vacuüm assisted wound closure naar de thuissituatie

Upload: serraes-b

Post on 11-Feb-2018

218 views

Category:

Documents


0 download

TRANSCRIPT

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    1/66

    @foax`yl ggoh`iea`o qeq c`q i`cgm`o tgo c`q af~mekg igjc`mey fo a` t`y~m``hlpoa`Gjga`kf`bggy 9>>8 9>>3

    Tgjpkqc`yg~f` oggy a` qcpfzz`qqfoh

    LgCe Zfoq+Mf`t`o+ Jgk~pz XGGZ

    Cez~fqggmzqyggq 9:

    67>> Zfoq+Oflmggz

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    2/66

    Z`yyg`z Iy`jcq

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    3/66

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    4/66

    @foax`yl ggoh`iea`o qeq c`q i`cgm`o tgo c`q af~mekg igjc`mey fo a` t`y~m``hlpoa`Gjga`kf`bggy 9>>8 9>>3

    Tgjpkqc`yg~f` oggy a` qcpfzz`qqfoh

    LgCe Zfoq+Mf`t`o+ Jgk~pz XGGZ

    Cez~fqggmzqyggq 9:

    67>> Zfoq+Oflmggz

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    5/66

    Z`yyg`z Iy`jcq

    @foax`yli`h`m`fafoh2 L/ Dm``ygll`yz `o G/ A` Imejl

    Xeeya teeygd

    A` pfqx`ylfoh tgo afq `foax`yl fz qeq zqgoa h`lek`o- agolrfb a` cpm~ tgo c``m xgq k`oz`o/ C`q

    mfblq k` ago eel h`~gzq ek ``o agolxeeya q` yfjcq`o qeq c`o- af` y`jcqzqy``lz ed eoy`jcqzqy``lz

    c`ii`o ifbh`aygh`o qeq c`q y`gmfz`y`o tgo a`r` qc`zfz/

    Fo a` ``yzq` ~mggqz xfm fl a` k`a`x`yl`yz tgo Lfo`qfj Jeoj`~qz Foj/ K`afjgm I`mhfpk ITIG

    i`agol`o fo c`q ifbreoa`y` ipzfo zz pofq kgogh`y< Bgo Ieoog`y`oz- ~yeb`jq kgogh`y< Jcyfz

    Ieyzq`o- gjjepoq Kgogh`y< Tgmyf` C`ykgo teey cpo i`y`faxfmmfhc`fa ifb c`q pfqxfzz`m`o tgo

    i`mgohyfbl` forfjcq`o `o c`q a`m`o tgo fodeykgqf`/ Afq xgz ``o jypjfgm` zjcgl m- af` c``m xgq

    ifbaye h qeq a r` qc`zfz/

    Aggyoggzq xgz c`q cgyq+ `o tggqj`oqypk 7- GR Zfoq Imgzfpz q` A`oa`ykeoa` fo c`q ifbreoa`y`

    `foax`ylk`oqey Jgyfo K``yq `o Afyl Ezq zq``az i y`fa ek qfba tyfb q` kgl`o `o k` ifb q`

    zqggo k`q ygga `o agga/ Fl xfm c`o ago eel agol`o teey a` ifbzqgoa af` r` k` t`ym``oa`o/

    Eel K`ty/ Dm `ygll`yz L/ `o K`ty/ A` Imejl G/+ kfbo `foax yli`h`m fazq`yz tgo a`

    Lgqcemf`l` Ceh`zjceem Zfoq+Mf`t`o + xfm fl i`agol`o teey cpo ygga `o c`q t`yqyepx`o/

    T`ya`y yfjcq fl a` hyeeqzq` agoli`qpfhfoh ggo kfbo epa`yz + rfb c`ii`o k` a` lgoz h`h`t`o ek

    q` zqpa`y`o `o c`ii`o k` h`zq`poa fo a` ke`fmfbl` kek`oq`o + `o kfbo tyf`oafo teey c`q m`r`o

    `o eoa`yzq`po`o tgo afq `foax`yl/ Iet`oaf`o xfm fl eel ``o xeeya tgo agol yfjcq`o ggo Bgo

    A`k``zq`y + ceeda reyha`~gyq`k`oq Xeeo+ `o Reyhj`oqypk Zfoq+Tfoj`oqfpz TRX+ `o

    Jgqcgyfog a` Zmeet y teey c q m`r`o `o c q t`zqy`ll`o tgo a` oeafh` fodeykgqf` yeoa

    xeoai`cgoa`mfoh fo c`q gmh`k``o/

    Aeey a`r` ayf`bgyfh` e~m`fafoh i`o fl of`q gmm``o gmz qe`lekzqfh` t`y~m``hlpoafh` kggy eel gmz

    k`oz h`hye`fa e~ t`yzjcfmm`oa` tmgll`o/

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    6/66

    Bpof 9>>3- Zfoq+ Oflmggz

    Z`yyg`z Iy`jcq

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    7/66

    Focepaze~hgt`

    LGCE ZFOQ+MF@T@O+ JGK^PZ XGGZ ////////////////////////////////////////////////////////////////////////////////////////////////////////////////7

    CEZ^FQGGMZQYGGQ 9:67>> ZFOQ+OFLMGGZ ////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////7

    LGCE ZFOQ+MF@T@O+ JGK^PZ XGGZ ////////////////////////////////////////////////////////////////////////////////////////////////////////////////1

    CEZ^FQGGMZQYGGQ 9:67>> ZFOQ+OFLMGGZ ////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////1

    XEEYA TEEYGD //////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////0

    FOCEPAZE^HGT@ ////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////8

    FOM@FAFOH ///////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////3

    7/ GOGQEKF@ TGO A@ CPFA ///////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////6

    7/7/ A@ CPFA GMZ EYHGGO //////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////6

    7/9/ A@ DPOJQF@Z TGO A@ CPFA ////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////6

    9/ TGJPPK GZZFZQ@A XEPOA JMEZPY@ QC@YG^F@ //////////////////////////////////////////////////////////////////////////////77

    :/ C@Q ZVZQ@@K ///////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////76

    1/ X@YLFOHZK@JCGOFZK@ ///////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////99

    1/7/ C@Q OEYKGM@ XEOAH@O@RFOHZ^YEJ@Z //////////////////////////////////////////////////////////////////////////////////////////99

    1/9/ FOTME@A TGO TGJPKQC@YG^F@ E^ XEOAH@O@RFOHZ^YEJ@Z ////////////////////////////////////////////91

    1/:/ T@Y^M@@HLPOAFH@ CGOA@MFOH@O //////////////////////////////////////////////////////////////////////////////////////////////////////:9

    1/1/ T@Y^M@@HLPOAFH@ GGOAGJCQZ^POQ@O ////////////////////////////////////////////////////////////////////////////////////////////:00/ FOAFJGQF@Z- JEOQYG+FOAFJGQF@Z //////////////////////////////////////////////////////////////////////////////////////////////////////////////:8

    4/ TEEY+ @O OGA@M@O TGO QC@YG^F@ //////////////////////////////////////////////////////////////////////////////////////////////////////////17

    8/ AFZJPZZF@ //////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////10

    3/ LEZQ^YFBZ \:1[ //////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////13

    6/ TGJPKQC@YG^F@ FO A@ QCPFZZFQPGQF@ # ^YGLQFZJC@ A@@M & //////////////////////////////////////////////////07

    6/7/ ZQPAF@ FO O@A@YMGOA //////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////07

    6/9/ EOQXFLL@MFOH@O FO I@MHF ///////////////////////////////////////////////////////////////////////////////////////////////////////////////////0:

    7>/ LO@M^POQ@O //////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////08

    77/ JEOJMPZF@ /////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////4>

    79/ IFIMFEHYGDF@ ////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////49

    GYQFL@MZ //////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////49

    IE@L@O //////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////40

    DEMA@YZ ////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////40

    FOQ@YO@Q /////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////44

    KEOA@MFOH@ FODEYKGQF@ //////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////44

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    8/66

    Fom`fafoh

    A` eoa`yx`y~zl`pr` tgo afq `foax`yl- cga fl ~`yzeeomfbl gm tgzqh`m`ha fo a` mee~ tgo c`q

    qx``a` bggy/ Fl mf`~ zqgh` e~ cgyq+ `o tggqj`oqypk 7 fo GR Zfoq Imgzfpz q` A`oa`ykeoa`- xggy

    tgjpkqc`yg~f` gmz xeoai`cgoa`mfohzk`qcea` x`ya qe`h`~gzq/ Eoagolz kfbo `yh i`loe~q`

    l`oofz et`y a` x`q`ozjcg~~`mfbl` forfjcq`o- m``l afq teey kfb ``o dpqpyfzqfzjc xeoa ykfaa m fo

    a` xeoai`cgoa mfoh/ A`r` qc`yg~f ieea eoh med`mfbl` y`zpmqgq o af k q ``o h`xeo`

    xeoai`cgoa mfohk`qcea` eoqe`y fl oa xgy o/ Kggy ce`t`y zqggq c`q x`q ozjcg~~`mfbl`

    i`xfbz5 Fo afq `foax yl rpmm`o t`yzjcfmm`oa` zqpaf z ggoiea lek`o af` e~ gmm`ym`f tmgll`o

    i`xfbz xfmm`o m`t`y`o/

    Ek afq `foax`yl qeq zqgoa q` iy`oh`o i`o fl t`yqyell`o tgopfq ``o pfqh`iy`fa` mfq`ygqppyzqpaf`

    xggyaeey fl ``o y`m`tgoq` ekzjcyfbtfoh lgo kgl`o et`y tgjpkqc`yg~f`- a` teey+ `o oga`m`o-

    foafjgqf z `o a` x q`ozjcg~~ mfbl` `tfa`oqf / Fo afq x yl rpmm o t yzjcfmm`oa`

    y`d`y`oqf`opkk`yz ``o mfol kgl`o k`q a` gyqfl`mz pfq a` ifimfehygdf`/

    Ek t`ya`y q` hggo e~ a` mfq`ygqppyzqpaf` i`o fl e~ re`l h`hggo oggy a` lo`m~poq`o/ Xggyek

    xeyaq tgjpkqc`yg~f` oeh of`q qe`h`~gzq fo a` qcpfzzfqpgqf`5 Afq rep ``o t`yypfkfoh tgo a`

    xeoareyh fo a` qcpfzzfqpgqf` i`q`l`o`o/ K``y k`oz`o rpmm`o qe`hgoh c`ii`o qeq a` qc`yg~f`/ Fo

    O`a`ymgoa fz tgjpkqc`yg~f` gm e~h`oek`o oggy a` qcpfzzfqpgqf` tgo a` ~gqfoq `o xeyaq a`r`

    qe`~gzzfoh gm q`yphi qggma aeey a` reyht`yr`l`yggyz/ Aeey afq keh mfbl q` kgl`o fz c q

    foafjgqf`h`if`a t`yypfka `o c`ii`o eel ~gqfoq`o fo a` qcpfzz`qqfoh a` keh`mfblc`fa ek tgo

    a`r` qc`yg~f` h`iypfl q` kgl`o/ Ce` t`y zqggq I`mhf fo a` eyhgofzgqf` tgo a`r` qc`yg~f` oggy a`

    qcpfzz`qqfoh5 Fz c`q keh`mfbl- i`qggmiggy5

    Xgq rfbo a` `ytgyfoh`o tgo a` ~gqfoq`o `o t`y~m``hlpoafh`o ifb c`q qe`~gzz`o tgo a` qc`yg~f`5

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    9/66

    7/ Gogqekf` tgo a` cpfa

    Afq ceedazqpl hggq af`~`y fo e~ a` gogqekf` `o dvzfemehf` tgo a` cpfa/ Afq fz ``o `zz`oqf``m

    eoa`ya``m ek c`q jek~m`s` xeoah`o`rfohz~yej`z q` lpoo`o i`hyfb~`o/

    7/7/ A` cpfa gmz eyhggoA` cpfa lgo e~h`a``ma xeya`o fo ayf` mgh`o< k``y i`~ggma a` e~~`ycpfa ed `~fa`ykfz- a`

    m`a`ycpfa ed a`ykfz jeyfpk `o a` cv~ea`ykfz ed zpijpqfz #eoa`ycpfa&/

    A` e~~`ycpfa

    ed `~fa`ykfz

    fz a`

    e~~`ytmgllfh`

    cpfa `o

    i`zqggq r`md

    pfq k``ymghfh t`yceeyoa `~fqc``m/ A`r` mggh i`zqggq r`md oeh ``oz pfq tfbd mgh`o ogk`mfbl< a`

    igzgm` mggh- a` leyy`mmggh- a` hygopmgfy` mggh- a` c`ma`y` mggh `o a` ceeyomggh/ A`

    e~~`ycpfa i`tgq qx`` i`mgoh`yfbl` hye`~`o j`mm`o- k``y i`~ggma< a` k`mgoejvq`o `o a`

    l`ygqfoejvq`o/ K`mgoejvq`o eoqzqggo fo a` igzgm` mggh `o ~yeapj`y`o ``o ~fhk`oqzqed-

    k`mgofo`- af` reyhq teey a` cpfazlm`py/ L`ygqfoejvq`o rfbo gdh`zqeyt`o j`mm`o af` rfjc fo a`

    iet`ozq` aea` mggh i`tfoa`o< a` ceeyomggh/ Ekagq a` e~~`ycpfa h``o ime`atgq`o i`tgq

    xeya`o a` j`mm`o teeyrf`o tgo rppyzqed `o te`afohzzqedd`o aeey a` eoa`ymfhh`oa` a`ykfz/

    A` m`a`ycpfa ed a`ykfz jeyfpk i`zqggq pfq zq`tfh ifoax` dz`m `o i`tgq lm`fo` ime`atgq`o-

    mvkd`tgq`o- r`opxpfq`foa`o- qgzqrfoeyhgo`o- rfoqpfheyhgo`o teey xgykq` `o lepa`-

    cggydemmfl`mz- qgmhlmf`y`o `o rx``qlmf`y`o/ A`r` cpfamggh i`tgq `t`o``oz ``o y`z`ytefy ggo

    `~fa`ykgm` j`mm`o- xggypfq og t`yxeoafoh `~fqc``m lgo hye`f`o/

    A` eoa`ycpfa ed cv~ea`ykfz i`zqggq teeyogk`mfbl pfq t`qx` dz`m agq ``o zqpjqpy`m` dpojqf`

    c``dq wpg eoa`yzq`pofoh `o reyhq teey xgykq`+fzemgqf`/ Fo a`r` cpfamggh i`tfoa`o rfjc a`

    hyeq`y` ime`atgq`o `o r`opx`o/ \:7[

    7/9/ A` dpojqf`z tgo a` cpfa

    Dfhppy 7 \19[

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    10/66

    @y lgo apfa`mfbl h`zq`ma xeya`o agq a` cpfa ``o i`zjc`ykfoh if`aq q`h`o fotme`a`o tgo ipfq`ogd

    /

    Qc`ykey`hpmgqf`

    Aeey ggox`rfhc`fa tgo t`q `o a` y`h`mfoh tgo a` ime`ajfyjpmgqf` `o qygoz~fygqf` xeyaq a`

    q`k~`ygqppy et`y c`q c`m` mfjcggk ifbog jeozqgoq h`cepa`o/ C`q qc`ykey`hpmgqf`eyhggo< a`

    cv~eqcgmgkpz y`h`mq rex m a` xgykq ~yeapjqf` gmz a` xgykq +gdhfdq / Ifb ``o q` ceh`

    mfjcggkzq`k~`ygqppy rgm c`q qc`ykey`hpmgqf`eyhggo a` ce`t` mc`fa qygoz~fygqf`tejcq ae`o

    qe`o`k`o xggyaeey gdle`mfoh eoqzqggq `o `t`o``oz gdtgmzqedd`o xeya`o t`xfba`ya/

    Igyyfy` `o fkkpofq`fq

    A` cpfa i`a`lq eoz c`m` mfjcggk `o if`aq i`zjc`ykfoh q`h`o k`jcgofzjc h`x`ma- jc`kfzjc`

    zqedd`o- fotgzf` tgo kfjye+eyhgofzk`o aeey ``o rppykgoq`m q` teyk`o e~ a` ceeyomggh/

    Xggyo`kfoh`o

    Fo a` cpfa i`tfoa`o rfjc r`opxpfq`foa`o xggytgo zekkfh`o fozqggo teey a` qgzq< c`q te`m`o

    `o goa`y`o fozqggo teey c`q c`yl`oo`o tgo xgykq` ed lepa`/

    Zejfggm jeoqgjq `o jekkpofjgqf`

    A` cpfa i`~ggmq eoz pfq`ymfbl `o z~``mq ``o i`mgoh`yfbl` yem ifb zejfgm` y`mgqf`z/ C`q ``yzq` xgq

    goa`y`o rf`o fz c`q h`rfjcq- a` cpfa/

    Qygoza`ykgm` qe`af`ofoh% e~ogk`

    A` cpfa lgo i`~ggma` gjqf`t` i`zqgoaa`m`o gizeyi`y`o/ Afq fz ``o h`kgll`mfbl` kgof`y ek

    k`afjgqf` qe` q` af`o`o tfg ``o ~m`fzq`y- rgmt`o/ Tfg a` cpfa lgo tfqgkfo` A ggoh`kgglq

    xeya`o- xgq ``o i`mgohyfbl` tfqgkfo` teykq teey a` zl`m`qe~iepx/ ^yetfqgkfo` A xeyaq eoa`y

    fotme`a tgo pmqygtfem`q zqygm`o ekh`r`q qeq tfqgkfo` A/ A`r` tfqgkfo` reyhq `yteey agq jgmjfpk

    xeyaq e~h`oek`o pfq a` agyk`o `o oggy c`q ieqx``dz`m t`yte`ya xeyaq/ \:7[

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    11/66

    9/ Tgjppk Gzzfzq`a Xepoa Jmezpy` Qc`yg~f`

    Tgjpk Gzzfzq a xepoa Jmezpy Qc`yg~f` #TGJ&- eel i`l`oa eoa`y a` ogk`o

    tgjpkqc`yg~f`- tgjpk z`gmfoh- o`hgqft` ~y`zzpy` ay`zzfoh- o`hgqf`t` ~y`zzpy` zpjqfeo- qe~fjgmo`hgqft` ~y`zzpy` #QO^& ed o`hgqft` ~y`zzpy` xepoa qc`yg~v #O^XQ& fz ``o of`q fotgzf`t`-

    gjqf`t` xeoai`cgoa`mfohzk`qcea - h`iypflkgl`oa tgo ``o zqyflq h y`hpm `ya` melgm`

    eoa`yaypl/ A`r` q`jcof`l fz of`q fotgzf`d ggoh`rf`o `y qfba`oz a` i`cgoa`mfoh h``o fotgzf`t`

    e~ ygqf z h`i`py`o/ C`q fz ``o gjqf t` xeoai`cgoa`mfohzk`qcea` ekagq- aeey kfaa`m tgo

    eoa`yaypl- c`q q` t` m ggo foq yzqfqf` m `o `sqygj mmpmgfy tejcq xeyaq t`yxfba`ya/ @t`o``oz

    eoqzqggq cf`yaeey ``o t`ykfoa`ya` x``dz`maypl xggyaeey a` aeeyime`afoh i`teya`ya xeyaq/ A`

    tgjpkqc`yg~f` reyhq q`t`oz teey ``o k`jcgofzjc` zqfkpmgqf` tgo a` j`mm`o/ @y eoqzqggq ``o

    t`yzo ma` teykfoh tgo hygopmgqf`x``dz`m eoa`y aypl/ Aeey kfaa`m tgo ``o ogpxl`pyfh

    h y`hpm` ya` melgm` eoa`yaypl fozq miggy tgo 0> kkCh qeq 780 kkCh xeyaq ``o

    h mfblkgqfh` rpfhlygjcq t`yeeyrgglq e~ a` xeoaiea`k `o a` xeoaygoa`o/ A` melgm`

    zpigqkezd`yfzjc` aypl xeyaq h`h`o y``ya `o fz y`hpm` yiggy tfg ``o `m`lqyfzjc` ~ek~- a`

