Effectiveness of Autologous Platelet-Rich Plasma and Stromal Vascular Fraction in Autologous Skin Grafting

Introduction: Despite the medical advances, burns remain a serious challenge and require new and promising treatment options, such as biomedical technologies with a high potential for burn wound treatment. However, high cost and complexity of biotechnologies limit their routine use, but autologous tissues, such as stromal vascular fraction (SVF) and autologous platelet-rich plasma (PRP), overcome these shortcomings.   Objective: To demonstrate a successful case of using a combination of adipose-derived SVF and autologous PRP during autologous skin grafting in a severely burned patient.   Material and methods: We present a successful case of 84-year-old Patient B. treated at Saint Petersburg I. I. Dzhanelidze Research Institute of Emergency Medicine in September-October 2022. He was diagnosed with a 11% (6%) / II-III degree flame burn of the head, neck, trunk, and upper extremities and first-degree inhalation injury. At the first stage, the general condition of the patient was stabilized, and he was prepared for surgery. At the second stage, on day 25 of treatment we performed skin grafting using split-thickness autografts with rare perforations and application of SVF and autologous PRP on a burn wound. We evaluated the treatment effectiveness using planimetry, cytology, and histology.   Results: We observed complete engraftment of the autograft with no lysis or rejection during the first dressing change on day 3 after surgery and complete skin restoration on day 11. Cytologic findings over time showed an active decrease in inflammatory cells and an increase in regenerative cells, indicating successful wound healing. Histology demonstrated formation of normal stratified squamous epithelium with areas of hyperkeratosis and young granulation tissue in the superficial layers of the dermis on day 6.   Conclusions: Our case demonstrated that the combination of SVF and autologous PRP facilitates split-thickness skin autograft engraftment

Минно-взрывное сочетанное ранение головы, груди и конечностей

The article presents the experience of treating wounded K., 29 years old, who, as a result of the suicide bombing of a homemade shell-free explosive device in a moving car of the St. Petersburg Metro 03.04.2017 received a severe mine-explosive combined wound to the head, chest and limbs with a fragmented blind skull. The trauma was accompanied by brain damage, a fracture of the cranial vault bones, lungs contusion, and fragmented fracture of the right tibia bones. The patient underwent sequential bifrontal decompressive craniotomy, external fixation of the right shin bones fractures, blocked intramedullary osteosynthesis of the latter, dura mater plasty, cranioplasty with a titanium plate after its computer modeling. The complex treatment allowed the patient to be discharged from the hospital after 4 months in a satisfactory condition.В статье представлен опыт лечения раненой К., 29 лет, которая в результате приведения в действие смертником самодельного безоболочечного взрывного устройства в движущемся вагоне Санкт-Петербургского метро 03.04.2017получила тяжелое минновзрывное сочетанное ранение головы, груди и конечностей с осколочным слепым ранением черепа. Травма сопровождалась повреждением головного мозга, переломом костей свода черепа, ушибом легких, осколочным переломом костей правой голени. Пациентке последовательно выполнялись бифронтальная декомпрессивная трепанация черепа, внешняя фиксация перелома костей правой голени, блокируемый интрамедуллярный остеосинтез последних, пластика твердой мозговой оболочки, краниопластика титановой пластиной после ее компьютерного моделирования. Проведнное комплексное лечение позволило выписать больную из стационара через 4 мес в удовлетворительном состоянии

Результаты трансплантации почки пациентам с терминальной почечной недостаточностью, обусловленной аутосомно-доминантным поликистозом почек

