Heberprot P en lesión grave de la mano e injerto bipediculado al abdomen. Presentación de caso / Heberprot P in serious hand injury and bipedicular graft to the abdomen. Case report

RESUMEN Fundamento: El Heberprot P es una terapia que contribuye a la reparación de tejidos dañados. Su utilización en las lesiones ortopédicas de los miembros superiores es muy reciente y de escasa publicación. Objetivo: Describir la evolución de una paciente con lesión grave del dorso de la mano derecha en el que se utilizó el Heberprot P, seguido de injerto pediculado. Presentación de caso: Paciente que sufrió accidente con lesión grave en la mano derecha. Se realizó diagnóstico clínico e imagenológico con pérdida de piel, tejido celular subcutáneo y fractura del cuarto y quinto metacarpianos, se le aplicó procedimiento quirúrgico. Evolucionó de forma tórpida con infección profunda, pérdida de tendones extensores y exposición ósea, se decidió iniciar tratamiento con Heberprot P para incentivar tejido de granulación; 21 días después se logró cubrir las estructuras óseas, se operó los tendones y cobertura cutánea con injerto bipediculado al abdomen con evolución favorable. La paciente se reincorporó a su actividad social y laboral a los 10 meses. Conclusiones: El Heberprot P aceleró la cicatrización de tejidos, asociado a colgajos a distancia facilitó una evolución satisfactoria y evitó la amputación, disminuyó estadía hospitalaria, asimismo propició la reincorporación a la vida social y laboral.

ABSTRACT Background: Heberprot P is a therapy that contributes to the repairing of damaged tissues. Its use in orthopedic injuries of the upper limbs is very recent and of little publication. Objective: To describe the evolution of a patient with a serious injury to the back of the right hand in which the Heberprot P was used, followed by a pedicle graft. Case report: Patient who suffered an accident with a serious right hand injury. Clinical and imaging diagnosis was made with skin loss, subcutaneous cellular tissue and fracture of the fourth and fifth metacarpals, a surgical procedure was applied. It evolved torpidly with deep infection, loss of extensor tendons and bone exposure, it was decided to start treatment with Heberprot P to stimulate granulation tissue; 21 days later, the bone structures were covered, the tendons and skin coverage were operated with a bipedicular graft to the abdomen with a favorable evolution. The patient returned to her social and work activity at 10 months. Conclusions: Heberprot P accelerated tissue healing, associated with remote flaps, facilitated a satisfactory evolution and avoided amputation, decreased hospital stay, and also favored return to social and work life.

Absceso glúteo y malformación sacrocoxígea compleja / Gluteal abscess and complex sacrococcygeal malformation

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Evolución de heridas crónicas infectadas en un paciente con elefantiasis / Evolution of Infected Chronic Wounds in a Patient with Elephantiasis

Se presenta un caso clínico de un paciente con elefantiasis y úlceras sobreinfectadas en ambas extremidades inferiores, incluyendo una valoración enfermera, diagnósticos prioritarios, plan de cuidados, justificación del tratamiento elegido y la evolución posterior. La evidencia de infección de las úlceras planteó la necesidad de instaurar una terapia con cadexómero yodado para tratar localmente la infección, e hidrogel para evitar la formación de biopelículas. Transcurrido un mes del alta del paciente se realizó un seguimiento en el que se observó una evolución favorable con aumento de tejido de granulación y tejido epitelial en varias de las lesiones presentes, por lo que se valoró de forma favorable el procedimiento de cura en ambiente húmedo; la mejora en los hábitos higiénico-dietéticos se completó por parte del paciente

We present the clinical case of a patient with elephantiasis and superinfected ulcers in both lower limbs, including the Nursing assessment, primary diagnosis, plan of care, justification for the treatment selected, and subsequent evolution. The evidence of ulcer infection required to initiate therapy with cadexomer iodine in order to treat the infection locally, and hydrogel to prevent the formation of biofilms. Follow-up was conducted one month after the patient was discharged, and favourable evolution was observed, with an increase in granulation tissue and epithelial tissue in many of the lesions; therefore, the procedure of healing in a moist environment was assessed as favourable, and the improvement in hygienic-dietary habits was completed by the patient

Efectividad de la terapia de presión negativa en la cura de úlceras de pie diabético: revisión sistemática / Effectiveness of negative pressure therapy in diabetic foot ulcer: systematic review

