- MeSH
- amfotericin B farmakologie terapeutické užití MeSH
- Aspergillus patogenita MeSH
- aspergilóza * diagnóza farmakoterapie MeSH
- debridement metody MeSH
- kazuistiky jako téma MeSH
- lidé MeSH
- mukormykóza * diagnóza farmakoterapie MeSH
- novorozenci extrémně nezralí * MeSH
- novorozenec MeSH
- Rhizopus patogenita MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- ženské pohlaví MeSH
- Publikační typ
- přehledy MeSH
Jedenkrát za čtyři roky jsou aktualizována mezinárodní doporučení pro léčbu syndromu diabetické nohy. Článek shrnuje nejnovější doporučení v léčbě infekce a lokální léčbě diabetických uicerací.
Every four years the international guidelines for diabetic foot treatment are updated. This article covers actualization in guidelines in treatment of diabetic foot related infections and local wound therapy.
- Klíčová slova
- Sukrózo-oktasulfát, amniová membrána, náplasti z leukocytů,destiček a fibrinu,
- MeSH
- amputace MeSH
- bakteriální infekce farmakoterapie klasifikace MeSH
- časná diagnóza MeSH
- debridement metody MeSH
- diabetická noha * farmakoterapie komplikace mortalita prevence a kontrola MeSH
- hyperbarická oxygenace MeSH
- lidé MeSH
- obvazy klasifikace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Chronic, non-healing wounds represent a significant challenge for healthcare systems worldwide, often requiring significant human and financial resources. Chronic wounds arise from the complex interplay of underlying comorbidities, such as diabetes or vascular diseases, lifestyle factors, and genetic risk profiles which may predispose extremities to local ischemia. Injuries are further exacerbated by bacterial colonization and the formation of biofilms. Infection, consequently, perpetuates a chronic inflammatory microenvironment, preventing the progression and completion of normal wound healing. The current standard of care (SOC) for chronic wounds involves surgical debridement along with localized wound irrigation, which requires inpatient care under general anesthesia. This could be followed by, if necessary, defect coverage via a reconstructive ladder utilizing wound debridement along with skin graft, local, or free flap techniques once the wound conditions are stabilized and adequate blood supply is restored. To promote physiological wound healing, a variety of approaches have been subjected to translational research. Beyond conventional wound healing drugs and devices that currently supplement treatments, cellular and immunotherapies have emerged as promising therapeutics that can behave as tailored therapies with cell- or molecule-specific wound healing properties. However, in contrast to the clinical omnipresence of chronic wound healing disorders, there remains a shortage of studies condensing the current body of evidence on cellular therapies and immunotherapies for chronic wounds. This review provides a comprehensive exploration of current therapies, experimental approaches, and translational studies, offering insights into their efficacy and limitations. Ultimately, we hope this line of research may serve as an evidence-based foundation to guide further experimental and translational approaches and optimize patient care long-term.
- MeSH
- debridement metody MeSH
- diabetes mellitus * MeSH
- hojení ran * fyziologie MeSH
- imunoterapie MeSH
- kůže MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Since 1970 surgeons have managed deep burns by surgical debridement and autografting. We tested the hypothesis that enzymatic debridement with NexoBrid would remove the eschar reducing surgery and achieve comparable long-term outcomes as standard of care (SOC). In this Phase 3 trial, we randomly assigned adults with deep burns (covering 3-30% of total body surface area [TBSA]) to NexoBrid, surgical or nonsurgical SOC, or placebo Gel Vehicle (GV) in a 3:3:1 ratio. The primary endpoint was complete eschar removal (ER) at the end of the debridement phase. Secondary outcomes were need for surgery, time to complete ER, and blood loss. Safety endpoints included wound closure and 12 and 24-months cosmesis on the Modified Vancouver Scar Scale. Patients were randomized to NexoBrid (n = 75), SOC (n = 75), and GV (n = 25). Complete ER was higher in the NexoBrid versus the GV group (93% vs 4%; P < .001). Surgical excision was lower in the NexoBrid vs the SOC group (4% vs 72%; P < .001). Median time to ER was 1.0 and 3.8 days for the NexoBrid and SOC respectively (P < .001). ER blood loss was lower in the NexoBrid than the SOC group (14 ± 512 mL vs 814 ± 1020 mL, respectively; P < .0001). MVSS scores at 12 and 24 months were noninferior in the NexoBrid versus SOC groups (3.7 ± 2.1 vs 5.0 ± 3.1 for the 12 months and 3.04 ± 2.2 vs 3.30 ± 2.76 for the 24 months). NexoBrid resulted in early complete ER in >90% of burn patients, reduced surgery and blood loss. NexoBrid was safe and well tolerated without deleterious effects on wound closure and scarring.
