[Modern wound dressings]. / Suvremena pokrivala za rane.

Chronic wounds are, due to the slow healing, a major clinical problem. In addition to classic materials, a great number of supportive wound dressings for chronic wound treatment, developed on the basis of new knowledge about the pathophysiological events in non-healing wounds, are available on the market. Today we know that modern wound dressings provide the best local environment for optimal healing (moisture, warmth, appropriate pH). Wound dressings control the amount of exudate from the wound and bacterial load, thus protecting local skin from the wound exudate and the wound from secondary infections from the environment. Using supportive wound dressings makes sense only when the wound has been properly assessed, the etiologic factors have been clarified and the obstacles making the wound chronic identified. The choice of dressing is correlated with the characteristics of the wound, the knowledge and experience of the medical staff, and the patient's needs. We believe that the main advantage of modern wound dressing versus conventional dressing is more effective wound cleaning, simple dressing application, painless bandaging owing to reduced adhesion to the wound, and increased absorption of the wound exudate. Faster wound granulation shortens the length of patient hospitalization, and eventually facilitates the work of medical staff. The overall cost of treatment is a minor issue due to faster wound healing despite the fact that modern supportive wound dressings are more expensive than conventional bandaging. The article describes different types of modern supportive wound dressings, as well as their characteristics and indications for use.

[Role of negative pressure therapy in the treatment of chronic wounds]. / Uloga terapije negativnim tlakom u tretmanu kronicnih rana.

Negative Pressure Wound Therapy (NPWT) is one of the supportive options for chronic wound treatment. The level of negative pressure is between 40 and 125 mm Hg below ambient. Good results in increasing angiogenesis, improvement of blood flow in wounds, edema reduction, regulation of moist environment, granulation tissue stimulation and wound retraction have been proved. In addition, bacterial burden in the wound and the amount of harmful products (exotoxins, endotoxins, cytokines and matrix metalloproteinases) are also significantly reduced. Chronic wound healing time is accelerated in comparison with other conservative treatments. The NPWT can be applied in either inpatient or outpatient settings.

[Application of modern wound dressings in the treatment of chronic wounds]. / Primjena suvremenih obloga u lijecenju kronicnih rana.

Chronic and acute infected wounds can pose a major clinical problem because of associated complications and slow healing. In addition to classic preparations for wound treatment, an array of modern dressings for chronic wound care are currently available on the market. These dressings are intended for the wounds due to intralesional physiological, pathophysiological and pathological causes and which failed to heal as expected upon the use of standard procedures. Classic materials such as gauze and bandage are now considered obsolete and of just historical relevance because modern materials employed in wound treatment, such as moisture, warmth and appropriate pH are known to ensure optimal conditions for wound healing. Modern wound dressings absorb wound discharge, reduce bacterial contamination, while protecting wound surrounding from secondary infection and preventing transfer of infection from the surrounding area onto the wound surface. The use of modern wound dressings is only justified when the cause of wound development has been established or chronic wound due to the underlying disease has been diagnosed. Wound dressing is chosen according to wound characteristics and by experience. We believe that the main advantages of modern wound dressings versus classic materials include more efficient wound cleaning, simpler placement of the dressing, reduced pain to touch, decreased sticking to the wound surface, and increased capacity of absorbing wound exudate. Modern wound dressings accelerate the formation of granulation tissue, reduce the length of possible hospital stay and facilitate personnel work. Thus, the overall cost of treatment is reduced, although the price of modern wound dressings is higher than that of classic materials. All types of modern wound dressings, their characteristics and indications for use are described.

[Role of debridement in treatment of chronic wounds]. / Uloga debridmana u lijecenju kronicnih rana.

Debridement is the process of removing dead tissue from the wound bed. Since devitalized tissue can obstruct or completely stop healing of the wound, it is indicated to debride wound bed as part of the treatment process. The aim of debridement is to transform a chronic wound into an acute wound and to initiate the process of healing. Debridement is the foundation of each wound treatment and it has to be repeated, depending on the necrotic tissue formation. There are several types of debridement: surgical, autolytic, chemical, enzymatic, mechanical, and biological. Using previous knowledge and advances in technology, new types of debridement have been introduced. Besides standard methods, methods of pulsed lavage debridement (hydro-surgery, water-jet) and ultrasound-assisted wound treatment (UAW) are ever more widely introduced. The method of debridement the clinician will choose depends on the amount of necrotic (devitalized) tissue in the wound bed, the size and depth of the wound, the underlying disease, the possible comorbidity, as well as on the general condition of the patient. Frequently, the methods of debridement are combined in order to achieve better removal of devitalized tissue. Debridement in addition significantly reduces bacterial burden. Regardless of the method of debridement, it is essential to take pain to the lowest point.

[Calciphylaxis]. / Kalcifilaksija.

Calciphylaxis is a form of extra-skeletal calcification characterized by calcium deposits in arterial tunica media and vascular thrombosis, which leads to tissue ischemia including skin ischemia with consequential skin necrosis. Necroses may also develop in the subcutaneous adipose tissue and skeletal muscle. The cause of this disorder remains unknown. It was first described by Bryant and White as early as 1989 in association with uremia, and the syndrome remained clinically inadequately recognizable until 1976. Then, Gipstein and coworkers described the disorder in more detail, followed by a great number of calciphylaxis case reports since then, including data on morbidity and therapeutic dilemmas. Calciphylaxis has been reported in association with hepatic insufficiency, obesity, and diabetes mellitus. The authors present the clinical procedure of identifying and treating major ulcerations on both lower legs in a patient with polymorbidity and recognized calciphylaxis, which caused skin necroses with consequential chronic leg ulcers.