APPLICATION OF MODERN WOUND DRESSINGS IN THE TREATMENT OF CHRONIC WOUNDS

Kronične i akutne inficirane rane mogu zbog komplikacija i sporog cijeljenja biti veliki klinički problem. na tržištu je osim klasičnih preparata za skrb o rani na raspolaganju čitav spektar suvremenih obloga za liječenje kroničnih rana. namijenjeni su za rane koje su nastale pod utjecajem fizioloških, patofizioloških i patoloških uzroka i koje nisu zarasle na očekivani način nakon primjene standardnih postupaka liječenja. Klasični materijali, kao što su gaze i zavoji danas se smatraju zastarjelima, tj. imaju samo povijesno značenje, jer su u praksi u primjeni suvremeni materijali koji se koriste u skrbi i liječenju rane te osiguravaju optimalne uvjete za zarastanje rane, kao što su vlaga, toplota i odgovarajući pH. Suvremene obloge upijaju sekrete iz rane, smanjuju bakterijsku kontaminaciju, štite okolinu rane od sekundarne kontaminacije iz okoline, štite okolnu kožu. Osim toga sprječavaju i prenošenje uzročnika iz okoline na površinu rane, ali i iz rane u okolinu. upotreba suvremenih obloga opravdana je samo onda kada je utvrđen uzrok nastajanja rane, ili je zbog primarne bolesti dijagnosticirana kronična rana. obloge biramo prema karakteristikama rane i na osnovi kirurškog iskustva. Pri tome mislimo da je najveća prednost suvremenih obloga u odnosu na klasične materijale u tome što se s njima rana učinkovitije čisti, postavljanje obloga je jednostavnije, smanjena je bol na dodir, smanjeno je sljepljivanje s površinom rane, a povećan kapacitet upijanja eksudata iz rane. uz te obloge ubrzava se stvaranje granulacija, skraćuje trajanje hospitalizacije i olakšava posao osoblju koje skrbi o bolesniku. Zbog svega toga su ukupni troškovi liječenja smanjeni, iako su cijene suvremenih obloga više u odnosu na klasične materijale.Chronic and acute infected wounds can pose a major clinical problem because of associated complications and slow healing. In addition to classic preparations for wound treatment, an array of modern dressings for chronic wound care are currently available on the market. These dressings are intended for the wounds due to intralesional physiological, pathophysiological and pathological causes and which failed to heal as expected upon the use of standard procedures. Classic materials such as gauze and bandage are now considered obsolete and of just historical relevance because modern materials employed in wound treatment, such as moisture, warmth and appropriate pH are known to ensure optimal conditions for wound healing. Modern wound dressings absorb wound discharge, reduce bacterial contamination, while protecting wound surrounding from secondary infection and preventing transfer of infection from the surrounding area onto the wound surface. The use of modern wound dressings is only justified when the cause of wound development has been established or chronic wound due to the underlying disease has been diagnosed. Wound dressing is chosen according to wound characteristics and by experience. We believe that the main advantages of modern wound dressings versus classic materials include more efficient wound cleaning, simpler placement of the dressing, reduced pain to touch, decreased sticking to the wound surface, and increased capacity of absorbing wound exudate. Modern wound dressings accelerate the formation of granulation tissue, reduce the length of possible hospital stay and facilitate personnel work. Thus, the overall cost of treatment is reduced, although the price of modern wound dressings is higher than that of classic materials. All types of modern wound dressings, their characteristics and indications for use are described

Plant-Derived Medicines with Potential Use in Wound Treatment

The skin is among the largest and one of the most important organs in the human body. It represents the first line of defence of the body; provides protection from mechanical impacts of the environment, limits the influence of variations in the temperature, prevents entrance of chemicals and microorganisms and restricts radiation effect. Skin damage affects all skin functions; therefore, wounds can compromise patient’s well-being, self-image, working capacity and independence. Due to all mentioned, a good wound management is necessary not only for the individual but also for the community. Herbal medicines have been used to accelerate wound healing since ancient times. Recently, scientists have been able to employ scientific methods to prove efficacy of many of these herbs and to get a better understanding of mechanisms of their actions. The popularity of herbal medicines may be explained by the perception that herbs cause minimal adverse effects. Preparations from traditional medicinal plants in wound management involve disinfection, debridement and the provision of suitable environment for natural healing process. In this chapter, the field of wound healing is briefly introduced. Further, the crucial information regarding plants, which are effectively used as wound healing agents in traditional medicine are gathered

