INTRODUCTION: It is hypothesized that systemically administered antibiotics penetrate wound sites more effectively during negative pressure wound therapy (NPWT). However, there is a lack of clinical data from patients who receive NPWT for deep sternal wound infection (DSWI) after open-heart surgery. Here, we evaluated vancomycin penetration into exudate in this patient group. PATIENTS AND METHODS: For this prospective observational study, we enrolled 10 consecutive patients treated with NPWT for post-sternotomy DSWI. On the first sampling day, serum and exudate samples were synchronously collected at 0 (pre-dose), 0.5, 1, 2, 3 and 6 h after vancomycin administration. On the following three consecutive days, additional samples were collected, only before vancomycin administration. RESULTS: The ratio of average vancomycin concentration in wound exudate to in serum was higher for free (unbound) (1.51 ± 0.53) than for total (bound + unbound) (0.91 ± 0.29) concentration (p = 0.049). The percentage of free vancomycin was higher in wound exudate than serum (0.79 ± 0.19 vs. 0.46 ± 0.16; p = 0.04). Good vancomycin wound penetration was maintained on the following three days (vancomycin trough exudate-to-serum concentration ratio > 1). The total hospital stay was significantly longer in patients with DSWI (46 ± 11.6 days) versus without DSWI (14 ± 11.7 days) (p < 0.001). There was no in-hospital or 90-day mortality. Two patients experienced late DSWI recurrence. All-cause mortality was 4.8% during a median follow-up of 2.5 years. CONCLUSION: Vancomycin effectively penetrates wound exudate in patients receiving NPWT for DSWI after open-heart surgery.The protocol for this study was registered at ClinicalTrials.gov on July 16, 2024 (NCT06506032).

• MeSH
• antibakteriální látky * farmakokinetika   aplikace a dávkování   MeSH
• exsudáty a transsudáty metabolismus   mikrobiologie   MeSH
• infekce chirurgické rány * MeSH
• kardiochirurgické výkony * škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• prospektivní studie MeSH
• senioři MeSH
• sternotomie * škodlivé účinky   MeSH
• sternum chirurgie   MeSH
• terapie ran pomocí řízeného podtlaku * metody   MeSH
• vankomycin * aplikace a dávkování   farmakokinetika   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH

The pertinent literature widely describes ultrasound-guided procedures targeting the retrocalcaneal bursa and the tendon tissue to manage insertional Achilles tendinopathy. Synovial bursae and cutaneous nerves of the superficial retrocalcaneal pad are often overlooked pain generators and are poorly considered by clinicians and surgeons. A layer-by-layer dissection of the superficial soft tissues in the retrocalcaneal region of two fresh frozen cadavers was matched with historical anatomical tables of the textbook Traite d'Anatomie Topographique Avec Applications Médico-Chirurgicales (1909 by Testut and Jacob). An accurate and detailed description of the superficial retrocalcaneal pad with its synovial bursae and cutaneous nerves was provided. Cadaveric dissections confirmed the compartmentalized architecture of the superficial retrocalcaneal fat pad and its histological continuum with the superficial lamina of the crural fascia. Superficial synovial tissue islands have been demonstrated on the posterior aspect of the Achilles tendon in one cadaver and on the posterolateral surface of the tendon in the other one. Digitalization of the original anatomical tables of the textbook Traite d'Anatomie Topographique Avec Applications Médico-Chirurgicales (1909 by Testut and Jacob) showed five potential locations of the superficial calcaneal bursa and a superficial retrocalcaneal nerve plexus within the Achilles tendon-fat pad interface. In clinical practice, in addition to the previously described interventions regarding the retrocalcaneal bursa and the tendon tissue, ultrasound-guided procedures targeting the synovial and neural tissues of the superficial retrocalcaneal pad should be considered to optimize the management of insertional Achilles tendinopathy.

