This case report presents a unique study focused on relationship between nutritional parameters, C-reactive protein (CRP), and the marker of oxidative stress 8-hydroxy-2'-deoxyguanosine (8-OHdG), in 61-year-old male paraplegic patient with multiple pressure ulcers. A multidisciplinary approach was essential for the timing of the successful reconstruction process. The patient had a history of paraplegia since 1999 due to a skiing accident with fractures of thoracic vertebrae (Th6-Th9), requiring spinal surgery. His medical background includes acute pancreatitis with biliary tract revisions, partial pancreatic resection, acute respiratory failure with tracheostomy, renal failure treated with hemodialysis, bronchopneumonia, pseudomembranous colitis, and hyperuricemia. The patient also underwent multiple surgical interventions, including treatment for ulnar nerve paresis, cholecystectomy, and multiple pressure ulcer reconstructions. The study describes the relationship between selected biochemical parameters and overall clinical status in a paraplegic patient with three deep pressure ulcers located in the left-sided ischial, trochanteric, and sacral regions during their multistage surgical therapy. The reconstructive procedure and collection of biological samples for determination of selected biochemical parameters were performed according to the same schedule: debridement of pressure ulcers at the beginning of the particular hospitalization and on the day of surgical reconstruction. The patient's severe condition was accompanied by decreased levels of both 8-OHdG and selected nutritional parameters (albumin, prealbumin, and total protein) and increased CRP levels at the beginning of the treatment process. The evaluation of the dynamics of the measured parameters during the gradual improvement of the patient's condition and the multistage reconstruction of pressure ulcers in six hospitalizations over a period of 17 months was continued resulting in the healing of all pressure ulcers. This case highlights the crucial importance of investigating selected biochemical parameters, with emphasis on 8-OHdG, and nutritional parameters, for the timing of surgical strategy and comprehensive therapy in patients with multiple pressure ulcers and severe, complex medical histories.
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Základem léčby hlubokých dekubitů (III. a IV. kategorie) jsou různé chirurgické techniky provázené konzervativní terapií a preventivními opatřeními. Transplantace kůže představuje jednu z možností v chirurgické léčbě dekubitů, má však své specifické indikace. Cílem tohoto článku je tyto indikace v rámci plastické chirurgie objasnit a popsat nevýhody transplantace kůže v rekonstrukci dekubitů. Jedna z těchto indikací je prezentována v kazuistice 89leté pacientky s neklasifikovatelným dekubitem paty, který byl chirurgicky rekonstruován pomocí transplantace kůže.
Optimal treatment of deep category of pressure ulcers/injuries (category III and IV) is represented by numerous surgical procedures accompanied with conservative therapy and preventative measures. Skin grafting represents a reconstructive option in plastic surgery with very specific indications in pressure ulcer‘s surgical therapy. The aim of this article is to clarify the indications for plastic surgery interventions and to describe possible disadvantages of skin grafting in pressure ulcers reconstruction. One of the specific indications is presented as case report of 89-years-old women with unstageable pressure ulcer in heel area that was surgically reconstructed by skin grafting.
Polyunsaturated fatty acids (PUFA) play an important role in reparative processes. The ratio of PUFAs n-3 to n-6 may affect wound healing. The study aimed to evaluate the effect of dietary supplementation with n-3 and n-6 PUFA in two proportions on skin wounds in laboratory rats. Adult male Wistar rats received 20% fat emulsion with a ratio of 1.4:1 (group A) or 4.3:1 (group B) for n-3:n-6 PUFAs at a daily dose of 1 mL/kg. The control group received water under the same conditions. The animals were supplemented a week before and a week after the skin excision performed on the back. The level of wound closure, various parameters of oxidative stress, and plasma fatty acids composition were evaluated. Wound tissue samples were examined by electron microscopy. The administration of fat emulsions led to significant changes in plasma polyunsaturated fatty acid composition. The increased production of reactive nitrogen species, as well as more numerous newly formed blood vessels and a greater amount of highly organized collagen fibrils in both groups A and B may indicate more intensive healing of the skin wound in rats supplemented with polyunsaturated fatty acids in high n-3:n-6 ratio.
- MeSH
- hojení ran MeSH
- krysa rodu rattus MeSH
- mastné kyseliny * MeSH
- nenasycené mastné kyseliny farmakologie MeSH
- omega-3 mastné kyseliny * farmakologie MeSH
- potkani Wistar MeSH
- potravní doplňky MeSH
- zvířata MeSH
- Check Tag
- krysa rodu rattus MeSH
- mužské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- Klíčová slova
- plazmaterapie,
- MeSH
- bakteriální infekce terapie MeSH
- bércové vředy MeSH
- chronická nemoc MeSH
- dekubity MeSH
- diabetická noha MeSH
- hojení ran MeSH
- plazma bohatá na destičky MeSH
- rány a poranění MeSH
- výsledek terapie MeSH
- Publikační typ
- kazuistiky MeSH
- MeSH
- amputace MeSH
- chirurgické laloky * MeSH
- dolní končetina patologie MeSH
- hojení ran MeSH
- infekce v ráně * terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- výsledek terapie MeSH
- zákroky plastické chirurgie * metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- MeSH
- hidradenitis suppurativa chirurgie terapie MeSH
- zákroky plastické chirurgie MeSH
- Publikační typ
- kazuistiky MeSH
Hojení ran je etapovitý proces probíhající na celulární i subcelulární úrovni jako souhra řady biochemických a fyziologických pochodů a interakcí. Rychlost a kvalita hojení jsou ovlivněny mnoha faktory, a to jak lokálními (typ, velikost, hloubka a lokalizace rány, bakteriální biofilm, stav mikrocirkulace, zásobení kyslíkem), tak systémovými (věk, komorbidity, kouření, stav nutrice, aj). I z tohoto důvodu je proces hojení předmětem zájmu řady studií a je zkoumán různými metodickými přístupy na mnoha úrovních. Je známo, že reaktivní formy kyslíku a dusíku hrají významnou roli ve všech fázích hojení ran. Navzdory rostoucí pozornosti, která je výzkumu role oxidativního stresu v procesu hojení ran věnována, jsou závěry aktuálních studií stále ještě rozporuplné. Cílem příspěvku je tedy poskytnout přehled o oučasných znalostech o úloze oxidativního stresu v procesu hojení ran.
Wound healing is a complex process based on a subtle coordination of biochemical and physiological interactions. Healing process itself and its quality are affected by numerous factors, both local (type, size, depth, and localization of the wound, bacterial contamination, microcirculation, oxygen supply, etc.) and systemic (age, comorbidities, smoking, nutritional status, etc.). Many studies, using various methodological approaches, focus on wound healing process at various levels. It is well known that reactive oxygen and nitrogen species play an important role in all phases of wound healing. Regardless increasing knowledge about the role of oxidative stress in wound healing process, the conclusions of research in this area are still rather contradictory. Therefore, aim of this paper is to summarize current knowledge about the role of oxidative stress in wound healing process.
