Manejo de tejidos blandos en trauma de miembros inferiores: a propósito de un caso / Soft tissue management in lower limb trauma: about a case

Los miembros inferiores están sujetos frecuentemente a traumas que ocasionan daño de estructuras vitales y que pueden dejar secuelas funcionales y estéticas en las personas. Las lesiones de tejidos blandos son las que asientan en la piel, tejido celular subcutáneo, aponeurosis, músculos, vasos y nervios. Del manejo oportuno y adecuado de las lesiones que se presenten posteriores a un trauma de tejidos blandos dependerá el resultado, el tiempo de recuperación, costos de hospitalización y sobre todo la preservación de las funciones de locomoción y sostén del miembro afectado

The lower limbs are frequently exposed to traumas that cause vital structures damage and can leave functional and aesthetic sequelae in patients. Soft tissue lesions are those that affect the skin, subcutaneous cellular tissue, fascia, muscles, vessels, and nerves. The result, recovery time, hospitalization costs and, above all, the preservation of the locomotion and support functions of the affected limb will depend on the timely and adequate management of injuries that occur after a soft tissue trauma.

Application of chen yuangao in the treatment of soft tissue injury of football players / Aplicação de chen yuangao no tratamento da lesão dos tecidos moles de jogadores de futebol / Aplicación de chen yuangao para tratar lesiones de tejidos blandos en jugadores de fútbol

ABSTRACT The treatment of soft tissue injury in football players generally includes physical therapy, anti-inflammatory and analgesic drug treatment, surgical treatment and early rest immobilization. Western medicine treatment of soft tissue injury can quickly heal the wound and relieve pain in a short time. The treatment of traditional Chinese medicine is based on the whole and must seek the root of the disease. It is believed that the occurrence of certain diseases is related to Qi, blood, liver and kidney deficiency, so we should pay attention to the overall adjustment during treatment of symptoms. In view of this, this study analyzed the effect of Chen Yuan ointment, from traditional Chinese medicine, in the treatment of soft tissue injury. Sixty-eight football players who completed ankle ligament reconstruction were divided into four groups according to the type of operation and whether Chen Yuangao-assisted rehabilitation was used or not. The results showed that the Ankle Hindfoot Function Score and the visual analog scale (VAS) score of patients in the fibula brevis tendon reconstruction Chen Yuan ointment group were 98.3 and 0.3, respectively, at the last follow-up, which were better than those in other groups, and had lower pain scores. This result shows that Chen Yuangao has a certain effect in the treatment of soft tissue injury, which can provide a research idea for the rapid rehabilitation of football players.

RESUMO O tratamento de lesões dos tecidos moles em jogadores de futebol inclui geralmente terapia física, tratamento anti-inflamatório e analgésico, tratamento cirúrgico e imobilização de repouso precoce. O tratamento de lesões nos tecidos moles, utilizando a medicina ocidental, pode curar rapidamente as lesões e aliviar a dor em pouco tempo. A medicina tradicional chinesa se baseia no todo e deve procurar a raiz da doença. Acredita-se que a ocorrência de certas doenças está relacionada à deficiência de Qi, sangue, fígado e rim do corpo humano, por isso devemos prestar atenção ao ajuste global no tratamento dos sintomas. A partir desta perspectiva, este estudo analisou o efeito da tradicional pomada chinesa Chen Yuan no tratamento de lesões dos tecidos moles. No total, 68 jogadores de futebol que fizeram reconstrução dos ligamentos do tornozelo foram divididos em quatro grupos de acordo com o tipo de operação e se a pomada Chen Yuangao ajudou ou não na reabilitação. Os resultados mostraram que o escore da função do tornozelo retropé (Ankle Hindfoot Function Score) e o escore da Escala Analógica Visual (EVA) dos pacientes do grupo pomada Chenyuan para reconstrução do tendão fibular curto foram 98,3 e 0,3, respectivamente, no último seguimento, sendo melhores do que os de outros grupos e apresentando menores níveis de dor. Estes resultados mostra que a pomada Chen Yuangao exerce certo efeito no tratamento de lesões dos tecidos moles, pode constituir uma ideia de pesquisa para a rápida reabilitação dos jogadores de futebol.