    TGJ Pofq/ Aeey kfaa`m tgo ``o dm`sfi`m` ~emvtfovm+zmgoh zqggq a`r` fo t`yifoafoh k`q ``o

    zjcpfkt`yigoa af` fo a` xeoa` ggoh`iygjcq xeyaq/ \73- :0[

    A` eeyz~yeoh tgo a` tgjpkqc`yg~f` z~``ma` rfjc gd cgmd x`h a` bgy`o 3> `o mgh fo

    cgoa`o tgo Ypzzfzjc` gyqz`o/ Fo af ~`yfea` xgz `y ``o qe`o`k`oa` ggoagjcq teey

    xeoah`o`rfoh `o a` e~lekzq tgo ``o of`px z~`jfgmfzk` agq rfjc yfjcqq` e~ a` h`o`rfoh tgo

    zm jcq h`o`r`oa` xeoa`o `o a` fk~gjq af` afq c` dq e~ a` lxgmfq fq tgo m`t`o `o

    m`t`ozt`yxgjcqfoh tgo ~gqfoq`o/ Fo y`j`oq` gyqfl`mz lekq tggl oggy teey agq c`q hggq ek ``o

    Gk`yflggoz eoqa`llfoh/ Gk yflggoz` kpmqfogqfeogmz c`ii`o a` keh`mfblc`a`o tgo a`

    qc`yg~f` t`ya`y eoqxfll`ma `o x`y`maxfba h`jekk`yjfgmfz``ya/ \0[ I`mgohyfbl` eoa`yre`l`o

    rfbo gdlekzqfh tgo c`q Gk`yflggoz` ape< ^yed/ Mepfz Gyh`oqg #~mgzqfzjc` jcfypyh& `o Ay/

    Kfjcg`m Keyvlxgz #y`z`gyjc gyqz&- i`fa`o t`yieoa`o ggo a` Xgl` Dey`zq Poft`yzfqv q`

    Xfizqeo+Zgm`k- Oeyqc Jgyemfog #TZ +7636&/ Cpo `yzq` eoa`yre`l`o ogk`o tf`y bggy fo i`zmgh-

    xggyog a` qc`yg~f` aeey a` ~ezfqf`t` y`zpmqgq`o- iy`a`y x`ya qe`h`~gzq/ Afq ape z~fqzq` rfjc

    teeygm qe` e~ a` i`cgoa`mfoh tgo jcyeofzjc` xeoa`o k`q melgm` eoa`yaypl `o

    ~emvpy`qcggot`yigoa/ A` Apfqz` ^yed/ Ay/ Xfmc`mk Dm`fzjckgoo #qygpkgqemeeh- jcfypyh +

    766:& yfjcqq rfjc teeygm e~ c`q h`iypfl tgo tgjpkqc yg~f` ifb gjpq` xeoa`o k q ``o

    ~emvtfovmgmjecemt`yigoa/ Cfb yfjcqq` rfjc teeygm e~ a` k`qcea` ek ``o aygfogh` q` i`lek`o

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    12/66

    aeey c`q jy`y`o tgo eoa`yaypl/ Rfbo ggoagjcq hfoh teeygm oggy c`q i`mgoh agq a` aygfo of`q

    afy`jq fo jeoqgjq lxgk k`q c`q xeoai`a- xggyaeey i`zjcgafhfoh tgo c`q hygopmgqf`x``dz`m lgo

    e~qy`a`o/ C q jek~m q` zvzq` k i`zqeoa pfq ``o aygfo + xggymgohz z~e mfoh`o x ya o

    pfqh`te`ya + `o e~qfkgm` eoa yaypl af zjcekk`ma` yeoa 9>> kkCh af` of q jeoqfop

    y`hpm``yiggy xgz/ \9- 77- 0>[

    Ay/ M/ Gyh`oqg `o Ay/ K/ Keyvlxgz rejcq`o `o eoa`yrejcq`o a`r` of`px` xfbr` tgo

    xeoai`cgoa`mfoh ekagq a` jeot`oqfeo`m` qc`yg~f`o q`leyq zjceq`o gmz ga`wpgq` i`cgoa`mfoh

    teey ``o hyeq tgyfgqf` fo xeoa`o/ A` Gk`yflgo`o yfjcqq o rfjc ago eel oggy `ol`m`

    i`~ yl`oa` dgjqey`o af` a` xeoah`o`rfoh t`yqyggha`o% t`ycfoa`ya`o2

    C`q eoqzqggo tgo fod`jqf`z aeey igjq`yfm` lemeofzgqf`/

    C q melggm t yzm jcq`o tgo a` kfjyejfyjpmgqf

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    13/66

    z~f`yx``dz`mz im`t`o eoi`zjcgafha aeey a` qe`te`y tgo te`az`myfbl ime`a< a` eoqxfll`mfoh tgo

    c`q hygopmgqf`x``dz`m zq``h zfhofdfjgoq `o c`q ggoqgm igjq`yfo aggma` og h`iypfl tgo tf`y agh`o/

    K`q a`r` y`zpmqgq`o eoa`yrejcq`o ^yed/ M/ Gyh`oqg `o Ay/ K/ Keyvlxgz c`q `dd`jq tgo a`

    qc`yg~f` e~ ayf`ceoa`ya ~gqfoq`o- t`ya``ma fo ayf` hye`~`o oggyh`mgoh c`q zeeyq xeoa`/ A`

    ``yzq` `o hyeeqzq` hye`~ i`tgqq` 780 ~`yzeo`o k`q jcyeofzjc` xeoa`o tgo kfofkpk o x``l

    i`zqggozappy `o h``o q`l`o`o tgo h`o`rfoh/ Tgo agq ggoqgm xgy`o `y 717 ~gqfoq`o k`q ``o

    jcyeofzjc` xeoa`- a`jpifqpz xeoa`o tgo hygga ayf` `o tf`y/ A` qx``a` hye`~ i`tgqq` 61

    ~gqfoq o k`q zpigjpq` xeoa`o k`q a`cfzj oqf` `o imeeqmfhh`oa ieq eoqzqggo fo ``o ~`yfea` tgo

    kfoa`y ago r`t`o agh`o/ A` mggqzq` hye`~ tgo :7 ~gqfoq`o i`zqeoa pfq gjpq` xeoa`o regmz

    `tfzj`ygqf`z fo ``o ~`yfea` tgo kfoa`y ago 79 ppy eoqzqggo/ Og a` i`cgoa`mfoh k`q a` o`hgqf`t`

    gqkezd`yfzjc` aypl lxgk`o temh`oa` jeojmpzf`z oggy iet`o/ Fo hye`~ o xgz a` qc`yg~f` ifb

    f`a`y``o `dd`jqf`d- reyha` teey ``o xeoah`o`rfoh/ Ifb :9 tgo a` ~gqfoq`o k`q pmj`yg #717&

    c``ma` a` xeoa` fo qx`` qeq r`zqf`o x`l`o/ 14 tgo a` xeoa`o zmeq`o teey k``y ago 3> `o

    x`ya`o t`ya`y i`cgoa`ma k`q cpfa`oq`o ed goa`y` i`teya`y`oa` xeoac`m`oa` q`jcof`l`o/ Ifb

    a` t`o`pr` pmjpz zqgyqq` a` hygopmgqf` og 1+4 agh`o `o 6> tgo a` xeoa`o y`gh``ya`o e~ a`

    ``yzq` cpfa`oq/ Fo hye`~ qx`` y`gh``ya`o a` 61 zpigjpq` xeoa`o oeh zo`mm`y ago a` jcyeofzjc`

    xeoa`o #``yzq` hye`~&/ 94 c``ma`o c`m`kggm- ifb a` et`yfh` 43 ~gqfoq`o t`ylm`foa`o a`

    xeoa`o `o x`ya`o t`ya`y i`cgoa`ma k`q goa`y` k`qcea`o ago ``o cpfa`oq/ Fo hye`~ ayf`

    x`ya`o a` xeoa`o i`a`lq k`q ``o cpfa`oq ed xgz c`q x``dz`m tgor`md afjcqh`hye`fa/ A`

    xeoa`o pfq a`r` hye`~ eoqxfll`ma`o c`q zo`mzq hygopmgqf`x``dz`m/ Tgopfq a`r` zqpaf`z rfbo a`

    y`zpmqgq`o r``y i`met`oa kggy `y fz ``o hyeeq oga``m 2 a` zqpaf`z rfbo oeefq h`ieoa`o ggo ``o

    jeoqyem`hye`~/ A` y`m`tgoqf` tgo a` jeojmpzf` fz ``o hyeeq tygghq`l`o/ \7>[

    Eoagolz a` t``mi`met`oa` jeojmpzf z rfbo y`m`tgoq lxgmfqgqf`d eoa`yiepxa` zqpaf`z

    zjcggyz/ Qejc x ya zfoaz 7660- eoa y fk~pmz tgo Lfo qfj Jeoj`~qz Foj/ #LJF& a`

    tgjpkqc`yg~f` e~ a` Gk`yflggoz` kgylq h`iygjcq eoa`y a` oggk TGJ2 Tgjpk Gzzfzq`a

    xepoa Jmezpy`/ Zfoaz c`q `foa tgo a` bgy`o 6> xeyaq TGJqc`yg~f` x`y`maxfba h`~yekeeq/

    Lfo`qfj Jeoj`~qz Foj/ x`ya e~h`yfjcq fo Gk`yflg k`q a` foq`oqf` ek ~gqfoq`o ``o i`q`y`

    m`t`ozlxgmfq`fq q` i`reyh`o fo gmm` reyhekh`tfoh`o- rex`m qcpfz gmz fo c`q rf`l`ocpfz/ Fo 9>>:

    ly``h LJF- a` mfj`oqf`cepa`y- jeojpyy`oqf` tgo K`af~yed Cemmgoa IT/ A`r` fz o`q gmz LJF ``o

    dgiyflgoq `o cgoa`meoa`yo`kfoh fo k`afzjc` gyqfl`m`o `o g~~gygqppy teey k`afzjc h`iypfl

    xggyeoa`y eel tgjpk~ek~`o/ K`af~yed kgglq h`iypfl tgo c`q zjcpfkt`yigoa c`q k`yl

    Jema`s `o xeyaq tfg zmgoh`o t`yieoa`o ggo K`a`mg Igzfj :>+~ek~ #K`afaygfo ed K`aftgj&/

    C`q zjcpfkt`yigoa xeyaq gdh`~mglq aeey kfaa`m tgo ``o demf` `o t`ytemh`oz eoa`y tgjpk

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    14/66

    h`iygjcq/ A`r` jeojpyy`oqf`zqyfba m`faa` pfq foa`mfbl qeq ``o y`jcqrggl/ A` i`mgohyfblzq`

    gyhpk`oq`o tgo LJF mpfaa` gmz temhq2

    K`af~yed eoqiy``lq a` t`y~mfjcq` J@+kgyl`yfoh e~ rex`m a` K`a`mg ~ek~ gmz c`q

    Jema`s zjcpfkt`yigoa/ A`r` fz x`mfzxggy t`y`fzq aeey a` O`a`ymgoaz` X`q e~ a`

    K`afzjc` Cpm~kfaa`m`o o c`q O`a`ymgoaz` I`zmpfq K`afzjc` Cpm~kfaa`m`o/

    C`q h`c`m` i`cgoa`mfohzzvzq``k tgo K`af~yed fz eoh`zjcflq teey xeoai`cgoa`mfoh

    eoa`y aypl/ Rfb if`a`o ``o ~ek~- aygfoz `o zjcpfkt yigoa ggo- kggy h``o

    gda`ldemf` af` oeeargl`mfbl fz ek tgjpk q` jy`y`o/

    Agq LJF ``o ~gq oq cga e~ a` xeoai`cgoa mfoh aeey kfaa m tgo tgjpk-

    `t`o``oz t`yleoafha`o cpo k`a`x`yl`yz agq a` ~yeapjq`o tgo K`a`mg of`q k``y

    h`iypflq keh`o xeya`o- ekagq `y fo c`q ipfq`omgoa ``o y`jcqzrggl mf`~ xggypfq

    im``l agq a` K`a`mg ~ek~`o eot`fmfh rfbo `o a` Jema`s zjcpfkt`yigoa hfdqfh/

    Ifb c`q pfq`foa`mfbl` eeya``m x`ya K`af~yed h``o zjcga`t`yhe`afoh gdh`axeoh`o/ C`q x`ya

    `ol`m e~ a` tfoh`yz h`qflq ekxfmm` tgo a` eoqiy`l`oa` gda ldemf`- q`yxfbm r` x`ma`h`mfbl

    t`yk`maa`o agq r` a` h`c`m` i`cgoa`mfoh ggoiea`o/ Eel x`ya`o r` t`y~mfjcq ek cpo ~yeapjq`o

    q` mgq`o l`py`o `o ``o J@+kgyl`yfoh q` teya`y`o/ Kek`oq``m i`zjcfll`o r` et`y ``o J@+

    kgyl`yfoh teey i`~ggma` eoa`ya`m`o kggy of`q teey c`q h`c`m` zvzq``k/ \11[ Fo 7660 lxgk ``o

    goa`y` eoa`yo`kfoh e~ a` kgylq- Eyqcek`afje/ O`q regmz LJF `o K`af~yed< t`ycpy o ed

    t`yle~`o rfb cpo ~yeapjq`o ggo rf`l`ocpfr`o- fozq`mmfoh`o ed y`jcqzqy``lz ggo a` ~gqfoq`o/ C`q

    ifbreoa`y` ggo a`r` eoa`yo`kfoh fz agq rfb rfjc of`q `ol`m yfjcq`o qeq a` xeoai`cgoa`mfoh k`q

    tgjpk #DK 99> Foq`ykfqq y oa jek~y`zzf`zvzq``k Dmexk`afj& kggy `t`o` oz k q

    H`~pmz``ya` Gle`zqfzjc` hemt`o #a`ykg~gj` ~pmz`a gjepzqfj j`mmpmgy `s~y`zzfeo&/

    DK 99> Foq`ykfqq`y`oa jek~y`zzf`zvzq``k Dmexk`afj

    Afq zvzq``k x`ylq k`q ``o foq`ykfqq`oq` aypl af` fo `ol`m` z`jeoa`o ``o ~f`lxggya`

    i`y`flq tgo 3> kkCh `o t`ytemh`oz q`yph xeyaq gdh`mgq`o/ A` zo`mm`

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    15/66

    ceh`ayplq`jcoemehf` c``dq i`x`r`o agq r` reyhq teey ``o t`yi`q`ya` ime`azekmee~ fo

    a` eoa`yzq` m`a`kgq`o xggyaeey r` ``o y`m`tgoq` i`cgoa`mfoh fz teey t`o`pr` `o gyq`yfm`

    tggqmfba`yz- pmj`yg `o afgi`q`z te`qxeoa`o/ A` i`cgoa`mfohzappy fz gdcgol`mfbl tgo a`

    ggoae`ofoh tgo a` ~gqfoq `o xeyaq qx`` ayf` ppy ~`y agh h`aygh`o/ C`q h`iypfl tgo

    a`r` q`jcoemehf` fz oeh i`~`ylq/ \17- 13[

    A`ykg ~gj` ~pmz`a gjepzqfj j`mmpmgy `s~y`zzfeo

    Aeey kfaa`m tgo ~pmz`o xeyaq ``o qygpkg t`yeeyrgglq q`y ceehq` tgo a` kfjyej`mm`o/

    H`temh cf`ytgo fz agq a`r` j`mm`o ~yeq`o`o tyfbh`t`o/ A`r` ~yeq`o`o i`zqggo eoa`y

    goa`y` pfq jvqelfo`z- af` ``o fodmgkkgqefy` y`z~eoz e~ hgoh iy`oh`o/ Afq reyhq `yteey agq

    ``o jcyeofzjc` qe`zqgoa xeyaq ekh`r`q fo ``o gjpq` qe`zqgoa `o c`q c`mfohz~yej`z x``y

    ggotgohq/ Ifb a` i`cgoa`mfoh t`yceehq a` ce`t``mc`fa tgo hye`fdgjqey`o regmz Tgzjpmgfy`

    @oaeqc`mfgm` Hye`fdgjqey #T@HD&- agq reyhq teey ``o of`px` tgzjpmgyfzgqf` q`y ceehq` tgo

    c`q i`cgoa`ma` h`if`a/ Qx`` kggm ~`y x``l k`q ``o ~`yfea` tgo qx`` qeq kgsfkpk tfbdkfopq`o- h`apy`oa` qx`` x`l`o xeyaq a` xeoa` imeeqh`zq`ma ggo a` ~pmz`o/ Ifb a`

    i`cgoa`mfoh xeyaq h`iypfl h`kgglq tgo ``o zq`yf m` jet`y #e~~ ytmgl agq fo jeoqgjq lekq

    k`q xeoae~~`ytmgl& `o zq`yf`m` h`m ek fod`jqf` q` teeylek`o/ Afq zeeyq q`jcof`l`o fz

    h`zjcflq ifb ~ezqe~`ygqf`t` i`cgoa`mfoh tgo q``ogk~pqgqf`z- ezq`ekv`mfqfz- ~mgoqgfy` #e~

    rfba` tgo a` te qreem& pmjpz- afgi`q z pmj`yg/ Og tf y i`cgoa`mfoh`o fz c`q y`zpmqggq

    rfjcqiggy/ A`r` q`jcof`l zq`poq e~ a` foq`yjey~ey`m` y`gjqf`/ \1>- 13[

    Aeeyagq LJF c`q ~gq`oq fo cgoa`o cga `o gmz ``yzq` c`q ~yeapjq e~ a` kgylq iygjcq`o-

    cgaa`o r` `t`o``oz a` qfba ek ``o x`y`maxfba o`qx`yl pfq q` iepx`o/ A` foq`y`zz` fo a`r`

    q`jcof`l `s~mea``ya` fo ``o teeyqapy`oa x`q`ozjcg~~`mfbl eoa`yre`l agq `y qe` m`faa` agq

