the wound surface. The dressing is not occlusive but open in terms of drainage, thus the term, “Open Wet-dressing Therapy; OpWT”, was coined. Although materials used for food-wrap-treatment are not medical products, they are sanitary enough for use in excrement-soaked environment. In March 2010, the board of Ja