Introducción: Las úlceras de pie diabético son una de las mayores causas de incapacidad en pacientes con Diabetes Mellitus (DM). La Terapia de Presión Negativa (TPN) se presenta como uno de los mejores procedimientos en su tratamiento, estimulando la granulación, drenando el exudado y reduciendo el edema. Objetivos: Realizar una revisión sistemática acerca de la efectividad y la aplicabilidad clínica real del uso de la TPN en las úlceras de pie diabético. Material y métodos: Búsqueda bibliográfica realizada en noviembre de 2016 en las bases de datos PubMed, CINAHL, SciELO y Web of Science, con las palabras clave («negative pressure wound therapy» OR «vacuum assisted closure» OR «vacuum sealing drainage») AND («diabetic foot» OR «diabetic wound» OR «diabetic ulcer»). Se seleccionaron las publicaciones cuyos diseños fueran ensayos clínicos aleatorizados (ECA), según los criterios de la declaración PRISMA, y analizaran el objetivo planteado. Resultados: Se encontraron 12 ECAs de calidad metodológica suficiente. 7 de los ECAs utilizaron como variable principal la superficie del lecho de la herida y 5 utilizaron el tiempo hasta la granulación. Conclusiones: La TPN consigue una mayor superficie de tejido de granulación, un menor tiempo de cicatrización y una diminución del tiempo hasta que comienza la granulación (AU)

Background: Diabetic foot ulcers are one of the major causes of disability in patients with Diabetes Mellitus (DM). The Negative Pressure Wound Therapy (NPWT) is one of the major procedures in his treatment, estimulating granulation, draining exudate and reducing edema.e Objectives: To realize a systematic review about the effectiveness and the real clinical application of NPWT use in diabetic foot ulcers. Methods: The literature search has been made in November 2016 in PubMed, CINAHL, SciELO and Web of Science databases, with the kew words («negative pressure wound therapy» OR «vacuum assisted closure» OR «vacuum sealing drainage») AND («diabetic foot» OR «diabetic wound» OR «diabetic ulcer»). Were selected publications whose designs were randomized clinical trials (RCTs), according PRISMA declaration criteria, and whose objective was to analyze the study objective. Results: Twelve RCTs were found with sufficient methodological quality. 7 of the RCTs used as the main variable the surface of the wound bed and 5 used the time to granulation. Conclusions: NPWT get a greater granulation area, a smaller wound healing time and a minor time to start the granulation (AU)

Terapia larval. Caso clínico en atención domiciliaria / Maggot therapy: case study in home care

Introducción. La terapia larval es un método de preparación del lecho de la herida de utilización ancestral. Su uso quedó relegado con la aparición de los antibióticos, hasta nuestros días, donde está resurgiendo como opción en el tratamiento de heridas crónicas. Metodología. Presentamos un caso clínico, donde una herida en pie diabético de seis meses de evolución tórpida y con varios cambios de tratamiento poco efectivos mejora en 3-4 días tras la utilización de terapia larval en el domicilio. El lecho de la herida queda preparado para el proceso de granulación. Resultados. Se puede apreciar cómo, tras cuatro días de tratamiento con la terapia larval, el lecho de la herida queda libre de esfacelos y disminuye también el exudado y el edema. Se consigue una herida en óptimas condiciones para la cicatrización. Se objetivó, aplicando la escala EVA, una clara disminución del dolor tras la terapia. Se demostró que la terapia larval puede utilizarse en atención domiciliaria o comunitaria sin inconvenientes. Conclusión. La terapia larval es un método de desbridamiento rápido, efectivo y seguro, que se puede aplicar en el domicilio del usuario (AU)

Introduction. Maggot therapy is a wound bed preparation method of ancestral use. Its use was relegated with the emergence of antibiotics, until today, where is reemerging as an option in the treatment of chronic wounds. Methodology. We report a case study where a six months wound in diabetic foot with torpid evolution and with several changes of ineffective treatment, improved in 3-4 days after the use of maggot therapy at home; leaving the wound bed prepared for the process of granulation. Results. As could see, after four days from the application of maggot therapy, the wound bed was free of slough, also decreasing exudation and edema. Leaving the optimal conditions for wound healing. It was assessed by the VAS scale decreased pain after dressing changes. It was demonstrated that maggot therapy can be used in home or community care without inconvenience. Conclusion. The maggot therapy is a method of debridement fast, effective and safe, this method can be used in home care (AU)

[Enhanced local gene transfection in rats with injured achilles tendons and granulation tissues using ultrasound and microbubble].

OBJECTIVE: To identify best local ukrasound transfection conditions in rats with injured achilles tendons and granulation tissues. METHODS: Rat models with bilateral injured achilles tendons were established. A mixture of microbubbles and enhanced green fluorescent protein (EGFP) plasmids were injected into the achilles tendons. The injured tendons were subject to ultrasound irradiation under different output intensity, duty cycle and irradiation time. The rats were divided into four groups: (1) plasmid+microbubbles- ultrasound (PL+MB+US); (2)plasmid + microbubble (PL+MB); (3)plasmid + ultrasound (PL+US); (4) plasmid only (PL). We identified the best ultrasound conditions based on the highest transfection efficiency in the achilles tendons and granulation tissues and the least normal tissue damage. RESULTS: Under the condition of 2 W/cm2 power output and 20% duty cycle of ultrasound irradiation for 10 min, EGFP expression was demonstrated in the achilles tendons and granulation tissues without showing significant damage to normal tissues. Higher levels of EGFP expression were found in the group of PL+ MB+ US than the other groups (no significant differences in EGFP expression were found among the other three groups). CONCLUSION: Under proper conditions, ultrasound and microbubble can enhance in vivo gene transfection efficiency in rats with injured achilles tendons and granulation tissues without causing obvious normal tissue damage, which could provide a sound basis for experimental study of gene therapy for injured tendons.