    Tgjpk Gzzfzq`a xepoa Jmezpy e~ ``o leyq` qfba ``o zqgoaggya x`ya ifb t`yzjcfmm`oa`

    xeoai`cgoa`mfoh`o/\:4[ Fo 9>>9 te`ya` B/A/A/ Tp`yzqg`l +tgo c`q k`afzjc` j`oqypk ^gylzqga

    fo O`a`ymgoa+ ``o y`qyez~`jqf`t`- of`q h`ygoaekfz` ya` zqpaf` af` i`zqeoa pfq c`q i`cgoa`m`o

    tgo 14 y`zfzq`oq` `o jcyeofzjc` pmj`yg/ K`q a`r` zqpaf` xep k`o oghggo x`ml` t`yzjcfmm`o `y

    rfbo qpzz`o a` i`cgoa`mfoh k`q c`q Tgjpk Gzzfzq a xepoa Jmezpy` `o a` jeot`oqfeo`m`

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    16/66

    i`cgoa`mfohzq jcof`l e~ tmgl tgo y`fofhfohzappy `o e~ogk`appy/ A` zqpaf` ektgqq` qx``

    hye`~`o- ogk`mfbl a` i`cgoa`mfoh k`q c`q Tgjpk Gzzfzq`a xepoa Jmezpy` `o a` i`cgoa`mfoh

    e~ a` jeot`oqfeo`m` kgof`y- af` `t`o``oz gmz jeoqyem`hye`~ x`ya i`zjcepxa/ Teeygd x`ya`o

    a` ~gqfoq`o h`zjy``oa e~ ``o ggoqgm `sjmpzf` jyfq yfgz2 h`iypfl tgo fkkpoezp~y`zzftg-

    ggox`rfhc`fa tgo tgzjpmfqfz- pmj`yg k`q gjqf`t` ime`afoh`o- zqemmfohzqeeyofzz`o- gmm`yhf` e~

    xeoat`yreyhfohz~yeapjq`o- afgi`q z k`mmfqpz/ Gmz fojmpzf`jyfq`yfg2 c`q pmjpz ke`q mgoh`y ago 4

    kggoa`o ggox`rfh rfbo `o eoagolz a` xeoai`cgoa`mfoh h``o h`o`rfohz~yej`z l`oo`o/ A`

    hye`~ ~gqfoq`o xggy a` Tgjpk Gzzfzq`a xepoa Jmezpy` ifb zqgyqq`- i`zqeoa pfq 9: ~gqfoq`o

    xggytgo 76 tyepx`o `o 1 kgoo`o/ Pfq a`r` hye`~ lxgk`o zpihye`~`o tgo 6 t`o`pr` pmj`yg- 4

    t`o`pz gyq`yfm` pmj`yg `o 3 gyq`yfemezjm`yeqfzjc` pmj`yg/ A` h`kfaa`ma` m``dqfba xgz 81-3 bggy

    k`q z~y`fafoh qpzz`o 0: + 30 bggy- c`q h`kfaa`ma` pmjpze~~`ytmgl i`aye`h 1:-9 jk9 k`q ``o

    z~y`fafoh qpzz`o 1 + 46 jk9/

    Qgi`m 7% t`ya`mfoh tgo c`q ggoqgm ~gqfoq`o

    t`o`pr` pmj`ygt`o`pz+ `o gyq`yfm`

    pmj`yg

    gyq`yfemezjm`yeqfzjc`

    pmj`yg

    Tgjpkqc`yg~f` #O& 6 4 3

    Jeot`oqfeo`m`

    i`cgoa`mfohzq jcof`l #O&6 4 3

    Fo a` jeoqyem`hye`~ xgy`o `t`o``oz 9: ~gqfoq`o `o i`zqeoa `t`o``oz pfq c`qr`mda` ggoqgm ~`y

    zpihye`~% zqygqg/ A` h`kfaa`ma` m``dqfba i`aye`h 81 bggy k`q y`d`y`oqf`z qpzz`o 03 + 34 bggy/ C`q

    h`kfaa`ma` pmjpze~~ ytmgl i`aye`h 9:-4 jk9 k q y d`y`oqf`z qpzz o 3 + 19 jk9/ Fo c`q

    eoa`yre`l cf`ma k`o `t`o``oz y`l`ofoh k`q a` zqgqfzqfzjc` t`yzjcfmm`o qpzz`o i`fa` hye`~`o `o

    zqygqg- aeey kfaa`m tgo a` Kgoo+ Xcfqo`v Q`zq/ Ce` k`o q` x`yl hfoh k`q c`q Tgjpkzvzq``k

    x`ya temm`afh i`z~yel`o- q`yxfbm et`y a` k`qcea` tgo a` jeot`oqfeo`m`

    xeoai`cgoa`mfohzq`jcof`l of`qz x`ya x``yh`h`t`o/ Jcyeofzjc` pmjpz jypyfz af` i`cgoa`max`ya`o k`q tgjpkqc`yg~f` eoa`yhfoh`o ``o ggoqgm dgz`o/ A` ``yzq` dgz` fz a` y`fofhfohzdgz`-

    aeey h`iypfl q` kgl`o tgo tgjpk x`ya a` xeoa` e~ ``o of`q+ fotgzf`t` xfbr` ``o tfqgm` `o

    gjpq` xeoa`/ Gmz `y ago h``o xeoah`o`rfoh keh`mfbl xgz- x`ya ``o cpfa`oq h`qygoz~mgoq``ya/

    Afq x ya `t`o` oz aeey c q Tgjpkzvzq `k eoa yzq poa- aeey c q h`iypfl tgo ``o

    ~emvtfovmgmjecem z~eoz/ A`r` c``dq ``o rgjcq` zqypjqppy `o xeyaq h`iypflq ek c`q qygoz~mgoq

    qfba`mfbl q` i`zjc`yk`o/ Aeey a` o`hgqf`t` aypl af` c`q zvzq``k if`aq xeyaq a` gac`zf` qpzz`o

    qygoz~mgoq k q a` xeoaiea`k `o a` `~fqc`mfgmfzgqf` i`teya`ya/ Xgoo``y a` xeoa` a`

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    17/66

    `~fqc`mfgmfzgqf dgz` c` dq foh`r`q- x`ya a` xeoa` i`cgoa`ma k`q gkipmgoq` jek~y zzf` `o

    melgm` tejcqfh` xeoai`cgoa`mfoh/

    Qgi`m 9% A` appy tgo a` y`fofhfohzdgz` #agh`o&

    t`o`pr` pmj`ygt`o`pz+ `o gyq`yfm`

    pmj`yg

    gyq`yfemezjm`yeqfzjc`

    pmj`yg

    Tgjpkqc`yg~f` #O& 7>-9 #O;6& 74-8 #O;1& 7>-4 #O;3&

    Jeot`oqfeo`m`

    i`cgoa`mfohzq jcof`l #O&91-6 #O;6& 91 #O;4& 91 #O;3&

    Pfq a` y`zpmqgq`o tgo a` y`qyez~`jqf`t` zqpaf` qpzz`o a` i`cgoa`mfoh k`q c`q Tgjpkqc`yg~f` `o

    a` jeot`oqfeo`m` xeoai`cgoa`mfohzq`jcof`l im``l agq< fo c`q lga`y tgo a` y`fofhfohzdgz` a`

    h`kfaa`ma` appy ifb c`q zqygqpk tgo jcyeofzjc` t`o`pr` pmj`yg + i`cgoa`ma k`q tgjpk + 7>-9

    agh`o i`aye`h/ Q`yxfbm afq ifb a` jeot`oqfeo`m` xeoai`cgoa`mfohzq`jcof`l ``o appy tgo 91-6

    agh`o xgz/ A` h`kfaa`ma` appy ifb a` zqygqpk tgo a` jcyeofzjc` t`o`pz%gyq`yfm` pmj`yg +

    i`cgoa`ma k`q tgjpk + i`aye`h 74-8 agh`o/ Fo q`h`ozq`mmfoh qeq a` jeoqyem`hye`~ xggy a`

    h`kfaa`ma` y fofhfohzappy 91 agh`o i aye`h/ Fo a` zpihye`~ tgo a` jcyeofzjc`

    gyq`yfemezjm`yeqfzjc` pmj`yg i`aye`h a` h`kfaa`ma` y`fofhfohzappy + i`cgoa`ma k`q tgjpk +

    7>-4 agh`o/ Afq fo q`h`ozq mmfoh qeq a` h`kfaa ma` 91 agh`o tgo a` i`cgoa mfoh fo a`

    jeoqyem`hye`~/ A` gmh`k`o` tgzqzq`mmfoh fo c q lga`y tgo a` y fofhfohzappy- im `l a`

    y`fofhfohzdgz` ifb a` i`cgoa`mfoh k`q c`q Tgjpkzvzq``k 06 zo`mm`y q` hggo fo c`q zqygqpk

    tgo t`o`pr` pmj`yg- :>-0 fo c`q zqygqpk tgo t`o`pz%gyq`yfm` pmj`yg `o 04 fo c`q zqygqpk tgo

    gyq`yfemezjm`yeqfzjc` pmj`yg/

    Qgi`m :% A` qeqgm` e~ogk`appy #agh`o&

    t`o`pr` pmj`ygt`o`pz+ `o gyq`yfm`

    pmj`yg

    gyq`yfemezjm`yeqfzjc`

    pmj`yg

    Tgjpkqc`yg~f` #O& 98-9 #O; 6& 17-8 #O; 1& :1-6 #O; 3&Jeot`oqfeo`m`

    i`cgoa`mfohzq jcof`l #O&0:-3 #O; 6& 07-8 #O; 4& 08-1 #O; 3&

    Fo c`q lga`y tgo a` e~ogk`appy teey a` t`o`pr`- t`o`pz%gyq`yfm` `o gyq yfemezjm yeqfzjc`

    pmj`yg + i`cgoa`ma k`q tgjpk + i`aye`h afq y`z~`jqf`t`mfbl 98-9 agh`o< 17-8 agh`o `o :1-6

    agh`o/ Q`yxfbm afq fo a` jeoqyem`hye`~ y`z~`jqf`t`mfbl 0:-3 agh`o< 07-8 agh`o `o 08-1 agh`o

    i`aye`h/ A` gmh`k`o` tgzqzq`mmfoh fo c q lga`y tgo a` e~ogk`appy xgz agq a` i`cgoa`mfoh k`q

    tgjpk 16 leyq`y fz ifb t`o`pr` pmj`yg- :6-9 ifb a` gyq`yfemezjm`yeqfzjc` pmj`yg/ Fo a` hye`~

    tgo a` t`o`pz%gyq`yfm` pmj`yg xgz h``o zfhofdfjgoq` y`apjqf` x``yh`h`t`o/ Afq ekxfmm` tgo c`q

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    18/66

    d`fq agq a` hye`~ q` lm`fo xgz ogagq qx`` ~gqfoq`o a` zqpaf` t`ymf`q`o #rf` qgi`m 9 `o :&/ Y`a`o

    cf`yteey xgy`o ~fbolmgjcq`o `o c`q dgm`o tgo a` q`jcof`l/ K`q ``o lyfqfzjc` imfl lekq k`o qeq

    c`q gmh`k`o` i`zmpfq agq Tgjpkqc`yg~f` ``o he`a gmq`yogqf`d lgo if`a`o fo a` z`qqfoh tgo c`q

    i`cgoa`m`o tgo jcyeofzjc` pmj`yg/ Eel gm l`oq tgjpkqc`yg~f` zpjj`ztemm` foq`yt`oqf`z- c`q

    `sgjq` x`q ozjcg~~`mfbl` i`xfbz fz oeh of`q h`m t`ya/ K`o ~m fq teey t`ya`y` lezq`o+ `o

    `dd`jqftfq`fqzqpaf`z- af` afq i`xfbz lpoo`o m`t`y`o/ @`o teeyi``ma cf`ytgo lgo rfbo ``o zqpaf`

    oggy focfi`y`oa` dgjqey`o af` a` xeoah`o`rfoh t`yqygh`o ed a` fotme`a tgo k`jcgofzjc` zqy`zz

    e~ xeoac`mfoh/\93[

    A` lezq`o`dd`jqftfq`fq tgo tgjpkqc`yg~f` lxgk fo c`q teyfh` gyqfl`m gm oggy teey/ Fo

    9>>8 c``dq a` @pye~`go Xepoa Kgogh`k`oq Gzzejfgqfeo #@XKG& ggoh`h`t`o agq

    tgjpkqc`yg~f` ``o pfqzq`l`oa gmq`yogqf`d fz teey a` h`xeo` xeoai`cgoa`mfoh #i`zqggoa` pfq

    t`yigoa`o&/ Rfb hgt`o iet`oaf`o ggo agq a` lezq`o k`q a` tgjpkqc`yg~f` of`q ceh`y e~me~`o

    ago a` lmgzzf`l` xeoai`cgoa`mfoh/ Cpo t`ylmgyfoh cf`yteey fz a` zo`mm`y` xeoah`o`rfoh af`

    t`yly`h`o xeyaq k`q a` qc`yg~f`/ Aeey a` qe`~gzzfoh tgo a` tgjpkqc`yg~f` xeyaq a` xeoa`

    zo`mm`y h`y`fofha `o eoqzqggq c`q hygopmgqf`x``dz`m zo`mm`y- afq fo t`yh`mfblfoh k`q a` lmgzzf`l`

    xeoai`cgoa`mfoh/\7:[ Cpo i`tfoafoh fz k`a` h`igz``ya e~ c`q d`fq agq kgq`yfggmlezq`o kggy

    ``o dygjqf` pfqkgl`o tgo a` qeqgm` lezq`o teey c`q i`cgoa`m`o tgo ~gqfoq`o/ Lezq`o teey

    e~ogk` `o t`y~m` hlezq`o xeya`o k`q T/G/J/ Qc yg~v h`y apj``ya/ C`q Veyl C`gmqc

    @jeoekfjz Jeozeyqfpk eoqxfll`ma` ``o y`l`okea`m agq e~ igzfz tgo ~``y+y`tf`x`a zqpaf`z ``o

    i`y`l ofoh kgglq/ Fo afq kea`m lpoo`o rf`l`ocpfr`o z~`jfdf l` agqg fote`h`o xggyog i`y`l`oa

    xeyaq xgq a` keh`mfbl` i`z~gyfoh fz e~ a` qeqgm` lezq`o tgo i`cgoa`mfoh/ \07[

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    19/66

    :/ C`q zvzq``k

    Tgjpk Gzzfzq`a xepoa Jmezpy` #TGJ& i`zqggq pfq ``o zqyeekz~goofoh lgi`m- foq`yo`

    gjjp- TGJpofq- t`ytgohigy` e~tgohi`l y k`q dm`sfi m` ^emvtfovmzmgoh- ``o Qc`yg~`pqfjY`hpmgq a Gjjpygq Jgy`~ga k q dm`sfi`m` ^emvtfovmzmgoh- zjcpfkt yigoa% degk `o

    aeeyrfjcqfh TGJdemf`t`yigoa/ C`q TGJzvzq``k i`zqggq oeh kggy 71 bggy `o fz fo af`

    ~`yfea` `oeyk h`hye`fa/ @`yzq xgz `y a` TGJ jmgzzfj #~ek~& fo 7661/ Aeeyagq LJF

    teeyqapy`oa zqy` da` oggy teeypfqhgoh lxgk fo 9>>9 ``o t`yi`q ya` t`yzf` tgo a` ~ek~

    TGJGQZ/\07[ @y i`zqggo t`yzjcfmm`oa` teyk`o tgo TGJpofqz/ \14[

    Tgjpk Gzzfzq`a xepoa Jmezpy` Dy``aek/ T/G/J/Dy``aek fz ``o jek~gjq- aygghiggy

    zvzq``k xggyaeey a` ~gqfoq rfbo agh`mfblz` gjqftfq`fq`o lgo imfbt`o pfqe`d`o`o/

    A` mfjcq` `o aygghigy` pofq c``dq ``o t`ytgohigy` e~tgohi`l`y k`q ``o a`if`q tgo :>>km/ A`

    foq`yo` gjjp reyhq `yteey agq k`o qxggmd ppy mgoh reoa`y zqyeekz~goofoh qejc a` qc`yg~f` lgo

    t`ya`y r`qq`o/ A`r` pofq xeyaq ggoh`y`flq ggo ~gqfoq`o af` oeh keif`m rfbo `o eoh`cfoa`ya cpo

    agh`mfblz` gjqftfq`fq`o xfmm`o pfqte`y`o/\:8- 14[

    A` Tgjpk Gzzfzq`a xepoa Jmezpy` Gat`oj`a Qc yg~v Zvzq k #T/G/J/GQZ& fz

    kfoa`y jek~gjq `o xeyaq tggl h`iypflq ifb hyeq` xeoaekqy`ll`o- i`am`h`yfh` ~gqfoq`o/

    Afq h`gtgoj``ya` zvzq``k c``dq ``o t`ytgohigy` e~tgohi`l`y k`q ``o a`if`q tgo 0>>km/ A`

    foq`yo` gjjp c``dq ``o jg~gjfq`fq tgo tf`y ppy/

    @`o jek~gjq`y` pofq fz a` GjqfT/G/J/- eoqxfll`ma teey ~gqfoq`o qcpfz ed ~gqfoq`o af`

    pfq c`q rf`l`ocpfz xeya`o eoqzmgh`o/

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    20/66

    A`r` teyk aygghq c``m xgq h`mfbl`ofzz`o k`q T/G/J/Dy``aek/ C`q fz ``o jek~gjq`- aygghigy`

    pofq- af` c``dq ``o t`ytgohigy` e~tgohi`l`y k`q ``o a`if`q tgo :>>km/ A` foq`yo` gjjp reyhq

    `yteey agq k`o t``yqf`o ppy mgoh reoa`y zqyeekz~goofoh qejc a` qc`yg~f` lgo t`ya`y r`qq`o/ \:3-

    14[

    Regmz ``ya`y x`ya t`yk`ma lpoo`o qx`` t`yzjcfmm`oa` zjcpfkt`yigoa`o% degk xeya`o

    h`iypflq- gdcgol mfbl tgo c`q qv~` xeoa` `o a` teeye~h zq ma` ae mzq mmfoh`o/ ^yed/ Mepfz

    Gyh`oqg `o Ay/ Kfjcg`m Keyvlxgz z~fqzq`o rfjc teeygm e~ a` i`cgoa`mfoh tgo jcyeofzjc`

    xeoa`o k q melgm` eoa`yaypl `o ~emvpy`qcggot`yigoa #^P& qe`/ Eel x m c q T/G/J/

    hygopdegk h`oggka `o h`~yeapj``ya aeey LJF/

    Afq rxgyq`- dm`sfi`m `o ayeeh zjcpfkt`yigoa c``dq ``o o`qteykfh e~`o ~eyfozqypjqppy agq reyhq

    teey ``o h mfblkgqfh` o`hgqf`t` ayplt ya`mfoh `o ``o i q`y gdte y tgo `szpaggq/ A`

    zqgoaggyaaypl fozq`mmfoh tgyf``yq qpzz`o 0> + 790 kkCh/ A`r` o`qteykfh` degk fz teeygm

    h`oafj``ya ifb af`~`- eoy h mkgqfh h`teyka` xeoa` `o%ed zq yl `szpa y`oa` xeoa`o/ A`

