BIO-CORROSIVE CHARACTERISTICS OF TITANIUM-MAGNESIUM COMPOSITE MATERIAL

U dugogodišnjoj kliničkoj primjeni titanija sve se više uočavaju štetni učinci kao što je otpuštanje iona Ti4+ uslijed neprihvatljivog biokorozijskog ponašanja. Magnezij se u posljednje vrijeme često primjenjuje u biointeraktivnim konceptima oseointegracijskih površina kao značajan čimbenik oseointegracije u biodegradacijskom procesu otpuštanja iona Mg2+. Kako se titanij i magnezij ne mogu legirati, metalurgija praha smatra se tehnikom izbora za proizvodnju titanij-magnezijeva kompozitnoga materijala. Svrha ovog rada je istraživanje biokorozijskih svojstava titanij-magnezijeva materijala kroz proučavanje otpuštanja iona Ti4+ i Mg2+ te promatranje promjena nastalih na površini. Pripravljene su tri vrste materijala, s 1, 2 i 5 % magnezija u titanijskoj osnovi. Kao kontrolna skupina upotrijebljen je komercijalno čisti titanij stupnja 4. Za otpuštanje iona Ti4+ i Mg2+ korišten je test uranjanja u četiri vrste otopina: umjetnoj slini, umjetnoj slini s pH 4 i s dodanim fluorom te Hankovoj otopini koje su zatim analizirane metodom masene spektrometrije induktivno spregnutom plazmom. Površine uzoraka karakterizirane su skenirajućom elektronskom mikroskopijom, energijskom disperzivnom spektroskopijom, rendgenskom difrakcijskom analizom te profilometrijskim određivanjem hrapavosti površine. Rezultati istraživanja pokazali su značajno manje otpuštanje iona Ti4+ u usporedbi s kontrolnom skupinom. Dok su na otpuštanje iona Ti4+ statistički značajan utjecaj imale vrste otopina, otpuštanje iona Mg2+ bilo je pod utjecajem vrste ispitivanog materijala. Na površinama je uočena intenzivnija fizikalno kemijska aktivnost ispitivanog materijala koja sugerira na zaključak o potencijalnoj biointeraktivnosti istog. Istovremeno, magnezijeva korozija se je u nekim uvjetima pokazala neprihvatljivom za primjenu in vivo. Stoga su potrebna daljnja istraživanja strukture i sastava inovativnog titanij-magnezijeva kompozitnoga materijala proizvedenog tehnikom metalurgije praha.Introduction: Titanium and its alloys have been widely used as an implantable alloplastic biomaterial in the field of dental medicine for the last half century. Good mechanical properties, favourable corrosion behaviour and excellent biocompatibility are mentioned as the main reasons for such a large clinical application. The important bio-corrosive characteristic of titanium is the formation of dioxide layer of TiO2 which protects the metal of dissolving. However, such a surface layer plays poor protective role in some environmental conditions such are low pH value of the medium and the presence of fluorides. Magnesium enhances osteoinduction, osteoconduction and osseointegration of implantable biomaterial by promoting some osteogenic processes in the alveolar bone during a peri-implant bone formation. However, magnesium, as a pure metal, demonstrates poor bio-corrosive behaviour resulting in the gaseous H2 evolution and the alkalization of surrounding area. The powder metallurgy technique has been shown as the method of choice to unify the positive properties of two metals. In that way produced titanium-magnesium composite material could demonstrate better corrosive behaviour and develop an innovative and biomimetic surface characteristics in order to improve the process of osseointegration of such an implantable material. Aim: The aim of this study is to investigate the bio-corrosive characteristics of titanium-magnesium composite by determining the amount of released titanium and magnesium ions and by observing the surface changes during the corrosion test in simulated body fluids. Materials and methods: Three groups of innovative titanium-magnesium composite were produced by means of powder metallurgy technique: 1 mass%, 2 mass% and 5 mass% of magnesium in titanium matrix. Commercially pure titanium was used as a control group. The standardized static immersion test was used to carry out the bio-corrosion testing. Artificial saliva, artificial saliva with pH 4, artificial saliva with fluorides added and Hank’s balanced salt solution were prepared. The amount of released titanium and magnesium ions in the solution were determined by means of inductively coupled plasma mass spectrometry. The surface topography was observed by means of scanning electron microscopy, energy dispersive spectroscopy and X-ray diffraction analysis. To compare the surface roughness before and after the immersion, profilometry method was emloyed. Statistical evaluation was done by Statistica 7.0 software package. Significance level in all tests was set to p<0.05. Results and discussion: The amount of released titanium ions from all of three tested groups was significantly lower in comparison to the control group except in the case when the 5 mass% magnesium in titanium tested group was immersed in Hank’s balanced salt solution. According to the literature data, the amount of released titanium ions from tested material obtained in this study can’t provoke any biologically harmful side effect. Statistical analysis showed the significant influence of the type of solution on titanium ions release. At the same time, the magnesium ions release was more intense and faster than the titanium corrosion and under the influence of type of tested material. According to the literature data, the results of this investigation revealed that only the composite with 1 and 2 mass% of magnesium in titanium matrix performed biologically favourable corrosive behaviour. In the case of 5 mass% magnesium in titanium matrix group, the magnesium corrosion could provoke harmful biological side effects. Surface topography examination showed that localized forms of corrosion, dominantly pitting, prevailed on the surfaces of tested materials whereas the generalized corrosion was distinctive for the material of the control group. Chemical microanalysis of the surface after immersion revealed the presence of the atoms contained in the solutions and crystallographic examination confirmed the presence of hydroxyapatite and magnesium-oxide crystals formations. This could refer to the potentially biomimetic surface characteristic of the innovative titanium-magnesium composite. Profilometric study of the tested surfaces revealed that the vertical dimension of the roughness increased more than any other. Conclusion: Based on the bio-corrosion tests performed, one can conclude that the innovative titanium-magnesium composite showed better corrosive behaviour in terms of titanium ions release. The surface changes observed suggest the high bio-interactive potential of the tested material. The magnesium to titanium matrix ratio is found as the most significant factor in the development of a biodegradable titanium-magnesium composite concept with an acceptable magnesium corrosion rate. Since the results of the magnesium release revealed, in certain conditions, poor corrosive behaviour, further research on the development of titaniummagnesium composite are recommended

