Early excision and grafting changed dramatically topical wound treatment, but are restricted by difficulty in diag- nosing burn depth, by limited donor sites and by technical skills to excise special areas (perineum, face). In addi- tion to the extent of burn and the age of the patient the depth is determinant of mortality, morbidity and of patient's quality of life. It results from the time-temperature relation and is further influenced by local and systemic causes of conversion: dehydration, edema, infection and shock hypoxia, metabolic derangements, peripheral ves- sels diseases may contribute do deepening of burn wound. Superficial burn on day one appears deep dermal by day three, where spontaneous epithelization lasts much longer than 21 days and results in hypertrophic scarring. To prevent this sequelae deep dermal burn may be treated like full-thickness injury with excision and autografting. Another way is removal of dead layers of corium and using biological or synthetic cover. We have found a more effective way to reach wound closure (not only cover) in the method of „upside-down” application of recombined human/pig skin (RHPS), composed of allogeneic human keratinocytes cultured on cell-free pig dermis. The allo- geneic epidermal cells temporarily „take”, „close” the excised wound and simultaneously encourage epithelization from adnexa remnants in the wound bed. Thus definitive closure is achieved.
- MeSH
- Biological Dressings MeSH
- Research Support as Topic MeSH
- Wound Healing MeSH
- Keratinocytes physiology transplantation MeSH
- Skin cytology growth & development MeSH
- Humans MeSH
- Burns pathology therapy MeSH
- Skin Transplantation MeSH
- Skin, Artificial MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
BACKGROUND: Prevention of infection is a paramount concern after open fracture of the tibia. Previous studies have shown that delay in soft-tissue coverage may raise infection rates. Use of vacuum-assisted closure devices in open fracture wounds has become common. The authors analyzed whether use of the vacuum-assisted closure sponge can allow delay of flap coverage for open tibia fractures without an increase in infection rate. METHODS: The authors identified 38 patients with Gustilo grade IIIB open fractures from their trauma registry with a minimum 1-year follow-up. From the medical record, the authors collected information on the time from injury to definitive wound coverage, type of fixation, type of coverage, and demographics. Infected patients were defined as patients that required surgical debridement after coverage with positive cultures. RESULTS: Patients who underwent definitive coverage within 7 days had a significantly decreased rate of infection (12.5 percent) compared with patients who had coverage at 7 days or more after injury (57 percent) (p < 0.008). The overall infection rate was 36 percent with routine use of the vacuum-assisted closure sponge. Patients who developed infection had a greater mean time to coverage than patients who did not develop infection (8.9 days versus 4.8 days; p < 0.029). CONCLUSIONS: Routine use of vacuum-assisted closure with open tibia fractures is safe and provides a good primary dressing over open wounds. For Gustilo grade IIIB tibia fractures, vacuum-assisted closure therapy does not allow delay of soft-tissue coverage past 7 days without a concomitant elevation in infection rates.
- MeSH
- Bacterial Infections etiology prevention & control MeSH
- Time Factors MeSH
- Adult MeSH
- Tibial Fractures complications therapy MeSH
- Humans MeSH
- Fractures, Open complications therapy MeSH
- Negative-Pressure Wound Therapy * MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Úvod: Článek se zabývá možnostmi débridementu, které lze využít u pacientů s nehojícími se ranami. Cílem příspěvku je přiblížit možnost provedení débridementu přiložením sterilně pěstovaných larev. Výzkumné šetření se zabývalo porovnáním débridementu, který byl proveden buď larvální terapií, nebo moderním obvazovým materiálem. Metoda a materiál: Výzkumné šetření probíhalo metodou studia dokumentace a krátkého dotazníkového šetření pro pacienty, kterým byl proveden débridement nehojící se rány moderním terapeutickým krytím (20 pacientů) nebo larvální terapií (20 pacientů) na septické části chirurgického oddělení a v ambulanci pro léčbu chronických ran v nemocnici okresního typu. Výsledky: Débridement provedený larvami trval u sledovaných pacientů průměrně 3,75 dne a jeho cena byla 3895 Kč. Při čistění rány terapeutickým krytím trval débridement průměrně 33,6 dne a finanční náklady na něj byly 2975 Kč. Diskuze: Výhodou larvální terapie je rychlý débridement rány, nevýhodou může být určitý odpor k tomuto typu léčby, z tohoto důvodu by ji nepodstoupilo až 50 % dotazovaných pacientů léčených terapeutickým krytím. Mezi nevýhody autolytického débridementu terapeutickým krytím se řadí zejména časová náročnost.
