Fibrin gel as a scaffold for skin substitute ­ production and clinical experience.

The purpose of this study was to create a fibrin-based human skin substitute in vitro with epidermal and dermal component and to assess its healing potential in deep partial and full thickness burns. Fibrin scaffolds were prepared from commercial fibrin glue kits. Human fibroblasts were cultured in fibrin gel. Human keratinocytes were seeded on the top of the gel. Viability of cells was determined fluorimetrically. Scanning electron microscope and immunocytochemistry analysis of cultured cells were performed. After hydrosurgical preparation of deep burn necrotic tissue, wound bed was prepared for skin substitutes. Progress of healing was documented using visual estimation and photos. Scanning electron microscope images showed good cell attachment and colony spreading of keratinocytes and fibroblasts on fibrin scaff old. Immunofluorescent staining of cell cultures on fibrin scaffold showed expression of vimentin, a marker of fibroblast cells, cytokeratin 19, a marker of epithelial stem cells, as well as involucrin, a marker of differentiated keratinocytes. Clinical results clearly showed that appearance of the skin did not differ significantly from the areas of transplanted skin using split-thickness skin graft techniques. In conclusion, using these fibrin-cultured autografts on massive full-thickness burn resulted in good healing.

Course and rate of post-fracture bone healing in correlation with bone-specific alkaline phosphatase and bone callus formation.

Alkaline phosphatase (ALP) and bone-specific alkaline phosphatase (S-bone ALP) activities may serve as markers of the course and rate of bone healing after sustained fractures. The aim of this study was to examine whether the assessment of S-bone ALP as a biochemical parameter in the early posttraumatic phase may indicate the course of fracture healing. To date, the methods used to monitor the bone healing process have been based on the patients' assessment and the radiographic findings. In view of the fact that patient opinion is highly subjective, that the radiographic findings depend on the radiologist's experience and that the monitoring of bone healing is a long-lasting process, measurements of biochemical parameters appear to be the only objective evidence of the changes occurring during bone regeneration. In this study, the activity of bone-specific alkaline phosphatase was measured in the serum of 41 patients who had sustained long bone fractures. The participants included 26 males and 15 females, aged 15 to 80 years. All patients were treated surgically. The activity of S-bone ALP was assessed every seven days over a period of 4 weeks. The study patients were followed up radiologically for several months. Our research showed that the increase of alkaline phosphatase correlated with an increase of S-bone ALP levels. In addition, changes in ALP levels on days 7 and 14 as compared to those on day 1 post injury were associated with changes in S-bone ALP levels on the same day. Likewise, the callus volume correlated with the decrease, no change or increase in the levels of ALP and S-bone ALP in the same way. Based on these results, it may be concluded that monitoring changes in the biochemical parameters alkaline phosphatase and bone-specific alkaline phosphatase allows early detection of fracture healing rates. A minor increase in the activity or no change in the level of the biochemical parameters ALP and S-bone ALP in the period of the first two weeks indicates successful fracture fixation, rapid bone healing and the formation of a minimal or insignificant callus. A major increase in the activity of the biochemical parameters ALP and S-bone ALP in the period of the first two weeks indicates inadequate fracture fixation, delayed bone healing and the formation of a visible and significant callus.

Our experience with modified osteomyoplasty for reamputation of war-related transtibial amputees.

The aim of this study was to examine the efficacy of the operative method of modified osteomyoplasty in relation to primary "guillotine" amputation in Croatian war amputees. From 1995 to 2000 a total of 425 patients underwent transtibial amputation for their war-related injuries. From these group, 52 patients were selected that were unable to tolerate prosthetic wear. Following primary amputation, these 52 patients underwent reamputation surgery using the technique of modified osteomyoplasty. The efficacy of the operative method was assessed in relation to age, presence of complications before amputation, the level of amputation, the number of amputations, motivation for social integration, and the normalization of physical activity and the patient's level of satisfaction (graded from 1, unsatisfactory to 5, completely satisfactory). The results of the analysis showed that the application of modified osteomyoplasty as the method of choice for transtibial residual limb reconstruction creates the basic prerequisite for functional prosthetic fitting. The level of satisfaction significantly increased from the mean value of 1.21 before the surgery to the mean of 2.96 one year after the surgery (Z = -6.270, p < 0.001, Wilcoxon signed rank test).

Prognostic significance of BsALP in healing of long bone fractures.

