Článek má za cíl poukázat na větší provázanost a spolupráci zdravotní a sociální péče v oblasti hojení ran. Pochopení a respektování přesahu jednotlivých intervencí je klíčové nejen pro urychlení a kvalitu hojení, ale především pro větší pochopení souvislostí mezi doporučením lékaře a možnostmi či schopnostmi pacienta daná doporučení dodržet.
The article aims to point to greater interconnectedness and cooperation between health and social care in the field of wound healing. It emphasizes understanding and respecting the mutual effects of individual interventions. This is crucial not only for accelerating and improving wound healing but also for better understanding the context between a doctor's recommendations and a patient's ability to follow them.
Doporučený postup České angiologické společnosti ČLS JEP pro léčbu chronických žilních chorob (CVD, chronic venous disease) byl publikován v roce 2023 jako odraz mezinárodních doporučení vydaných v poslední době. Šlo především o guidelines Evropské společnosti cévní chirurgie, které byly pod názvem "European Society for Vascular Surgery 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs" publikovány v roce 2022. Česká doporučení jsou s těmito mezinárodními doporučeními v souladu a text multidisciplinárního týmu českých autorů deklaroval jak mezinárodně uznávané principy léčby CVD, tak reflektoval místní zkušenosti a zvyklosti. V návaznosti na práci odborné společnosti vyšla v roce 2024 novelizace doporučených diagnostických postupů pro všeobecné praktické lékaře. V naší práci jsou probrány a komentovány hlavní změny, které se v těchto novelizovaných dokumentech objevují.
The guidelines of the Czech Society of Angiology for the treatment of chronic venous disease (CVD) was published in 2023 as a reflection of international recommendations issued recently. These were mainly the European Society for Vascular Surgery 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs, published in 2022. The Czech recommendations are in line with these international recommendations, and the text of the multidisciplinary team of Czech authors declared both internationally accepted principles of CVD treatment and reflected local experience and practices. Following the work of the Czech society of angiology, an amendment to the guidelines of diagnostic and therapeutic procedures for general practicioners was published in 2024. Our paper discusses and comments on the main changes that appear in both these documents.
Successful engraftment of skin grafts highly depends on the quality of the wound bed. Good quality of blood vessels near the surface is critical to support the viability of the graft. Ischemic, irradiated scar tissue, bone and tendons will not have the sufficient blood supply. In such situations flaps are to be resorted. However, the flaps also need to have good vascularity over the limbs. The introduction of dermal substitutes has provided a novel method for repairing various severe skin defects. These substitutes act as dermal regenerative templates, which facilitate dermal reconstruction and regeneration. This study was done to ascertain the effectiveness of these substitutes in the treatment of complex wounds. Between January 2022 and June 2023, 20 patients who had complex wounds, which could not be treated with simple skin grafting and who were treated with collagen and elastin matrix and split skin grafting (SSG) were retrospectively studied. The percentage of SSG take as per the records was noted at a 10-day post-operative period. Patient characteristics, comorbidities, duration and outcomes of the treatment were noted. Twenty patients were included in the study. The minimum size of the ulcer was 5 × 4 cm (area of 20 cm2) and the maximum size of the ulcer was 15 × 15 cm (225 cm2). Average take of skin graft was 93.7% at 10th post-operative day. Recurrence at 6 months was nil. The scar quality was assessed by patient and observer at 3 months and 6 months post-operatively. The lower-limb ulcers with compromised surrounding tissue are complex. The major goal in these cases is to do simple surgery and prevent recurrence. The collagen and elastin matrices provide structural support for cellular infiltration, which helps maximize a SSG take and a stable long-term scar.