Aim. To investigate the renal transplantation results for patients with end-stage renal disease (ESRD) due to autosomal dominant polycystic kidney disease (PKD).Materials and methods. The study included a prospective and retrospective analysis of the kidney transplantation results in 46 patients with ESRD caused by PKD, performed in the period from 2003 to 2018. Two groups of patients were formed. The comparison group consisted of 23 (50%) cases of kidney transplantation in patients whose polycystic-changed kidneys were preserved at the time of transplantation. The study group included 23 (50%) patients who underwent pretransplantation nephrectomy of native kidneys for clinical indications or to prepare for the waiting list. During the study, an algorithm of examination and surgical preparation for inclusion patients with PKD in the waiting list for kidney transplantation was developed and actively used.Results. The mean follow up period of patients who underwent pretransplantation nephrectomy was 3.6 ± 2.5 years, patients with preserved native kidneys - 5.3 ± 3.08 years (p > 0.05). Periodic pain in the lumbar region disturbed 12 (52.2%) patients with preserved polycystic-changed kidneys. The frequency of episodes of leukocyturia, bacteriuria and(or) hematuria significantly differed and amounted to 0.27 ± 0.35 cases per year in the study group, 1.49 ± 0.54 (p < 0.05) in the comparison group. Posttransplant nephrectomy of polycystic-changed kidneys at different times after transplantation was required in 5 (21.7%) patients. Five-year graft survival in the study group was 87.5%, in the comparison group - 76.1%. Among the patients of the comparison group, 76.4% of transplants lost their function after 10 years. The 5 and 10-year survival rates of patients with preserved native kidneys were 90.5% and 80%, respectively. In particular, there was one fatal outcome due to sepsis on the background of infection with cysts of preserved polycystic kidney. There were no deaths in the study group.Conclusion. Among patients whom polycystic-changed kidneys removed, there is a more favorable course of the post-transplant period due to the low frequency of infectious complications. More than 60% of patients with PKD need to perform nephrectomy of native kidneys during life for various reasons, including more than 21,7% need it after kidney transplantation due to complications during immunosuppressive therapy. Reasonable assessment of the polycystic kidneys and timely pretransplantation nephrectomy are an integral part of the preparation and management of the waiting list for transplantation of a patient with PKD.Цель. Целью данного исследования явилось изучение результатов трансплантации почки пациентам с терминальной почечной недостаточностью (тХПН), обусловленной аутосомно-доминантным поликистозом почек (АДПП).Материалы и методы. В ходе исследования был проведен проспективный и ретроспективный анализ результатов трансплантаций почки 46 больным с тХПН, обусловленной АДПП, выполненных в период с 2003-го по 2018 год. Сформировано две группы пациентов. Группа сравнения составлена из 23 (50%) случаев пересадки почки больным, у которых поликистозно-измененные почки (ПКП) на момент трансплантации были сохранены. Исследуемая группа включала 23 (50%) пациента, которым по клиническим показаниям или с целью подготовки в лист ожидания была выполнена предтрансплантационная нефрэктомия нативных почек. В ходе исследования разработан и активно применялся алгоритм обследования и хирургической подготовки к включению в лист ожидания пересадки почки больных с АДПП.Результаты исследования. Средний срок наблюдения пациентов, перенесших предтрансплантационную нефрэктомию, составил 3,6 ± 2,5 года, больных с сохраненными нативными почками - 5,3 ± 3,08 года (р > 0,05). Периодические боли в поясничной области беспокоили 12 (52,2%) пациентов с сохраненными ПКП. Частота эпизодов лейкоцитурии, бактериурии и(или) гематурии значимо отличалась и составила в исследуемой группе 0,27 ± 0,35 случая в год, в группе сравнения - 1,49 ± 0,54 (р < 0,05). Посттрансплантационная нефрэктомия ПКП в различные сроки после трансплантации потребовалась 5 (21,7%) пациентам. Пятилетняя выживаемость трансплантатов в исследуемой группе составила 87,5%, в группе сравнения - 76,1%. Среди больных группы сравнения через 10 лет функцию утратили 76,4% трансплантатов; 5- и 10-летняя выживаемость пациентов с сохраненными нативными почками составила 90,5% и 80% соответственно, в том числе имел место один летальный исход, обусловленный сепсисом на фоне инфицирования кист сохраненных ПКП. В исследуемой группе летальных исходов не было.Выводы. Среди пациентов, которым удалены ПКП, отмечается более благоприятное течение посттрансплантационного периода за счет низкой частоты инфекционных осложнений. Более 60% больных с АДПП нуждаются в выполнении нефрэктомии нативных почек в течение жизни по различным причинам, в том числе более 21,7% - после пересадки почки в связи с осложнениями на фоне иммуносупрессивной терапии. Разумная оценка состояния ПКП и своевременная предтрансплантационная нефрэктомия являются неотъемлемой частью подготовки и ведения в листе ожидания трансплантации пациента с АДПП