• MeSH
• Achillova šlacha * anatomie a histologie   diagnostické zobrazování   MeSH
• bursa synovialis * anatomie a histologie   diagnostické zobrazování   MeSH
• intervenční ultrasonografie metody   MeSH
• lidé MeSH
• mrtvola * MeSH
• patní kost * anatomie a histologie   inervace   diagnostické zobrazování   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Spinal cord injury results in permanent neurological impairment and disability due to the absence of spontaneous regeneration. NG101, a recombinant human antibody, neutralises the neurite growth-inhibiting protein Nogo-A, promoting neural repair and motor recovery in animal models of spinal cord injury. We aimed to evaluate the efficacy of intrathecal NG101 on recovery in patients with acute cervical traumatic spinal cord injury. METHODS: This randomised, double-blind, placebo-controlled phase 2b clinical trial was done at 13 hospitals in the Czech Republic, Germany, Spain, and Switzerland. Patients aged 18-70 years with acute, complete or incomplete cervical spinal cord injury (neurological level of injury C1-C8) within 4-28 days of injury were eligible for inclusion. Participants were initially randomly assigned 1:1 to intrathecal treatment with 45 mg NG101 or placebo (phosphate-buffered saline); 18 months into the study, the ratio was adjusted to 3:1 to achieve a final distribution of 2:1 to improve enrolment and drug exposure. Randomisation was done using a centralised, computer-based randomisation system and was stratified according to nine distinct outcome categories with a validated upper extremity motor score (UEMS) prediction model based on clinical parameters at screening. Six intrathecal injections were administered every 5 days over 4 weeks, starting within 28 days of injury. Investigators, study personnel, and study participants were masked to treatment allocation. The primary outcome was change in UEMS at 6 months, analysed alongside safety in the full analysis set. The completed trial was registered at ClinicalTrials.gov, NCT03935321. FINDINGS: From May 20, 2019, to July 20, 2022, 463 patients with acute traumatic cervical spinal cord injury were screened, 334 were deemed ineligible and excluded, and 129 were randomly assigned to an intervention (80 patients in the NG101 group and 49 in the placebo group). The full analysis set comprised 78 patients from the NG101 group and 48 patients from the placebo group. 107 (85%) patients were male and 19 (15%) patients were female, with a median age of 51·5 years (IQR 30·0-60·0). Across all patients, the primary endpoint showed no significant difference between groups (with UEMS change at 6 months 1·37 [95% CI -1·44 to 4·18]; placebo group mean 19·20 [SD 11·78] at baseline and 30·91 [SD 15·49] at day 168; NG101 group mean 18·23 [SD 15·14] at baseline and 31·31 [19·54] at day 168). Treatment-related adverse events were similar between groups (nine in the NG101 group and six in the placebo group). 25 severe adverse events were reported: 18 in 11 (14%) patients in the NG101 group and seven in six (13%) patients in the placebo group. Although no treatment-related fatalities were reported in the NG101 group, one fatality not related to treatment occurred in the placebo group. Infections were the most common adverse event affecting 44 (92%) patients in the placebo group and 65 (83%) patients in the NG101 group. INTERPRETATION: NG101 did not improve UEMS in patients with acute spinal cord injury. Post-hoc subgroup analyses assessing UEMS and Spinal Cord Independence Measure of self-care in patients with motor-incomplete injury indicated potential beneficial effects that require investigation in future studies. FUNDING: EU program Horizon2020; Swiss State Secretariat for Education, Research and Innovation; Wings for Life; the Swiss Paraplegic Foundation; and the CeNeReg project of Wyss Zurich (University of Zurich and Eidgenössische Technische Hochschule Zurich).

• MeSH
• dospělí MeSH
• dvojitá slepá metoda MeSH
• krční mícha * zranění   MeSH
• krční obratle MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• Nogo proteiny * MeSH
• poranění míchy * farmakoterapie   MeSH
• senioři MeSH
• spinální injekce * MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky, fáze II MeSH
• multicentrická studie MeSH
• randomizované kontrolované studie MeSH

PURPOSE OF THE STUDY: Os vesalianum pedis (OVP) is a rare accessory bone of the foot located at the base of the fifth metatarsal bone. It is usually asymptomatic and incidentally seen on radiographs. When symptomatic, it manifests itself with lateral foot pain. OVP, which can become symptomatic as a result of traumatic injuries, can also be confused with fracture. The aim of this study is to determine the prevalence and morphometric characteristics of OVP in the Turkish population. MATERIAL AND METHODS: Radiographic images of 5268 individuals aged 16 years and older (mean 39.65±17.21) who completed ossification of the fifth metatarsal bone were evaluated for OVP. Of the cases included in the study, 44.8% were female and 55.2% were male. The general and sex-based prevalence of OVP was calculated, and morphometric measurements were done. RESULTS: OVP prevalence in the Turkish population was found to be 0.15% regardless of sex. OVP prevalence was calculated to be 0.24% in men and 0.04% in women. CONCLUSIONS: Anatomy, radiology, orthopedics and emergency medicine physicians are frequently encountered with foot disorders in clinical and educational practices. It is important to keep in mind the rare presence of OVP (0.15%), in the preliminary diagnosis. KEY WORDS: os vesalianum pedis, accessory ossicle, foot, radiography.