BIO-CORROSIVE CHARACTERISTICS OF TITANIUM-MAGNESIUM COMPOSITE MATERIAL

U dugogodišnjoj kliničkoj primjeni titanija sve se više uočavaju štetni učinci kao što je otpuštanje iona Ti4+ uslijed neprihvatljivog biokorozijskog ponašanja. Magnezij se u posljednje vrijeme često primjenjuje u biointeraktivnim konceptima oseointegracijskih površina kao značajan čimbenik oseointegracije u biodegradacijskom procesu otpuštanja iona Mg2+. Kako se titanij i magnezij ne mogu legirati, metalurgija praha smatra se tehnikom izbora za proizvodnju titanij-magnezijeva kompozitnoga materijala. Svrha ovog rada je istraživanje biokorozijskih svojstava titanij-magnezijeva materijala kroz proučavanje otpuštanja iona Ti4+ i Mg2+ te promatranje promjena nastalih na površini. Pripravljene su tri vrste materijala, s 1, 2 i 5 % magnezija u titanijskoj osnovi. Kao kontrolna skupina upotrijebljen je komercijalno čisti titanij stupnja 4. Za otpuštanje iona Ti4+ i Mg2+ korišten je test uranjanja u četiri vrste otopina: umjetnoj slini, umjetnoj slini s pH 4 i s dodanim fluorom te Hankovoj otopini koje su zatim analizirane metodom masene spektrometrije induktivno spregnutom plazmom. Površine uzoraka karakterizirane su skenirajućom elektronskom mikroskopijom, energijskom disperzivnom spektroskopijom, rendgenskom difrakcijskom analizom te profilometrijskim određivanjem hrapavosti površine. Rezultati istraživanja pokazali su značajno manje otpuštanje iona Ti4+ u usporedbi s kontrolnom skupinom. Dok su na otpuštanje iona Ti4+ statistički značajan utjecaj imale vrste otopina, otpuštanje iona Mg2+ bilo je pod utjecajem vrste ispitivanog materijala. Na površinama je uočena intenzivnija fizikalno kemijska aktivnost ispitivanog materijala koja sugerira na zaključak o potencijalnoj biointeraktivnosti istog. Istovremeno, magnezijeva korozija se je u nekim uvjetima pokazala neprihvatljivom za primjenu in vivo. Stoga su potrebna daljnja istraživanja strukture i sastava inovativnog titanij-magnezijeva kompozitnoga materijala proizvedenog tehnikom metalurgije praha.Introduction: Titanium and its alloys have been widely used as an implantable alloplastic biomaterial in the field of dental medicine for the last half century. Good mechanical properties, favourable corrosion behaviour and excellent biocompatibility are mentioned as the main reasons for such a large clinical application. The important bio-corrosive characteristic of titanium is the formation of dioxide layer of TiO2 which protects the metal of dissolving. However, such a surface layer plays poor protective role in some environmental conditions such are low pH value of the medium and the presence of fluorides. Magnesium enhances osteoinduction, osteoconduction and osseointegration of implantable biomaterial by promoting some osteogenic processes in the alveolar bone during a peri-implant bone formation. However, magnesium, as a pure metal, demonstrates poor bio-corrosive behaviour resulting in the gaseous H2 evolution and the alkalization of surrounding area. The powder metallurgy technique has been shown as the method of choice to unify the positive properties of two metals. In that way produced titanium-magnesium composite material could demonstrate better corrosive behaviour and develop an innovative and biomimetic surface characteristics in order to improve the process of osseointegration of such an implantable material. Aim: The aim of this study is to investigate the bio-corrosive characteristics of titanium-magnesium composite by determining