Iliosacral Screw Fixation in Patients with Polytrauma

The need to perform iliosacral fixation in patients with polytrauma and unstable pelvic injuries in the acute period of injury is still an unresolved issue. Minimally invasive techniques of pelvis internal fixation allow to perform single step reconstructive surgery in the acute period of the trauma.Purpose — to evaluate the results of minimally invasive acute iliosacral fixation in patients with polytrauma and unstable pelvic injuries.Materials and methods. The authors analyzed treatment outcomes in 105 patients with polytrauma and unstable pelvic injuries after iliosacral screw fixation in acute period. 69 (65.7%) patients had B-type and 36 (34.3%) patients had c-type of unstable pelvic injuries by AO/ASIF classification. Mean age was 35.5±11.7 years. The severity of injury on the ISS scale was 22.5±12.9 points. Ап patients underwent minimally invasive iliosacral fixation with screws in the acute period of the trauma.Results. Patients classified according to the severity of their status as «stable» (n = 50) and «borderline» (n = 26) with stable hemodynamics (SAD >90 mm Hg) underwent minimally invasive iliosacral screw fixation of posterior pelvic ring straight in the anti-shock surgery. Injured classified as «unstable» (n = 15) and «borderline» (n = 14) with unstable hemodynamic parameters (SAD <90 mm Hg), who needed urgent large surgical procedures (laparotomy, thoracotomy et al.), underwent temporary pelvis stabilization by external fixation and/or c-frame, and as the hemodynamic parameters were stabilized iliosacral screw fixation within 48 hours from the moment of injury. The functional pelvis state in 58 patients by S.A. Majeed scale rated 90.7±11.2 points. The quality of life was assessed using the SF-36 questionnaire.Conclusion. Restoration of the anatomical shape of the pelvic ring and its fixation, primarily posterior aspects, in the acute period of trauma allowed to obtain good anatomical and functional treatment outcomes in 94.9% of the patients with polytrauma

Experience of application of extraperitoneal pelvic packing in unstable pelvic ring injuries

OBJECTIVE. Clinical efficacy of extraperitoneal pelvic packing for hemostasis was assessed in patients with unstable pelvic ring injuries and signs of unstable hemodynamics. MATERIAL AND METHODS. The results of treatment were analyzed in 19 patients with hemodynamically unstable pelvic ring injuries. Extraperitoneal pelvic packing was applied in order to stop bleeding after mechanical pelvic stabilization. The evaluation of hemostasis efficacy was performed by using computerized helical tomography with intravenous contrast. RESULTS. The extraperitoneal pelvic packing allowed doctors to achieve stop of bleeding in 14 (73,7 %) patients. CONCLUSIONS. Complex of mechanical stabilization and extraperitoneal pelvic packing of damaged pelvic ring could be actively used in cases of severe injuries for victims in critical conditions

Development of management of emergency surgical care for patients with acute traumatic and nontraumatic spinal pathologies in conditions of megapolis

OBJECTIVE. The authors developed the management strategy of emergency care for patients with acute spinal surgical pathology in conditions of megapolis. MATERIAL AND METHODS. A comparative statistical analysis was made in 2627 patients. The patients (n =777) underwent treatment in multicenter hospitals of emergency care of the spine (decentralized system). The other patients (n = 1850) were treated in Municipal Center of Emergency Surgery of the Spine (centralized system). RESULTS. It is appropriate to establish departments of emergency surgery of the spine on the base of separate multicenter hospitals in megapolis. These hospitals should be properly equipped and they should have specially trained doctors and nurses, stable financing, effective management on admission to hospital. CONCLUSIONS. The efficacy of proposed measures allowed authors to recommend them to wide practical application

The structure and incidence of infection in the cysts in patients with autosom al dominant polycystic kidney disease on the waiting list of kidney transplantation

Aim. To investigate the structure and frequency of occurrence of the infection in the cysts of the kidneys in patients with end-stage renal disease (ESRD) due to autosomal dominant polycystic kidney disease (PKD).Materials and methods. For the first time the microbiological study of the biological materials obtained from the patients with PKD were performed. That  were the polycystic-altered kidneys removed in preparation of potential  recipients for kidney transplantation, which were made as a routine step. All  patients underwent surgical treatment in order to prepare for kidney  transplantation or according to clinical indications. Two groups of patients have  been distinguished: the 1st group – 7 (33.3%) patients with asymptomatic  course of disease, the 2nd group – 14 (76.7%) patients who had symptoms of infection of kidneys and urinary tract.Results. As a result of this work, the presence of latent and active infection in  18 (85.7%) patients, including 6 (85.7%) patients with asymptomatic polycystic course, was proved. At microbiological research the causative agent of infection was not revealed only at the 1st patient in the first group and in 2  patients in the second group. Infection of cysts of kidneys of 6 patients with asymptomatic course of PKD was proved only after research of their  contents taken intraoperatively. There is no correlation between the presence of  infection, symptoms and the size of polycystic kidneys. Multidrug resistant infection only sensitive to modern antibiotics ultrawide spectrum of  action was detected in 6 patients, including 2 patients with asymptomatic.Conclusion. Critically high actual infection of more than 80% of polycystic-altered kidneys has been established, which allows to consider them as a source  of chronic infection in the context of future transplantation. The presence of  latent, including multiresistant infection in cysts, worsens the prognosis of kidney transplantation in this category of patients without nephrectomy