COMPREHENSIVE CARE OF OBESITY PATIENT WITH CHRONIC LEG WOUNDS AND LYMPHEDEMA - CASE REPORT

Abstract

In the process of wound healing, numerous processes occur that, even under ideal circumstances, create functionally less valuable tissue with structural and functional changes. There are numerous risk factors for the development of chronic and so called hard to heal wounds. The presence of a wound, as well as long duration of treatment, affect all spheres of the patient's life and lead to a decline in the quality of life. A model of care according to the principle of comprehensive individualized care with a biopsychosocial approach is described in the presentation of an obese patient with lower leg wounds, lymphedema and difficult, painful moving due to hip os-teoarthritis and peroneal nerve paresis with clubfoot. Non-healing wounds and obesity were an obstacle to the necessary surgical total hip endoprosthesis implantation procedure. Diagnostic procedures included assessment of the patient and healing factors, assessment of the vascular status of the legs by ultrasound color doppler im-aging and measurement of the ankle brachial index, assessment of edema, wounds, and psychosocial status of the patient. In the ther-apy, compression therapy devices, local wound therapy and dress-ings and skin care were used. The patient and family member were educated on compression therapy, along with advice and counseling on diet and exercise, as well as supportive psychotherapy. Chronic wounds on the right lower leg healed in two weeks, and on the left in 11 weeks, without recurrence for two years. In a period of 20 months, the patient reached the recommended body weight and underwent a planned operation, which obtained a good therapeutic result in the form of disappearance of pain and good walking, with-out any complications from the procedure. The partner relationship with the patient with a high level of motivation and adherence, es-pecially in compression therapy, influenced not only the healing of wounds, which was the primary goal, but also the improvement of the overall quality of the patient's life. Such a scope of care requires additional specific knowledge and skills of healthcare professionals, as well as additional equipment of medical institutions that care for patients with wounds.