the amount of released titanium and magnesium ions and by observing the surface changes during the corrosion test in simulated body fluids. Materials and methods: Three groups of innovative titanium-magnesium composite were produced by means of powder metallurgy technique: 1 mass%, 2 mass% and 5 mass% of magnesium in titanium matrix. Commercially pure titanium was used as a control group. The standardized static immersion test was used to carry out the bio-corrosion testing. Artificial saliva, artificial saliva with pH 4, artificial saliva with fluorides added and Hank’s balanced salt solution were prepared. The amount of released titanium and magnesium ions in the solution were determined by means of inductively coupled plasma mass spectrometry. The surface topography was observed by means of scanning electron microscopy, energy dispersive spectroscopy and X-ray diffraction analysis. To compare the surface roughness before and after the immersion, profilometry method was emloyed. Statistical evaluation was done by Statistica 7.0 software package. Significance level in all tests was set to p<0.05. Results and discussion: The amount of released titanium ions from all of three tested groups was significantly lower in comparison to the control group except in the case when the 5 mass% magnesium in titanium tested group was immersed in Hank’s balanced salt solution. According to the literature data, the amount of released titanium ions from tested material obtained in this study can’t provoke any biologically harmful side effect. Statistical analysis showed the significant influence of the type of solution on titanium ions release. At the same time, the magnesium ions release was more intense and faster than the titanium corrosion and under the influence of type of tested material. According to the literature data, the results of this investigation revealed that only the composite with 1 and 2 mass% of magnesium in titanium matrix performed biologically favourable corrosive behaviour. In the case of 5 mass% magnesium in titanium matrix group, the magnesium corrosion could provoke harmful biological side effects. Surface topography examination showed that localized forms of corrosion, dominantly pitting, prevailed on the surfaces of tested materials whereas the generalized corrosion was distinctive for the material of the control group. Chemical microanalysis of the surface after immersion revealed the presence of the atoms contained in the solutions and crystallographic examination confirmed the presence of hydroxyapatite and magnesium-oxide crystals formations. This could refer to the potentially biomimetic surface characteristic of the innovative titanium-magnesium composite. Profilometric study of the tested surfaces revealed that the vertical dimension of the roughness increased more than any other. Conclusion: Based on the bio-corrosion tests performed, one can conclude that the innovative titanium-magnesium composite showed better corrosive behaviour in terms of titanium ions release. The surface changes observed suggest the high bio-interactive potential of the tested material. The magnesium to titanium matrix ratio is found as the most significant factor in the development of a biodegradable titanium-magnesium composite concept with an acceptable magnesium corrosion rate. Since the results of the magnesium release revealed, in certain conditions, poor corrosive behaviour, further research on the development of titaniummagnesium composite are recommended

