Autologous platelets and leukocytes can improve healing of infected high-energy soft tissue injury.

Despite advances in surgical techniques and pharmacology, healing of injury-associated soft tissue defects is frequently complicated by infections, which often requires a secondary intervention. Cytokines are important mediators of healing. Application of autologous platelet-rich plasma enriched in growth factors and antimicrobial proteins, known also as platelet-leukocyte rich plasma (PLRP), represents a novel approach to the treatment of soft tissue and bone healing disturbances. This case is the first report on the application of PLRP in an infected high-energy soft tissue injury and shows that the volume and concentration of platelets and leukocytes is adequate to induce healing processes despite concurrent infection.

Military injuries to the popliteal vessels in Croatia.

OBJECTIVE: The paper reviews military popliteal vascular injuries in Croatia. SUMMARY BACKGROUND DATA: Popliteal vascular injuries still pose difficult problems for vascular surgeons despite improvements in resuscitation, surgical techniques and wound coverage. Popliteal vascular injuries, both arterial and venous, with a high incidence of associated musculoskeletal injuries are presented in patients with military injuries in South Croatia. METHODS: 26 wounded with popliteal vascular injuries are presented. Explosive injuries are found in 21 and associated fractures in 9 cases. In immediate repair group the time interval between trauma and surgery was 2 to 30 hours (average 9.8 hours). In the delayed repair group the interval between trauma and surgery was 11 days to 24 days. RESULTS: 21 out of 26 patients with popliteal vascular injuries had combined arterial and venous injuries; 4 patients had isolated popliteal arterial injuries, while 8 patients had other vascular injuries along with the popliteal ones; 8 amputations resulted (30.8%). CONCLUSION: Popliteal vascular injuries caused by typical military mechanism during the war in Croatia present large and extensive defects of tissues and bones, are often associated with other injuries and require more extensive surgical therapy. Evacuation of the wounded under very difficult conditions as well as considerable organization and transportation problems are characteristic for this war and greatly affect the success of vascular reconstruction. Hyperbaric oxygen therapy offers a safe noninvasive method of improving wound healing and decreasing edema formation in popliteal vascular injuries.