RESUMEN El tratamiento de lesiones de los tejidos blandos en jugadores de fútbol incluye generalmente terapia física, tratamiento antinflamatorio y analgésico, tratamiento quirúrgico e inmovilización de reposo precoz. El tratamiento de lesiones en los tejidos blandos, utilizando la medicina occidental, puede curar rápidamente las lesiones y aliviar el dolor en poco tiempo. La medicina tradicional china se basa en el todo y debe procurar la raíz de la enfermedad. Se cree que la ocurrencia de ciertas enfermedades está relacionada a la deficiencia de Qi, sangre, hígado y riñón del cuerpo humano, por eso debemos prestar atención al ajuste global en el tratamiento de los síntomas. A partir de esta perspectiva, este estudio analizó el efecto de la tradicional pomada china Chen Yuan en el tratamiento de lesiones de los tejidos blandos. En total, 68 jugadores de fútbol que hicieron reconstrucción de los ligamentos del tobillo fueron divididos en cuatro grupos de acuerdo con el tipo de operación y si la pomada Chen Yuangao ayudó o no en la rehabilitación. Los resultados mostraron que el escore de la función del retropié del tobillo (Ankle Hindfoot Function Score) y el escore de la Escala Analógica Visual (EVA) de los pacientes del grupo pomada Chenyuan para reconstrucción del tendón fibular corto fueron 98,3 y 0,3, respectivamente, en el último segmento, siendo mejores que los de otros grupos y presentando menores niveles de dolor. Estos resultados muestran que la pomada Chen Yuangao ejerce cierto efecto en el tratamiento de lesiones de los tejidos blandos, puede constituir una idea de investigación para la rápida rehabilitación de los jugadores de fútbol.

Collagen membranes for skin wound repair: A systematic review.

Membranes or skin dressing are common treatments for skin wound injuries, collagen being one the most effective materials for their manufacturing. Many different sources of collagen with diverse methods of extraction and processing have been used, with evidence of positive effects on the stimulation of skin wound healing. In spite of these factors, there is still limited understanding of the interaction between collagen membranes and biological tissues, especially due to the series of different types of collagen origin. In this context, this study aimed to conduct a systematic review of the available literature examining the effect of various collagen membranes for accelerating skin wound healing in experimental animal models and clinical trials. The present review was performed from March to May of 2020 searching in two databases (PubMed and Scopus). The following Medical Subject Headings (MeSH) descriptors were used: "collagen", "dressing", "membranes", "skin" and "wound". After the eligibility assessment, 16 studies were included and analyzed. The studies demonstrated that collagen was obtained predominantly from bovine and porcine sources, by acetic acid and/or enzyme dissolution. Additionally, most of the studies demonstrated that the membranes were processed mainly by freeze-drying or lyophilization methods. All the in vivo and clinical trial studies evidenced positive outcomes in the wound healing process, thus confirming that collagen membranes are one of the most efficient treatment for skin wounds, highlighting the enormous potential of this biomaterial to be used for skin tissue engineering purposes.

Collagen I and III ratios and tenacity of rats muscle injured and treated with platelet-rich plasma / Relaciones de colágeno I y III y tenacidad del músculo de rata lesionado y tratado con plasma rico en plaquetas

SUMMARY: Severe muscle injuries are common in accidents and have a delayed recovery of muscle integrity. In these cases, muscle suture surgery is the standard treatment. However, Platelet Rich Plasma (PRP), has been widely used in orthopedic injuries due to its growth factors. Thus, the objective of the study will be to analyze the association of suture and PRP techniques in the collagen and tenacity of the injured muscle. Were used seventy rats, divided into five groups: control (C), injury control (CI), injury and suture (IS), injury and PRP (IP), injury, suture, and PRP (ISP). Were sectioned approximately 50 % of the width and 100 % of the thickness of the gastrocnemius muscle. The homologous PRP was applied 24h after the injury. On the 7th day after the injury, the animals were euthanized and their muscles subjected to mechanical testing to measure tenacity or collagen analysis to calculate the ratio between type I and III collagen. The results show a significant decrease (p <0.05) in the values of the relationship between collagens in all injured groups (CI, IS, IP, ISP) compared to group C. In injured groups, the tenacity was significantly (p <0.05) reduced compared to the control group, with no observed difference between treatments and injured groups. The amount of collagen in the injured area has increased, but it did not affect the tenacity of the muscles, which was reduced.