    Gk`yflggoz` z~eoz c``dq gmz oga`mfh h`temh agq a` hyeq` ~eyfo h`kgll`mfbl jemmgi`y`o ifb ceh`

    aypl/ Cf`yaeey xeyaq c`q xeoai`a zq`yl foh`ty`q`o- xgq m`faq qeq ``o ~ezfqf`d `o `dd`jqf`t`y

    a`iyfa`k`oq- kggy eel teey ``o ~fbomfbl`y` t`yigoaxfzz m/ Of`q+lm`t`oa` rgmdhgr`o qpzz`o c`q

    xeoai`a `o a` z~eoz lpoo`o afq ~yeim``k hyeq`oa``mz e~tgoh`o/ @`o teeyi``ma tgo of`q+

    lm`t`oa` rgmdhgr`o fz k`~fq`m - a` zfmfjeo`o e~`o ~eyfo reyhq teey kfoa`y t`ylm`tfoh k`q a`

    z~eoz/ LJF iygjcq y`j`oq T/G/J/ HygopDegk Zfmt`y< ``o o`qteykfh zjcpfkt`yigoa k`q ``o

    e~`o ~eyfozqypjqppy af` rfmt`ytpmmfoh i`tgqq`/ Aeey a` o`hgqf`t` eoa`yaypl lek`o a` ~eyfo

    afy`jq fo jeoqgjq k`q c`q xeoai`a/ Rfmt`y c``dq `ddfjfoq` goqfigjq`yfm` x`ylfoh /

    A` Apfqz`y ^yed/ Ay/ Xfmc`mk Dm`fzjckgoo te`ya` tgjpkqc`yg~f` pfq ifb gjpq` xeoa`ok`q Jema`s zjcpfkt`yigoa< h`~yeapj``ya aeey K`af~yed/ Fo 9>>: t`ylmggya` LJF agq afq

    http://www.diabetes-news.de/markt/kci/images/granufoam.jpg
  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    21/66

    zjcpfkt`yigoa hfdqfh` zqedd`o i`tgq/ LJF iygjcq ``o tgyfgoq e~ a` kgylq agq i`l`oa fz eoa`y a`

    ogk`o~emvtfovmgmjecemt`yigoa #^TG& ed T/G/J/T yzgdegk/

    Afq xfqq`- of`q+lm`t`oa `o teeyi`tejcqfha #zq`yf`m xgq`y& zjcpfkt`yigoa c``dq ``o afjcq`y`-

    kfoa`y e~`o of`q+o`qteykfh` ~eyfozqypjqppy/ Aeey a` kfjye~ey`pr` zqypjqppy xeyaq a` fohye`f

    tgo hygopmgqf` x``dz`m q`h`oh`hggo xggyaeey a` t`yigoaxfzz`m kfoa`y eoggoh`oggk t`ymee~q/

    A` zqgoaggyaaypl fozq`mmfoh tgyf``yq qpzz`o 790 + 9>> kkCh/ A`r` T`yzgdegk fz h`oafj``ya

    xgoo``y eoa`ymfhh`oa` zqypjqpy`o regmz z~f`y`o- ~`r`o- r`opx`o- qygoz~mgoqgq`o ke`q`o xeya`oi`zjc yka/ Aeey rfbo ceh` qy`llygjcq fz c`q t`yigoa eel kgll mfbl q` ~mggqz`o fo qpoo`mz `o

    lm`fo` cemq`z/

    Tgjpk Gzzfzq a xepoa Jmezpy #TGJ& c` dq eel ggoagjcq teey af`h`o` af` a`

    t`yigoaxfzz`m ke`q`o pfqte`y`o/ Gdcgol`mfbl tgo a` ~mggqz tgo a` xeoa` jy``ya` LJF a`

    gatgoj`a ay`zzfohhye`~- k q a` i`ae`mfoh ek c q ifblof~~`o `o t yteyk`o tgo a`

    zjcpfkt`yigoa`o q` i`~`yl`o `o a` cgoa`mfoh q` t`yzo`mm`o/ A` TGJ a` gatgoj`a ay`zzfoh+

    hye`~ i`zqggq pfq T/G/J/ hygopDegk c``m ay`zzfoh #cf`m&- TGJ giaekfogm ay`zzfoh zvzq`k

    #e~`o ipflxeoa`o&- T/G/J/ hygopDegk Qcfo ay zzfoh #e~~`ytmgllfh` xeoa`o&- T/G/J/

    hygopDegk Yepoa ay`zzfoh #af`~`y` xeoa`o&- T/G/J/ hygopDegk cgoa ay zzfoh

    #cgoaxeoa`o&/ \4- 70- 73- :6- 14-[

    http://www.diabetes-news.de/markt/kci/images/versaform.jpg
  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    22/66

    1/ X`ylfohzk`jcgofzk`

    1/7/ C`q oeykgm` xeoah`o`rfohz~yej`z

    Xeoah`o`rfoh fz ``o jek~m`s zgk`oz~`m tgo ~yej`zz`o xggyfo mgohrggk k``y forfjcq`o

    xeya`o t`yxeyt`o aeey x`q`ozjcg~~`mfbl eoa`yre`l/ Ek c`q x`ylfohzk`jcgofzk` tgo Tgj+

    qc`yg~f` pfq q` m`hh`o- rgm ``yzq leyq et`yme~`o xeya`o xgq a` oeykgm` dgz` `o a` i`otme`a`oa`

    dgjqey`o tgo a` xeoah`o`rfoh rfbo/ Eoa`y a` q`yk xeoa` t`yzqggo x` temh`oz a` a`dfofqf`

    tgo c`q Xfq+ H`m` lypfz Tmggoa`y`o2 @`o ~gqcemehfzjc` qe`zqgoa- xggyifb x``dz`mz eoa`ymfoh

    tgo `mlggy h`zjc`fa`o ed t`yof`qfha rfbo/ Fo oeykgm` ekzqgoafhc`a`o eoqzqggq `y ``o oeykgm`

    xeoac`mfoh af reoa`y `sq`yo` cpm~kfaa`m o lgo h`o`r`o/ A` xeoac mfoh ektgq c qxeoah`o`rfohz~yej`z agq i`zqggq pfq t`yzjcfmm`oa` dgz`o2

    Eoqzq`lfoh+ ed fodmgkkgqf`dgz`

    Ifb c`q gjppq eoqzqggo tgo a` xeoa` y`gh``yq c`q mfjcggk k`q ``o tgzjpmgfy` y`z~eoz-

    tgzeafmgqgqf`- h`temha aeey a` kfhygqf` tgo yea` ime`aj`mm`o `o ime`a~mggqb`z oggy a`

    xeoae~~`ytmglq`/ Cf ye~ temhq ``o tgzejeozqyfjqf` `o a` ime`a~mggqb`z jeghpm y`o-

    zjc`fa o dfiyfoeh` o gd teey ``o dfiyfo`o`qx`yl/ Afq gmm z ek c`q ime`at`ymf z q`

    i`~`yl`o/ Aggyog tfoaq tgzeafmgqgqf` ~mggqz ek a` h`o`rfoh q` i`teya`y`o/ @y xeyaq

    q`t`oz ~mgzkg gdh`h`t`o k q melggm e`a``k qeq h`temh/ Kgjyedgh`o z~ m`o ``o

    i`mgohyfbl` yem ifb c`q `mfkfo`y`o tgo aea` x` dz`mj`mm`o `o dghejvqez /

    Hygopmgqf`+ ed y`h`o`ygqf`dgz`

    Afq ektgq a` teykfoh tgo of`px ifoax``dz m `o of`px` ime`atgq`o/ Aeey a`

    kgjyedgh`o xeya o dfiyeimgzq o h`teyka< af` fozqggo teey a` ~yeapjqf` tgo a`

    `orvk`o< jemmgh``o `o `mgzqfo`/ Aeey a` hye`f tgo `oaeqc``mj`mm`o `o a` ~yeapjqf` tgo

    hye`fdgjqey`o xeya`o of`px` jg~fmmgfy`o e~h`iepxa< o`etgzjpmgyfzgqf`/ Cf`yaeey lgo

    rppyzqedyfbl- te`afohzqedyfbl ime`a c`q xeoac`yzq`m oeh t`yi`q`y`o/

    Kgqpygqf`+ ed y`kea`mm`yfohzdgz`

    A` x` dz mzq`ylq` tgo a` xeoa` xeyaq t yceeha aeey y`kea mm`yfoh tgo a`

    jemmgh` ot`r`m/ Dfiyeimgzq`o afdd`y`oqfy`o rfjc qeq kvedfiyeimgzq o- af` xeoaygoa`o

    hggo zgk`oqy ll`o `o reyh`o re teey xeoajeoqygjqf`z/ @y xeyaq of`px `~fqc` m

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    23/66

    h`teyka aeey kfqez`/ Xgoo` y a` of`px` `~fqc` mj mm`o fo jeoqgjq lek`o k q

    i`zqggoa` j`mm`o zqe~q a` ~yemfd`ygqf`/ @~fqc mfgmfzgqf` i`zjc ykq a` xeoa` q`h`o

    tejcqt`ymf`z `o c`q ifoo`oayfoh`o tgo kfjye+eyhgofzk`o/

    A`r` dgz`o tgo c`q xeoah`o`rfohz~yej`z zqggo fo t`yifoafoh k`q `mlggy `o et`ymg~~`o `mlggy/

    C`q oeykgm` xeoah`o`rfohz~yej z i`zqggq `o yrfbaz pfq ~yej`zz`o af` a` xeoah`o`rfoh

    zqfkpm`y`o #gjqftgqeyz& `o ~yej`zz`o af` a` h`o`rfoh gdy`kk`o #focfifqey`o&/ Gjqftgqeyz rfbo

    hye`fdgjqey`o #regmz Qygozdeykfoh Hye`fdgjqey i`qg #QHDi`qg&&- a` `orvk`o #~yeq`fogz`& af`

    eoqzqggo ifb c`q t`ytgm tgo ime`a~mggqb`z `o qyekifo`/ A` xeoah`o`rfoh lgo xeya o gdh`y`ka

    aeey q`t` m xeoa`szpaggq- q` t` m `orvk o- ggox`rfhc`fa tgo fod jqf` ed fodmgkkgqfey`

    dgjqey`o- ``o zm`jcq` kfjyejfyjpmgqf` fo `o yeoa a` xeoa`- ``o zm`jcq` gmh`k`o` qe`zqgoa tgo a`

    ~gqfoq/

    ' @`o q`t``m ggo xeoa`szpaggq i`tgq tggl ``o et`ykggq ggo `orvk`o h`~yeapj``ya

    aeey eoqzq`lfohzj`mm`o/ A` i`mgohyfblzq` rfbo2 `mgzqgz`z- k`qgmme~yeq`ogz`o #a`r` y`kk`o

    a` i`hfoo`oa` xeoah`o`rfoh& `o ~mgzkfo` #eoa`y fotme`a tgo ~mgzkfo` xeyaq dfiyfo`

    ekh`r`q fo gdtgmzqedd`o&/ A`r `orvk`o `o gdtgm~yeapjq`o lpoo`o oggzq cpo opqqfh`

    dpojqf` #c`q e~ypfk o tgo igjq yfo `o aeea x` dz`m& eel a` xeoah o`rfoh `yozqfh

    cfoa`y`o/ Et`ykgqfh t``m `szpaggq reyhq teey kgj`ygqf` tgo a` xeoa `o a` xeoaygoa`o/

    Fo jcyeofzjc` xeoa`o rfbo q`t``m kgjyedgh`o ggox`rfh #k``zq` fogjqf`d&- gmz h`temh tgo

    et`y~yeapjqf`/ Kgjyedgh`o z~`m`o ``o i`mgohyfbl` yem ifb c`q y`hpm`y`o a` xeoah`o`rfoh

    teey rex m a` e~ypfkfoh tgo mfjcggkzty `ka` kgq yf gmz zqfkpmgqf` tgo

    hygopmgqf`x``dz`m teykfoh/

    Ifb ``o oeykgm xeoah`o`rfoh fz apz ``o `t`oxfjcqfh` igmgoz oeafh qpzz`o gjqftgqeyz `o

    focfifqey`o/ Aeey qe`~gzzfoh tgo a` tgjpkqc`yg~f` fo ``o pfqh`igmgoj``ya` xeoa`- rpmm`o a`

    o`hgqf`t` dgjqey`o t`yxfba`ya xeya`o- xggyaeey c`q t`yzqeeya` `t`oxfjcq c`yzq`ma xeyaq `o a`

    h`o`rfoh i`teya`ya xeyaq/ Fo lmfofzjc` qyfgmz fz eoa`yrejcq ed c`q e~ a` xeoa ggoiy`oh`o ed

    fob`jq`y`o tgo hye`fdgjqey`o a` xeoah`o`rfoh ifb jcyeofzjc` xeoa`o lgo i`otme`a`o/ A`

    eoa`yre`lzy`zpmqgq`o rfbo kgqfh- t`ya`y eoa`yre`l fz oeeargl`mfbl/ \:7- 16[

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    24/66

    1/9/ Fotme`a tgo tgjpkqc`yg~f` e~ xeoah`o`rfohz~yej`z

    A` tgjpkqc`yg~f` c``dq x`m a`h`mfbl `dd`jq e~ a` xeoac`mfoh- regmz oggy teeylxgk fo a`

    hyeoam`hh`oa` zqpaf` tgo Ay/ Mepfz Gyh`oqg `o Ay/ Kfjcg`m Keyvlxgz/

    @dd`jq e~ a` ime`aqe`te`y `o foq`yzqfqfm` t ygoa`yfoh`o

    Ifb jcyeofzjc` xeoa`o eoqzqggq zq``az ``o ~`yfd``y e`a``k yeoa c`q jg~fmmgfy` `o c`q

    ~mggqz`mfbl` mvkdgqfzjc` zvzq``k/ A`r` `sqyg ce`t` mc`fa tejcq rep jek~yfk`y`oa

    x`yl`o e~ c`q tgq`ozvzq``k xggyaeey a` ime`azqyeek aggmq/ Aeey a` qe`~gzzfoh tgo

    tgjpkqc`yg~f` xeyaq c`q foq`yzqfqfm` e`a``k h`y`apj``ya `o eoqzqggq ``o t`yceeha`

    a ykgm ~ ydpzf / C q `s~ yfk`oq m eoa`yre`l e~ a` tgyl`oz qeeoa` ``o

    t`ytf`ytepafhfoh tgo a` kfjyejfyjpmgqf` fo c`q xeoae~~`ytmgl- afq ifb ``o eoa`yaypl tgo

    790 kkCh/ E~ igzfz tgo a`r` tgzqzq`mmfoh x`ya a`r` eoa`yaypl ``o zqgoaggyaxggya`/

    Y`j`oq eoa`yre`l zphh`y``yq c`q h`iypfl tgo mgh`y` aypl xggya`o tgo 80 7>> kkCh-

    afq gdcgol`mfbl tgo c`q qv~` x``dz`m `o a` ime`a~`ydpzf`/ \:>[ Zgzlfg Ggyofol #9>>8&

    iepxa` t`ya`y e~ a`r` gjcq`yhyeoa `o a``a ``o eoa`yre`l oggy a` aeeyime`afoh fo `o

    yeoa ayf` t`yzjcfmm`oa` jcyeofzjc` xeoa`o qfba`oz c`q h`iypfl tgo tgjpkqc`yg~f`/ @`o

    i`q`y` ime`a~`ydpzf` c` dq ``o i`q`y h`o`rfohz~yej`z qeq h`temh/ R` jeojmpa` ya` agq a`

    aeeyime`afoh qfba`oz a` qc`yg~f` lgo h`k`q`o xeya`o k`q a` mgz`y ae~~m`y ~`ydpzfeo

    fkghfoh q`jcof`l/ K`q a`r` q`jcof`l xeyaq ``o deqe h`kgglq tgo a` aeeyime`afoh tgo

    a` cpfa ifb ``o af`~q` tgo >-0 7 kk/ E~ afq kek`oq xeya`o `ol`m` tfzp`m` foz~`jqf`z

    `o `ytgyfoh`o tgo i`cgoa`m`oa` ~yed`zzfeogmz h`ceeya/ Aeey a`r` q`jcof`l fz c`q

    keh`mfbl ek og q` hggo ed a` ~gqfoq k`q ``o i`~ggma` xeoa` x`m ed h``o iggq c``dq k`q

    a` tgjpkqc`yg~f`/ Goa`y` q`jcof`l`o regmz pmqygzepoa `o qygozjpqgo` rppyzqedk`qfoh

    x`ya`o pfqh`zmeq`o ekagq dvzf`l jeoqgjq oeafh fz `o c`q ke`fmfbl fz ek afq qfba`oz a`

    qc`yg~f` qe` q` ~gzz`o/ E~ c`q `foa` tgo cggy eoa`yre`l lxgk r` qeq a` jeojmpzf` agq

    tgjpkqc`yg~f` a` aeeyime`afoh tgo ``o xeoa` lgo t`yi`q`y`o/ Qejc kgglq rfb eel a`

    i`a`olfoh agq t`ya`y i`xfbz oggy a` fotme`a tgo tgjpkqc`yg~f` e~ a` aeeyime`afoh

    t`ya`y ke`q xeya`o eoa`yrejcq/ A` jeojmpzf` pfq c`q eoa`yre`l lgo c`m~`o ifb c`q e~

    ~poq zq mm`o tgo a` tgjpkqc`yg~f`/ Cf`yk`` xeyaq h`ozfop``ya agq f`a`y` ~gqfoq fo a`

    qe`lekzq i`cgoa ma lgo xeya o k q ``o goa`y` eoa`yaypl/ A` xggya` tgo a`

    eoa`yaypl rgm ago gdh`zq`ka xeya`o ggo a` ~`yzeeo `o c`q zeeyq xeoa`/ Qeq op qe`

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    25/66

    xeyaq f`a`y` jcyeofzjc` xeoa` tggl e~ a`r`mda` kgof`y- k`q a`r`mda` eoa`yaypl #79>

    kkCh& i`cgoa ma/ Cf yaeey xeyaq ~gqfoq+ `o xeoaz~`jfdfjgqf` of q e~ `mlggy

    gdh`zq`ka/ \4- 79- 1:-14- 0>[

    @dd`jq tgo a` zeeyq tgo eoa`yaypl

    Tgjpkqc`yg~f` c``dq qx`` t`yzjcfmm`oa` kgof`y`o xggye~ k`o ``o o`hgqf`t` aypl lgo

    pfqte`y`o2

    e Jeoqfop` eoa`yaypl2 c q xeoae~~`ytmgl xeyaq h`apy`oa` a` c m`

    i`cgoa`mfoh imeeqh`zq`ma ggo ``o h`mfblkgqfh` aypl/

    e Foq`ykfqq`oq` eoa`yaypl2 c`q xeoae~~`ytmgl xeyaq h`apy`oa` 0 kfopq`o

    tgjpk ggoh`reh`o- t`ytemh`oz temhq ``o ypzq~`yfea` tgo 9 kfopq`o/

    Rex`m foq`ykfqq`oq` gmz jeoqfop` tgjpkqc`yg~f` m`fa`o qeq ``o zfhofdfjgoq` qe`ogk` tgo

    hygopmgqf`x``dz`m- kggy c`q k``zq pfqh`z~yel`o `dd`jq xeyaq h`rf`o ifb foq`ykfqq`oq`

    tgjpkqc`yg~f`/

    e Jeoqfop` eoa`yaypl c``dq ``o ~yej`oqp`m` zqfbhfoh tgo hygopmgqf`x``dz`m

    #h`kfaa`ma` zqgoaggyaa`tfgqf`& k`q 4:-:- fo c`q af`y`o`s~`yfk`oq ifb

    tgjpkqc`yg~f` q`o e~ rfjcq` tgo a` jeot`oqfeo`m` qc`yg~f` k`q tejcqfh`

    hggzt`yigoa`o/

    e Foq ykfqq`oq eoa`yaypl c``dq ``o ~yej`oqp`m zqfbhfoh tgo

    hygopmgqf`x` dz`m #h`kfaa`ma` zqgoaggyaa`tfgqf`& k`q 7>:-1 fo c`q

    af`y`o`s~`yfk`oq ifb tgjpkqc`yg~f` q`o e~rfjcq` tgo a` jeot`oqfeo`m`

    qc`yg~f` k`q tejcqfh` hgr`o/ \77- 97[

    ^cfmi`jl #9>>8& eiz yt` ya` a`r` xggya`o `o c``dq qx` t`ylmgyfoh`o teey a`

    `ddfjfoqf` tgo foq`ykfqq`oq` eoa`yaypl q`o e~rfjcq` tgo jeoqfop` eoa`yaypl/ Gmz ``yzq`

    reyhq c`q foq`ykfqq`oq ggorpfh`o tgo c`q x``dz`m teey ``o yfqkfzjc` ~`ydpzf` af` c`q