Titanium Ions Release from an Innovative Titanium-Magnesium Composite: an in Vitro Study

Svrha: U ovom radu istraživala su se korozijska svojstva inovativnog titanij-magnezijeva (Ti-Mg) kompozita proizvedenog metodom metalurgije praha (P/M). Materijal i metode: Ispitivane su dvije grupe eksperimentalnog materijala – s 1 masenim udjelom (mass% Ti-1Mg) i 2 masena udjela (mass% Ti-2Mg) magnezija u titanijskoj osnovi te su uspoređene s komercijalno čistim titanijem (CP Ti). Test uranjanja i kemijska analiza četiriju otopina: umjetne sline, umjetne sline pH 4, umjetne sline s dodatkom fluora i Hankove otopine, provedeni su nakon 42 dana uranjanja metodom masene spektrometrije induktivno spregnutom plazmom (ICP – MS) kako bi se ustanovila količina otpuštenih iona titanija (Ti). Za određivanje svojstava površine korištene su analize SEM i EDS. Rezultati: Razlika u rezultatima između različitih ispitivanih otopina procjenjivana je ANOVA-om i Newman-Keulsovim testom na razini značajnosti od p < 0,05. Utjecaj prediktorskih varijabli utvrđivan je multiplom regresijskom analizom. Rezultati ovog istraživanja pokazuju nisku stopu korozije titanija u ispitivanoj skupini Ti-Mg. Uočeno je do 46 puta, odnosno 23 puta manje otapanje iona titanija iz Ti-1Mg i Ti-2Mg u usporedbi s kontrolnom skupinom. Između ispitivanih otopina, umjetna slina s dodatkom fluora pokazala je najveći korozijski učinak među svim ispitivanim uzorcima. SEM-analiza pokazala je sačuvanu dvofaznu strukturu površine, a EDS-analiza upozorila je na moguća bioaktivna svojstva površine. Zaključak: Ti-Mg kompozit proizveden metodom P/M-a sugerira se kao materijal boljih korozijskih svojstava u usporedbi s čistim titanijem (CP Ti).The innovative titanium-magnesium composite (Ti-Mg) was produced by powder metallurgy (P/M) method and is characterized in terms of corrosion behavior. Material and methods: Two groups of experimental material, 1 mass% (Ti-1Mg) and 2 mass% (Ti-2Mg) of magnesium in titanium matrix, were tested and compared to commercially pure titanium (CP Ti). Immersion test and chemical analysis of four solutions: artificial saliva; artificial saliva pH 4; artificial saliva with fluoride and Hank balanced salt solution were performed after 42 days of immersion, using inductively coupled plasma mass spectrometry (ICP-MS) to detect the amount of released titanium ions (Ti). SEM and EDS analysis were used for surface characterization. Results: The difference between the results from different test solutions was assessed by ANOVA and Newman-Keuls test at p<0.05. The influence of predictor variables was found by multiple regression analysis. The results of the present study revealed a low corrosion rate of titanium from the experimental Ti-Mg group. Up to 46 and 23 times lower dissolution of Ti from Ti-1Mg and Ti-2Mg, respectively was observed compared to the control group. Among the tested solutions, artificial saliva with fluorides exhibited the highest corrosion effect on all specimens tested. SEM micrographs showed preserved dual phase surface structure and EDS analysis suggested a favorable surface bioactivity. Conclusion: In conclusion, Ti-Mg produced by P/M as a material with better corrosion properties when compared to CP Ti is suggested