An uncommon treatment of totally extruded and lost talus: a case report

6siIntroduction: Total extrusion and loss of the talus is a rare injury with a wide choice of appropriate treatment, but rarely resulting in a fully functional recovery. We report on an uncommon case, both for the severity of the injury and for the uncommon treatment due to the patient’s rejection of secondary surgery. Case presentation: We treated a 16-year-old Caucasian man with the most extreme variant of a totally extruded and lost talus, accompanied with complex injury of the soft tissues of the ankle and foot. The treatment included urgent microvascular foot reimplantation, microvascular muscle free flap transfer, and temporary fixation. This kind of injury should typically be treated by tibiocalcaneal arthrodesis. However, this was not performed, as after the successful early stages of the treatment he strongly objected to another surgery due to his fully functional status and the successful therapeutic results of our early treatment. Conclusions: The injury described in this case study would ordinarily be treated by amputation, but due to the well-executed treatment in the early stages after the injury, the outcome was satisfying. Surprisingly and against our expectations, the late results of the treatment were successful even without arthrodesis. He is now 37 years old and has a functional foot 21 years after the injury.openopenSmrke, Dragica Maja; Rožman, Primož; Gubina, Borut; Frangež, Igor; Smrke, Barbara Rejec; Arnež, Zoran MarijSmrke, Dragica Maja; Rožman, Primož; Gubina, Borut; Frangež, Igor; Smrke, Barbara Rejec; Arnez, ZORAN MARI

APPLICATION OF MODERN WOUND DRESSINGS IN THE TREATMENT OF CHRONIC WOUNDS

Kronične i akutne inficirane rane mogu zbog komplikacija i sporog cijeljenja biti veliki klinički problem. na tržištu je osim klasičnih preparata za skrb o rani na raspolaganju čitav spektar suvremenih obloga za liječenje kroničnih rana. namijenjeni su za rane koje su nastale pod utjecajem fizioloških, patofizioloških i patoloških uzroka i koje nisu zarasle na očekivani način nakon primjene standardnih postupaka liječenja. Klasični materijali, kao što su gaze i zavoji danas se smatraju zastarjelima, tj. imaju samo povijesno značenje, jer su u praksi u primjeni suvremeni materijali koji se koriste u skrbi i liječenju rane te osiguravaju optimalne uvjete za zarastanje rane, kao što su vlaga, toplota i odgovarajući pH. Suvremene obloge upijaju sekrete iz rane, smanjuju bakterijsku kontaminaciju, štite okolinu rane od sekundarne kontaminacije iz okoline, štite okolnu kožu. Osim toga sprječavaju i prenošenje uzročnika iz okoline na površinu rane, ali i iz rane u okolinu. upotreba suvremenih obloga opravdana je samo onda kada je utvrđen uzrok nastajanja rane, ili je zbog primarne bolesti dijagnosticirana kronična rana. obloge biramo prema karakteristikama rane i na osnovi kirurškog iskustva. Pri tome mislimo da je najveća prednost suvremenih obloga u odnosu na klasične materijale u tome što se s njima rana učinkovitije čisti, postavljanje obloga je jednostavnije, smanjena je bol na dodir, smanjeno je sljepljivanje s površinom rane, a povećan kapacitet upijanja eksudata iz rane. uz te obloge ubrzava se stvaranje granulacija, skraćuje trajanje hospitalizacije i olakšava posao osoblju koje skrbi o bolesniku. Zbog svega toga su ukupni troškovi liječenja smanjeni, iako su cijene suvremenih obloga više u odnosu na klasične materijale.Chronic and acute infected wounds can pose a major clinical problem because of associated complications and slow healing. In addition to classic preparations for wound treatment, an array of modern dressings for chronic wound care are currently available on the market. These dressings are intended for the wounds due to intralesional physiological, pathophysiological and pathological causes and which failed to heal as expected upon the use of standard procedures. Classic materials such as gauze and bandage are now considered obsolete and of just historical relevance because modern materials employed in wound treatment, such as moisture, warmth and appropriate pH are known to ensure optimal conditions for wound healing. Modern wound dressings absorb wound discharge, reduce bacterial contamination, while protecting wound surrounding from secondary infection and preventing transfer of infection from the surrounding area onto the wound surface. The use of modern wound dressings is only justified when the cause of wound development has been established or chronic wound due to the underlying disease has been diagnosed. Wound dressing is chosen according to wound characteristics and by experience. We believe that the main advantages of modern wound dressings versus classic materials include more efficient wound cleaning, simpler placement of the dressing, reduced pain to touch, decreased sticking to the wound surface, and increased capacity of absorbing wound exudate. Modern wound dressings accelerate the formation of granulation tissue, reduce the length of possible hospital stay and facilitate personnel work. Thus, the overall cost of treatment is reduced, although the price of modern wound dressings is higher than that of classic materials. All types of modern wound dressings, their characteristics and indications for use are described