    ~yej`z tgo a` jg~fmmgfy` r`mdy`h`mfoh cgoacggdq/ J`mm`o xeya`o c`q i`zq h`gjqft``ya qeq

    a`m o xgoo` y `y ``o gdxfzz`m`oa h`c``m tgo ypzq #eoa`yaypl gdx`rfh& `o gjqftgqf`

    #eoa`yaypl ggox`rfh& i`zqggq/ Goa`yrfbaz ifb jeoqfop` eoa`yaypl xeya`o a` x``dz`mz

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    26/66

    jeoqfop h`gjqft``ya/ Afq m`faq qeq gag~qgqf` teey a` zqfkpmf xggyaeey a`r` k`qcea`

    fo`ddfjfoq xeyaq/ ^cfmi`jl h`iypflq cf`yteey a` q`yk fhoey` zqfkpmf/ \:9[

    @dd`jq e~ a` teykfoh tgo hygopmgqf`x` dz`m- k`jcgofzjc` zqy`zz`dd jq

    Aeey qygjqf` pfq q` e`d`o`o e~ a` j`mm`o- a`m`o a`r` rfjc zo`mm`y/ Afq `dd`jq fz gm mgoh`y

    i`l`oa fo a` eyqce~ af` #i``ot ym`ohfoh& `o a` ~mgzqfzjc` jcfypyhf` #qfzzp` `s~goafoh>1& -

    i`t`zqfh`o of`q gmm` lmfofzjc` zqpaf`z c q `dd`jq tgo a` t ykfoa ya` igjq`yfm` hye`f/ \99[

    Fo 9>>7 x`ya ``o Jejcygo`+ zqpaf` pfqh`te`ya/ Pfq ``o zvzq`kgqfzjc mfq`ygqppyeoa`yre`l

    tgo x`q`ozjcg~~`mfbl` gyqfl`mz imfbl`o qe`o zm`jcqz qx`` lm`fo` h`ygoaekfz``ya` zqpaf`z

    q` i`zqggo- Bez`~c @/ + O`x qc`yg~`pqfj g~~yegjc`z fo xeoajgy` `o Kjjgmmeo Z/

    Tgjjpk Gzzfzq`a Xepoa Jmezpy t`yzpz zgmfo`kefzq`oa hgpr` fo qc` c`gmfoh ed

    ~ezqe~`ygqft` afgi`qfj deeq xepoaz/

    Bez`~c @/ te`ya` fo 7666 ``o ~yez~`jqf d h`ygoaekfz``ya eoa`yre`l oggy

    tgjpkqc`yg~f` q`o e~rfjcq` tgo ``o zqgoaggya xeoai`cgoa`mfoh ifb jcyeofzjc` xeoa`o/

    A` zqgoaggya xeoai`cgoa`mfoh xgz a` jeoqyem hye`~- xggy ayf`kggm agghz k`q repq

    h`ay`olq` hgr`o x`ya`o gdh`a`lq/ A` eoa`yre`l~e~pmgqf` i`zqeoa pfq 91 ~gqfoq`o k`q fo

    qeqggm :4 jcyeofzjc` xeoa`o/ A`r` xgy`o et`y c`q k`y`oa``m a`jpifqpz xeoa`o #o;93&-

    goa`y`o xgy`o a`cfzj`oqf` #o;:&- qygpkg #o;9&- aeey ygafeqc`yg~f` #o;7& `o t`o`pr`

    fozpddfjfoqf` #o;9&/ A` i mgohyfblzq jeojmpzf` xgz agq c q xeoae~~`ytmgl k q

    tgjpkqc yg~f` i`cgoa ma ~yej`oqp` m h y`apj` ya xgz k q 44/ Q yxfbm fo a`

    jeoqyem`hye`~ kggy ``o ~yej`oqp`m` y`apjqf` tgo 9> tgo c`q xeoae~~`ytmgl xgz xggy

    q` o`k`o/ T`ya`y x`ya ifb a` qe`~gzzfoh tgo tgjpkqc`yg~f` 41 hygopmgqf`x``dz`m

    eoqa`lq- q`yxfbm afq ifb a` lmgzzf`l` xeoai`cgoa`mfoh 76 xgz/ Aggyifb zq`ma` k`o tgzq

    agq `y fo a` jeoqyem`hye`~ q`l`o`o xgy`o tgo eoqzq`lfoh `o dfiyez`/ A`r` q`l`o`o xgy`o

    qeqggm gdx`rfh ifb a` xeoa`o xggy tgjpkqc`yg~f` x`ya`o qe`h`~gzq/ Qejc fz Bez`~c @/

    teeyrfjcqfh k`q a`r` tgzqzq`mmfoh ekxfmm tgo a` lm`fo` t`yzjcfmm`o qpzz`o a` qc`yg~f`o/

    \77[

    Kjjgmmeo `q gm/ #9>>>& eoa yrejcq o c q `dd jq tgo tgjpkqc`yg~f` ifb a`

    ~ezqe~`ygqf`t` i`cgoa`mfoh tgo afgi`q`zte`q`o/ A` eoa`yrejcq` ~e~pmgqf` i`zqeoa pfq 7>

    ~gqfoq`o af` og ``o jcfypyhfzjc eoa`yre`l eoxfmm l`pyfh t`ya` ma x`ya`o fo ``o

    `s~`yfk`oq`m` hye`~ #tgjpkqc`yg~f`- o;0& `o jeoqyem` hye`~ #repqh`ay`olq` hgr`o o;0&/

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    28/66

    A` jeojmpzf` tgo afq eoa`yre`l qeeoa` ggo agq `y ``o zo`mm`y` xeoah`o`rfoh xgz ifb

    xeoa`o i`cgoa`ma k`q tgjpkqc`yg~f`/ Eoa`y h`o`rfoh x`ya i`ae`ma agq `y z`jpoagfy`

    `~fqc`mfgmfzgqf` ~mggqzteoa ed a` xeoa` ~yfkgfy h`zmeq`o leo xeya`o/ E~tgmm`oa xgz agq

    ifb 1 e~ 0 ~gqfoq`o k`q tgjpkqc`yg~f` i`cgoa`ma- a` xeoa` ~yfkgfy leo h`zmeq`o

    xeya`o/ Fo t`yh`mfblfoh qeq a` jeoqyem`hye`~- xgz agq 9 e~ a` 0 ~gqfoq`o/ I`mgohyfbl`

    e~k`ylfoh`o2 afq eoa`yre`l x`ya h`zpizfaf``ya aeey LJF< cf`yifb yfbzq a` tyggh ed a`eoa`yre`l`y h``o fotme`a l`oa` tgo a` dgiyflgoq `o cgoa`mzeoa`yo`kfoh fo k`afzjc`

    gyqfl`m`o/ T`ya`y fz c`q eoa`yre`l q` lm`fo ek zqgqfzqfzjc` zfhofdfjgoq` y`zpmqgq`o tgzq q`

    zq`mm`o/ X`m lpoo`o `y i`mgohyfbl` jeojmpzf`z pfq h`qyell`o xeya`o/ \9>[

    Kgjyea deykgqf`

    Afq fz a` dvzf`l` y`gjqf` af` k`q``o rfjcqiggy fz aeey c`q zgk`oqy`ll`otgo a` xeoaygoa`o/ Cf`yaeey xeyaq c`q xeoatempk` h`y`apj``ya/

    Aeey ifb f`a y` t`yigoaxfzz`m a` degk q`ml`oz lm fo`y q` lof~~`o

    xeyaq tgo a`r` `fh`ozjcg~ h`iypflh`kgglq/

    Aeey h`iypfl q` kgl`o tgo a` zqgoaggyaeoa`yaypl 790 kkCh `o a`

    rxgyq` HygopDegk xeyaq a` aypl h`mfblkgqfh t`ya``ma/ C`q x``dz`m

    tgo a` xeoaiea`k xeyaq `ofhzrfoz fo a` ~eyfo tgo c`q

    zjcpfkt`yigoa h`qyell`o- xgq ``o y`l e~ a` j`mm`o qeq h`temh c``dq

    Qgi`m 1 2 y`zpmqgq`oTgjpkqc`yg~f` Repq h`ay`olq` hgr`o

    H`kfaa`ma` xeoa

    h`o`rfoh #agh`o&99-3 19-3

    Xeoae~~`ytmglq`

    #~yej`oqp``m&+ 93-1 , 6-0

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    29/66

    tgo 0 9> / A`r` kfjyea`deykgqf` c``dq i`mgohyfbl` ifemehfzjc`

    y`gjqf`z qeq h`temh/

    A` j mm`o y`gh`y`o e~ a`r` y`l aeey c q ~yfll m`o tgo z~`jfgm`

    y`j`~qey`o e~ c`q e~~`ytmgl `o c`q fo hgoh r`qq`o tgo h`o`qfzjc`

    ~yej`zz`o af` a` j`ma`mfoh zqfkpm`y`o/

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    30/66

    Afq reyhq teey ``o t`yceeha` k`qgiemfzjc` gjqftfq`fq- zqfkpmgqf` tgo

    dfiyeimgzq`o- t`yceeha` j`m~yemfd`ygqf` `o ~yeapjqf` tgo `sqygj`mmpmgfy`

    kgqyfs/ Aeey a` t`ykfoa`yfoh tgo e`a``k `o t`yi`q yfoh tgo a`

    aeeyime`afoh xeyaq a` ggote`y tgo ime`a- te`afohzzqedd`o- rppyzqed

    `o hye fdgjqey`o t yceeha/ Afq gmm z m faq qeq zo`mm teykfoh tgo

    h`reoa hygopmgqf`x``dz`m fo a` xeoa` `o a` lgyglq`yfzqf`l` zqypjqppy

    af` b` rf`q fo xeoa`o af` k`q tgjpkqc`yg~f` rfbo i`cgoa`ma/

    Fo 9>>1 t yzjc`o`o a` y`zpmqgq o tgo ``o x q`ozjcg~~ mfbl eoa`yre`l agq

    kfjyea`deykgqf` `o j`m~yemfd`ygqf` ifb c`q h`iypfl tgo tgjpkqc`yg~f` i`zqpa``ya`/ A` fo

    tfqye zqpaf z eoa y m fafoh tgo Ay/ Zgs`og jeojmpa`y o a` cv~eqc`z` agq

    tgjpkqc yg~f `yteey reyhq agq f`a y` foaftfap`m j`m ``o t`yteykfoh eoa`yhggq>1&- ``o tfyqp`m`

    zfkpmgqf` h`teyka- af` ``o t`yh`mfblfoh x` yh``dq qpzz`o ``o r`t oagghz of q+tgjpk

    i`cgoa`ma` xeoa` `o `o r`t`oagghz tgjpki`cgoa`ma` xeoa`/ \07[

    Of`q tgjpki`cgoa`ma` xeoa` Tgjpki`cgoa`ma` xeoa`

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    32/66

    1/:/ T`y~m``hlpoafh` cgoa`mfoh`o

    Ek tgjpkqc`yg~f` qe` q` ~gzz`o- rfbo `yt`yzjcfmm`oa` kgq`yfgm`o oeafh/

    Zjcpfkt`yigoa agq fo t`yzjcfmm`oa` hyeeqq`z i`zqggq/ Afq lgo rex`m c`q

    ~emvtfovmgmjecemt yigoa rfbo< c`q xfqq` t`yigoa k`q a` lm`fo` ~eyfo- agq ceedargl`mfbl

    h`iypflq xeyaq ifb ~fbomfbl` ed e~~`ytmgllfh` hygopm y`oa` xeoa`o- ed c q

    ~emvpy`qcggot`yigoa rfbo- c`q rxgyq` t`yigoa k`q a` hyeq`y` ~eyfo- agq ceedargl`mfbl

    h`iypflq xeyaq ifb af`~`- eoy`h`mkgqfh h`teyka` xeoa`o `o%ed zq`yl `szpa`y`oa` xeoa`o/

    Gda`ldemf` pfq ~emvpy`qcggo2 afq xeyaq og a` ~mggqzfoh tgo c`q zjcpfkt`yigoa ggoh`iygjcq

    ek c`q h`c``m mpjcqafjcq q` kgl`o/

    Aygfo ed QYGJ ~ga- gdrpfhzmgoh e~tgohi`l`y- ~ek~pofq< ek a` eoa`yaypl gd q` zq`mm`o/

    Zq`yf`m` zjcggy ek zjcpfkt`yigoa q` lof~~`o e~ kggq tgo a` xeoa`/

    Cgoazjce`o`o rex`m lf`ktyfb` gmz zq`yf`m`

    Gmz mggqzq` a` ~yeapjq`o teey a` xeoay fofhfoh< regmz lek~y zz`o- ~foj`q- AGT z`q-

    eoqzk`qqfohztme`fzqed `o `t`oqp``m zjc``yk`zb`/

    Ek a` q`jcof`l apfa`mfbl q` kgl`o- rgm a`r`zqg~zh`xfbz xeya`o et`yme~`o/

    7/ A` ~gqfoq fodeyk`y`o et y xgq- xggyek- ce` a` t yigoaxfzz`m rgm t`yme~`o- c`q kgq yfggm

    lmggym`hh`o/ Gmz a` ~gqfoq oeh h``o tgjpkqc`yg~f` cga- xeyaq a` ~ek~ h`jeoqyem``ya `o

    xeyaq a` e~tgohi`l`y `o a` gdrpfhzmgh k`q `mlggy t`yieoa`o/ Xgoo``y a` ~gqfoq y``az

    tgjpkqc`yg~f` ly``h< xeyaq a` x`yl`oa` ~ek~ h`zqe~q `o xeyaq a` aygfo `o gdrpfhzmgh

    gdh lm`ka/ Cf yog xeya`o of q zq yf`m` cgoazjce`o`o ggoh`aggo ek c`q t`yigoa q`

    t`yxfba`y`o/ A` demf` lgo b` c`q i`zq t`yxfba y`o aeey a`r` xgq pfq q` y`ll`o/ Xgoo``y c`q

    zjcpfkt`yigoa tgzq rfq ggo a` xeoa`- xeyaq a`r` i`zq mezh`x``lq k`q ``o dvzfemehfzjc`

    e~mezzfoh/

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    33/66

    9/ A` xeoa` xeyaq re hyeoafh `o reyhtpmafh keh mfbl eoqaggo tgo i zmgh/ Ifbreoa`y`

    ggoagjcq hggq oggy a` hyeeqq`- lm`py- h`py- ce`t``mc`fa tejcq tgo a` xeoa` `o a` cpfa

    yeoaek a` xeoa` xeyaq h`jeoqyem``ya e~ lm`py- ayplm`qz`mz- cpfai`zjcgafhfoh ed fyyfqgqf`/

    Teey ``o i q`y` e~temhfoh tgo a` xeoa` lgo ``o deqe h`oek`o xeya o ekagq a`

    i`zjcyfbtfoh tgo a` xeoa` zekz q` i`~`ylq fz/ Og c`q reyhtpmafh y`fofh`o- fz c`q i`mgohyfbl

    ek a` xeoaygoa`o `o ekmfhh`oa` cpfa ayeeh q` a`~~`o goa`yz lgo kgj`ygqf` eoqzqggo/

    :/ Og a` t`yreyhfoh tgo a` xeoa` xeya`o a` of q+zq`yf`m cgoazjce`o`o pfqh`qyell`o `o

    xeya`o zq`yf`m` cgoazjce`o ggoh`aggo/ C`q lof~~`o tgo c`q zjcpfkt`yigoa ke`q zq`yf`m

    h`i`py`o/ C`q t`yigoa ke`q c`q xeoai`a jek~m``q gdzmpfq`o `o a` xeoaygoa`o ygl`o/

    I`mgohyfbl` ggoagjcqz~poq`o< c`q t`yigoa kgh of`q e~ a` xeoaygoa ypzq`o goa`yz eoqzqggo

    `y ayplm qz mz/ Og c`q lof~~`o tgo c`q t`yigoa xeya`o mezmfhh`oa` y`zqb`z t`yxfba`ya-

    goa`yz lek`o a`r` fo a` xeoa` q` y`jcq/ Xgoo``y c`q tgjpkzvzq``k et`y ``o aygfo

    i`zjcflq af` fo c`q zjcpfkt`yigoa ke`q h`iygjcq xeya`o- ago xeyaq afq op h aggo/

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    34/66

    1/ T ytemh`oz xeyaq a` gda`ldemf` e~ kggq h`lof~q< a r` ke`q ypfkzjceeqz et`y a`

    zjcpfkt`yigoa`o lm`t`o `o qx`` qeq ayf` j`oqfk`q`y e~ a` xeoaygoa`o/ Tgogd op xeyaq c`q

    zjcpfkt`yigoa fo a` xeoa` ggoh`iygjcq `o xeyaq a`r` gdh`a`lq k`q a` demf`/ A` demf` ke`q

    r``y he`a tgzqh`~mglq xeya`o reagq `y h``o mpjcqm`ll`o eoqzqggo- eel e~ a` ~mggqz xggy a`

    aygfo oggy a` ~ek~ mee~q/

    0/ Xgoo` y c`q tgjpkzvzq `k et y ``o QYGJ ~ga k`q ~gqjc+zvzq``k i`zjcflq xeyaq `y

    ``o e~`ofoh tgo qx`` j`oqfk`q`y fo a` demf` h`kgglq/ A` QYGJ ~ga fz ``o z~`jfgm`

    eoqxfll`mfoh tgo LJF< af` r``y pof`l fz/ Goa`y` ~yeapj`oq`o i`zjcfll`o cf`y of`q et`y/ A`