- MeSH
- bércové vředy patologie terapie MeSH
- elastin terapeutické užití MeSH
- kolagen terapeutické užití MeSH
- lidé středního věku MeSH
- lidé MeSH
- poranění dolní končetiny * patologie terapie MeSH
- průzkumy zdravotní péče metody statistika a číselné údaje MeSH
- transplantace kůže * metody MeSH
- vředy dolních končetin patologie terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- klinická studie 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
- neúspěšná terapie MeSH
- poranění dolní končetiny chirurgie komplikace patologie terapie 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
OBJECTIVE: The management of pelvic venous disorders (PeVD) remains controversial. Open surgical and endovascular methods are currently used for treatment, but there are few data in the literature on the morphology and histology of the ectatic ovarian vein (OV). This study aimed to explore the histomorphological changes in a dilated OV in patients with PeVD and compare it with a normal OV obtained post-mortem and a normal great saphenous vein (GSV). METHODS: Histology of the OV was studied in 16 patients who underwent surgery for PeVD, 10 control cadavers from whom fragments of the OV without visible gross changes were taken at autopsy, and nine control patients in whom the GSV was resected to be used for coronary artery bypass. RESULTS: The OV wall in patients with PeVD consisted of three layers: intima, media, and adventitia. The OV looked very similar to the GSV wall because of a clearly developed layer of smooth muscle fibres. The thickness of the normal OV was significantly different to the OV wall in PeVD (475.3 μm, IQR 370.7, 607.6 vs. 776.3 μm, IQR 668.9, 879.6, p < .001) and did not differ significantly from the thickness of a normal GSV wall (784.3 μm, IQR 722.2, 898.2). The intima-media complex of the OV was significantly thinner than the GSV in PeVD (118.9 μm, IQR 75.6, 159.6 vs. 415 μm, IQR 399.5, 520.0, р < .001); however, the adventitia of the OV was significantly thicker than in normal OV and GSV (599.6 μm, IQR 444.3, 749.7 vs. 373.5 μm, IQR 323.8, 482.0 vs. 308.4 μm, IQR 275.9, 338.2, p < .001). CONCLUSION: Dilatation of the OV in patients with PeVD was accompanied by a significant increase in the overall thickness of the vein wall, which brings it closer in structure to the GSV. This implies that the OV may be used safely for transposition into the inferior vena cava or iliac vein.
- MeSH
- koronární bypass MeSH
- lidé MeSH
- pánev MeSH
- varixy * chirurgie MeSH
- vena cava inferior MeSH
- vena saphena chirurgie MeSH
- žilní insuficience * chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Klíčová slova
- CVD Control II,
- MeSH
- kvalita života MeSH
- nemoci cév diagnóza epidemiologie farmakoterapie klasifikace MeSH
- teleangiektazie diagnóza epidemiologie farmakoterapie MeSH
- varixy diagnóza epidemiologie farmakoterapie MeSH
- výzkum MeSH
- žilní insuficience * diagnóza epidemiologie farmakoterapie MeSH
- Publikační typ
- přehledy MeSH
- Geografické názvy
- Česká republika MeSH
- Klíčová slova
- sulodexid, apixaban,
- MeSH
- antikoagulancia * farmakologie terapeutické užití MeSH
- bércové vředy * farmakoterapie ošetřování MeSH
- chronická obstrukční plicní nemoc MeSH
- diosmin farmakologie terapeutické užití MeSH
- erysipel farmakoterapie MeSH
- glykosaminoglykany farmakologie terapeutické užití MeSH
- hojení ran MeSH
- hyperbarická oxygenace metody MeSH
- infekce dýchací soustavy etiologie farmakoterapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- penicilin G farmakologie terapeutické užití MeSH
- pyrazoly farmakologie terapeutické užití MeSH
- pyridony farmakologie terapeutické užití MeSH
- rivaroxaban farmakologie terapeutické užití MeSH
- senioři MeSH
- warfarin škodlivé účinky MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- Klíčová slova
- MPFF,
- MeSH
- antikoagulancia farmakologie terapeutické užití MeSH
- bércové vředy prevence a kontrola MeSH
- diosmin farmakologie terapeutické užití MeSH
- lidé MeSH
- posttrombotický syndrom farmakoterapie komplikace MeSH
- žilní insuficience * terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- novinové články MeSH