Introduction: The article deals with possibilities of a debridement, which can be used for patients with non-healing wounds. This paper aims to bring the possibility of the debridement execution by placing sterile grown larvae. The research have focused on the comparison of the debridement, which was performed either by the larval therapy or by the modern bandage material. Methods and materials: The research was carried out by the documentation study and the brief questionnaire survey of the patients who were performed by debridement of nonhealing wounds by the modern therapeutic coverage (20 patients) or the larval therapy (20 patients) on a septic part of a surgical department and ambulance for treatment of chronic wounds in a district hospital. Results: The larvae debridement of monitored patients took an average of 3.75 days and its price was 3895 CZK. While the therapeutic coverage debridement took 33.6 days on average and it costed 2975 CZK. Discussion: The benefit of the larval therapy is the fast debridement of wounds, the disadvantage may be some resistance to this type of treatment, for this reason it wouldn't be undergone by up to 50% of the responding patients treated by the therapeutic coverage. The disadvantage of the autolytic therapeutic coverage debridement is long time duration.
- Keywords
- larvoterapie,
- MeSH
- Pain etiology classification MeSH
- Chronic Disease therapy MeSH
- Debridement * economics methods statistics & numerical data MeSH
- Suppuration therapy MeSH
- Wound Healing MeSH
- Wound Infection etiology therapy MeSH
- Larva MeSH
- Middle Aged MeSH
- Humans MeSH
- Health Care Costs statistics & numerical data MeSH
- Bandages MeSH
- Aged MeSH
- Wound Closure Techniques statistics & numerical data MeSH
- Outcome and Process Assessment, Health Care statistics & numerical data MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Comparative Study MeSH
- MeSH
- Adult MeSH
- Fasciitis, Necrotizing pathology surgery MeSH
- Transplantation, Homologous * MeSH
- Upper Extremity pathology surgery MeSH
- Humans MeSH
- Critical Care * MeSH
- Wounds and Injuries surgery MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Skin Transplantation * MeSH
- Leg Ulcer pathology surgery MeSH
- Plastic Surgery Procedures methods MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
- MeSH
- Skin MeSH
- Humans MeSH
- Leg Injuries surgery complications therapy MeSH
- Skin Transplantation MeSH
- Check Tag
- Humans MeSH
- Publication type
- Case Reports MeSH
Vhodně zvolený terapeutický materiál na vlhké hojení ran a správná edukace pacienta a jeho rodiny pomáhá nejen zdravotnickým pracovníkům v péči o pacienty s bércovými vředy, dekubity, diabetickými ulceracemi, ale zajistí i kvalitu života pacienta. Zapomínat nesmíme ani na ekonomickou profitabilitu, které lze docílit využitím správného terapeutického materiálu, který odpovídá fázovému hojení. Podíváme li se do současného Číselníku VZP, zjistíme, že skupina 01, kam byly a jsou tyto novinky ze skupiny zdravotnických prostředků pravidelně zařazovány, je pro běžného uživatele neobslužná a málo přehledná a těšíme se na období, kdy budou jednotlivé materiály řazeny pomocí tzv. „kategorizačního stromu“, který se bude týkat jednotlivých terapeutických skupin, jež budou dále děleny dle bližších specifik jednotlivých materiálů a dalších látek v nich obsažených. Pro běžného uživatele bude tento přehled zřetelný, protože ze současně dostupných podkladů bohužel není jasné, že například číslo úhradové skupiny 01.02.05.06 zahrnuje materiály na bázi alginátů s aktivní látkou.
Appropriately selected therapeutic materials for moist wound healing and to educate patients and their families not only helps healthcare professionals in the care of patients with leg ulcers, pressure ulcers, diabetic foot ulcers, but also ensures the quality of life of the patient. We must not forget the economic profitability, which can be achieved using appropriate therapeutic material which corresponds to the phase of healing. If we look into the current General Health Insurence Company, we find that a group of 01, and where were these new groups of medical devices regularly added, is for ordinary users and non-serving little transparent and look forward to a period when different materials are sorted using the ”categorization tree”, which will cover the various therapeutic groups, which are further divided according to the more detailed specifics of individual materials and other substances contained in them. For the average user will clear this list, because of the currently available evidence is unfortunately not clear, for example, that the number reimbursement 01.02.05.06 group includes materials based on alginates of the active ingredient.