Deep vascular imaging in wounds by two-photon fluorescence microscopy.

Deep imaging within tissue (over 300 µm) at micrometer resolution has become possible with the advent of two-photon fluorescence microscopy (2PFM). The advantages of 2PFM have been used to interrogate endogenous and exogenous fluorophores in the skin. Herein, we employed the integrin (cell-adhesion proteins expressed by invading angiogenic blood vessels) targeting characteristics of a two-photon absorbing fluorescent probe to image new vasculature and fibroblasts up to ≈ 1600 µm within wound (neodermis)/granulation tissue in lesions made on the skin of mice. Reconstruction revealed three dimensional (3D) architecture of the vascular plexus forming at the regenerating wound tissue and the presence of a fibroblast bed surrounding the capillaries. Biologically crucial events, such as angiogenesis for wound healing, may be illustrated and analyzed in 3D on the whole organ level, providing novel tools for biomedical applications.

Histopathological prevalence of subchondral insufficiency fracture of the femoral head.

OBJECTIVE: Subchondral insufficiency fracture of the femoral head (SIF) is a recently recognised cause of acute onset arthritis mostly in older women, which previously had been commonly considered either as osteonecrosis or osteoarthritis. The purpose of this study is to report the histopathological incidence of SIF using surgically removed femoral heads. METHODS: We reviewed 7718 consecutive femoral heads from 7286 patients removed over a 4-year period (2001-2004). There were 4211 women and 3507 men. The age range was from 13 to 96, average age was 60. There were 7349 hips with a preoperative clinical diagnosis of osteoarthritis and 369 with a preoperative clinical diagnosis of osteonecrosis. RESULTS: SIF was diagnosed histologically as the primary process in 501 of 7718 resected femoral heads (6.5%). The age range in these patients was from 20 to 93, with an average age of 68, in which 79% (394 hips) were over 60. They were 305 hips in women and 196 in men. The affected side was the right one in 253 hips and left in 248. The prevalence of SIF in cases with a preoperative diagnosis of osteoarthritis was 6.3% (460 of 7349), and with osteonecrosis was 11.1% (41 of 369). In all cases, callus and granulation tissue were observed histologically along the fracture line. CONCLUSIONS: In this large series of total hip replacements SIF as the cause of disease was diagnosed histologically in 6.5% of the surgically removed femoral heads.

Lesiones vasculares en la infancia: experiencia institucional del hospital del niño "Dr. Ovidio Aliaga" La Paz Bolivia de 1999-2008 / Vascular lesions in childhood: institucional experiencie children`s hospital

Las lesiones vasculares son frecuentes en la infancia, se las ha clasificado en tumores y malformaciones vasculares. En nuestro estudio se revisaron 113 casos de pacientes con lesiones vasculares a lo largo de 10 años, encontrándose 52 hemangiomas, 52 linfangiomas, 8 hemolinfangiomas y 1 hemangioendotelioma. Los hemangiomas y linfangiomas se presentaron con más frecuencia en el sexo femenino. La localización más frecuente del hemangioma fue la cabeza, siendo el hermangioma capilar el tipo histológico más frecuente. El linfangiomase presentó en la región cervical, siendo el linfangioma quístico la variedad más frecuente...

Vascular lesions are frequent during infancy, they are classified in tumors and vascular malformations. A total of 113 cases of patients with vascular lesions were collected in a 10 year-period, we found 52 hemangiomas, 52 lymphangiomas, 8 hemolymphangiomas and 1 hemangioendothelioma. Hemangiomas and lymphangiomas were more frequent in females than in males. Most of the hemangiomas were located on the head, the capillary hemangioma was the most frequent. Lymphangiomas were located on the neck, the cystic lymphangioma being the most frequent. (AU)

[The reaction of regenerating connective tissue to acetylcholine in the dynamics of the denervation-reinnervation process]. / Reaktsiia reheneruiuchoï spoluchnoï tkanyny na atsetylkholin u dynamitsi denervatsiino-reinervatsiinoho protsesu.

The granulation tissue of wounds on upper surface of feet on the 7th day under repeated acetylcholine (Ach) application (0.02 g/1) was studied. In the control group, Ach-induced intensification of inflammatory process and bad condition of regenerating tissue of skin. This pathological reaction increased (fastly appeared ulceration) at once after crushing of right sciatic nerve in the denervated wound. It was less pathological in the contralateral (innervated) wounds. The effect of ACh was positive on later term of neurodystrophic process in the denervated wound and in the contralateral one. Cholinoceptive of granulation tissue of bilateral wound became normal after reinnervation.