SUSTITUTE AND ALTERNATIVE FORMS OF TREATMENT OF SKIN DEFECTS

Gubitak kožnog pokrova ima različite uzroke te zahtijeva pokrivanje defekta da bi se smanjile posljedice i komplikacije, te produljenje hospitalizacije uz povećanje troškova liječenja. Standarne plastično rekonstrukcijske metode često nisu moguće ili su prekompleksne, tako da alternativni oblici liječenja koji uključuju zamjene za kožu imaju važnu ulogu.Damage to skin barrier has different causes, and in case of prolonged exposure without expeditious coverage it entails consequences such as prolonged hospitalization and higher treatment costs. Standard plastic reconstructive techniques of coverage are not always possible, so alternative skin coverage techniques have an important role in treatment

SUSTITUTE AND ALTERNATIVE FORMS OF TREATMENT OF SKIN DEFECTS

Gubitak kožnog pokrova ima različite uzroke te zahtijeva pokrivanje defekta da bi se smanjile posljedice i komplikacije, te produljenje hospitalizacije uz povećanje troškova liječenja. Standarne plastično rekonstrukcijske metode često nisu moguće ili su prekompleksne, tako da alternativni oblici liječenja koji uključuju zamjene za kožu imaju važnu ulogu.Damage to skin barrier has different causes, and in case of prolonged exposure without expeditious coverage it entails consequences such as prolonged hospitalization and higher treatment costs. Standard plastic reconstructive techniques of coverage are not always possible, so alternative skin coverage techniques have an important role in treatment

SURGICAL EXPERIENCES IN THE TREATMENT OF ULCER COMPLICATIONS

Potkoljenični vrijed je učestala bolest u općoj populaciji koja ima za posljedicu znatan morbiditet. Poseban problem je široka diferencijalna dijagnoza što se etiologije tiče tako da uzrok može biti metabolički, imunološki, vaskularni, onkološki ili miješani. Pristup liječenju je multidisciplinaran. Uz niz uključenih medicinskih struka kirurgija je bitan faktor u liječenja komplikacija vrijeda, postoji niz učinkovitih zahvata koji uz pravu indikaciju imaju za ishod cijeljenje . Uz plastično rekonstrukcijske metode postoji i niz komplementarnih metoda uglavnom iz domene vaskularne kirurgije kojima se optimizira lokalno i regionalno stanje te poboljšava rezultat liječenja.Lower leg ulcers have a high in incidence in general population and are associated with a significant morbidity rate. Wide differential diagnosis considering their etiology poses considerable problem, as the causes are diverse including metabolic, immune, oncologic, vascular and mixed ones. Approach to treatment should be multidisciplinary, and among various medical specialties surgery plays an important role. There are numerous efficient procedures that require proper indication to be successful. Along with reconstructive methods, there are complementary methods, mainly from the field of vascular surgery; when combined, they produce good results

PRESSURE ULCER TREATMENT EXPERIENCE AT CLINICAL DEPARTMENT OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY, DUBRAVA UNIVERSITY HOSPITAL: COMPARISON OF RESULTS RECORDED IN THE 2011-2016 AND 2003-2008 PERIOD