RESUMEN: Las lesiones musculares graves son comunes durante los accidentes y la integridad del músculo está sujeta a una larga recuperación. En esos casos la cirugía, para la sutura del músculo, es el tratamiento común, no obstante el plasma rico en plaquetas (PRP) ha sido utilizado recientemente en lesiones ortopédicas, debido a sus factores del crecimiento. El objetivo del estudio fue analizar la asociación de las técnicas de sutura y PRP en la histología y tenacidad de músculo lesionado. Fueron utilizadas 70 ratas distribuidas en cinco grupos: control (C), control lesión (CL), lesión y sutura (LS), lesión y PRP (LPRP), lesión, sutura y PRP (LSPRP). Aproximadamente en la lesión, el 50 % de la longitud y el 100 % del espesor del músculo gastrocnemio fueron seccionados. El PRP homólogo fue aplicado 24 horas después de la lesión. En el 7º día después de la lesión los animales fueron eutanasiados y las muestras fueran sometidas al ensayo mecánico para la medición de la tenacidad y análisis del colágeno, para realizar el cálculo de la relación entre los colágenos I y III. Los resultados demostraron una reducción significativa (p<0,05) en los valores de la relación entre los colágenos en todos los grupos lesionados en relación al grupo C. La tenacidad fue (p<0,05) reducida significativamente en los grupos lesionados en relación al grupo control, sin diferencia entre los tratados. En la lesión muscular hubo disminución de los valores de colágeno, aunque en los tratamientos se observó elevación de la cantidad de colágeno en la área lesionada, esta no tuvo efecto en la tenacidad de los músculos que fue disminuida en la lesión.

Efficacy of platelet-rich plasma for non-transfusion use: Overview of systematic reviews.

INTRODUCTION: Platelet-rich plasma (PRP) is a blood component therapy with a supraphysiological concentration of platelets derived from allogenic or, more commonly, autologous blood. PRP has been used in different non-transfusion indications because of its role in the promotion of tissue repair and healing, in fields such as Traumatology, Dermatology and Dentistry. OBJECTIVE: To provide a synthesis of the efficacy of PRP for different clinical situations. METHODS: Systematic searches were carried out in MEDLINE, Embase, Cochrane Library and LILACS in July 2018 to identify systematic reviews (SRs) of randomized clinical trials (RCTs) focusing on PRP for non-transfusion use. Two authors independently screened all retrieved references in two stages (titles and abstracts at a first stage and full texts at a second stage). The methodological quality of SRs that met the eligibility criteria was appraised by AMSTAR 2. Conclusions were based on the most recent SRs with highest quality. RESULTS: One thousand two hundred and forty references were retrieved. After checking the inclusion criteria, 29 SRs of RCTs related to three different fields (wound care, Orthopedics and Dentistry) were included. The results suggest the benefit of PRP for different clinical situations, such as diabetic wounds, acute lesions of musculoskeletal system, rotator cuff lesions, tendinopathies, knee and hip osteoarthritis, total knee arthroplasty, allogenic bone graft for dental implants and periodontal intrabony defects. CONCLUSION: There is low to moderate quality evidence supporting the efficacy of PRP for specific clinical situations. The low quality of the evidence limits the certainty of these findings. Well-planned and well-conducted RCTs are still needed to further assess the efficacy of PRP.

Is radial extracorporeal shock wave therapy combined with a specific rehabilitation program (rESWT + RP) more effective than sham-rESWT + RP for acute hamstring muscle complex injury type 3b in athletes? Study protocol for a prospective, randomized, double-blind, sham-controlled single centre trial.