CALCIPHYLAXIS

Kalcifilaksija je jedan oblik vanskeletne kalcifikacije koju karakteriziraju odlaganje kalcija u tuniku mediju arterija i vaskularna tromboza, a što vodi u ishemiju tkiva uključujući i ishemiju kože s njenom posljedičnom nekrozom. nekroze se također mogu razviti i u potkožnom masnom tkivu i skeletnim mišićima. uzrok nije poznat. tu su bolest prvi put opisali Bryant i White već 1898. godine u svezi s uremijom, i sve do 1976. godine taj sindrom nije bio klinički dovoljno prepoznatljiv. tada je Gipstein sa suradnicima podrobnije opisao tu bolest i od tada pa nadalje pojavljuje se veliki broj opisa slučajeva kalcifilaksije s podacima o morbiditetu i terapijskim dilemama. opisana je povezanost bolesti s insuficijencijom jetre, debljinom i šećernom bolešću. u radu je prikazan klinički tijek prepoznavanja i liječenja većih ulceracija na obje potkoljenice kod polimorbidnog bolesnika s prepoznatom kalcifilakcijom koja je bila uzrokom nastanka nekroza kože s posljedičnim kroničnim potkoljeničnim vrijedovima.Calciphylaxis is a form of extra-skeletal calcification characterized by calcium deposits in arterial tunica media and vascular thrombosis, which leads to tissue ischemia including skin ischemia with consequential skin necrosis. Necroses may also develop in the subcutaneous adipose tissue and skeletal muscle. The cause of this disorder remains unknown. It was first described by Bryant and White as early as 1989 in association with uremia, and the syndrome remained clinically inadequately recognizable until 1976. Then, Gipstein and coworkers described the disorder in more detail, followed by a great number of calciphylaxis case reports since then, including data on morbidity and therapeutic dilemmas. Calciphylaxis has been reported in association with hepatic insufficiency, obesity, and diabetes mellitus. The authors present the clinical procedure of identifying and treating major ulcerations on both lower legs in a patient with polymorbidity and recognized calciphylaxis, which caused skin necroses with consequential chronic leg ulcers

CALCIPHYLAXIS

Kalcifilaksija je jedan oblik vanskeletne kalcifikacije koju karakteriziraju odlaganje kalcija u tuniku mediju arterija i vaskularna tromboza, a što vodi u ishemiju tkiva uključujući i ishemiju kože s njenom posljedičnom nekrozom. nekroze se također mogu razviti i u potkožnom masnom tkivu i skeletnim mišićima. uzrok nije poznat. tu su bolest prvi put opisali Bryant i White već 1898. godine u svezi s uremijom, i sve do 1976. godine taj sindrom nije bio klinički dovoljno prepoznatljiv. tada je Gipstein sa suradnicima podrobnije opisao tu bolest i od tada pa nadalje pojavljuje se veliki broj opisa slučajeva kalcifilaksije s podacima o morbiditetu i terapijskim dilemama. opisana je povezanost bolesti s insuficijencijom jetre, debljinom i šećernom bolešću. u radu je prikazan klinički tijek prepoznavanja i liječenja većih ulceracija na obje potkoljenice kod polimorbidnog bolesnika s prepoznatom kalcifilakcijom koja je bila uzrokom nastanka nekroza kože s posljedičnim kroničnim potkoljeničnim vrijedovima.Calciphylaxis is a form of extra-skeletal calcification characterized by calcium deposits in arterial tunica media and vascular thrombosis, which leads to tissue ischemia including skin ischemia with consequential skin necrosis. Necroses may also develop in the subcutaneous adipose tissue and skeletal muscle. The cause of this disorder remains unknown. It was first described by Bryant and White as early as 1989 in association with uremia, and the syndrome remained clinically inadequately recognizable until 1976. Then, Gipstein and coworkers described the disorder in more detail, followed by a great number of calciphylaxis case reports since then, including data on morbidity and therapeutic dilemmas. Calciphylaxis has been reported in association with hepatic insufficiency, obesity, and diabetes mellitus. The authors present the clinical procedure of identifying and treating major ulcerations on both lower legs in a patient with polymorbidity and recognized calciphylaxis, which caused skin necroses with consequential chronic leg ulcers

Regeneration of Chronic Wounds with Allogeneic Platelet Gel versus Hydrogel Treatment: a Prospective Study

The aim of the study was to evaluate the efficacy and safety of the new method of platelet-rich plasma activation in the form of platelet gel, used in the treatment of non-healing ­chronic lower leg ulcers. The study was prospectively randomized, double blind and placebo controlled. We treated 60 patients (42 males and 18 females, mean age 69.43 years, SD 14.74) with chronic lower leg ulcers of different etiologies. Thirty patients were treated with allogeneic platelet gel and 30 with ­hydrogel. Both groups were comparable for duration of ulcer and its size. Treatment was repeated once a week for three consecutive weeks and then the last examination was scheduled at 6 months of the first platelet gel application. The t-test was used to analyze independent samples. Healing of chronic wounds with platelet gel was statistically significantly more effective compared to the treatment with hydrogel (p<0.05). At 6 months of platelet gel application, the mean wound area in the experimental group decreased to 35.01% (SD 53.69) of the initial wound size. In the control group, the wound area decreased to 89.95% (SD 71.82) of the initial wound size (p=0.001). The circumference of the wounds diminished to 54.62% (SD 39.85) of the initial value in the experimental group, compared to 91.28% (SD 29.32) in the control group (p<0.001). Allogeneic platelet gel prepared by the new ­method used in this study was found to be a good treatment option for non-healing chronic wounds when other methods are ineffective