    QYGJ ~ga a` ggoc`jcqfoh tgo a` aygfo k`q a` demf` i`zjcflq et`y tf`y lgogm`o af` fo

    zqggq rfbo ek a` aypl q` k`q`o/ Cf`yaeey fz c`q keh`mfbl ek a` foh`zq`ma` aypl e~ a` ~ek~

    aggax`yl`mfbl qe` q` ~gzz`o/ A` ~gqjc xeyaq e~ a` demf` h`~mglq/ Cf`yog xeyaq a` aygfo oeh

    ``oz `sqyg i`t`zqfha ggo a` cpfa reagq `y h``o eokfaa`mmfbl` qygjqf` e~ a` demf` fz/ Reyh

    `yteey agq a` aygfo xgq mez rfq tgo a` cpfa reagq `y h``o ayplm`qz`mz eoqzqggo/ T`ytemh`oz

    xeyaq a` aygfo t`yieoa`o ggo a` gdrpfhzmgoh/ A` gdrpfhzmgoh`o xeya`o e~`oh`r`q `o a`

    ~ek~ ggoh`r q e~ a` teeyh`zjcy`t`o rpfhlygjcq/

    4/ Og c`q ggoiy`oh`o tgo c`q zvzq``k- af`oq `y xeya`o h`jeoqyem` ya e~ m`llgh` tgo mpjcq ed

    xeoatejcq/ \9:- 0>[

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    35/66

    1/1/ T`y~m``hlpoafh` ggoagjcqz~poq`o

    Fo t`yh`mfblfoh k`q a` lmgzzf`l` xeoai`cgoa`mfohzk`qcea`o xeyaq a` xeoai`cgoa`mfoh

    k`q tgjpkqc`yg~f` ek a` ayf` qeq tf y agh`o pfqh`te`ya/ Mgoh y ago a`r` mfkf q fzyfzfjetem ekagq c`q hygopmgqf`x``dz`m q` af`~ fo c`q zjcpfkt`yigoa rgm foh`hye`fa rfbo

    xggyaeey a` t`yigoaxfzz`m r` y ~fbomfbl t`ymee~q/ Ifb f`a y` t`yigoaxfzz m xeyaq a`

    e~tgohi`l`y eel t`ytgoh`o/ \9:[

    Ifb c`q t`yxfba`y`o lgo c`q zjcpfkt`yigoa fo c`q xeoai`a lm`t`o/ Cf yifb lgo c`q

    zjcpfkt`yigoa mezh`x``lq xeya`o k`q ``o dvzfemehfzjc` e~mezzfoh/ \9:[

    Gmz a` ~ek~ xeyaq gdh`r`q ed eoa`yiyel`o< kgh afq of`q mgoh`y ago r`zqfh kfopq`o apy`o

    goa`yz fz `y q` t``m e~ce~foh tgo xeoatejcq `o igjq`yfo fo a` xeoa` xggyaeey `y ``o

    fod`jqf`iyeo eoqzqggq/ A` `ofh` e~mezzfoh fz c`q t`yigoa t`ytgoh`o/ \4- 9:[

    C`q fz i`mgohyfbl ek og q` hggo ce` a` ~gqfoq rfjc te`mq ifb a`r` qc`yg~f`/ Xeyaq a`

    foh`zq`ma` eoa`yaypl of`q gmz `yh ~fbomfbl `ytgy`o5 @`o ~gqfoq af` teey a` ``yzq` kggm

    xeyaq i`cgoa`ma k`q a` tgjpkqc`yg~f` lgo ~fbo eoa`ytfoa`o gmz a` o`hgqf`t` aypl xeyaq

    e~h`ay`t`o/ C`q fz keh`mfbl ek a` aypl fo zqg~~`o tgo 90 kkCh e~ q` iepx`o qeq a`

    h`x`ozq` aypl fz i`y`flq/ Eel e~ zejfggm tmgl ke`q `y y`l`ofoh h`cepa`o xeya`o/ A`

    ~gqfoq rfq q`ozmeqq` tgzq ggo ``o ~ek~- xggyaeey rfbo m` dx`y`ma i`~`ylq y fz/ \9:[

    Xgoo``y a` ~gqfoq gohzq c``dq ek ~fbo q` c`ii`o qfba`oz a` i`cgoa`mfoh ed c`q rf`q `y oggy

    pfq agq a` t`yigoaxfzz`m ~fbomfbl rgm t`yme~`o- fz c`q ggo q` yga`o ek ``o ~fbozqfmm`y q`

    h`t`o/ \4- 7- 9:[

    A` t`y~m``hlpoafh` ke`q c`q t`yigoa he`a ~mggqz`o fo c`q xeoai`a/ Cf`yifb xeya`o a`

    xeoaygoa`o of`q et`ymg~q goa`yz eoqzqggo ayplm`qz`mz/ C`q fz tggl ke`fmfbl a` xeoa` re

    ogpxl`pyfh q` i`zjcyfbt`o' @`o deqe o`k`o- lgo ``o e~mezzfoh rfbo- afq lgo q`t`oz eel

    teeyh`m`ha xeya`o ggo a` gyqz/ \9:[

    Tgjpkqc`yg~f` x`ylq kfoa`y he`a xgoo``y o`jyeqfzjc x``dz`m ggox`rfh fz/ Teey a`

    i`cgoa`mfoh xeyaq afq fo `ml h`tgm jcfypyhfzjc t`yxfba ya- qfba`oz a` t`yigoaxfzz m fz c`q

    oeeargl`mfbl ek xeoai`zmgh `o leyzq`o reyhtpmafh q` t`yxfba`y`o/ \4- 9:[

    C`q fz i`mgohyfbl agq c`q zjcpfkt`yigoa re zq`yf`m keh`mfbl xeyaq ggoh`iygjcq e~ c`q

    xeoae~~`ytmgl/ Ifb c q lof~~`o e~ kggq keh o h``o kfopzjpm y zq o tgo c q

    zjcpfkt`yigoa fo a` xeoa` i`mgoa`o/ Afq m`faq qeq a` k``zq teeylek`oa` jek~mfjgqf`/ @`o

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    36/66

    i`~`ylq ggoqgm lm`fo` dyghk`oq`o aygghq h``o h`temh`o kggy a` hyeq`y` zqpll o lpoo`o

    zjcga`mfbl rfbo/ A`r` dyghk`oq`o xeya`o e~h`oek`o qpzz`o c`q hygopmgqf`x``dz`m `o reyhq

    #foaf o hyeq ce`t` mc fa& teey eoqzq`lfohzy`gjqf`/ C q h`iypfl tgo t``mtepafh`

    z~eozdyghk`oq`o xeyaq gdh`yga`o/ Fz afq of`q keh`mfbl ago xeyaq c`q ggoqgm z~eoz`o fo ``o

    xeoa h`y`hfzqy``ya- reagq `y h``o zqpll`o fo a` xeoa` imfbt`o/ \:[

    Og a` ~mggqzfoh ke q h`jeoqyem``ya xeya`o ed `y h``o m`llgh` tgo mpjcq ed tejcq fz/ @`o

    m`llgh` tgo mpjcq fz ceeyiggy #dmpfq`oa- zfzz`oa h`mpfa& `o rfjcqiggy ggo c`q zjcpfkt`yigoa

    agq eotemm`afh folm`kq/ Fo c`q t`y~m``haezzf`y xeyaq zq``az h`oeq``ya ce`t``m a` foh`zq`ma`

    aypl `o a` lm`py- y`pl `o ce`t``mc`fa tgo c`q xeoatejcq fz/ \4[ C`q T/G/J/ qe`zq`m tgo

    LJF i`zjcflq et`y ``o zkgyq gmgykzvzq``k agq ``o zfhoggm h``dq xgoo``y `y ``o m`llgh`-

    imell`yfoh fz- a` e~tgohi`l`y tem fz- a` igqq`yfb ifbog m` h fz/ \07[

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    37/66

    0/ Foafjgqf`z- jeoqyg+foafjgqf`z

    Tgj+qc yg~f fz h`oafj `ya e~ a` mgh`y h`m h`o `sqy`kfq`fq o- ieyzq- zq yopk- ipfl- mf`z-

    zgjypk- yph- iggo tgo c`q eeh- rex`m ifb gjpq` gmz jcyeofzjc` xeoa`o/ @`o jcyeofzjc` xeoa` fz``o xeoa` af` `y of`q fo zmgghq ek c`q oeykgm` h`o`rfohz~yej`z q` aeeyme~`o- fo ``o i`~ggma

    ~yej`z ek ``o gogqekfzjc `o dpojqfeo` m c`yzq`m q` i y`fl`o/ C`q hggq et y ``o gqeo` xeoa` af`

    zm`jcq h`tgzjpmgyfz``ya fz/ Aeey k`q tgjpkqc`yg~f` q` zqgyq`o- xeyaq a` zqfmh`tgmm`o xeoa`

    h gjqft` ya qeq teykfoh tgo hygopmgqf x``dz m/\90[ C q x q`ozjcg~~`mfbl` i`xfbz agq

    tgjpkqc`yg~f` zq`yl ggoh`x`r`o fz ifb jcyeofzjc` xeoa`o x`ya eoa`y goa`y` h`m`t`ya aeey

    a` hyeoam hh`oa` zqpaf` tgo ^yed/ Mepfz Gyh`oqg `o Ay/ Kfjcg`m Keyvlxgz- Bez ~c @/-

    Kjjgmmeo ZL/ Z~`jf`df`l` foafjgqf`z rfbo2 \:- 4- 73- 9:- :0[

    A`cfzj`oqf`z- `sqygtgzgqf`/

    Qc`yg~f`y`zfzq`oq` xeoa`o/

    Qygpkgqfzjc`+- h`od`jq``ya` xeoa`o- ~ezqe~`ygqf`t` i`cgoa`mfoh tgo ``o e~`o zq`yopk

    og ``o zq`yofqfz ed k`afgzq`ofqfz/ Pfq ``o eoa`yre`l eoa`y m`fafoh tgo LJF x`ya c`q `dd`jq

    tgo k`q ``o tgjpkqc`yg~f` i`cgoa`ma` xeoa` t`yh`m`l`o k`q ``o xeoa` i`cgoa`ma k`q

    ``o jeot`oqfeo`m qc`yg~f / Aggypfq im `l agq og ``o ~`yfea` tgo ayf` kggoa`o a`

    ~yej`oqp`m` et`ym`tfohzlgoz tgo ``o xeoa` i`cgoa`ma k`q tgjpkqc`yg~f` 7>> xgz/

    Q`yxfbm a` ~yej`oqp`m` et`ym`tfohzlgoz ifb a` jeot`oqfeo`m` qc`yg~f`< og ayf` kggoa`o

    30 xgz/ @t`o``oz lxgk pfq c`q eoa`yre`l oggy teey agq `y ``o zo`mm` y`fofhfoh- zmpfqfoh

    ~mggqzteoa ifb xeoa`o i`cgoa`ma k`q tgjpkqc yg~f`/ Aeeyagq `y zqgifmfq fq lxgk fo a`

    xeoac`mfoh- t`yi`q`ya` a` meohdpojqf`- xgz `y t``m kfoa`y ~fbo/ \94- 07[

    Fo a` y qyez~ jqf d zqpaf z tgo Ay/ Bgvgoq ^/ x`ya ogh`hggo ed

    tgjpkqc`yg~f` `ddfjfoq fz ifb a` i`cgoa`mfoh tgo zq`yogm` xeoa`o k`q ed

    reoa`y k`afgzqfofqfz/ A` qc yg~f` x`ya qe`h`~gzq og ``o a`iyfa`k`oq qeq a`dfofqf t`

    zmpfqfoh ed c`q c`mfohz~yej`z t`yi`q`ya`/ @y x`ya`o fo a` ~`yfea` qpzz`o Bpof 7666 `o

    Kggyq 9>>1< 7>: ~gqfoq`o k`q zq`yogm` xeoa`o i`cgoa`ma/ A`r` ~e~pmgqf` i`zqeoa pfq 48

    kgoo o `o :4 tyepx`o k q ``o h`kfaa`ma` m``dqfba tgo 09 bggy #z~y`fafoh qpzz`o

    :kggoa`o `o 67 bggy&/ A` zq`yogm` xeoa`o x`ya`o e~h`a``ma fo ayf` hye`~`o< zq`yf`m`

    xeoa`o- e~~`ytmgllfh` i`zk`qq` xeoa`o `o k`afgzqfofqfz/ A` zqpaf` ektgqq` ~gqfoq`o

    k`q afgi`q`z- jcyeofzjc` eizqypjqf`t` meohrf`lq`- `foazqgafpk of`yrf`lq`- xggytgo 41

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    38/66

    k`q a` afghoez` k`afgzqfofqfz `o :4 ``o e~~`ytmgllfh` i`zk`qqfoh`o ed ``o zq`yf`m`

    xeoa cgaa`o/ A` qc`yg~f` x`ya h`iypflq teey ``o h`kfaa`ma` ~`yfea` tgo 77 agh`o ~`y

    ~gqfoq/ Ifb 43 #8> tgo 7>:& tgo a` ~gqfoq`o x`ya ``o a`dfofqf`t` ieyzqzmpfqfoh

    t`yly`h`o/ A` y`zq`y`oa` :9 #:: tgo 7>:& cgaa`o h``o a`dfofqf`t` zmpfqfoh/ Cf`ytgo

    xgy`o 96 ~gqfoq`o et`ym`a`o ggo ``o z`~zfz q`o h`temh` tgo k`afgzqfofqfz `o of`q q`o

    h`temh` tgo a` qc`yg~f`/ Pfq a` y`zpmqgq`o tgo c`q eoa`yre`l- jeojmpa``ya` Ay/Bgvgoq ^/

    agq tgjpkqc`yg~f` ifb a` i`cgoa`mfoh tgo~ezq+zq`yoeqekf` xeoa`o t`fmfh `o

    `ddfjfoq fz/ A` keyqgmfq fqjfbd`yz af` oggy teeylek`o fo afq eoa yre`l rfbo c`q h`temh tgo

    c`q eoa`ymfhh`oa` rf`lq`~yej`z `o rfbo h``o x``yz~f`h`mfoh tgo jek~mfjgqf`z t`yieoa`o

    ggo a` qc`yg~f`/ T`ya`y tgmq e~ q` k`yl`o agq c`q xeoae`a``k- a` h`o`rfohzqfba `o c`q

    ggoqgm igjq`yfo y`apj` yq/ A` eoa`yre`l yz fbt y`o `yteey agq tgjpkqc`yg~f` ``o

    zqgoaggya~yeqejem fo a` ``yzq`mfbozi`cgoa`mfoh t`ylyfbhq ifb zq`yogm` xeoa`o/ \74[

    Eoa`yqpzz`o fz tgjpkqc`yg~f` he`ah`l`pya gmz zqgoaggyai`cgoa`mfoh teey af`~`

    zq`yogm` xeoai`zk`qqfoh`o/ Fo a` ~yglqfbl m`faq afq qeq pfqzq`l`oa` lmfofzjc` y`zpmqgq`o/ /

    C q x q`ozjcg~~`mfbl` i`xfbz i qy dd`oa` c q k`jcgofzk` tgo xeoac`mfoh lekq

    mgohrggk oggy iet`o/ A` l`oofz i`qy`dd`oa` a` h`temh`o teey cgyq `o meohdpojqf` rfbo

    oeh i`~`ylq/ A` eyhgo`o fo c`q k`afgzqfopk rfbo c`keavogkfzjc `zz`oqf``m/ Ifb ~gqfoq`o

    k`q ~ezq+zq`yoeqekf` k`afgzqfofqfz- ke`q`o lx`qzigy` ekm`fafohz`oq`o `o a` t`ykfoa`ya`

    cgyqdpojqf` fo et`yx`hfoh h`oek`o xeya`o qfba`oz tgjpkqc`yg~f`/ Aeey a` cpfafh`

    l`oofz tgo tgjpkqc`yg~f` rfbo `y ggorf`omfbl` lgoz`o ek a` q`jcof`l fo cgyqjcfypyhf` q`

    eoqxfll`m`o `o q` e~qfkgmfz`y`o/ \76[

    Afgi`q z pmj yg/ Aeey h`iypfl q` kgl`o tgo a` tgjpkqc`yg~f` xeyaq a` hye`f tgo

    hygopmgqf`x``dz`m h`zqfkpm``ya/ Xgq ``o hpozqfh` `tempqf` tgo c`q xeoai`a q`x` h

    iy`ohq `o c`q yfzfje e~ gk~pqgqf` t`ymgghq/ Fo a`j`ki`y tgo 9>>8 ~pimfj` ya` Ay/ Impk`

    ^/G/ a` focepa`mfbl` zqypjqppy tgo rfbo eoa`yre`l/ Fo agq eoa`yre`l x`ya ``o t`yh`mfblfoh

    h`kgglq oggy a` t`fmfhc`fa `o lmfofzjc` ae`mqy`dd`oac`fa tgo O`hgqf`t` Aypl Qc`yg~f`

    #O^XQ& q`o e~rfjcq` tgo a` H`gtgoj``ya` Tejcqfh` Qc`yg~f` tgo a` Xeoa #GKXQ&

    ek afgi`q`z~gqfoq`o k`q pmj`yg q` i`cgoa`m`o/ Afq kpmqfj`oq`y #k``ya`y` rf`l`ocpfr`o< 7

    Jgogag `o 93 fo PZG& ygoaekfr`a jeoqyemm`a qygfm fz ``o r``y y`j`oq eoa`yre`l agq

    y`m`tgoq` `o z~ygglkgl`oa` jeojmpzf`z i`tgq' Fo qeqggm ogk`o :19 ~gqfoq`o #h`kfaa`ma`

    m``dqfba 03 bggy& a``m ggo c q eoa yre`l xggytgo 86 kgoo`o `o c q et`yfh` a` m

    tyepx`o/ K`q temm`afh` zmpfqfoh tgo a` pmj`yg x`ya i`ae`ma agq `y 7>> `~fqc` mx``dz`m

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    39/66

    x ya h`teyka/ A` ~gqfoq`o x ya`o xfmm l`pyfh t ya` ma fo ``o hye`~ xggy

    tgjpkqc`yg~f` #o;746& `o ``o goa`y` hye`~ xggy GKXQ #o;744& #teeygm cvayeh`mz `o

    gmhfogq`o& x`ya qe`h`~gzq/ C`q eoa`yre`l mf`~ et`y 779 agh`o ed qeq pmj`yg zmpfqfoh qeq

    zqgoa lxgk/ @ml` `tgmpgqf` tgo a` xeoa` i`zqeoa pfq ``o i`eeya`mfoh tgo a` zmpfqfoh/ Pfq

    c`q eoa`yre`l im``l agq 8: tgo a` 746 xeoa`o #1:-9&- i`cgoa`ma k`q tgjpkqc`yg~f`

    ``o temm`afh` zmpfqfoh i`lxgk`o qfba`oz a` 779 agh`o/ Fo a` hye`~ tgo a` GKXQ< im``l