BACKGROUND: Acute injuries of the hamstring muscle complex (HMC) type 3b (interfascicle/bundle-tear) are frequently observed in various sports disciplines both in elite and recreational sport. The treatment of choice of acute HMC injuries type 3b is a progressive physiotherapeutic exercise programme. Besides this, there is currently only insufficient scientific evidence to support other treatment methods, including local infiltrations and injections of platelet-rich-plasma. Very recently, it was demonstrated that extracorporeal shock wave therapy (ESWT) may accelerate regeneration after acute skeletal muscle injury. The aim of the present study is to test the hypothesis that the combination of radial ESWT (rESWT) and a specific rehabilitation program (RP) is effective and safe in treatment of acute HMC injury type 3b in athletes, and is statistically significantly more effective than the combination of sham-rESWT and RP. METHODS: We will perform a double blind, randomized, sham-controlled clinical trial at the clinic KinEf Kinesiología Deportiva, Ciudad Autónoma de Buenos Aires, Argentina. Forty patients with acute HMC injury type 3b will be randomly allocated to receive either rESWT (nine rESWT sessions; three sessions per week; 2500 radial extracorporeal shock waves (rESWs) per session; energy density depending on what the patient tolerates) or sham-rESWT. In addition, all patients will receive a specific rehabilitation program that will last for 8 weeks. The primary outcome measure will be the individual time (days) necessary to return to play. Secondary outcomes will include the presence or absence of reinjury during a time period of 6 months after inclusion into the study. DISCUSSION: Because of the lack of adequate treatment options for acute HMC injury type 3b in athletes and particularly the high reinjury rate, we hypothesize that the results of this trial will be of importance and have impact on clinical practice. TRIAL REGISTRATION: ClinicalTrials.gov ID NCT03473899 . Registered March 22, 2018.

Knee Dislocation and Multiple Ligament Injuries of the Knee.

The purpose of this paper is to present an overview of the progress in treatment of knee dislocations and posterior cruciate ligament (PCL)-based multiple ligament knee injuries over the past 25 years. The perspectives of where we were 25 years ago, where we are today, and where we will be in the future will be explored.

Úlceras por presión: cómo prevenirlas / Pressure ulcers: how to prevent them

Las úlceras por presión han constituido un problema para la salud en general a través del tiempo. La realidad es que son una preocupación para el cuidado de la salud y todos los profesionales son responsables de su prevención y tratamiento. Se requieren múltiples estrategias de intervención para evitar el daño de la piel; una de ellas, el manejo de las cargas sobre los tejidos blandos. La correcta elección de las superficies de apoyo, la adecuada redistribución de la presión especialmente en las prominencias óseas y un progresivo programa de movilización constituyen las bases para evitar la producción de las úlceras por presión. (AU)

Pressure ulcers (PU) have been as a health problem throughout time. The reality is that PU are a global health care concern and all the professionals need to be responsible for the prevention and treatment of them. Multiple intervention strategies are needed to avoid the skin breakdown. Managing loads on the skin and associated soft tissue is one of these strategies. Properly chosen support surfaces, adequate periodic pressure redistribution, protection of specially vulnerable bony prominences and a progressive program of joint mobilization are the basis to avoid PU production. (AU)

Lesiones radiopacas en tejido blando bucofacial. Comportamiento clínico-epidemiológico y manejo terapéutico en pacientes implantológicos / Radiopaque lesions in orofacial soft tissue. Clinical and epidemiological behavior and therapeutic management in indwelling patients