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- MeSH
- amoxicilin aplikace a dávkování terapeutické užití MeSH
- antibakteriální látky terapeutické užití MeSH
- debridement metody MeSH
- infekce spojené s protézou * chirurgie terapie MeSH
- klindamycin aplikace a dávkování terapeutické užití MeSH
- lidé MeSH
- replantace metody MeSH
- rifampin aplikace a dávkování škodlivé účinky terapeutické užití MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
PURPOSE OF THE STUDY The paper presents a monocentric retrospective study of patients treated surgically for spinal tuberculosis. Clinical and radiological results are analysed, early and late complications are recorded. The study aims to answer the following questions. 1. Can we use instrumentation to restore the stability and alignment in the infected spinal focus? 2. Should we always perform radical anterior resection of TBC lesions? 3. What is the prognosis of surgical treatment of TBC patients with neurological deficit manifestation? MATERIAL AND METHODS Between 2010 and 2020, a total of 12 patients were treated for spinal tuberculosis at our department, of whom 9 patients (5 men, 4 women) with the mean age of 47.3 years (range 29 to 83 years) underwent a surgery. A total of three patients were operated on before the final confirmation of the TBC and treatment with antituberculosis medication, four patients in the initial therapy phase and two patients in the continuous phase. Two patients only underwent a non-instrumented decompression surgery followed by external support fixation. In the other seven patients, always with spinal deformity, instrumentation was used (3 cases of isolated posterior decompression, transpedicular fixation, posterior fusion, 4 cases of anteroposterior instrumented reconstruction). In 2 cases a structural bone graft and in 2 cases an expandable titanium cage were used for anterior column reconstruction. RESULTS Of the total number of patients, altogether eight patients were assessed at 1 year after surgery (one 83-year-old patient died from heart failure 4 months after surgery). Of the remaining eight patients, three patients exhibited a neurological deficit and postoperative regression of the finding. The McCormick score improved from the preoperative mean score of 3.25 to 1.62 at 1 year after surgery (p < 0.001). The clinical VAS score regressed from 5.75 to 1.63 at 1 year after surgery (p < 0.001). Radiographic healing of the anterior fusion was achieved in all patients, both after decompression and instrumented surgery. The initial mean kyphosis of 20.36 degrees of the operated segment measured by the mCobb angle was corrected to 14.6 degrees postoperatively, with a subsequent slight deterioration to 14.86 degrees (p < 0.05). The greatest correction was achieved in patients who had undergone a two-stage surgery with anterior resection and AP reconstruction. DISCUSSION In our cohort, titanium instrumentation was used in seven of nine patients. One patient only manifested persistent tuberculosis with nonspecific bacterial flora superinfection. Revision surgery with anterior radical debridement and subsequent treatment with antituberculotic drugs healed the patient. There were four patients with major preoperative neurological deficit persisting more than 2 weeks before the final treatment with subsequent improvement in all cases. These patients were treated with anteroposterior reconstruction and anterior radical debridement. CONCLUSIONS No increased risk of recurrent infection associated with the use of spinal instrumentation was found in the study. Anterior radical debridement is performed in patients with manifested kyphotic deformity and spinal canal compression, followed by reconstruction with a structural bone graft or a titanium cage. The other patients are treated based on the principle of "optimal" debridement with or without the use of transpedicular instrumentation. If adequate spinal canal decompression and stability are achieved, neurological improvement can be anticipated even in case of a major neurological deficit. Key words: spine tuberculosis, tuberculous spondylitis, Pott's disease, anterior debridement, spine instrumentation.
- MeSH
- bederní obratle chirurgie MeSH
- chirurgická dekomprese MeSH
- debridement metody MeSH
- discitida * chirurgie MeSH
- dospělí MeSH
- fúze páteře * MeSH
- hrudní obratle chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- titan MeSH
- tuberkulóza páteře * chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
Hluboké nekrotizující infekce měkkých tkání (deep necrotizing soft tissue infections) jsou závažné, život ohrožující afekce. Chirurgický debridement je nedílnou součástí terapie a jeho podcenění či nedostatečná razance významně zhoršuje výsledky léčby. Autoři dokumentují případ mla- dého muže bez významnějšího předchorobí se zhmožděním měkkých tkání bérce po dopravní nehodě s rozvojem septického šoku na podkladě progredující fasciitidy způsobené Streptococcus pyogenes a předkládají řešení stavu v multidisciplinárním týmu. Chirurgický debridement je do značné míry závislý na osobní zkušenosti chirurga s těmito afekcemi a hlavním kritériem debridementu je včasná nekrektomie do makroskopicky zdravé tkáně. Závažnost těchto infekcí může být při postižení hlubokých struktur velmi lehce podceněna, což vede k nedostatečné sanaci fokusu. Agresívní přístup v nekrektomii, byť za cenu vzniku velkých defektů, může zachránit pacientům život, délku a funkci končetiny.
Deep necrotizing soft tissue infections are serious, life-threatening conditions. Surgical debridement is an integral part of therapy, and its underestimation or lack of thoroughness significantly worsens treatment outcomes. The authors present the case of an otherwise healthy young man with no significant comorbidities presenting with a contusion of the soft tissues of the lower leg after a motor vehicle accident. Post initial treatment, the subsequent development of septic shock can be explained to be caused by progressive fasciitis elicited by Streptococcus Pyogenes. The authors present the method of treatment of this condition via a multidisciplinary team approach. Surgical debridement is largely dependent on the surgeon’s personal experiences with these conditions, and the main criterion for debridement is early necrectomy to macroscopically healthy tissue. The seriousness of these infections can be very easily underestimated when deep structures are involved, leading to insufficient revision of the initial focus. An aggressive approach to necrectomy, even at the cost of creating large defects, can save patients' lives as well as the length and function of the limb.
- MeSH
- debridement metody ošetřování MeSH
- hojení ran fyziologie MeSH
- infekce v ráně chirurgie farmakoterapie komplikace MeSH
- lidé MeSH
- obvazy MeSH
- rány a poranění * komplikace ošetřování terapie MeSH
- terapie ran pomocí řízeného podtlaku metody ošetřování MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- antiinfekční látky lokální aplikace a dávkování terapeutické užití MeSH
- bércové vředy * etiologie terapie MeSH
- chronická bolest MeSH
- debridement metody MeSH
- kompresní obvazy MeSH
- lidé MeSH
- vazokonstriktory aplikace a dávkování terapeutické užití MeSH
- žilní insuficience terapie MeSH
- Check Tag
- lidé MeSH