• MeSH
• dospělí MeSH
• klinická relevance MeSH
• lidé středního věku MeSH
• lidé MeSH
• metatarzální kosti * diagnostické zobrazování   abnormality   MeSH
• mladiství MeSH
• mladý dospělý MeSH
• prevalence MeSH
• rentgendiagnostika metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Turecko MeSH

The bone transport technique uses the principle of distraction-osteogenesis and fill bone defects with the aid of an external fixator. In order to evaluate the clinical effect of femoral internal fixation with Ortho-Bridge System after bone transport, 4 patients after femoral bone transport from October 2020 to October 2022 are studied in this paper. Among them, 3 patients ran refracture of femur after removal of the Limb reconstruction system, 1 patient just finish femoral bone transport and request internal fixation. The surgery results show that Ortho-Bridge System can be used in the situation that conventional Locking compression plate and intramedullary nail are not suitable due to anatomical variation after femoral bone transport. Key words: femoral fracture; Ortho-Bridge System; bone transport; postoperative complications of bone transport.

• MeSH
• dospělí MeSH
• externí fixátory MeSH
• femur chirurgie   MeSH
• fraktury femuru * chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• osteogeneze pomocí distrakčního aparátu metody   přístrojové vybavení   MeSH
• pooperační komplikace etiologie   MeSH
• vnitřní fixace fraktury metody   přístrojové vybavení   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Significant malrotation of the femur after osteosynthesis is a serious complication of treatment and has a number of consequences for the patients and causes deterioration of their quality of life. Therefore, it is necessary to be familiar with intraoperative techniques to control the correct rotation, mostly clinical and radiological, which give us the possibility to minimize rotational errors. In the postoperative period, with even a slight suspicion of malrotation, it is necessary to proceed to its exact verification and, in indicated cases, to perform necessary correction. We recommend one of the CT techniques as a very reliable method, however in younger patients we prefer to use MRI. Early diagnosis of the rotational error and especially its size is essential from the point of view of potential reconstructive surgery, which is then chosen also with regard to the location of the original lesion. Key words: femoral osteosynthesis, limb malrotation, methods of measuring.

• MeSH
• femur chirurgie   diagnostické zobrazování   MeSH
• fraktury femuru * chirurgie   MeSH
• lidé MeSH
• magnetická rezonanční tomografie metody   MeSH
• počítačová rentgenová tomografie MeSH
• pooperační komplikace diagnóza   etiologie   MeSH
• vnitřní fixace fraktury * škodlivé účinky   metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH

PURPOSE: The aim of this study was to describe the incidence and a complex pathoanatomy of posterior malleolus fractures in a Maisonneuve fracture. METHODS: The study included 100 prospectively collected patients with a complete clinical and radiological documentation of an ankle fracture or fracture-dislocation including a fracture of the proximal quarter of the fibula. RESULTS: A posterior malleolus fracture was identified in 74 patients, and in 27% of these cases it carried more than one quarter of the fibular notch. Displacement of the posterior fragment by more than 2 mm was shown by scans in 72% of cases. Small intercalary fragments were identified in 43% of cases. Fractures of the Tillaux-Chaput tubercle were identified in 20 patients. CONCLUSION: Our study has proved a high rate of posterior malleolus fractures associated with a Maisonneuve fracture, and documented their considerable variability in terms of involvement of the fibular notch, tibiotalar contact area, direction of displacement and frequency of intercalary fragments. Of no less importance is a combination of Tillaux-Chaput fractures with a Maisonneuve fracture.