Introducción: Las radiopacidades en tejido blando bucofacial, aparecen habitualmente de manera incidental en radiografías panorámicas, exhibiendo una frecuencia relativamente baja. Objetivo: Identificar la frecuencia de lesiones radiopacas en tejido blando bucofacial en pacientes implantológicos, las implicaciones clínicas presentes y el manejo terapéutico implementado. Material y Métodos: Se realizó un estudio descriptivo, de corte transversal en una muestra constituida por 578 pacientes, evaluados en la consulta multidisciplinaria de implantología de la Facultad de Estomatología Raúl González Sánchez, quienes contaban con estudio radiográfico panorámico, en el período comprendido entre enero de 2014 y enero de 2016 con criterios de inclusión debidamente establecidos. Cada paciente se sometió a interrogatorio, examen clínico y al análisis exhaustivo de su radiografía panorámica. Se analizaron las variables edad, sexo, tipo de desorden de la radiopacidad, denominación, presencia de entidades patológicas previas, hallazgos clínicos al examen actual y modalidad terapéutica implementada. Resultados: Se encontraron lesiones radiopacas en 4,7 por ciento de la muestra; predominaron en el sexo masculino (3,1 por ciento); prevalecieron las calcificaciones idiopáticas (66,6 por ciento) y los sialolitos (55,5 por ciento). El 66,6 por ciento de los hallazgos fue asintomático. Un 33,4 por ciento requirió exéresis de la radiopacidad con el tejido asociado. Conclusiones: Las lesiones radiopacas de tejido blando bucofacial en pacientes implantológicos son poco frecuentes, predominan las calcificaciones idiopáticas particularmente los sialolitos, y la mayoría de las lesiones requiere manejo terapéutico(AU)

Introduction: The radiopacities in the orofacial soft tissue appears habitually as an incidental finding in panoramic x-rays, exhibiting a relatively low frequency. Objective: To identify the frequency of orofacial radiopaque lesions in soft tissue in indwelling patients, its clinical consequences and therapeutic management. Material and Methods: A descriptive transversal study was carried out in the Dentistry Faculty Raúl Gómez García, from January 2014 to January 2016. The sample was constituted by 578 patients evaluated by the multidisciplinary Implantology service, who had a panoramic study with properly established inclusion criteria. To each patient was performed an interrogatory, clinical exam and exhaustive analysis of his panoramic x-ray. The analyzed variables included: age, sex, denomination, presence of pathological previous entities, presence of clinical findings at the moment of examination, and therapeutic management. Results: The radiopaque lesions appeared in 4,7 percent of the sample analyzed, they prevailed in males (3,1 percent), the idiopathic calcifications reported a 66,6 percent and the sialoliths a 55,5 percent. A 66,6 percent of discoveries were asymptomatic. A 33,4 percent needed removal of radiopacities with associate tissue. Conclusions: The radiopaque lesions of orofacial soft tissue in indwelling patients are not very frequent, the idiopathic calcifications prevails, particularly the sialoliths, and most of the lesions require therapeutic handling(AU)

Guía clínica manejo del paciente gran quemado

Contribuir a disminuir la mortalidad y las secuelas de los pacientes grandes quemados y a mejorar su calidad de vida de manera de lograr el reintegro psicosocial.

Ultrasound biomicroscopy and claudication test for in vivo follow-up of muscle repair enhancement based on platelet-rich plasma therapy in a rat model of gastrocnemius laceration

PURPOSE:To track the regeneration process of lateral gastrocnemius due to a muscle laceration in rats, and to treatment with plateletrich plasma (PRP).METHODS:Ultrasound (40 MHz) images were used for measuring pennation angle (PA), muscle thickness (MT) and mean pixel intensity, along with claudication scores, of treated (PRPG) and non-treated (NTG) groups of rats.RESULTS:NTG showed a PA increase for the non-injured leg (p<0.05) and a tendency of MT to increase, whereas for PRPG there were no differences. There was a progressive reduction of the claudication score for the PRPG group throughout the entire period, with an immediate difference after seven days (p<0.05), whereas the NTG had a significant reduction only at day 28 (p<0.05).CONCLUSION:It was observed a compensatory hypertrophic response due to the overload condition imposed to healthy leg for NTG that did not occur in PRPG, suggesting an accelerated repair process of the injured leg due to treatment, anticipating its use.(AU)

Prevalence of soft tissue injuries in pediatric patients and its relationship with the quest for treatment.

