[APPLICATION OF TOPICAL HEMOGLOBIN SPRAY IN INFECTED POSTTRAUMATIC AND POSTOPERATIVE WOUNDS].

Posttraumatic and postoperative infective wounds that progress to chronic wounds can pose serious problem for the traumatized patient with reduced biological potential for healing. Also, due to the need for specific and individual approach to such a patient, they represent a challenge for physicians. The use of topical hemoglobin spray (Granulox®) with protective and supportive local action ensures and improves physiological conditions for healing, thus providing additional possibilities for adequate and safe healing of complicated infected wounds.

Can non-adhesive short stretch bandages change a life?

Venous stasis ulcers are common in patients who have a history of leg swelling, varicose veins, or a history of blood clots in either the superficial or the deep veins of their legs. The treatment is long and hard but the main aim of it is to create such an environment that allows skin to grow over an ulcer. Chronic wounds are a growing social, economical and health issue throughout the world. The purpose of this retrospective study was to establish detailed characterization of how effective a compression is in reducing the time of wound healing. A total of 176 patients with leg ulcers were included in our three years study. The measurements were taken based on the anamnesis, presenting clinical symptoms, digital photography at each dressing foam change, and, finally, wounds. During a 3 years period (2011-2013) a total of 176 patients (61 male and 115 female, 34.66% and 65.34% respectively) with different types of leg ulcers were treated at our Hospital. The average age is 68.94 years (male 68 years, female 70 years). We measured how long the patient had the wound before starting the treatment, and also how long the treatment lasted. This led us to the conclusion that compression therapy shortened the time of treatment by two thirds, compared to the usual therapy. Compression systems improve the healing of venous leg ulcers and should be used routinely regarding venous ulcers.

Impact of adolescents awareness on perception of sexually transmitted infections.

Sexually transmitted infections (STIs) are diseases transmitted by direct contact during sexual intercourse. Because of high incidence and possibility of development severe consequences on general and reproductive health, STIs are a major problem among young people in the world. Lack of information is one of the major risk factors for STI transmission. Most of young people (53.3%) had their first sexual intercourse at the age of 18 years, 67.7% of students have no knowledge about STI, 53.3% of students have already entered into sexual relations and 13% of them with more than 4partners. 31.1% of students who are sexually active was not examined by a gynecologist because of shame and fear. Most sexually active adolescents did not use contraceptives and they are not satisfied with the available information about STI. There is also continuing problem of teen pregnancy. The main goal of this research is to examine whether there is relationship between level of information and awareness of surveyed adolescents and their perception of sexually transmitted diseases.

[Chronic wound in waiting-room]. / Kronicna rana u cekaonici.

Chronic wounds are wounds that in addition to standard methods of treatment do not heal within 6-8 weeks, depending on their localization and etiology. Wound healing is affected by a number of factors: physical, psychosocial, relationship to the patient's disease, the condition of the wound itself, as well as the experience and knowledge of medical personnel and financial resources of the institution. Treating chronic wounds begins taking adequate history. Holistic approach is very important in each patient. It should take into account all the situations that can lead to the prolonged healing of wounds. The psychosocial status of the patient plays an important role in the treatment of chronic wounds.

[Plausible solution to prevent major amputation in diabetic foot patients]. / Sto nakon amputacije dijabetickog stopala?

Diabetes mellitus is one of the leading public health problems in the world. Complications of diabetes mellitus include cardiovascular diseases, retinopathy, neuropathy and diabetic foot, which can in turn lead to lower extremity amputations. This is the main cause of mortality and the biggest expenditure for health system. Treatment is long and frustrating for the patient and also for medical staff. Amputations are becoming more frequent, while the quality of life after amputation is greatly reduced. Healing of postoperative infection is long lasting and demands a lot of hard work from the surgeon and the rest of medical staff, while causing severe suffering for the patient. Progression of infection increases mortality. Negative pressure therapy after minor foot amputations greatly reduces healing time. Negative Pressure Wound Therapy (NPWT) was applied after surgical treatment. All necrotic tissue and fibrin deposits were removed. Initial therapy was administered continuously with 125 mm Hg of vacuum. The NPWT was continued intermittently. Additionally, all patients underwent additional hyperbaric treatment and local hemoglobin administration. In conclusion, in all cases presented, combined NPWT, hyperbaric and topical hemoglobin therapy proved to be a highly effective therapeutic option in preventing pending major amputation following minor diabetic foot amputation.

[debridement algorithm]. / Algoritam primjene debridmana.

Prolonged life expectancy increases the proportion of elderly population. The incidence of injury increases with older age. A variety of comorbidities (circulation disorders, diabetes mellitus, metabolic imbalances, etc.) and reduced biological tissue regeneration potential that accompanies older age, lead to a higher prevalence of chronic wounds. This poses a significant health, social and economic burden upon the society. Injuries in the elderly demand significant involvement of medical and non-medical staff in the prehospital and hospital treatment of the injured, with high material consumption and reduced quality of life in these patients, their families and caregivers. Debridement is a crucial medical procedure in the treatment of acute and chronic wounds. The aim of debridement is removal of all residues in wound bed and environment. Debridement can be conducted several times when there is proper indication. There are several ways of debridement procedure, each having advantages and disadvantages. The method of debridement is chosen by the physician or other medical professional. It is based on wound characteristics and the physician's expertise and capabilities. In the same type of wound, various types of debridement can be combined, all with the aim of faster and better wound healing.

[Can decubitus ulcer be fatal? - case report]. / Moze li dekubitalni ulkus biti fatalan? - prikaz bolesnika.

A patient aged 69, homeless, alcoholic, hospitalized because of general weakness and disability, with decubitus ulcer in the area of left hip, measuring 5x5 cm, is presented. On admission, numerous parameters of inflammation were observed. Antibiotics and repeated extended skin necrectomy were indicated. Acinetobacter spp. and Enterococcusfaecium were isolated in the swab obtained from surgical wound. In spite of extensive supportive measures, dermatologic therapy and surgery, the patient rapidly developed widespread necrosis in the left hip area and paravertebrally, and he passed away in the clinical picture of sepsis.

[Weight loss and healing of ulcers - case report]. / Mrsavljenjem do cijeljenja ulkusa - prikaz bolesnika.

Diabetes mellitus type 2 is one of the most common diseases with a prevalence increasing with age. If blood sugar is not controlled, complications arise and diabetic foot ulcer occurs. Depending on the blood vessels involved, we distinguish venous and arterial ulcers. Venous ulcers respond very well to modern methods of treatment such as compression therapy and hydrocolloid dressings, but for arterial ulcer prevention is most significant, e.g. weight loss, dietary modification, etc. The aim of this study was to show that despite all the available therapeutic options, we cannot cure ulcers completely because the patient's readiness to change his lifestyle plays a decisive role. Therefore, we present a patient having suffered from venous ulcers for several years and arterial ulcer that healed only after the patient had lost about 20 pounds.

[What is behind a wound?- case report]. / Sto se krije iza rane? - prikaz bolesnika.

Chronic wound is a wound that does not heal in four to eight weeks. The most important predisposing factors are tissue ischemia and infection. In approximately 80% of cases, chronic wounds of lower limbs are the final form of chronic venous insufficiency. We report a case of chronic wound of lower limb that was treated as a posttraumatic war wound. After proper treatment of chronic venous wound of lower limb, it healed after almost 20 years. When chronic wound of lower limb is present, all diagnostic criteria should first exclude chronic venous insufficiency, and then proper treatment should be introduced.

[Use of negative pressure therapy in the treatment of primary infected traumatic wounds of the foot caused by high energy impact]. / Uporaba terapije negativnim tlakom u lijecenju primarno inficiranih traumatskih rana stopala uzrokovanih ozljedivanjem visokom energijom.

Foot injuries caused by firearms and high pressure washing machines are not common, but due to high energy can be very destructive and contaminated with microorganisms. Due to the anatomical specificity of the foot, injures of the specific structure such as blood vessels, nerves and tendon-ligament apparatus are frequent. Soft tissue defect is often present. Functional and aesthetic recovery of the foot is a challenge for the surgeon. Direct and indirect effect of the negative pressure therapy helps in wound healing and provides good preparation for definitive surgical management of wounds.

[A role of negative pressure therapy in the treatment of surgical wound infection after intramedullary osteosynthesis in pertrochanteric femoral fracture]. / Uloga terapije negativnim tlakom u lijecenju infekcije kirurske rane nakon intramedularne osteosinteze pertrohanternog prijeloma bedrene kosti.

Fractures of the proximal femur are specific to older adults. Today, life expectancy for men and women is increasing, so one can expect an increased number of hip fractures. Elderly people suffer from associated diseases that may compromise the biological potential in healing of surgical wounds. On the other hand, there is an increased number of microorganisms resistant to antimicrobial drugs, so an increased number of postoperative infections can be expected. With conventional treatment methods of postoperative infections where the osteo-synthetic material is present in tissue, negative pressure therapy is gradually taking an increasingly important role in the treatment of these conditions. Because of its simple application in hospital or outpatient setting and good comfort with no pain for the patient, negative pressure therapy contributes significantly to healing of the wounds without removing osteosynthetic material from the wound.

Lorenz Heister's handbook of surgery in the Franciscan monastery in Pazin.

The oldest library in Istria (Croatia) is located in the Franciscan Monastery of Pazin, with a rich fund of worthy old books. Our attention was attracted by the book "Chirurgie" written by the German physician, surgeon and anatomist Lorenz Heister in the first half of the 18th century. This worthy book is relatively scanty known in Croatian history of surgery. By studying the contents of the book written in the 18th century, numerous surgical instruments, as well as surgical operations may be found, many of them being used even today with little modifications. Among the instruments different types of pincers, needles, scissors, knives, saws, hammers, chisels and others can be found. The description of different surgical procedures reveals great advancement in the surgical technique. The book was very popular in Europe for a century.

[Burn injuries: what have we learned from history]. / Opeklinska bolest: sto smo naucili iz povijesti

Severe burn injuries present a significant public health risk and are often associated with a life-threatening systemic inflammatory response. With the traditional approach, patients often stay in hospital longer and are more prone to problems like joint contractures, hypertrophic scars and infections due to delayed healing. The approach to burn injuries has been improving through and has been adopting new technologies and materials. Today, burn injuries are treated by general practitioners and surgeons. Unfortunately, this does not always ensure faster healing improvement of the quality of life.