Selective resection of the bone with preservation of soft tissues (“empty toe technique”) combined with negative pressure wound therapy for treatment of osteomyelitis of the great toe - a case report

Diabetic foot ulceration (DFU) is a serious complication of diabetes mellitus, and one that is difficult to treat. In many cases of DFU, chronic osteomyelitis occurs in the foot. The present paper describes the course of treatment for chronic osteomyelitis of the great toe with metatarsophalangeal arthritis using selective resection of the bone preserving the soft tissues (the “empty toe technique”). Following the procedure, to promote surgical wound healing, negative pressure wound therapy was administered for 7 days, with a constant pressure of –120 mmHg. The presented method was found to be effective in treating osteomyelitis in a patient with DFU, partially preserving the function and completely preserving the shape of the treated toe

Applying NPWT to bleeding open wounds after forefoot amputation in diabetic foot patients - a case report

NPWT is increasingly used in patients with diabetic foot. The protocol for performing NPWT is subject to debate. Main concerns regard the type of suction to use (continuous, intermittent, or variable), the wound-packing material, or the exact pressure to apply. Typically, an optimum pressure range of –80 to –125 mmHg is indicated. Following bone resection in diabetic foot patients, the surgical wound is left open, which often entails bleeding from the resection site. In these cases, the start of NPWT was typically delayed by 24–48 hours – during that time a pressure dressing was applied – and NPWT was only started once bleeding had ceased. In order to initiate NPWT as soon as possible, we decided to start it at a higher negative pressure than usual, i.e. –180 mmHg, expecting that this would stop the bleeding. Only then would we reduce the negative pressure. This paper presents the course of NPWT with high negative pressure values after an amputation in 2 diabetic foot patients. In both cases, our assumptions were confirmed. The patients did not bleed, the drained volume did not exceed 30 ml (which seems clinically insignificant) in the first 40 minutes of treatment. Later, with negative pressure at –120 mmHg, no bleeding into the dressing was observed. Following the treatment (which lasted for 9 days), the wounds granulated normally, with no signs of inflammation. Applying VAC dressing using high negative pressure values to bleeding wounds immediately after surgery may stop the bleeding, enabling immediate initiation of NPWT

Effective immobilisation of a metathesis catalyst bearing an ammonium-tagged NHC ligand on various solid supports

An ammonium-tagged ruthenium complex, 8, was deposited on several widely available commercial solid materials such as silica gel, alumina, cotton, filter paper, iron powder or palladium on carbon. The resulting catalysts were tested in toluene or ethyl acetate, and found to afford metathesis products in high yield and with extremely low ruthenium contamination. Depending on the support used, immobilised catalyst 8 shows also additional traits, such as the possibility of being magnetically separated or the use for metathesis and subsequent reduction of the obtained double bond in one pot

Hip Joint Replacement Using Monofilament Polypropylene Surgical Mesh: An Animal Model

Hip joint dysplasia is a deformation of the articular elements (pelvic acetabulum, head of the femur, and/or ligament of the head of the femur) leading to laxity of the hip components and dislocation of the femoral head from the pelvic acetabulum. Diagnosis is based on symptoms observed during clinical and radiological examinations. There are two treatment options: conservative and surgical. The classic surgical procedures are juvenile pubic symphysiodesis (JPS), triple pelvic osteotomy (TPO), total hip replacement (THR), and femoral head and neck resection (FHNE). The aim of this experiment was to present an original technique of filling the acetabulum with a polypropylene implant, resting the femoral neck directly on the mesh. The experiment was performed on eight sheep. The clinical value of the new surgical technique was evaluated using clinical, radiological, and histological methods. This technique helps decrease the loss of limb length by supporting the femoral neck on the mesh equivalent to the femoral head. It also reduces joint pain and leads to the formation of stable and mobile pseudarthrosis. The mesh manifested osteoprotective properties and enabled the formation of a stiff-elastic connection within the hip joint. The method is very cost-effective and the technique itself is simple to perform

Endoskopowa gastroplastyka rękawowa – doświadczenia z pierwszych zabiegów wykonanych w Polsce