    13 tgo a` 744 xeoa`o #93-6& ``o temm`afh` zmpfqfoh q` i`lek`o fo a`r`mda` ~`yfea`/ Pfq

    a` y`zpmqgq`o lxgk eel oggy teey agq `y kfoa`y z`jpoagfy` gk~pqgqf`z ke`q`o pfqh`te`ya

    xeya`o ifb a` qe`~gzzfoh tgo tgjpkqc`yg~f / Ifb a` `tgmpgqf` tgo c q ggoqgm

    qc`yg~f`agh`o im``l afq teey tgjpkqc`yg~f` #36-0& leyq`y q` rfbo ago a` i`cgoa`mfoh

    k`q GKXQ #60-:&/ E~ tmgl tgo t`fmfhc`fa x`ya`o h``o zfhofdfjgoq t`yzjcfmm`o

    xggyh`oek`o- af` i`qy`llfoh c`ii`o e~ i`zk`qqfoh- j`mmpmfqfz- `o ezq ekv`mfqfz/ A`

    gmh`k`o` jeojmpzf` tgo Ay/ Impk`2 Tgjpkqc`yg~f` zjcfboq re t`fmfh q` rfbo regmz- `o

    ae`mqy`dd`oa`y- ago GKXQ teey a` i`cgoa`mfoh tgo afgi`q`z pmj`yg/ \8[

    Ayplm`qz`mz< a`jpifqpz/ A` i`cgoa`mfoh tgo af`~`y` a`jpifqpz xeoa`o o``kq t``m qfba

    #x`l`o qeq kggoa`o& fo i`zmgh k`q a` jeot`oqfeo`m` xeoai`cgoa`mfohzk`qcea`o/ K`q

    tgjpkqc`yg~f` xeyaq a` ggokggl tgo hygopmgqf`x``dz`m t`yzo`ma/ Afq i`z~ggyq qfba `o

    mgohapyfh m``a teey a` ~gqfoq/ C q i`xfbz agq tgjpkqc`yg~f ggoh`x`r`o fz ifb

    a`jpifqpz xeoa`o x`ya h`m`t`ya fo a` hyeoam`hh`oa` zqpaf` tgo ^yed/ Mepfz Gyh`oqg `o

    Ay/ Kfjcg`m Keyvlxgz/ \9-77[

    Cpfaqygoz~mgoqgq`o #~y`+ gmz ~ezqe~`ygqf`t` k`zc`a z~mfq zlfo hygdqz&/ Aeey h`iypfl q`

    kgl`o tgo tgjpkqc`yg~f` appyq c`q ceehpfq 0 agh`o ek a` zmgghlgoz e~ fohye`f tgo a`

    hygdq q` e~qfkgmfz`y`o/ C`q et`yieafh` xeoatejcq xeyaq gdh`reh`o `o a` hygdq xeyaq

    zq`tfh h`dfs``ya q`h`o a` xeoaiea`k aeey a` eoa`yaypl/

    Gyq`yfm` `o t`o`pr` fozpddfjfoqf`- jcyeofzjc pmjpz jypyfz/ Fo c`q eoa`yre`l tgo B/A/A/

    Tp yzqg`l #9>>9& x`ya tgjpk i`cgoa`ma` pmj`yg y`qyez~`jqf d t`yh`m l`o k`q ``o

    jeoqyem hye`~ #pmj`yg i`cgoa`ma a/k/t/ jeot`oqfeo`m` xeoai`cgoa`mfohzq`jcof`l`o&/ Fo

    t`yh`mfblfoh k`q jeot`oqfeo`m` xeoai`cgoa`mfohzq`jcof`l`o- x`ya `y apz fo a` qeqgm`

    e~ogk`appy #qeq `o k`q xeoazmpfqfoh& ifb tgjpkqc`yg~f` i`cgoa`ma` pmj`yg ``o y`apjqf`

    h`rf`o tgo y`z~`jqf`t mfbl 16 ifb t`o`pr`+ `o :6-9 ifb gyq yfemezjm yeqfzjc`

    i``oxeoa`o/ Fo q`h`ozq`mmfoh qeq a` t`o`pr` `o gyq`yfemezjm`yeqfzjc` hye`~- x`ya `y h``o

    zfhofdfjgoq` y`apjqf` fo e~ogk` appy #qeq `o k`q xeoac`mfoh& h`rf`o fo a` h`jekifo``ya`

    t`o`pz% gyq`yfm` hye`~/ Afq fz keh`mfbl q` xfbq`o ggo c`q lm`fo` ggoqgm ~gqfoq`o fo a`r`

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    40/66

    hye`~ `o a` qx`` aye~+epqz x`ml` rfjc eel fo a`r` hye`~ i`teoa`o/ Y`a`o`o teey a`

    aye~+epqz rfbo2 ~fbolmgjcq`o `o c`q dgm`o tgo a` q`jcof`l/\93[

    Fo 9>>4 ~pimfj` ya` B/A/A/ Tp`yzqg`l ``o of`px eoa`yre`l oggy a` t`yzjcfmm`o

    qpzz`o tgjpkqc`yg~f` `o a` jeot`oqfeo`m` xeoai`cgoa`mfoh #cvayeh`mz `o gmhfogq`o&< e~

    tmgl tgo appy tgo c`mfoh- ~fbo- m`t`ozlxgmfq`fq `o lezq~yfbz/ C`q hfoh ek 4> ~gqfoq`o k`q

    jcyeofzjc pmjpz jypyfz- af` h`mfblkgqfh x`ya`o t`ya``ma fo a` jeoqyem` hye`~ `o a` hye`~

    xggy tgjpkqc yg~f` x`ya qe`h`~gzq/ A` h`kfaa`ma` qfba ek c`q c`m o q` temqeef`o

    i`aye h 96 agh`o #z~y`fafoh qpzz`o 90-0 + :9/0& ifb tgjpkqc`yg~f` `o h`kfaa`ma 10

    agh`o # z~y`fafoh qpzz`o :4-9 + 0:/3& fo a` jeoqyem`hye`~/ A` teeyi`y`fafoh tgo c`q

    xeoai`a qfba`oz tgjpkqc`yg~f` xgz i`apfa`oa leyq`y< ogk`mfbl 8 agh`o #z~y fafoh

    qpzz`o 0-8 + 3/:&/ Q`yxfbm afq ifb a` jeot`oqfeo`m` xeoareyh 78 agh`o #z~y`fafoh qpzz`o 7>

    + 91& i`aye`h/ A` lezq`o tgo jeot`oqfeo`m` xeoareyh xgy`o ceh`y ago tgjpkqc`yg~f`/

    I fa` hye`~`o cgaa`o ``o zfhofdfjgoq` t`ycehfoh tgo a` m`t`ozlxgmfq fq `o ``o

    zfhofdfjgoq` agmfoh tgo ~fbozjey`z ggo c`q `foa tgo qc`yg~f`/ B/A/A/ Tp`yzqg`l jeojmpa``yq

    agq tgjpkqc`yg~f` zp~`yf`py fz ggo a` jeot`oqfeo`m` xeoai`cgoa`mfoh< e~ tmgl tgo

    i`cgoa`mfohzqfba ifb tgo jcyeofzjc` pmjpz jypyfz/ \96[

    Tgjpkqc`yg~f` zqfkpm``yq a` hye`f tgo hygopmgqf` x``dz`m `o fz aggyek of`q ggoh`x`r`o e~

    xeoa`o k q dfzq`mz/ A` qc`yg~f reyhq teey ``o zqfkpmgoz teey a` dfzq`m- xggyaeey a`r`

    e~`oh`cepa`o xeyaq/ Xgoo` y `y z~ygl` fz tgo ezq`ekv`mfqfz ke`q a`r ``yzq i`cgoa`ma

    xeya`o gmtey`oz k`q a` tgjpkqc`yg~f` q` zqgyq`o/ Ekagq tgjpkqc`yg~f` h``o `dd`jq c``dq e~

    c`q ieqx``dz`m/ C`q h`iypfl e~ tyfb mfhh`oa` eyhgo`o- oeo+k`zc a z~mfq zlfo hygdqz fz `t`o``oz

    gdh`yga`o/ O`jyeqfzjc` xeoa`o- xeoa`o k`q lgol`yj`mm o rfbo eel of q h`oafj `ya teey

    tgjpkqc`yg~f`- q`orfb a`r` teey a` qe`~gzzfoh jcfypyhfzjc t`yxfba`ya xeya`o/ Xgoo``y a`

    tgjpkqc`yg~f` rep qe`h`~gzq xeya`o e~ kgmfho` x``dz`m rpmm`o a` kgmfho` j`mm`o rfjc t`ya`ya`m`o xggyaeey ``o pfqiy`fafoh tgo c`q lxggaggyafh` x``dz`m e~qy``aq/ @sqyg ggoagjcq ke`q

    xeya`o i`zq``a ggo ~gqfoq`o k`q zqemmfohzzqeeyofzz`o- ~gqfoq`o af` i`cgoa`ma xeya`o k`q

    ~mggqb`zghhy`hgqf`y`kk yz- ifb hyeq` tyfb mfhh`oa` t`o`o- gyq`yfo- r`opx`o/ A r` teyk`o h``o

    jeoqyg+foafjgqf` kggy ke`q`o x`m he`a e~h`temha xeya`o/ Ifb zqemmfohzzqeeyofzz`o i`zqggq a`

    lgoz e~ ``o gjqf`t` ime`afoh< aeey hyeeq ime`at`ymf`z lgo cv~etem`kf` e~qy`a`o xggyaeey a`

    ~gqfoq fo zcejl hggq/ \4- 3- 73- 9:- :0- 0>[

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    41/66

    4/ Teey+ `o oga`m`o tgo qc`yg~f`

    A` xeoai`cgoa`mfohzq`jcof`l aygghq c``m xgq teeya`m`o k`q rfjc k`` q`o e~rfjcq` tgo a`

    lmgzzf`l` xeoai`cgoa`mfoh/

    A` qc`yg~f` aygghq ifb qeq a` lxgmfq`fq tgo c`q m`t`o/ C`q c`ii`o tgo ``o xeoa` c``dq tggl

    ``o hyeq` fk~gjq e~ a` lxgmfq fq tgo c`q m`t`o `o ``o zo`mm` h`o`rfoh fz aggyek tgo hyeeq

    i`mgoh/ \07[

    Kfoa`y dy`wp`oq` t`yigoaxfzz`m< fo a` mfq`ygqppy rfbo t`yzjcfmm`oa` k`ofoh`o et`y ce`mgoh

    ``o t`yigoa q`y ~mggqz` kgh imfbt`o/ @`o iyeo c``dq c`q et`y 9+1 agh`o \4[< ``o goa`y` et`y

    : + 1 agh`o \9:[ `o oeh ``o goa`y` et`y 9 0 agh`o \77[/ X`m cgohq t``m gd tgo a` zqggq

    tgo a` xeoa`/ Og `ofh` ~yglqfzjc` tggyafhc`fa fz c`q t`yigoa ``otepafh ggo q` iy`oh`oxggyaeey a` x`ylmgzq aggmq/

    A` tgjpkqc`yg~f` c``dq ``o hyeeq foafjgqf`h`if`a/ Aeey a` teeyqapy`oa` eoqxfll`mfoh

    tgo z~`jfdf`l` t`yigoa`o #oggy mejgqf` qe`- zgk`ozq`mmfoh& xeyaq afq oeh t`ya`y pfqh`iy`fa/

    C`q et`ykgqfh` xeoatejcq xeyaq gdh`reh`o `o fo ``o h`zmeq`o zvzq``k e~h`tgoh`o/ Ifb

    xeoa`o af` t``m xeoatejcq gdh`t`o fz a`r` qc`yg~f` r``y teeya`mfh/

    A` qc yg~f` fz t fmfh< teeygm k q a` ~ek~`o tgo LJF/ A`r` i zjcfll`o tgogd a`

    ggozmpfqfoh k q a` o qz~goofoh qeq ifb a` xeoa` et`y ``o J@ j`yqfdfjgqf`/ Goa y`

    ~yeapj`oq`o c`ii`o afq h`a``mq`mfbl teey i`~ggma` eoa`ya`m o kggy of`q teey c`q temm`afh`

    zvzq``k/ \11- 07[

    Aeey a` jeoqfop` ed foq`ykfqq`oq` eoa`yaypl xeyaq a` xeoa` lygjcqfh h`y`fofha/ Q`t`oz

    xeyaq c`q xeoah`o`rfohz~yej`z i`teya`ya/ #T`yi q`yfoh gohfeh`o`z - gjqftgqf` tgo c`q

    hygopmgqf`x``dz m `o `~fqcgmfzgqf`- gdrpfh o tgo qesfo`o- igjq`yfo xggyaeey jcyeofzjc`

    xeoa`o pfq a` eoqzq`lfohzdgz` xeya`o h`cggma&

    Kfoa`y e`a``kteykfoh fo a` xeoay`hfe/ Aeey a` qe`~gzzfoh tgo tgjpkqc`yg~f` xeyaq

    c`q foq yzqfqf` m e`a``k h`y apj``ya `o eoqzqggq ``o t`yceeha` a`ykgm` ~`ydpzf / C`q

    `s~ yfk oq m eoa`yre`l e~ a` tgyl`oz qeeoa` ``o t ytf ytepafhfoh tgo a`

    kfjyejfyjpmgqf` fo c`q xeoae~~`ytmgl- afq ifb ``o eoa`yaypl tgo 790kkCh/

    Tfg a` tgjpkpofq fz c`q keh`mfbl ek e~ ``o i`qyepxigy` kgof`y ``o h`jeoqyem``ya

    tgjpkkfmf`p q` jy`y`o/ Agolrfb ``o i`t`fmfhfoh e~ c`q qepjc zjy``o lgo a` ~gqfoq a`

    qc`yg~f` of`q xfbrfh`o aeey jeoqgjq q` c`ii`o k`q c`q zjc`yk/ C`q zvzq``k i`zjcflq q`t`oz

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    42/66

    eel et`y ``o gmgyk agq zfhoggm h``dq xgoo``y a` e~tgohi`l`y tem fz `o xgoo``y c`q

    h`x`ozq` tgjpk of`q lgo xeya`o qe`h`af`oa #aeey m`llgh`&/

    A` lgoz teey c`q e~me~`o tgo ``o of`px` jeoqgkfogqf` qfba`oz a` i`cgoa`mfoh fz ofcfm aeey

    a` igyyfy` k`q a` ekh`tfoh- agolrfb a` demf`/ A` ~gqfoq kgh h`ypzq ``o aepjc` o`k`o

    \9:[/ Xgoo``y a` qc`yg~f` h`zqgglq xeyaq- kgh afq of`q mgoh`y ago r`zqfh kfopq`o apy`o-

    ekagq rfjc goa`yz q` t``m xeoatejcq `o igjq yfo e~ce~`o fo a` xeoa`/ A` `ofh`

    e~mezzfoh fz c`q t`yigoa q` t`ytgoh`o/

    Eoagolz a` zq`yl y`fofh`oa` `o gdtme f`oa` dpojqf` tgo et`ytme`afh xeoatejcq- imfbdq c`q

    xeoae~~`ytmgl tejcqfh/ @y qy``aq ogpx`mfblz kgj`ygqf` tgo a` xeoaygoa`o e~/ Reoeafh

    lpoo`o a`r` i`zjc`yka xeya`o aeey igyyfy`jyk`- dfmkmggh- cvayejemmea`o/ \4- 6- 77- 71-

    9:[

    Eoagolz a` qgmyfbl` teeya`m`o- rfbo `y `ol`m` o`hgqf`t` ~poq`o e~ q` k`yl`o/

    Xgoo``y k`o ``o q` ceh` jeoqfop` rpfhlygjcq qe`~gzq e~ c`q xeoae~~`ytmgl fz a` lgoz

    hyeeq agq c`q h`zqfkpm``ya` hygopmgqf`x` dz`m rfjc fo a` z~eozqypjqpy`o tgzqc`jcq/ C`q

    oga``m cf`ytgo fz agq a` t`yigoaxfzz`m ~fbomfbl`y t`ymee~q/ Ek afq ~yeim``k e~ q` mezz`o fz

    c`q keh`mfbl a` ~gqfoq teey f`a`y` t`yigoaxfzz`m ``o ~fbozqfmm`y qe` q` af`o`o #ifbteeyi``ma

    af~faemey foqygkpzjpmgfy\7- 4- 9:[&/ @`o goa`y` keh`mfblc`fa i`zqggq `yfo ek qpzz`o c`q

    xeoae~~ ytmgl `o a` z~eozzqypjqppy ``o of q t ylm`t`oa rgmdhggz #k`~fq m +

    zfmfjeo`ot`yigoa& ggo q` iy`oh`o ed c`q ggo~gzz`o tgo a` z~eoz/ ^emvtfovmgmjecemt`yigoa

    c``dq kfjye~ey`pr` zqypjqppy- af` a` fohye`f tgo hygopmgqf` x``dz`m q`h`ohggq xggyaeey a`

    t`yigoaxfzz`m kfoa`y eoggoh`oggk t`ymee~q/ Q`yxfbm ~emvpy`qcggot`yigoa ``o o`qteykfh

    e~`o ~eyfozqypjqppy c``dq- xggyifb a` lgoz hyeeq fz qeq tgzqc jcqfoh fo c q

    hygopmgqf`x``dz`m/

    Ifb c`q t`yxfba`y`o tgo a` z~eozzqypjqppy lpoo`o ime`afoh`o eoqzqggo/ Oggyh`mgoh a`ggoae`ofoh lgo af` `yozqfh rfbo- regmz ifb pmjpz jypyfz- gyq`yf``m tggqmfba`o/ A`r` ime`afoh`o

    lpoo`o xeya`o h`zq`m~q aeey y`jcqzqy``lz` aypl pfq q` e`d`o`o e~ a` ~mggqz tgo ime`afoh/

    Aeey a` jeoqfop` i`cgoa`mfoh mfhq a` ~gqfoq h`ieoa`o ggo c`q qe`zq`m tfg m`fafoh/ Afq

    qe`zq`m fz q`t`oz e~ rfbo i`pyq t`yieoa`o tfg ``o zqyeeklgi`m k`q a` o`qz~goofoh/ Aeey

    a`r` h`ieoa`oc fa fz a` ~gqfoq i`~`ylq fo rfbo keifmfq fq/ Ifb c q h`iypfl tgo a`

    Tgjpk Gzzfzq`a xepoa Jmezpy` Gatgoj`a Qc`yg~v Zvzq`k fz c`q keh`mfbl a`r` q`

    i`t`zqfh`o ggo ``o z`ypkzqggoa`y/ Qejc z~``ma` a` ~yeapj`oq e~ afq oga``m fo- aeey c`q

    pfqiepx`o tgo ``o aygghiggyqe`zq`m xggy q`t`oz ``o gjjp fo t`yx`ylq rfq/ Cf`yaeey fz a`

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    43/66

    ~gqfoq x`m oeh zq``az t`yieoa`o k`q c`q qe`zq`m tfg ``o m`fafoh- kggy a` zqyeeklgi`m fz

    h`apy`oa` `ol`m` py`o of`q oeeargl`mfbl/ Fo q`h`ozq`mmfoh qeq a` rxgy` pofqz rfbo a`r`

    mfjcq`y tgo h`xfjcq `o cgoafh k`` q` aygh`o/

    C`q kgq`yfggm tgo a`r` qc`yg~f` fz of`q he`alee~/ C`q fz apz pfqreoa`ymfbl i`mgohyfbl agq `y

    xeyaq ogh`hggo ed a` ~gqfoq x`m a`h`mfbl h`cem~`o lgo xeya`o k`q a` qc`yg~f`/ Cf`yifb

    ke`q teey+ `o oga`m`o he`a xeya`o gdh`xeh`o/ \4[

    C`q x`ylt`ma fz r``y ~ezfqf`d et`y a`r` qc`yg~f`/ Xeoa`o hye`f`o ``ya`y afjcq aeey r` fo

