Innovative advantages of the Zagreb surgical protocol of hand reconstruction in patients with epidermolysis bullosa

Kirurško liječenje deformiteta šaka bolesnika s buloznom epidermolizom, unatoč stalnomu napretku znanstvenih spoznaja, još je i danas obilježeno brojnim prijeporima. Cilj istraživanja je na temelju medicinske dokumentacije utvrditi karakteristike, specifičnosti i ishode svih bolesnika s buloznom epidermolizom koji su kirurški liječeni zbog deformiteta šake u Zagrebu u razdoblju od 1994. do 2009. godine. Zagrebački kirurški protokol rekonstrukcije (ZSRP) deformiteta šake u bolesnika s buloznom epidermolizom (EB) jedinstven je alat standardiziranih postupaka i jasno definiranog algoritma. Analizirani su značajke i ishodi u bolesnika s buloznom epidermolizom skupine bolesnika liječenih u razdoblju od 1994. do 2001. sa skupinom bolesnika koji su kirurški liječeni od 2002. do 2009. godine (s follow upom od 2 godine poslije termina operacije) s obzirom na to da su od 2002. godine u kiruršku praksu uvedene nove smjernice s brojnim modifikacijama postupka (ZSRP). Primjena Zagrebačkog kirurškog protokola rekonstrukcije deformiteta šake u bolesnika s buloznom epidermolizom sa svojim inovativnim sastavnicama ima praktične prednosti u usporedbi s prethodno primjenjivanim kirurškim postupcima zbog svoje veće učinkovitosti uz redukciju ukupnih troškova liječenja. Uzimanjem presatka kože po metodi PRST postiže se brže cijeljenje donorskog područja, uz smanjenje rizika očekivanih komplikacija u usporedbi s klasičnim tehnikama uzimanja STSG presatka kože dermatomom ili elektrodermatomom. Prema našem dosadašnjem 20-godišnjem iskustvu primjerena kirurška korekcija deformiteta šaka u bolesnika s EB-om omogućava uspješno višekratno ponavljanje kirurškog postupka koji je indiciran kao posljedica očekivane progresije lokalnog statusa zbog prirode same bolesti.Surgical treatment of the deformity in a handful of patients with epidermolysis bullosa (EB) is still marked by numerous controversies today despite constant advancement of scientific knowledge. The aim of the study was to determine, on the basis of medical documentation, the characteristics, specificities and outcomes of all EB patients surgically treated in Zagreb from 1994 to 2009. The Zagreb Surgical Reconstruction Protocol (ZSRP) of hand deformity in EB patients is a unique tool of standardized procedures and a clearly defined algorithm. Characteristics and outcomes were compared between EB patients treated from 1994 to 2001 and EB patients treated surgically from 2002 to 2009 (with 2-year follow-up after surgery), given that new guidelines with numerous modifications to the procedure (ZSRP) had been introduced into surgical practice from 2002. Using ZSRP for reconstruction of hand deformity in EB patients with its innovative components was found to have practical advantages compared to the previously applied surgical procedures because of its higher efficiency while reducing the overall cost of treatment. This method resulted in faster healing of the donor area, reducing the risk of expected complications compared to the conventional split-thickness skin grafting techniques with a dermatome or electrodermatome. According to our 20-year experience, appropriate surgical correction of hand deformity in EB patients enables successful repeated surgery, which is indicated as a result of the expected progression of local status due to the nature of the disease itself