The aim of this work was to assess the relationship of both total alkaline phosphatase (ALP) and bone-specific alkaline phosphatase (BsALP) with the course and outcome of operatively treated long-bone fractures. The activity of total ALP and BsALP was measured in 41 patients with a long bone fracture, comprising 26 men and 15 women. All patients were treated operatively. Total ALP and BsALP levels were measured in sera on day 1, 7, 14 and 21 after sustaining injury. Patient monitoring included X-rays. According to the outcome, patients were divided into two groups: the fast healing group and the slow healing group. The levels of total ALP and BsALP showed parallel trends in the course of this study. Depending on the healing outcome, on day 7 an increase in the case of slow healing, or a decrease in the case of fast healing, for both BsALP and total ALP was observed. No difference was found between various sites of bone fracture. This is an important result indicating the prognostic significance of total ALP and BsALP measurement in the monitoring of long bone fracture healing. In addition, an early change in the level of these enzymes was associated with the efficiency of the performed surgery.

Self-inflicted burns in patients with chronic combat-related post-traumatic stress disorder.

This study examined self-inflicted burns in case series of four patients with chronic combat-related post-traumatic stress disorder (PTSD). Those patients were hospitalized in the Burn Unit of the University Hospital of Traumatology in Zagreb because of severe burns and had a premorbid psychiatric history of PTSD. Demographic data and information regarding the circumstances surrounding the incident, burn severity, treatment and outcomes of these patients were collected. The authors have analyzed possible impacts of the sensationalistic way in which media present cases of self-inflicted burning that induce other, new cases of this suicide type, known in the literature as "Werther's syndrome". The importance of multidisciplinary approach in the treatment of burn patients is stressed with emphasis on the important role of liaison psychiatrist in treating these patients. It is necessary to educate media people to avoid sensational reporting on this kind of events. Continuous psychiatric treatment of vulnerable individuals could be useful in prevention of self-inflicted burns.

The amputees and quality of life.

The application of highly sophisticated computer technology and high technology materials allows production of quality prosthetic replacements both in the functional and esthetic sense. The basic prerequisite for successful use of prostheses is an adequately shaped stump, which can be achieved using new operative technique used for extremity amputation. In this way, the possibilities of prosthetic device usage are enlarged to fulfill not only basic daily needs but also highly active work-related, sports-related or recreational needs of the modern man. However, the adequate and successfully performed operative procedure and the implementation of a quality prosthetic device do not guarantee that all patient requirements for improved quality of life are fulfilled. The aim of this study was to examine therapeutic effects of the applied method of surgical and prosthetic treatment, with a special focus on the improvement of patient's quality of life. The research was conducted in a sample of healthy and active patients with trauma-related lower extremity amputation. Following a positive objective evaluation by the physician, who stated that surgical and prosthetic treatment was satisfactory, the subjective evaluation was performed by the patient using a specially designed questionnaire. The factors possibly influencing the overall satisfaction of the patient with therapy were analyzed. The satisfaction with prosthesis function was evaluated as very good by 63.5% of the patients, excellent by 9.6% and good by 26.9% of the patients.

Patients' satisfaction with prosthetic devices.

The purpose of the paper was to ascertain the factors which affect the satisfaction of patients with the prosthetic therapy. The purpose of the paper was also to ascertain if there are common factors characteristic for patients dissatisfied with the prosthetic therapy although the specialist appraises it as objectively successful. 52 patients of the Clinical Institute for Rehabilitation and Orthopedic Devices were participating in the research, to which, after unsuccessful surgical-prosthetic rehabilitation, reamputation and prosthetic provision was carried out, which was appraised successful by the doctor. It was endeavored to appraise to what extent the appraisal by the doctor corresponds to patient's satisfaction. On the basis of the questionnaire elaborated specifically for this research and the statistical processing, it was concluded that where the doctor appraised the prosthetic therapy as successful, the same opinion was shared by the majority of the patients (92.3%). Patients are similarly satisfied with the function and the esthetic quality of the prosthesis (73%). The reason why 7.7% of patients are dissatisfied in cases when the doctor considers that there are no objective reasons for that should be sought in non-medical factors. The age, the education, the marital status, the income state, the size of the residence and the regional affiliation do not have a significant influence on the satisfaction of patients with the prosthesis (p > 0.05). Patients with a minor handicap achieve satisfaction with the prosthetic therapy faster, as well as the right-handed persons if the prosthesis on the right-hand extremity is in question (p < 0.05). This investigation showed that the responsibility of not wearing prosthetic aids, both orthopedic, and dental prostheses, couldn't be only neuroticism by prosthetic patients, because that connection is not statistically significant (p < 0.09).