Prikazani rezultati kirurškog liječenja dekubitusa na Klinici za plastičnu, rekonstrukcijsku i estetsku kirurgiju KB Dubrava u vremenu od 2011. do 2016. nisu bitno različiti u odnosu na rezultate kirurškog liječenja iste patologije u studiji iz vremena 2003.-2008., što dokazuje i dalje odličnu planiranost i izvedivost kirurških zahvata, odgovarajuću pripremu bolesnika i adekvatnu postoperacijsku skrb. Unatoč manjem broju hospitaliziranih bolesnika s dekubitusom u studiji 2011.-2016. (31 bolesnik; 42 rekonstrukcijska zahvata) i dalje je učinjen sličan broj rekonstrukcijskih zahvata uspoređujući sa studijom 2003.-2008. (47 bolesnika; 57 rekonstrukcijskih zahvata). Kod rekonstrukcije dekubitusa na sakralnoj regiji kod naših bolesnika najbolje rekonstrukcijske rezultate postigli smo i dalje kliznim fasciokutanim, odnosno mišićnokutanim režnjevima. Kada je god to moguće, ovisno o kliničkoj slici defekta trebalo bi dati prednost mišićnokutanim režnjevima, posebno u slučajevima recidiva dekubitusa. Kod rekonstrukcije dekubitusa u području ishijadičnih zona vrlo dobri rezultati postignuti su uporabom mišićnih režnjeva semimembranozusa i /ili semitendinozusa koji se mobiliziraju u defekt, dok za područje trohanterne regije koristimo transpozicijski režanj fascije late. Liječenje bolesnika s dekubitusom je multidisciplinarno s naglaskom na kirurško liječenje koje se sastoji od radikalnog debridmana, ostektomije i egzaktno planirane i učinjene rekonstrukcije. Konzervativno liječenje mora biti podrška kirurškom liječenju s naglaskom na njegu i visoke higijenske mjere bolesnika. U novije vrijeme (studija 2011.-2016.) sve kvalitetnija uporaba konzervativnog načina tretmana dekubitalnih rana realno je dovela do smanjenja potrebe za hospitalizacijom i kirurškim liječenjem. Daljnjim edukacijama medicinskih sestara u smislu „wound care“-a u zdravstvenim učilištima i bolnicama trebalo bi dati posebno značenje što bi dovelo do prevencije, ali i pravodobnog početka liječenja bolesnika s dekubitusom.Results of this clinical study on surgical treatment of pressure ulcers at Department of Plastic, Reconstructive and Aesthetic Surgery, Dubrava University Hospital showed that there was no difference between the 2011-2016 and 2003-2008 periods, indicating continuation of good surgical treatment planning and appropriate postoperative care. Despite the smaller number of hospitalized patients in the 2011-2016 period (31 patients and 42 reconstructive procedures), the number of reconstructive procedure was similar to the recent 2003-2008 period (47 patients and 57 reconstructive procedures). The best results of reconstruction of sacral region pressure ulcer were achieved with fasciocutaneous and musculocutaneous flaps. Whenever possible, depending on the extent of the defect, musculocutaneous flaps should be preferred for reconstruction. It is especially suitable for pressure ulcer recurrence. For ischial region reconstruction, good results can be obtained by mobilizing the semimembranosus and/or semitendinosus in defect gap. For trochanteric region, the tensor fascia lata flap is a good choice. For maximal functional and reconstructive results, a multidisciplinary approach in pressure ulcer treatment has the leading role in the modern concept of wound healing. Surgical treatment should always include radical debridement, ostectomy and well planned defect reconstruction. Conservative treatment should be support to surgical treatment with a focus on patient health care and high hygiene measures. In recent years (2011-2016), the usage of better conservative treatment led to reduction of patient hospital stay and surgical treatment of pressure ulcer. Further ‘wound care’ nurses training in Croatia can lead the trend towards advanced practice nursing in pressure ulcer prevention and conservative treatment

PRESSURE ULCER TREATMENT EXPERIENCE AT CLINICAL DEPARTMENT OF PLASTIC, RECONSTRUCTIVE AND AESTHETIC SURGERY, DUBRAVA UNIVERSITY HOSPITAL: COMPARISON OF RESULTS RECORDED IN THE 2011-2016 AND 2003-2008 PERIOD