Wstęp: Otyłość staje się coraz istotniejszym problemem z zakresu zdrowia społecznego. Za najbardziej skuteczne metody leczenia otyłości uważa się operacje bariatryczne. Wiążą się one jednakże z ryzykiem istotnych powikłań i są kosztowne. Istnieje potrzeba szukania lepszych rozwiązań w zakresie chirurgii bariatrycznej. Jedną z nowych, obiecujących metod jest endoskopowa gastroplastyka rękawowa (endoscopic sleeve gastroplasty, ESG), która charakteryzuje się podobną skutecznością co inne zabiegi bariatryczne, jest jednak znaczenie mniej inwazyjna. Materiały i metody: Ośmioro pacjentów z otyłością poddanych zostało endoskopowej gastroplastyce rękawowej. W znieczuleniu ogólnym endoskop wprowadzono do żołądka, gdzie założono serie 4-5 ciągłych szwów (od części odźwiernikowej żołądka rozpoczynając, do okolicy podwpustowej). Każdy szew po założeniu został zaciągnięty, co spowodowało zmniejszenie światła żołądka w podobnym zakresie jak w przypadku laparoskopowej gastrektomii rękawowej. Wyniki: Zabiegi przebiegły bez istotnych powikłań okołooperacyjnych, jedynym powikłaniem było niewielkie, niewymagające interwencji chirurgicznej krwawienie u jednego z pacjentów. Po operacji pacjenci notowali wyraźny spadek masy ciała, średnio 8,6%, 15,4% i 19,6% po odpowiednio 1, 2 i 3 miesiącach. Wnioski: Endoskopowa gastroplastyka rękawowa jest obiecującą metodą leczenia otyłości ze względu na małą inwazyjność i dobrą skuteczność w obniżaniu masy ciała. Zabieg wymaga odpowiedniego sprzętu, sposób wykonania gwarantuje zmniejszenie pojemności żołądka odpowiadające resekcji rękawowej, a wstępne wyniki potwierdzają podobną skuteczność zabiegu w redukcji masy ciała. Dyskusja: W porównaniu z laparoskopową gastrektomią rękawową endoskopowa gastroplastyka rękawowa charakteryzuje się wyraźnie mniejszą inwazyjnością, krótszym czasem zabiegu i hospitalizacji. Dane z innych ośrodków pokazują średnio nieco mniejszą dynamikę spadku całkowitej masy ciała, ale rezultaty te wymagają potwierdzenia w dłuższej obserwacji

Initial experience with endoscopic sleeve gastroplasty in Poland

Introduction: Obesity is becoming one of the major public health problems. Bariatric procedures are considered the most effective methods of treating this condition but they are costly and entail a high risk of complications. Thus, there is a need to look for better bariatric treatment solutions. One of the newest, highly promising bariatric methods is endoscopic sleeve gastroplasty (ESG), which is comparably effective to other bariatric procedures in terms of weight loss but at the same time it is much less invasive. Materials and methods: Eight obese patients underwent ESG. Under general anaesthesia, an endoscope was inserted into the stomach, where a row of 4-5 running stitches was placed (from the pyloric part towards the GE junction). Each of the stitches was cinched tight, which resulted in gastric lumen reduction comparable to that achieved with laparoscopic sleeve gastrectomy. Results: The procedures were performed without any severe peri-operative complications. The only adverse event was a minor haemorrhage in one of the patients, which did not require any surgical intervention. After the surgery, the patients reported a substantial weight loss. Mean %TBWL was 8.6%, 15.4% and 19.6% at 1, 2 and 3 months, respectively. Conclusions: Minimally invasive and highly effective in body weight reduction, endoscopic sleeve gastroplasty is a promising method of treating obesity. The procedure requires appropriate tools and equipment. The method guarantees gastric volume reduction comparable to that achieved with sleeve resection. The initial results confirm that the effectiveness of the surgery in terms of body weight loss is similar to that seen in other forms of bariatric treatment. Discussion: Compared to laparoscopic sleeve gastrectomy, endoscopic sleeve gastroplasty is substantially less invasive. Also, it requires shorter procedure time and shorter hospital stay. Data from other medical centres demonstrate somewhat lower dynamics of total body weight loss but these results need to be verified in a long-term follow-up