- MeSH
- Adsorption MeSH
- Alginates MeSH
- Wound Healing * MeSH
- Hydrogels MeSH
- Humans MeSH
- Bandages, Hydrocolloid classification MeSH
- Bandages * economics classification standards MeSH
- Powders MeSH
- Wounds and Injuries classification MeSH
- Medicare Assignment MeSH
- Universal Health Insurance MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
UNLABELLED: PURPOSE OF THE STUDY Grade III open fractures are associated with infectious complications in 25-66% of injuries. Negative pressure wound therapy (NPWT) applied to an injured soft tissue coverage provides an impermeable barrier between the injured structures and the external environment, in addition to early secretion draining and a positive effect on the site of application. All this also prevents secondary bacterial contamination. The objective of the study was to compare the results of treatment methods in view of infectious complications in patients with soft tissue injury in grade-III open fractures managed either by NPWT and primary closure or by covering with combined dressing fabric (COM) in combination with continual wound lavage. MATERIAL AND METHODS This retrospective study comprised 77 patients with 80 grade III open fractures treated in the years 2008-2012; of these, 39 patients with 41 fractures met the inclusion criteria and were finally evaluated. The patients were divided into two groups. The control group included 19 patients with 20 fractures treated by the standard surgical procedure using stabilisation with an external fixator or intramedullary nail, thorough soft tissue debridement, continual wound lavage and suture of skin lesions or using a primary coverage of the defect with COM. The trial group consisted of 20 patients with 21 fractures treated according to the same principle, but NPWT was applied to injured soft tissue coverage first and skin suture or any other type of skin defect coverage was carried out when the healing process was good and bacteriological findings were negative. The results of both methods were evaluated based on the following criteria: development of superficial or deep infection in the wound, interval to negative bacteriological findings and osteomyelitis rate. The results were analysed by Fisher's exact test and the Man Whitney U test. RESULTS Infectious complications were recorded in a total of 15 (37%) fractures: 11 (55%) in the control group and four (19.1%) in the trial group (p = 0.025). Recurrent infection was observed in five control group fractures (25%) and in none of the trial group fractures (p = 0.021). Osteomyelitis was found only in two control group fractures. The average interval before negative bacteriological results were obtained was 22 days in the control group and 12 days in the trial group (p = 0.001). DISCUSSION The NPWT use as a temporary coverage of soft tissue defects in open fractures results in a significant reduction of infectious complications, as shown by many relevant studies including this study. In comparison with Gopal's "fix and flap" concept, the NPWT in our patient group had slightly higher incidence of infectious complications (15.4% versus 19.1%). However, these results can be achieved only if a specialist in reconstructive surgery and appropriate technical facilities are readily available. If this is not possible, then the NPWT, in comparison with conventional methods, provides the best possible way of temporary protection for an injured soft tissue coverage. CONCLUSIONS Application of NPWT within the primary treatment of injured soft tissue coverage in grade III open fractures results in a statistically significant reduction of bacterial contamination at the site of injury, as well as a reduction of the subsequent incidence of infectious complications. Primary application of NPWT also significantly reduced the risk of recurrent infection. KEY WORDS: open fracture, negative pressure wound therapy, continual wound lavage, infection.
- MeSH
- Fractures, Bone surgery MeSH
- Surgical Wound Infection etiology therapy MeSH
- Humans MeSH
- Fractures, Open surgery MeSH
- Retrospective Studies MeSH
- Suture Techniques MeSH
- Wound Closure Techniques * MeSH
- Negative-Pressure Wound Therapy methods MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Comparative Study MeSH
Článek se zabývá vývojem právní úpravy a praktickými postupy při předepisování zdravotnických prostředků pro vlhké hojení ran v ambulantní péči a problematikou praktické komunikace se zdravotní pojišťovnou ve věci úhrady těchto zdravotnických prostředků z veřejného zdravotního pojištění v České republice.
The article concerns with the development of legal regulations and practical procedures in prescribing medical devices for "moist" wound management in outpatient care and the issue of practical communication with health insurance companies in the matter of reimbursement of these medical devices from public health insurance in the Czech Republic.
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 methods MeSH
- Diabetes Mellitus * MeSH
- Wound Healing * physiology MeSH
- Immunotherapy MeSH
- Skin MeSH
- Humans MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