• MeSH
• dislokovaná fraktura diagnostické zobrazování   MeSH
• dospělí MeSH
• fibula zranění   diagnostické zobrazování   MeSH
• fraktury kotníku * diagnostické zobrazování   chirurgie   MeSH
• incidence MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• počítačová rentgenová tomografie MeSH
• prospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Achondroplasia is the most common form of human dwarfism caused by mutations in the FGFR3 receptor tyrosine kinase. Current therapy begins at 2 years of age and improves longitudinal growth but does not address the cranial malformations including midface hypoplasia and foramen magnum stenosis, which lead to significant otolaryngeal and neurologic compromise. A recent clinical trial found partial restoration of cranial defects with therapy starting at 3 months of age, but results are still inconclusive. The benefits of achondroplasia therapy are therefore controversial, increasing skepticism among the medical community and patients. We used a mouse model of achondroplasia to test treatment protocols aligned with human studies. Early postnatal treatment (from day 1) was compared with late postnatal treatment (from day 4, equivalent to ~5 months in humans). Animals were treated with the FGFR3 inhibitor infigratinib and the effect on skeleton was thoroughly examined. We show that premature fusion of the skull base synchondroses occurs immediately after birth and leads to defective cranial development and foramen magnum stenosis in the mouse model to achondroplasia. This phenotype appears significantly restored by early infigratinib administration when compared with late treatment, which provides weak to no rescue. In contrast, the long bone growth is similarly improved by both early and late protocols. We provide clear evidence that immediate postnatal therapy is critical for normalization of skeletal growth in both the cranial base and long bones and the prevention of sequelae associated with achondroplasia. We also describe the limitations of early postnatal therapy, providing a paradigm-shifting argument for the development of prenatal therapy for achondroplasia.

• MeSH
• achondroplazie * patologie   farmakoterapie   MeSH
• lebka patologie   účinky léků   MeSH
• lidé MeSH
• modely nemocí na zvířatech * MeSH
• myši MeSH
• receptor fibroblastových růstových faktorů, typ 3 * genetika   metabolismus   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• myši MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

Complex injuries to the posterior trunk can still pose a significant challenge to the reconstructive surgeon. Due to the lack of skin laxity, dependent anatomical location and the importance of the deeper structures, a systematic approach tailored to the individual defect should be considered for these types of reconstructions. In our case report, we present a reconstructive solution of a chronic defect of the back caused by resection of an ulceration. What was previously considered to be a relapse of a malignant melanoma turned out to be a chronic osteomyelitis of the spinous processes of the thoracic vertebrae. The defect after the resection of the ulceration and infected spinous processes of the thoracic vertebrae with exposed dorsal lamina was covered with pedicled myocutaneous flap. Reconstruction yielded well-vascularized tissue that provided sufficient volume and tissue quality. Even in the light of modern perforator flaps, local or locoregional muscle and myocutaneous flaps remain the first choice for the treatment of deep back defects. Considering all the factors in the given case, plastic surgeons are able to tailor the reconstructive technique to every individual case to match the desired reconstruction goal.

• MeSH
• chirurgické laloky * chirurgie   MeSH
• dermatochirurgické výkony metody   MeSH
• hrudní obratle chirurgie   patologie   MeSH
• lidé MeSH
• maligní melanom kůže komplikace   MeSH
• osteomyelitida * chirurgie   MeSH
• pooperační péče metody   MeSH
• senioři MeSH
• stafylokokové infekce komplikace   MeSH
• vřed chirurgie   komplikace   patologie   MeSH
• záda chirurgie   patologie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• kazuistiky MeSH

Background: We report a successful wound treatment of a chronic ulcer with bone exposure using a somehow forgotten technique of creating burr holes into the bone. Most clinics would promote flap surgery to cover wounds with bone exposure, however, in some cases invasive surgery is not mandatory. We bring up an alternative treatment for such cases. Case: We report a case of chronic ulcers on both lower extremities in a 43-year-old Caucasian male. He suffers from a leukocytoclastic vasculitis and sarcoidosis which is medicated by immunosuppressive medication. The patient‘s wounds were initially treated with mechanical debridement and split-thickness skin grafts, however, his wounds tended to worsen the more they were manipulated and finally resulted in tibial bone exposure. After levelling up his immune suppressive drugs, the wounds finally stabilized but didn’t heal after several weeks of follow-up. The wound was ultimately treated by placing burr holes in the underlying cortical bone. Conclusion: Chronic ulcers with bone exposure at the lower leg are challenging to treat. They often require local or free flap surgery. In some cases, because of underlying systemic disease, it is mandatory to stay away from invasive flap surgery. With this case, we like to put under attention an old technique of decorticating the exposed bone to promote secondary wound healing. It has been described mainly for scalp injuries, however, we have proven the viability of this technique for pretibial wounds as well.

• MeSH
• bércové vředy chirurgie   etiologie   patologie   terapie   MeSH
• dospělí MeSH
• imunosupresiva škodlivé účinky   MeSH
• komorbidita MeSH
• lidé MeSH
• poranění dolní končetiny chirurgie   komplikace   patologie   terapie   MeSH
• terapie neúspěšná MeSH
• tibie * chirurgie   patologie   zranění   MeSH
• záchrana končetiny metody   MeSH
• zákroky plastické chirurgie * metody   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH