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1.
Zhonghua Shao Shang Za Zhi ; 36(2): 133-136, 2020 Feb 20.
Artigo em Chinês | MEDLINE | ID: mdl-32114732

RESUMO

In February 2018, a 67-year-old male patient with infected abdominal aortic aneurysm was admitted to the Department of Vascular Surgery of Yantai Yuhuangding Hospital Affiliated to Qingdao University Medical College. After admission, abdominal aortic endovascular exclusion surgery, right iliac artery-double femoral artery vascular bypass+ infected abdominal aortic aneurysmectomy+ stent removal surgery, and active anti-infective treatment were performed in the department of vascular surgery. Seven days after the vascular prosthesis bypass surgery, the surface skin of the vascular prosthesis of the patient was red and swollen, and there was a purulent discharge, which was diagnosed as poor healing of sinus of vascular prosthesis. Surgeons of our department and the department of vascular surgery performed incision and debridement of sinus of vascular prosthesis+ vacuum sealing drainage (VSD) in the early stage under local anesthesia. After the local infection was controlled and wound blood supply was improved, stage Ⅱ surgery of resection of sinus of vascular prosthesis+ vascular prosthesis partial diversion+ local flap propulsion under general anesthesia was performed. The incision healed well after surgery, and the patient was discharged smoothly. During the follow-up of 6 months, the patient's flap was in good shape, and the wound was healed. This case prompts that after the diagnosis of infected abdominal aortic aneurysm vascular sinus poor healing, we can actively open the infected sinus, use VSD technology to treat granulation wounds, then divert the implanted vascular prosthesis to prepare fresh local flap which covers the vascular prosthesis, and use new silver ion dressing to cover the wounds, thus achieving satisfactory results.


Assuntos
Aneurisma da Aorta Abdominal , Tratamento de Ferimentos com Pressão Negativa , Idoso , Aneurisma da Aorta Abdominal/terapia , Prótese Vascular , Desbridamento , Humanos , Masculino , Retalhos Cirúrgicos , Resultado do Tratamento
2.
Zhongguo Gu Shang ; 33(2): 149-53, 2020 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-32133815

RESUMO

OBJECTIVE: To evaluate the clinical effects of debridement and bone grafting with internal fixation via anterior approach in treatment of tuberculosis of lower cervical vertebrae. METHODS: The clinical data of 15 patients with tuberculosis of lower cervical vertebrae who accepted the treatment of one-stage debridement and bone grafting with internal fixation from June 2010 to December 2018 were retrospectively analyzed. There were 9 males and 6 females, aged from 39 to 72 years with an average of (54.67±10.75) years. The lesion segment was C4 to C6. Pre- and post-operative neurologic functions were evaluated by ASIA grade. All the patients underwent the X-ray films of positive and lateral of cervical spine before and after the operation and accepted the periodic review of CT to evaluate the bone grafting. RESULTS: All the 15 operations were successful, no neurological or vascular injury occurred during the operation, and all patients were followed up for 18 to 52 months. The clinical symptoms improved significantly during the follow-up period and CT showed good bone grafting fusion. One patient suffered a relapse of the illness 3 years later, but was healed during the follow-up visit by strengthening the anti tuberculosis therapy. CONCLUSION: For the patients with vertebral destruction and loss of cervical stability, one-stage debridement and bone grafting with internal fixation via anterior approach has definite curative effects. On the basis of standard anti tuberculosis treatment before operation, the long-term standard anti-tuberculosis treatment after operation is the key to healing the tuberculosis of lower cervical vertebrae.


Assuntos
Fusão Vertebral , Tuberculose da Coluna Vertebral , Adulto , Idoso , Transplante Ósseo , Vértebras Cervicais , Desbridamento , Feminino , Fixação Interna de Fraturas , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Vértebras Torácicas , Resultado do Tratamento
3.
Zhongguo Gu Shang ; 33(2): 166-72, 2020 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-32133818

RESUMO

OBJECTIVE: To investigate the clinical effect of One-stage posterior debridement combined with lumbar-ilium fixation and bone graft fusion for the treatment of lumbosacral tuberculosis. METHODS: The clinical data of 31 patients with lumbosacral tuberculosis treated by one-stage posterior debridement combined with lumbar-ilium fixation and bone graft fusion from January 2013 to February 2018 were retrospectively analyzed. There were 18 males and 13 females, aged from 18 to 77 years old with an average of (45.9±9.1) years. The lesion segment was form L4 to S2. The preoperative ASIA grading showed that 2 cases were grade B, 17 cases were grade C, 12 were grade D. Pre- and post-operative C reactive protein (CRP), visual analogue scale (VAS), erythrocyte sedimentation rate (ESR), ASIA grade, lumbosacral angle and intervertebral space height were analyzed, the surgery complications, stability of internal fixation, bone fusion were observed. RESULTS: All the 31 patients were followed up for 10 to 24 months with an average of (16.0±3.1) months. One patient with local infection and subcutaneous hydrops was cured by dressing change. Other 30 cases got primary healing without sinus formation and no recurrence of spinal tuberculosis. All the patients were cured, no internal fixation loosening and breakage were found. All bone fusion was successful with an average fusion time of (4.7±1.1) months. At the final follow-up, ESR and CRP were normal, the VAS was decreased from (6.13±1.21) points preoperatively to (1.92±0.57) pioints, the ASIA grading showed that 2 cases were grade C, 6 cases were grade D, and 23 cases were grade E. The lumbosacral angle and intervertebral space height was increased from preoperative (21.42±3.75) °, (7.84±0.41) mm to (27.21±3.12) °, (9.80±0.38) mm at the final follow-up, respectively. CONCLUSION: One-stage posterior debridement combined with lumbar-ilium fixation and bone graft fusion is a practicable, effective and safe method for the treatment of lumbosacral tuberculosis. It can be recommended in clinical application.


Assuntos
Fusão Vertebral , Tuberculose da Coluna Vertebral , Adolescente , Adulto , Idoso , Transplante Ósseo , Desbridamento , Feminino , Fixação Interna de Fraturas , Humanos , Ílio , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Vértebras Torácicas , Resultado do Tratamento , Adulto Jovem
4.
Orthop Clin North Am ; 51(2): 141-146, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32138852

RESUMO

Prosthetic joint infection is still a rare but devastating complication following total hip and knee arthroplasty. The incidence of prosthetic joint infection ranges from 2% to 4% in primary procedures as opposed to nearly 20% in revisions. The challenges that arise here include mainly diagnostic uncertainty, management in immunocompromised patients, recurrent infection, infection around a well-fixed implant, and substantial bone loss, and require careful preoperative assessment and well-defined management plans. This article summarizes recent developments in the diagnosis and management of this increasingly prevalent issue specifically focusing on outcomes following debridement, antibiotics, and implants retention and one-stage revision procedures.


Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/terapia , Antibacterianos/uso terapêutico , Biomarcadores/análise , Desbridamento , Remoção de Dispositivo , Humanos , Prótese Articular/efeitos adversos , Prótese Articular/microbiologia , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/microbiologia , Reino Unido
6.
Medicine (Baltimore) ; 99(11): e18804, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176026

RESUMO

INTRODUCTION: Isolated metacarpal tuberculosis is rare in orthopedic surgery. In the case of poor efficacy of traditional treatment methods, such as debridement surgery and anti-tuberculosis treatment, it is necessary to consider whether there is a special type of infection. We describe a case of metacarpal tuberculosis with Nocardia infection in a patient. PATIENT CONCERNS: A 65-year-old male patient who suffered from pain and dysfunction lasted for 6 years. DIAGNOSES: Confirmation of the diagnosis was finally achieved by isolation of M tuberculosis and Nocardia actinomycetes from bone specimens. INTERVENTIONS: The patient underwent debridement surgery, Masquelet technique was used during the operation, and oral antibiotics were combined after surgery. OUTCOMES: Bone graft surgery was performed 6 weeks after the first surgery. We followed up on bone healing at 1 and 3 months postoperatively. CONCLUSION: Tissue-specific necrosis usually occurs in particular types of infections such as tuberculosis, which limits the spread of antibiotics. Masquelet technique seems to bring new options to solve this problem. The performance of Nocardia infection is similar to that of tuberculosis infection, so it is difficult to identify clinically. Therefore, for cases where tuberculosis is suspected, and anti-tuberculosis treatment is ineffective, the possibility of Nocardia infection needs to be considered.


Assuntos
Coinfecção/microbiologia , Metacarpo , Nocardiose/complicações , Tuberculose Osteoarticular/complicações , Idoso , Antibacterianos/uso terapêutico , Antituberculosos/uso terapêutico , Coinfecção/cirurgia , Desbridamento , Humanos , Masculino , Metacarpo/microbiologia , Metacarpo/cirurgia , Nocardiose/microbiologia , Nocardiose/cirurgia , Tuberculose Osteoarticular/microbiologia , Tuberculose Osteoarticular/cirurgia
7.
Zhonghua Shao Shang Za Zhi ; 36(1): 70-76, 2020 Jan 20.
Artigo em Chinês | MEDLINE | ID: mdl-32023723

RESUMO

Fournier gangrene is a relatively rare clinical critical disease, and its clinical symptoms are not specific and easily unrecognized by some clinicians. It has the features of acute onset, quick development, severe illness, and often accompanied by infection shock which is seriously life-threatening. It is difficult in treatment with high medical costs and long length of hospitalization, which increases pain for patients and relatives and brings heavy economic and psychological burden on patients, society, and medical workers. By reviewing the literature home and abroad and combined with clinical practice, I summarize the researches on concept, epidemiology, clinical manifestation, diagnosis and treatment of Fournier gangrene, in order to provide reference for vast number of clinical workers.


Assuntos
Gangrena de Fournier , Desbridamento , Humanos
9.
Medicine (Baltimore) ; 99(3): e18762, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011463

RESUMO

RATIONALE: The challenges with reconstruction of penile defects are plenty. In addition, no single and universally accepted reconstructive method exists for penile defect repair. Herein, we present the application of a circumferential penile shaft defect reconstruction using pull-up double-opposing keystone-designed perforator island flaps (KDPIFs) in one patient. This is the first case report of a circumferential penile shaft defect reconstruction using KDPIFs. PATIENT CONCERNS: A 43-year-old man who injected petroleum jelly into his penis 10 years ago presented with multiple firm nodular mass-like lesions adherent to the overlying skin along the penile shaft. Our urologic surgeon removed the foreign bodies and performed a primary closure with undermining. However, wound dehiscence developed, and skin necrosis was exacerbated 5 days postoperatively. DIAGNOSES: We performed debridement, and the final post-debridement defect was circumferential (5.5 × 12 cm) from the base of the glans to the midpoint of the penile shaft. INTERVENTIONS: We covered the defect using pull-up double-opposing KDPIFs (10 × 13 cm each) based on the hot spots of the superficial external pudendal artery perforators on each side from the suprapubic area to the scrotum. OUTCOMES: The flaps survived perfectly, with no postoperative complications. The patient was satisfied with the final outcome and had no erectile dysfunction or shortening of penile length after a 6-month follow-up. LESSONS: We successfully reconstructed a circumferential penile defect with pull-up double-opposing KDPIFs both esthetically and functionally. Our technique can be a good alternative modality for extensive penile defect reconstruction.


Assuntos
Corpos Estranhos/cirurgia , Doenças do Pênis/induzido quimicamente , Doenças do Pênis/cirurgia , Vaselina/administração & dosagem , Vaselina/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos , Retalhos Cirúrgicos , Adulto , Desbridamento , Humanos , Injeções , Masculino
10.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(1): 64-70, 2020 Feb 18.
Artigo em Chinês | MEDLINE | ID: mdl-32071465

RESUMO

OBJECTIVE: To compare the clinical effects of ultrasonic subgingival debridement and ultrasonic subgingival debridement combined with manual root planing on severe periodontitis and then to investigate the necessity and significance of manual root planing. METHODS: Twenty-three patients with severe periodontitis participated in this split-mouth randomized-controlled clinical trial. Baseline examination and randomization were performed after supragingival scaling: each of the upper and lower jaws had a quadrant as the test group treated with ultrasonic subgingival debridement combined with manual root planing, whereas the other two quadrants were the control group treated with ultrasonic subgingival debridement. Treatment of each patient was at intervals of one week and completed in two visits. Clinical indicators concerning probing depth (PD), clinical attachment loss (CAL) and bleeding index (BI) were recorded at baseline and 1 month, 3 months, 6 months after treatment. RESULTS: There was no significant difference of periodontal indicators between the test group and the control group at baseline. Both the test group and control group resulted in significant improvement of PD, CAL and BI. One and three months after treatment, reduction of PD in the test group was higher than that in the control group [1 month: (2.13±1.31) mm vs. (1.79±1.33) mm, P<0.01; 3 months: (2.46±1.33) mm vs. (2.17±1.38) mm, P<0.01] and reduction of CAL in the test group was higher than that in the control group [1 month: (1.89±2.03) mm vs. (1.65±1.93) mm, P<0.01; 3 months: (2.03±2.05) mm vs. (1.83±1.97) mm, P<0.05]. Six months after treatment, PD in the test group and the control group decreased by (2.52±1.40) mm and (2.35±1.37) mm respectively, and the improvement in the test group was significantly better than that in the control group (P<0.01). CAL in the test group and the control group decreased by (1.89±2.14) mm and (1.77±2.00) mm respectively, and there was no statistical difference between the groups. There was no significant difference in the changes of BI between the two groups 1, 3 and 6 months after treatment. CONCLUSION: Ultrasonic subgingival debridement combined with manual root planing has more reduction in PD and CAL compared with ultrasonic subgingival debridement. Therefore, it is still necessary to use manual instruments for root planing following ultrasonic subgingival debridement.


Assuntos
Periodontite , Ultrassom , Desbridamento , Raspagem Dentária , Humanos , Aplainamento Radicular , Resultado do Tratamento
11.
BMC Infect Dis ; 20(1): 13, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31906888

RESUMO

BACKGROUND: The development of respiratory infections secondary to Aspergillus spp. spores found ubiquitously in the ambient environment is uncommon in immunocompetent patients. Previous reports of invasive upper airway aspergillosis in immunocompetent patients have generally demonstrated the efficacy of treatment regimens utilizing antifungal agents in combination with periodic endoscopic debridement, with symptoms typically resolving within months of initiating therapy. CASE PRESENTATION: A 43-year-old previously healthy female presented with worsening respiratory symptoms after failing to respond to long-term antibiotic treatment of bacterial sinusitis. Biopsy of her nasopharynx and trachea revealed extensive fungal infiltration and Aspergillus fumigatus was isolated on tissue culture. Several months of oral voriconazole monotherapy failed to resolve her symptoms and she underwent mechanical debridement for symptom control. Following transient improvement, her symptoms subsequently returned and failed to fully resolve in spite of increased voriconazole dosing and multiple additional tissue debridements over the course of many years. CONCLUSIONS: Invasive upper airway aspergillosis is exceedingly uncommon in immunocompetent patients. In the rare instances that such infections do occur, combinatorial voriconazole and endoscopic debridement is typically an efficacious treatment approach. However, some patients may continue to experience refractory symptoms. In such cases, continued aggressive treatment may potentially slow disease progression even if complete disease resolution cannot be achieved.


Assuntos
Antifúngicos/uso terapêutico , Desbridamento , Aspergilose Pulmonar Invasiva/terapia , Adulto , Antifúngicos/farmacologia , Aspergillus fumigatus/efeitos dos fármacos , Aspergillus fumigatus/isolamento & purificação , Terapia Combinada , Farmacorresistência Fúngica , Endoscopia , Feminino , Humanos , Aspergilose Pulmonar Invasiva/microbiologia , Nasofaringe/microbiologia , Nasofaringe/patologia , Nasofaringe/cirurgia , Traqueia/microbiologia , Traqueia/patologia , Traqueia/cirurgia , Resultado do Tratamento , Voriconazol/farmacologia , Voriconazol/uso terapêutico
12.
FP Essent ; 489: 21-26, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31995351

RESUMO

Diabetes is associated with many complications, including foot ulcers. Individuals with diabetes have a 15% to 25% likelihood of developing a foot ulcer in their lifetime. The pathophysiologic mechanisms are multifactorial but the major etiologic factors are peripheral vascular disease and diabetic neuropathy. Foot examinations are recommended at least annually for patients with diabetes to assess the risk of foot ulcers and to detect, diagnose, and manage them. Management includes avoidance of walking, weight-bearing limitation, use of therapeutic footwear, use of dressings and debridement, and antibiotics. Due to immune dysfunction, diabetic neuropathy, and poor circulation, patients with diabetes are at increased risk of other types of infections. These include erythrasma, candidiasis, paronychia, onychomycosis, necrotizing fasciitis, Fournier gangrene, otitis externa, and nontuberculous mycobacterial skin infections. A high index of suspicion is required to diagnose these conditions. Patient evaluation may include a detailed physical examination, imaging, laboratory tests, and biopsies and cultures. Management may involve mechanical or surgical debridement, topical and oral antibiotics, and abscess drainage.


Assuntos
Queimaduras , Complicações do Diabetes , Dermatopatias Infecciosas , Queimaduras/complicações , Desbridamento , Humanos , Pacientes Ambulatoriais , Dermatopatias Infecciosas/diagnóstico , Dermatopatias Infecciosas/tratamento farmacológico , Dermatopatias Infecciosas/etiologia
13.
Medicine (Baltimore) ; 99(4): e18891, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977899

RESUMO

The aim of this study was to determine whether the infection control rate of a modified debridement, antibiotics, and implant retention (DAIR) protocol (DAIR with antibiotic-impregnated cement beads) is comparable to that of 2-stage revision for acute periprosthetic joint infection (PJI) after total knee arthroplasty (TKA). We also aimed to determine whether this modified DAIR technique produced better clinical results than those obtained using 2-stage revision in terms of functional outcome, range of motion (ROM), and patient satisfaction at 2 years after surgery.This retrospective comparative study included patients who underwent modified DAIR (7 patients, 9 knees) or 2-stage revision (8 patients, 9 knees) for acute PJI of the knee joint. Infection control rate, functional outcome measured using Western Ontario and McMaster Universities Arthritis Index (WOMAC) score, ROM and patient satisfaction were compared between the two groups.There was no difference in infection control rates between the modified DAIR and 2-stage revision groups (78% vs 78%, respectively). In contrast, surgical outcome in the modified DAIR group was tended to be better than 2-stage revision group, but it did not reach statistical significance. Median maximal range of flexion was 103° in the modified DAIR group and it was 90° in the 2-stage group (P = .191). In addition, the median WOMAC function score was 24 in the modified DAIR group and it was 30 in the 2-stage group (P = .076). Median patient satisfaction measured using visual analogue scale was 8 in the modified DAIR group and 5 in the 2-stage group (P = .069).The infection control rates of the modified DAIR protocol and 2-stage revision protocol were similar for the treatment of acute PJI of the knee joint. However, the modified DAIR protocol could not provide substantially increased functional outcomes and patient satisfaction compared to 2-stage revision. Therefore, the modified DAIR technique should be considered to be of limited use in patients with high surgical morbidity.


Assuntos
Antibacterianos/administração & dosagem , Artroplastia do Joelho/efeitos adversos , Cimentos para Ossos/uso terapêutico , Desbridamento/métodos , Infecções Relacionadas à Prótese , Vancomicina/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Articulação do Joelho , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/cirurgia , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
14.
Vasc Endovascular Surg ; 54(2): 172-174, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31714184

RESUMO

Axillary artery blowout is a rare life- and limb-threatening condition. The traditional surgical approach of ligation and extra-anatomic bypass is associated with a high morbidity and mortality. We present a case report of a 65-year-old male with axillary artery hemorrhage secondary to an irradiated squamous cell cancer. We propose a staged hybrid approach for the treatment of this unusual clinical entity consisting of emergent stent grafting followed by planned elective extra-anatomic bypass, debridement, and a course of specific antimicrobial therapy.


Assuntos
Artéria Axilar/efeitos da radiação , Artéria Axilar/cirurgia , Implante de Prótese Vascular , Carcinoma de Células Escamosas/radioterapia , Procedimentos Endovasculares , Hemorragia/cirurgia , Lesões por Radiação/terapia , Neoplasias Cutâneas/radioterapia , Idoso , Anti-Infecciosos/administração & dosagem , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Carcinoma de Células Escamosas/patologia , Desbridamento , Procedimentos Endovasculares/instrumentação , Hemorragia/diagnóstico , Hemorragia/etiologia , Humanos , Masculino , Lesões por Radiação/diagnóstico , Lesões por Radiação/etiologia , Radioterapia Adjuvante/efeitos adversos , Neoplasias Cutâneas/patologia , Stents , Resultado do Tratamento
15.
Int Endod J ; 53(3): 410-420, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31613994

RESUMO

AIM: To investigate the shaping and cleaning performance of the Clearsonic ultrasonic tip as a supplementary tool during the preparation of long oval-shaped root canals through micro-computed tomographic (micro-CT) imaging technology. The Reciproc M-Wire R40 instrument was used as a reference instrumentation technique for comparison. METHODOLOGY: Twenty mandibular incisors with single, straight and long oval-shaped canals were selected and pair-matched by micro-CT scanning. The root canals were prepared with Reciproc R25 and R40 instruments, scanned again in a micro-CT device and randomly allocated into one of the two experimental groups (n = 10), according to the supplementary debridement protocol used: Clearsonic or Reciproc R40 used in a brushing motion against buccal and lingual walls. Noninstrumented canal areas, accumulation of hard-tissue debris (AHTD) and volume of removed dentine were assessed using micro-CT imaging following the supplementary debridement protocols. Data were analysed statistically in two phases using a t-test with a significance level of 5%. RESULTS: In phase-1, there was a significant similarity between the samples regarding the evaluated micro-CT baseline parameters (P > 0.05), validating the anatomical similarity between the tooth pairs. In phase-2, there was a significant difference between the groups for canal volume, surface area, noninstrumented root canal walls and the amount of removed dentine for both absolute and percentage values (P < 0.05), but not for AHTD (P = 0.759). CONCLUSIONS: The Clearsonic tip outperformed the Reciproc R40 instrument as a supplementary debridement protocol as it was associated with significantly greater reduction of noninstrumented root canals walls and consequently a larger amount of removed dentine. Both groups performed similarly regarding the AHTD.


Assuntos
Preparo de Canal Radicular , Desbridamento , Cavidade Pulpar , Desenho de Equipamento , Ultrassom , Microtomografia por Raio-X
16.
J Surg Res ; 246: 284-291, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31622885

RESUMO

BACKGROUND: Platelet-rich plasma (PRP) improves the healing of refractory wounds, and its application is receiving more attention in the field of wound repair. However, when a patient's condition is very poor, it may be difficult to provide whole blood to harvest autologous PRP. METHODS: We evaluated the efficacy and safety of allogeneic PRP in the field of chronic refractory wound repair. Sixty patients (39 males and 21 females, 57 ± 10 y old) with chronic wounds were enrolled in this prospective, randomized, single-center study during January 2014 to January 2018. Their wounds were treated by standard care. The patients with chronic refractory wounds were divided into allogeneic PRP treatment and control groups on the basis of the presence or absence of allogeneic PRP in wounds after debridement, respectively. Allogeneic PRP was prepared by collecting whole blood from healthy individuals and two-step centrifugation. Clinical effects were evaluated by visually observing wound conditions and objectively assessing wound surfaces. RESULTS: After 30 d of treatment, the allogeneic PRP-treated group showed bright red granulation that bled easily with reduced inflammatory exudation. No rejection reactions were observed. The rate of chronic wound healing was much faster in the allogeneic PRP-treated group than that in the control group. CONCLUSIONS: The present study shows that combined treatment of chronic wounds by standard care and allogeneic PRP significantly shortens healing time, suggesting that allogeneic PRP is an effective, safe adjuvant treatment for chronic wounds.


Assuntos
Transfusão de Plaquetas/métodos , Plasma Rico em Plaquetas , Úlcera Cutânea/terapia , Pele/lesões , Cicatrização , Adulto , Idoso , Doença Crônica/terapia , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Desbridamento , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Transplante Homólogo/efeitos adversos , Transplante Homólogo/métodos , Resultado do Tratamento
17.
Unfallchirurg ; 123(1): 68-75, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31392345

RESUMO

This article presents the case of a rapidly progressing pyoderma gangrenosum (PG) following a minor trauma and surgical intervention. A 46-year-old patient was admitted to hospital after a minor trauma of the right lower leg with a suspected diagnosis of erysipelas bullosum. A magnetic resonance imaging (MRI) scan showed the suspicion of necrotizing fasciitis (NF) with indications for immediate incision and fascia resection. According to the results of the histopathological analysis and microbiological assessment without signs for a bacterial infection, high-dose steroid treatment and immunosuppressive treatment with cyclosporin A were initiated under the assumption of PG. Additionally, the patient was treated with hyperbaric oxygenation (HBO). The 2­year follow-up showed a gradual restitution of the soft tissues.


Assuntos
Fasciite Necrosante , Pioderma Gangrenoso , Desbridamento , Diagnóstico Diferencial , Fasciite Necrosante/etiologia , Fasciite Necrosante/terapia , Humanos , Imunossupressores , Pessoa de Meia-Idade , Pioderma Gangrenoso/etiologia , Pioderma Gangrenoso/terapia , Ferimentos e Lesões/complicações
19.
Clin Oral Investig ; 24(1): 201-209, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31079243

RESUMO

OBJECTIVES: The objective of this study was to evaluate the benefit of repeated subgingival cleaning with a low-concentrated hypochlorite/amino acid gel in subjects in maintenance care with residual pockets ≥ 5 mm. MATERIAL AND METHODS: Examiner masked, randomized two-arm parallel design. Thirty-two adult periodontal patients in maintenance phase, > 3 months after periodontal therapy, with at least one residual periodontal pocket ≥ 5 mm, were randomly assigned to treatment by subgingival ultrasonic debridement with the gel or ultrasonic debridement only. At months 0, 4, and 8, all sites presenting with a probing depth (PD) ≥ 5 mm were treated. Six sites were monitored on each tooth. The primary end point was the presence or absence of PD ≥ 5 mm after 12 months. Secondary clinical outcomes were oral tissue safety; patient acceptance; changes in PD; bleeding on probing; recession after 4, 8, and 12 months; and the presence or absence of six target microorganisms in treated pockets at baseline, after 7 days and 4 months. RESULTS: A total of 365 sites in 32 patients with PD ≥ 5 mm were treated at baseline. At the final evaluation at month 12, 47% of these sites in the test and 49% in the control group were still in this PD category. The difference between baseline and month 12 was significant in both groups (p < 0.01), whereas the difference between groups was not. Repeated short ultrasonic instrumentation with adjunctive administration of the test product resulted in a clinical attachment level (CAL) gain of 1.02 mm (p < 0.01) and led to - 0.97 mm of pocket reduction (p < 0.01) without inducing further recession. However, repeated short ultrasonic debridement without the gel led to a similar clinical outcome (p < 0.01). No adverse events were recorded. CONCLUSIONS: Short ultrasonic instrumentation of residual pockets with PD ≥ 5 mm during maintenance visits resulted in a clinically relevant CAL gain and PD reduction in the order of 1 mm in 1 year, without inducing further recession. CLINICAL RELEVANCE: This study corroborates the benefit of regular maintenance care after periodontal therapy, including short debridement of the residual pockets.


Assuntos
Ácido Hipocloroso , Desbridamento Periodontal , Ultrassom , Adulto , Aminoácidos , Desbridamento , Índice de Placa Dentária , Raspagem Dentária , Feminino , Seguimentos , Humanos , Resultado do Tratamento
20.
Med Oral Patol Oral Cir Bucal ; 25(1): e117-e123, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31880284

RESUMO

BACKGROUND: Titanium- prepared platelet rich fibrin (T-PRF) is an autologous hemo-component with a high concentration of platelets that also incorporates leukocytes, and growth factors into the dense fibrin matrix and can be used as a healing biomaterial. This study assesses the adjunctive use of T-PRF in intrabony defects (IBDs) with open flap debridement (OFD) in comparison with guided tissue regeneration (GTR) as a gold standard and OFD alone as a control. MATERIAL AND METHODS: A total of 45 patients (15 per group) were randomized as either T-PRF (test group), GTR (test group), or OFD alone (control group) sites. Probing depth (PD), clinical attachment level (CAL), and IBD were recorded. The radiographic depth of IBD was also measured. Primary outcomes assessed were changes in PD, CAL, and radiographic IBD that were assessed at the beginning and nine months later.  Results: The PRF and GTR group showed significant improvement in clinical parameters compared with the OFD alone (control group) at nine months. While there were no significant differences in PD and CAL between test groups (T-PRF and GTR groups), the significant difference was found in radiographic IBD depth. CONCLUSION: T-PRF may give similar successful results as GTR in the treatment of IBDs with endo-perio lesions.


Assuntos
Perda do Osso Alveolar , Fibrina Rica em Plaquetas , Desbridamento , Regeneração Tecidual Guiada Periodontal , Humanos , Titânio , Resultado do Tratamento
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