BACKGROUND/AIM: Soft tissue injuries (STI) are common in children and adolescents. This retrospective study evaluated the frequency of STI, gender, type of injury, and its location in pediatric patients, comparing the different age groups and how the presence of these lesions influences the pursuit for immediate care. MATERIAL AND METHODS: Medical records of patients 0-15 years old who had been treated between 2005 and 2013 at the Dental Trauma Surveillance Center, School of Dentistry, Universidade Federal do Rio de Janeiro were included in this study. Records with incomplete data and those in which the patient took more than 2 weeks to seek attendance were excluded. The data collected included the age and gender of the patient, the frequency, type and location of the injury, and immediate treatment (<24 h). Data were analyzed descriptively and with the chi-square test (P ≤ 0.05). RESULTS: Of the 543 patients who met the eligibility criteria, 56.2% had STI, and males (65.6%), and the age group of 0-3 years (39.7%) were the most affected. The concomitant presence of lesions in the intra- and extra-oral region was the most frequent in all age groups. In the extra-oral region, contusion (20.7%) and abrasion (19.3%) were more common to the upper lip and laceration to the lower lip (18.4%). In the intra-oral region, the injury was more frequent to the gums (41%), while the lips were the most affected by abrasion (12.2%) and laceration (24.9%). Regardless of the age groups, the pursuit for immediate care was statistically influenced by the presence of soft tissue lesions (P < 0.05). CONCLUSION: We conclude that there is a high prevalence of STI in the study sample; the lesions were more common in boys and in patients aged 0-3 years. The presence of STI proved to be a determining factor for the pursuit for immediate care.

Treatment and mechanism of BMMSCs on deep II degree scald of hamster skin.

In this study, we examined the treatment and mechanism of BMMSC on a deep II degree scald of the hamster skin. A deep II degree scald model on the skin of 40 hamsters was duplicated and divided randomly into a stem cell plantation group (group A) and model control group (group B). Skin cells were cultured in vitro until the allogeneic BMMSCs of the 5th generation formed with a cell count of 1 x 10(7)/mL. Local injection plus liquid supernatant smearing was used to plant the cells into the position of the scald in the stem cell plantation group. The control group was given an equivalent amount of normal saline to observe the healing action, and 5 samples were taken in each group after 1, 3, 7, and 14 days for hematoxylin and eosin staining for physiological observation. Polymerase chain reaction was used to detect the amount of chymotrypsin in mast cells. The speed of healing in the stem cell transplantation group was greater than that in the control group; staining results showed that the quality of healing in the transplantation group was better than that in the control group. Chymotrypsin expression was detected in both groups, reaching a peak on day 3. BMMSCs can accelerate wound healing, and chymotrypsin in mast cells may participate in the wound healing process.

Uso da terapia por pressão subatmosférica em feridas traumáticas agudas / Subatmospheric pressure therapy in the treatment of traumatic soft tissue injuries

OBJETIVO: avaliar a experiência com o emprego de terapia por pressão subatmosférica no tratamento das lesões traumáticas agudas das partes moles, em especial nos membros. MÉTODOS: cento e setenta e oito pacientes com feridas traumáticas foram tratados pelo Centro de Feridas Complexas no período de janeiro de 2010 a dezembro de 2011 e, submetidos à terapia por pressão subatmosférica. RESULTADOS: dos 178 pacientes submetidos à terapia por pressão subatmosférica, 129 (72,5%) eram do sexo masculino e 49 (27,5%) apresentavam idade entre 18 e 40 anos. Os ferimentos descolantes nos membros foram o tipo de ferida traumática mais comum, sendo responsáveis pela internação de 83 (46,6%) pacientes. O tempo médio de internação hospitalar foi 17,5 dias. Foram realizados 509 procedimentos cirúrgicos (média de 2,9 por paciente). A terapia por pressão subatmosférica foi utilizada em 287 procedimentos, sendo 209 (72,8%) sobre feridas traumáticas e 78 (27,2%) sobre enxertos de pele. O número de trocas de terapia por pressão negativa por paciente foi 1,6 e o tempo médio de utilização foi 8,5 dias por paciente. CONCLUSÃO: os resultados foram considerados satisfatórios, diminuindo consideravelmente a morbidade e o tempo de cicatrização dessas lesões em comparação com tratamentos anteriormente executados como curativos. A terapia por pressão subatmosférica é um método útil no tratamento de feridas agudas traumáticas, atuando como ponte entre o tratamento de urgência e a cobertura cutânea definitiva destas lesões, em comparação com métodos mais tradicionais da cirurgia plástica.