    ``o tgjpkkfmf`p q` i`cgoa`m`o/ C`q hyeeqzq` h`tggy fz agq t`y~m``hlpoafh`o `o gyqz`o gm

    c`q t`yqyepx`o m`hh`o fo a` qc`yg~f`-q`yxfbm k`o kfoa`y ggoagjcq- l`oofz c``dq et`y a`

    bpfzq` x`ylfoh tgo a` qc`yg~f`'\6[ C`q I mhfzjc` D`a`yggm l`oofzj`oqypk teey a`

    H`reoac fazreyh i zqpa` ya` fo 9>>8 ggo a` cgoa tgo ``o zvzq kgqfzjc` y`tf`x

    #mfq`ygqppyzqpaf & ed `y x q`ozjcg~~ mfbl` mfq`ygqppy i zqggq et`y c q `dd`jq tgo

    tgjpkqc`yg~f`/ Pfq ``o eoa`yre`l- eoa`y m`fafoh tgo #gyqz+`s~`yq& B/ Tmgv`o- imfbl`o `y

    kek`oq` m #elqei`y 9>>8& a`yqf`o y`m`tgoq lmfofzjc` zqpaf z q` i`zqggo xggytgo qx``

    ygoaekfr`a jeoqyemm`a qygfmz/ A`r` YJQz i`zqpa``ya`o c`q `dd`jq tgo tgjpkqc`yg~f` e~

    cpfahy`dd`o `o afgi`qfzjc te`qxeoa`o/ Aeey c`q i`~`ylq` ggoqgm fz afq eotemae`oa` ek a`

    i`cgoa`mfoh tgo a` qc`yg~f` q` t`ygoqxeeya`o/ Qejc yggaq B/ Tmgv`o a` qc`yg~f` of`q gd `o

    h``dq ``o ~m`faeef ek t`ya`y x`q`ozjcg~~`mfbl eoa`yre`l q` te`y`o aeey c`q ~ezfqf`t`

    `dd`jq q` i`mfjcq`o/ C`q hyeeqzq` ae`m tgo x`q`ozjcg~~`mfbl i`xfbz q` m`t`y`o- fz ek a`

    qc`yg~f q` lpoo`o t`yhe`a`o aeey c`q YFRFT/ C q Yfblzfozqfqppq teey Rf lq`+ `o

    Fotgmfafq`fqzt`yr`l`yfoh `fzq hyeoafh x`q`ozjcg~~`mfbl i`xfbz oggy a` `dd`jqftfq`fq `o a`

    t`fmfhc`fa tgo a` qc`yg~f` gmtey`oz a` i`cgoa`mfoh q` t`yhe`a`o/\98[ Qejc lmfolq `y t``m

    lyfqf`l e~ a` zqpaf` `o jeojmpzf` tgo c`q I`mhfzjc` D`a`yggm l`oofzj oqypk teey a`

    H`reoac`fazreyh/ Ay/ ^/ Zjcyeeq`o `o ^yed/ Ie jls #~mgzqfzjc` jcfypyhf`& tgo PTJ

    Iyphkgoo fo Iypzz m zjcy`t o zgk`o cpo y`gjqf` o``y/ Agq c`m` yg~~eyq c``dq of qzt`ygoa`ya ggo eor` e~fof` et`y T/G/J// A` lyfqf`l hggq `fh`omfbl et`y c`q d`fq agq zqpaf`z

    e~ xeoac`mfoh of`q i`eeya``ma lpoo`o xeya`o aeey ``o mfq`ygqppyzqpaf` k`q a` qe`~gzzfoh

    tgo a` Jejcygo` k`qceaemehf`/ @t`o``oz fz `y lyfqf`l agq gmm` i`zqggoa` zqpaf`z x`ya`o

    gdh`zjceq`o- aeeyagq `y ``o i`~ggma jyfq`yfpk- temh`oz a` Jejcygo` k`qceaemehf` x`ya

    qe`h`~gzq/ A` zqpaf`z k q tgmgi`m` h`h`t`oz x ya`o of q hyeoafh i`l`l`o/ K q a`

    jeojmpzf` agq a` zqpaf`z of`q tema`a`o ggo a` Jejcygo` jyfq`yfg xgz teey c`o a` rggl

    gdh`me~`o/ X` c`ii`o fo a` mfq`ygqppy eotemae`oa` ggoxfbrfoh`o h`teoa`o ek q` lpoo`o

    r`hh`o agq c`q ``o he`a zvzq``k fz/ Cpo jeojmpzf` h``dq h``o eeya``m et`y ce` xggya`tem

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    44/66

    a` i`~`ylq` y`m`tgoq` mfq`ygqppy fz/ @y x`ya oeefq ogh`hggo ce` ``o zqpaf` et`y xeoac`mfoh

    ke`q i`oga`ya xeya o/ T`ya`y mgq`o Ay/ ^/ Zjcyeeq`o `o ^yed/ Ie`jls cpo eoqheejc`mfoh

    imfbl`o et`y c`q d`fq agq `y h``o fofqfgqf`d x`ya h`oek`o ek ``o he`a` k`qg+gogmvz` q`

    kgl`o/ Ifb ``o k`qg+gogmvz` xeyaq ``o eoa`yre`l h`te`ya oggy gmm` eoa`yre`l`o af` et`y

    ``o tgjpkqc`yg~f` h`~pimfj``ya x`ya`o/ Aeey i`cpm~ tgo zqgqfzqfzjc` k`qcea` xeyaq ``o

    y`zpmqggq h`teyka xggypfq ``o jeojmpzf` lgo xeya`o h`teyka/ Agq rep tgjpkqc`yg~f`

    t`ya`y lpoo`o c`m~`o/ \90[

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    45/66

    8/ Afzjpzzf`

    Fo 9>>7 x`ya ``o Jejcygo`+zqpaf` pfqh`te`ya- pfq c`q zvzq`kgqfzjc` mfq`ygqppyeoa`yre`l tgo

    x`q`ozjcg~~`mfbl` gyqfl`mz im`l`o `y qe`o zm`jcqz qx`` lm`fo` h`ygoaekfz``ya` zqpaf`z #aeeyBez`~c @/ + O`x qc`yg~`pqfj g~~yegjc`z fo xepoajgy` `o Kjjgmmeo Z/ Tgjpk Gzzfzq`a

    Xepoa Jmezpy` t`yzpz zgmfo` kefzq`o`a hgpr` fo qc` c`gmfoh ed ~ezqe~`ygqft` afgi`qfj deeq

    xepoaz& q` i`zqggo oggy a` `dd`jqftfq`fq tgo a` qc`yg~f`/ Aeey a`r` i`~`ylq` i`xfbr`o x`ya

    h`jeojmpa` ya agq `y oeh h``o i`qyepxiggy i`xfbz i`zqggq agq a` ~ezfqf`t` fotme`a tgo

    tgjpkqc`yg~f` ggoqeeoq/ Fo 9>>8 zqgyqq` c`q Gjga`kfzjc` K`afzjc` J`oqypk #GKJ& q`

    Gkzq`yagk- eoa`y m`fafoh tgo C`zq`y T`yk`pm`o #t`y~m``hlpoafh eoa`yre`l`y& `o Afyl Piifol

    #gyqz eoa`yre`l`y& ``o p~agq tgo a` Jejcygo`+zqpaf` / A`r` xgz oeeargl mfbl ekagq og 9>>7

    t``m of`px` ~yfkgfy` zqpaf`z x`ya`o pfqh`te`ya/ Afq xgy`o of`q `ol`m zqpaf`z e~ jcyeofzjc` `o

    gjpq` xeoa`o kggy eel t`o`pr` xeoa`o- afgi`q`z pmj`yg- a`jpifqpz `o cpfaqygoz~mgoqgqf`z/ @`o

    goa y h`h`t`o agq a`r` zqpaf` oeeargl`mfbl kgglq - xgz agq c q GKJ ret``m keh mfbl

    `tfa`oj`+igz`a xfm x`yl`o/ A` qc`yg~f` xeyaq t` m h`iypflq q`yxfbm a` `dd`jqftfq`fq oeh

    eoapfa`mfbl fz/ Q`t`oz fz x`q`ozjcg~~`mfbl i`xfbz oeeargl`mfbl ek ``o q`yphi`qgmfoh tgo a`

    qc`yg~f` q` teeyrf`o/ \7:[ C`q aggax`yl`mfbl` ae`m tgo a` zqpaf` xgz ek a` ae`mqy`dd`oac`fa

    tgo tgjpkqc yg~f` q` i`eeya`m`o/ @y x`ya ``o pfqte`yfh` mfq ygqppyzqpaf` pfqh`te`ya/ A`

    y`m`tgoq` eoa`yre`l`o lxgk`o pfq c`q Jejcygo` J`oqyggm Y`hfzq`y tgo h`jeoqyem``ya` ~ye`t`o-

    a` hye`~ h`z~`jfgmfz``ya` y`hfzq`y tgo ~ye`t`o Jejcygo` Xepoaz- K@AMFO@- @KIGZ@ `o

    c`q JFOGCM h`h`t`ozi`zqgoa`o/ Temh`oz a` z`m`jqf` jyfq`yfg x`ya h`rejcq oggy ygoaekfz`a

    jeoqyemm`a qyfgmz af` a` ae`mqy`dd`oac`fa tgo tgjpkqc`yg~f` q`o e~rfjcq` tgo goa`y` xeoareyh

    t yigoa`o `tgmp`y`o/ A` forgk mfoh- gogmvz - h zjcflqc fa x ya i`t`zqfha aeey qx`

    y`j`oz`oq`o/ A`r` xgy`o eogdcgol`mfbl k`q c`q eoa`yre`l i`qyell`o/ Rfb zqeoa`o fo teey c`q

    i`eeya`m`o tgo a` k`qceaemehfzjc` lxgmfq fq tgo a` eoa`yre`l`o temh`oz a` O`a`ymgoaz` mfbzq

    tgo c`q J`oqypk Jejcygo`- k`q i`qy`llfoh qeq foq`yo` `o `sq`yo` h`mafhc`fa/ Qx`` goa`y`

    y`j`oz`oq`o tgqq`o a` h`h`t`oz zgk`o af` fo ggok`ylfoh lek`o teey a` zqpaf`/ A`r` qx``

    k`ofoh`o x`ya`o aeeyt yx`r o oggy ``o a`ya` y`j`oz`oq- re x`ya`o k`ofohzt yzjcfmm`o

    i`~ ylq/ Pfq`foa mfbl` im`l`o 7: ygoaekfz`a jeoqyemm`a qyfgmz q` i`zqggo af` tema`a`o ggo a`

    ae`mzq`mmfoh`o- z`m`jqf`+ `o Jejcygo` jyfq`yfgz/ Pfq a` zqpaf` xeyaq h`jeojmpa``ya agq `y x`fofh

    y`m`tgoq` lxgmfq`fqzeoa`yre`l`o i`zqggo xggyaeey c`q i`xfbzkgq`yfggm i`~`ylq fz `o a` l`pr`

    teey tgjpkqc`yg~f` i otme`a xeyaq/ Tgjpkqc yg~f` fz ``o he`a gmq`yogqf`d teey

    hggzt`yigoa`o `o if aq e~ tmgl tgo ~fbo- ~gqfoqq`ty`a`oc`fa `o t`yreyhfohzqfba k``y

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    46/66

    teeya`m`o/ T`ya`y eoa`yre`l fz t`y fzq ek c`q x`q ozjcg~~ mfbl` i`xfbz q` t`ycgya`o `o

    eoi`goqxeeya` tygh`o +regmz m`t`ozlxgmfq`fq `o jek~mfjgqf`z- regmz gdzjc`fafoh- m`llgh`- `o

    keyifafq`fq+ q` i`goqxeeya`o/ A` Jejcygo`+zqpaf` yggaq ggo- agq qe`lekzqfh` zqpaf`z temae`oa`

    xeya`o eoa`yzq`poa- agq h`mafh` jyfq`yfgz fo t`yigoa k`q c`q i`eeya`m`o tgo a` xeoac`mfoh

    xeya`o h`iypflq- agq ~fbo `o kggqy`h m`o xeya`o h`yg~~eyq` ya- agq et y``olekzq`o k`q

    goa`y` zqpaf`z xeya`o i`t`zqfha/ \98[

    Dfoo Heqqyp~ teeykgmfh` teeyrfqq`y tgo a` @pye~`go Qfzzp` Y`~gfy Zejf`qv zq`ma` fo

    rfbo gdzjc fay`a` #7666&2 Tgjppkqc yg~v fz qc` eomv zfhofdfjgoq ~ygjqfjgm gatgoj` fo

    xepoac`gmfoh fo qc` mgzq 70 v`gyz kggy oeh zq `az yfbzq a` tyggh ed afq x m ``o

    xeoa`ykfaa`m fz/ Yeoa 9>>> cga c`q GKJ ``o of`q ``oapfafh eeya``m et`y a` lezq~yfbz tgo a`

    q`jcof`l q`o e~ rfjcq` tgo a` lmgzzf`l` xeoai`cgoa mfoh/ Aeey c q zo`mm` `dd`jq tgo

    tgjpkqc`yg~f` e~ a` xeoa` xeyaq a` e~ogk`appy fo c`q rf`l`ocpfz t`yleyq q`o e~rfjcq` tgo

    ``o lmgzzf`l` xeoai`cgoa`mfoh- gmce`x`m a` lezq tgo c`q t`yigoa `o a` lezq tgo a` ~ek~ ceeh

    e~me~`o/ \4[ Fo 9>>8 c``dq a` @pye~ go Xepoa Kgogh`k`oq Gzzejfgqfeo #@XKG&

    ggoh`h`t`o agq tgjpkqc yg~f ``o pfqzq l`oa gmq yogqf d fz teey a` h`xeo

    xeoai`cgoa`mfoh #i`zqggoa pfq t`yigoa`o&/ Rfb hgt`o iet`oaf`o ggo agq a` lezq`o k`q a`

    tgjpkqc`yg~f` of`q ceh`y e~me~`o ago a` lmgzzf`l` xeoai`cgoa`mfoh/ Cpo t`ylmgyfoh cf`yteey

    fz a` zo mm`y xeoah o`rfoh af` t`yly`h`o xeyaq k`q a` qc yg~f / A`r` t`ylmgyfoh xeyaq

    qyepx`oz aeey t m` ~yglqfblzqpaf`z `o +`ytgyfoh i`ggka/ Aeey a` qe`~gzzfoh tgo a`

    tgjpkqc`yg~f` xeyaq a` xeoa` zo`mm`y h`y`fofha `o eoqzqggq c`q hygopmgqf`x` dz`m zo`mm`y- afq

    fo t`yh`mfblfoh k`q a` lmgzzf`l` xeoai`cgoa`mfoh/ Temh`oz ^/ Xfbogoaz #xeoareyhjeyafogqey

    q` ROG zqpft`oi`yh% Zq/ @ygzkpz rf`l`ocpfz& fz x`q`ozjcg~~`mfbl i`xfbz `ol`m rfotem ek a`

    lezq`o q` t`yhe`a`o/ Pfq cggy ~yglqfbl`ytgyfoh rf`q rfb x`ma`h`mfbl `dd`jq/ C`q i`~`ylq` i`zqggo

    tgo x`q`ozjcg~~`mfbl i`xfbz oggy c`q `dd`jq tgo a`r` qc`yg~f` fz teey cggy h``o y`a`o ek a`r`

    qc`yg~f` of`q q` h`iypfl`o/ \7:[

    Ygoaekfr`a Jeoqyemm`a Qyfgmz #YJQ& fz c q teeyoggkzq qv~` eoa`yre`l ek a`

    `dd`jqftfq`fq tgo tgjpkqc`yg~f` q` i`xfbr`o/ YJQ fz ``o eoa`yre`l xggy ~gqfoq`o xeya`o

    t`ya``ma et`y ``o `s~`yfk`oq`m` hye`~ `o jeoqyem` hye`~/ @y xeya`o t`yzjcfmm`oa` `fz`o h`zq`ma

    xggyggo ``o YJQ zqpaf` ke`q temae`o/ @`yzq xeyaq c`q ggoqgm ~gqfoq`o tgzqh`m`ha/ T`ytemh`oz

    xeya`o fojmpzf`+ `o `sjmpzf` jyfq`yfg e~h`zq`ma/ Aeey meqfoh #ed ``o goa`y` q`jcof`l& lpoo`o a`

    ~gqfoq o eoxfmm l`pyfh xeya`o eoa`yt ya``ma fo ` o jeoqyem`hye`~ `o `s~ yfk`oq`m` hye`~/ Og

    ygoaekfzgqf` lyfbh`o i`fa` hye`~`o cpo xeoareyh temh`oz ``o zqyflq ~yeqejem- agq eoa`y

  • 7/23/2019 vacum assisted wound closure naar de thuissituatie

    47/66

    a`r`mda` ekzqgoafhc`a`o ke`q xeya`o pfqh`te`ya/ Aeey a`r` `fz`o q` zq`mm`o- fz c`q keh`mfbl

    c`q t`yzjcfm fo `dd`jq qpzz`o i`fa` i`cgoa`mfohk`qcea`o x``y q` h`t`o/ Ek c`q eoa`yre`l

    af`~ y pfq q` te`y`o lgo k`o imfoa`yfoh qe`~gzz`o/ Afq lgo ~`yd`jq ifb k`afjfboeoa yre`l/ A`

    ~gqfoq o xeya`o e~h`a` ma fo ``o jeoqyem`+ `o `s~`yfk`oq m` hye`~- kggy x`q`o r`md of`q ed r`

    ``o ~mgj`ie ed c`q x`yl`mfbl` h`o``zkfaa`m qe`h`af`oa lyfbh`o/ Fo eoa`yre`l oggy c`q `dd`jq

    tgo tgjpkqc yg~f fz afq q`jcofzjc a`oliggy kggy `qcfzjc eot`ygoqxeeya' @y lgo h``o

    temm`afh zvzq``k xeya`o ggoh`m`ha reoa`y zpjqf` pfq q` te`y`o/ Afq rep a` lgoz e~ fod`jqf` ed

    z`~zfz t`yhyeq`o/ Eel a` ~gqfoq r`md lgo ke`fmfbl h`imfoa``ya xeya`o/ A` `ofh` keh`mfblc`fa

    ek afq qv~` eoa`yre`l `qcfzjc t`ygoqxeeya q` cepa`o- fz agq a` eoa`yre`l`y xeyaq h`imfoa``ya/

    Cf`yifb kgglq ``o eogdcgol`mfbl` eoa`yre`l`y deqez tgo a` t`yzjcfmm`oa` xeoa`o fo jeoqyem +

    `o `s~`yfk`oq`m` hye`~/ A` h`zqgoaggyafz``ya` deqez xeya`o teeyh`m`ha ggo a` eoa`yre`l`y

    r`md/ A` eoa`yre`l`y zqggq f