Prikazani rezultati kirurškog liječenja dekubitusa na Klinici za plastičnu, rekonstrukcijsku i estetsku kirurgiju KB Dubrava u vremenu od 2011. do 2016. nisu bitno različiti u odnosu na rezultate kirurškog liječenja iste patologije u studiji iz vremena 2003.-2008., što dokazuje i dalje odličnu planiranost i izvedivost kirurških zahvata, odgovarajuću pripremu bolesnika i adekvatnu postoperacijsku skrb. Unatoč manjem broju hospitaliziranih bolesnika s dekubitusom u studiji 2011.-2016. (31 bolesnik; 42 rekonstrukcijska zahvata) i dalje je učinjen sličan broj rekonstrukcijskih zahvata uspoređujući sa studijom 2003.-2008. (47 bolesnika; 57 rekonstrukcijskih zahvata). Kod rekonstrukcije dekubitusa na sakralnoj regiji kod naših bolesnika najbolje rekonstrukcijske rezultate postigli smo i dalje kliznim fasciokutanim, odnosno mišićnokutanim režnjevima. Kada je god to moguće, ovisno o kliničkoj slici defekta trebalo bi dati prednost mišićnokutanim režnjevima, posebno u slučajevima recidiva dekubitusa. Kod rekonstrukcije dekubitusa u području ishijadičnih zona vrlo dobri rezultati postignuti su uporabom mišićnih režnjeva semimembranozusa i /ili semitendinozusa koji se mobiliziraju u defekt, dok za područje trohanterne regije koristimo transpozicijski režanj fascije late. Liječenje bolesnika s dekubitusom je multidisciplinarno s naglaskom na kirurško liječenje koje se sastoji od radikalnog debridmana, ostektomije i egzaktno planirane i učinjene rekonstrukcije. Konzervativno liječenje mora biti podrška kirurškom liječenju s naglaskom na njegu i visoke higijenske mjere bolesnika. U novije vrijeme (studija 2011.-2016.) sve kvalitetnija uporaba konzervativnog načina tretmana dekubitalnih rana realno je dovela do smanjenja potrebe za hospitalizacijom i kirurškim liječenjem. Daljnjim edukacijama medicinskih sestara u smislu „wound care“-a u zdravstvenim učilištima i bolnicama trebalo bi dati posebno značenje što bi dovelo do prevencije, ali i pravodobnog početka liječenja bolesnika s dekubitusom.Results of this clinical study on surgical treatment of pressure ulcers at Department of Plastic, Reconstructive and Aesthetic Surgery, Dubrava University Hospital showed that there was no difference between the 2011-2016 and 2003-2008 periods, indicating continuation of good surgical treatment planning and appropriate postoperative care. Despite the smaller number of hospitalized patients in the 2011-2016 period (31 patients and 42 reconstructive procedures), the number of reconstructive procedure was similar to the recent 2003-2008 period (47 patients and 57 reconstructive procedures). The best results of reconstruction of sacral region pressure ulcer were achieved with fasciocutaneous and musculocutaneous flaps. Whenever possible, depending on the extent of the defect, musculocutaneous flaps should be preferred for reconstruction. It is especially suitable for pressure ulcer recurrence. For ischial region reconstruction, good results can be obtained by mobilizing the semimembranosus and/or semitendinosus in defect gap. For trochanteric region, the tensor fascia lata flap is a good choice. For maximal functional and reconstructive results, a multidisciplinary approach in pressure ulcer treatment has the leading role in the modern concept of wound healing. Surgical treatment should always include radical debridement, ostectomy and well planned defect reconstruction. Conservative treatment should be support to surgical treatment with a focus on patient health care and high hygiene measures. In recent years (2011-2016), the usage of better conservative treatment led to reduction of patient hospital stay and surgical treatment of pressure ulcer. Further ‘wound care’ nurses training in Croatia can lead the trend towards advanced practice nursing in pressure ulcer prevention and conservative treatment

Algorithm for classification and treatment of poststernotomy wound infections

The treatment of sternal wound infection still carries a high mortality. Treatment preferences range from more conservative treatments that do not include flaps, to more aggressive reconstructions using different types of flaps, and these could be resolved and standardised using a proper classification with a treatment algorithm. We propose modification of the existing classification, with different proposals for treatment, stressing the importance of the radicality of debridement, and report our results in 31 patients, 24 of whom were well satisfied. Eleven were left with some pain in the chest wall, and eight each with some muscular weakness and less than adequate cosmesis. We would also like to recommend the omental flap as the first choice for selected cases. With our selective approach we have achieved good functional and aesthetic results with satisfied patients