OBJECTIVE: To evaluate the use of subatmospheric pressure therapy in the treatment of acute traumatic injuries of the soft tissues, especially in the limbs. METHODS: One hundred and seventy-eight patients with traumatic wounds were treated by the Center for Complex Wounds in the period from January 2010 to December 2011, and submitted to subatmospheric pressure therapy (SPT). RESULTS: Of the 178 patients who underwent SPT, 129 (72.5%) were male and 49 (27.5%) were aged between 18 and 40 years. Degloving injuries to the limbs were the most common type of traumatic wounds, being responsible for the hospitalization of 83 (46.6%) patients. Mean hospital stay was 17.5 days. A total of 509 procedures were performed (average 2.9 per patient). SPT was used in 287procedures, 209 (72.8%) on traumatic wounds and 78 (27.2%) of skin grafts. The number of exchanges of the SPT apparel per patient was 1.6 and the mean time of use, 8.5 days. CONCLUSION: SPT significantly reduced morbidity and healing time of injuries when compared with previously performed dressing treatments. The subatmospheric pressure therapy is a useful method in treating acute traumatic wounds, acting as a bridge between the emergency treatment and the final coverage of the skin lesions, being better when compared with more traditional methods of plastic surgery.

[Our experience with orthopedic damage control in high-energy tibial pylon fractures]. / Nuestra experiencia en la aplicación del control de daños ortopédico en fracturas de pilón tibial por alta energía.

High-energy tibial pylon fractures represent some of the most severe injuries of the ankle joint and currently represent a challenge for the orthopedic surgeon. These are usually polytraumatized patients and before admitting them into the traumatology unit, spinal cord, pelvic or thoracoabdominal injuries should be ruled out. Due to the special anatomy of the area, its thin skin cover and subcutaneous location, soft tissues are usually severely affected and this is key when choosing the time for a surgical intervention. Although the definitive treatment of these injuries is controversial, the so called two-stage treatment seems to predominate in order to minimize soft tissue iatrogenic injuries applying the concept of orthopedic damage control of the limb. We present the preliminary results of 10 patients operated with this method at our center.

Subatmospheric pressure therapy in the treatment of traumatic soft tissue injuries.

OBJECTIVE: To evaluate the use of subatmospheric pressure therapy in the treatment of acute traumatic injuries of the soft tissues, especially in the limbs. METHODS: One hundred and seventy-eight patients with traumatic wounds were treated by the Center for Complex Wounds in the period from January 2010 to December 2011, and submitted to subatmospheric pressure therapy (SPT). RESULTS: Of the 178 patients who underwent SPT, 129 (72.5%) were male and 49 (27.5%) were aged between 18 and 40 years. Degloving injuries to the limbs were the most common type of traumatic wounds, being responsible for the hospitalization of 83 (46.6%) patients. Mean hospital stay was 17.5 days. A total of 509 procedures were performed (average 2.9 per patient). SPT was used in 287 procedures, 209 (72.8%) on traumatic wounds and 78 (27.2%) of skin grafts. The number of exchanges of the SPT apparel per patient was 1.6 and the mean time of use, 8.5 days. CONCLUSION: SPT significantly reduced morbidity and healing time of injuries when compared with previously performed dressing treatments. The subatmospheric pressure therapy is a useful method in treating acute traumatic wounds, acting as a bridge between the emergency treatment and the final coverage of the skin lesions, being better when compared with more traditional methods of plastic surgery.