Acta chirurgiae plasticae
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Acta chirurgiae plasticae · Jan 2009
Case ReportsUnsuccessful therapy of combined mycotic infection in a severely burned patient: a case study.
Patients with burn trauma are always in danger of contracting an infection. Although invasive mycotic infections are not as frequent as bacterial infections, high mortality and in many cases difficult diagnostics pose a serious threat not only for neutropenic patients. In more extensive burns the status is further complicated by specifically compromised immunity. ⋯ We present a case study of a young patient with 82% TBSA (total body surface area) burns, where we isolated simultaneously 3 different types of micromycetes (Aspergillus fumigatus, Fusarium sp., Absidia sp.). Mycotic infection is understood primarily as a complication in neutropenic patients and, after prophylactic antibiotic and antimycotic administration, in extensive burn trauma patients. The case ended with the death of the patient due to severe sepsis caused by the multiresistant strain Pseudomonas aeruginosa.
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Acta chirurgiae plasticae · Jan 2009
Vacuum-assisted closure downgrades reconstructive demands in high-risk patients with severe lower extremity injuries.
Primary soft tissue reconstruction in complex leg injuries is mandatory in order to protect exposed tissues; however, it may be precluded by the patient's clinical status or by local wound conditions. This retrospective study aims to evaluate the use of negative pressure as an adjunct to delayed soft tissue reconstruction in patients with complex lower limb trauma. ⋯ Negative pressure is a safe and effective adjunct to delayed soft tissue reconstruction in high-risk patients with severe lower extremity injuries, minimizing reconstructive requirements and therefore postoperative morbidity.
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Acta chirurgiae plasticae · Jan 2008
Randomized Controlled Trial Multicenter StudyEnzymatic necrolysis of acute deep burns--report of preliminary results with 22 patients.
Enzymatic debridement by the use of a proteolytic enzyme complex derived, isolated and purified from pineapple stems proves to be an innovative, rapid, effective, selective and safe method of postburn necrotic skin removal. The major advantages of the procedure include minimal invasivity, rapidity, effectiveness, possibility to perform the debridement at the bedside, minimal or no loss of blood and minimal interference with natural wound healing processes. Our preliminary experience with this treatment method showed that in most of the cases treated the debridement was excellent, safe and rapid. ⋯ No serious adverse events or reactions have been observed during the study. The time for healing was comparable with the standard of care methods. The second randomized multicenter study is still in progress and has not yet been finished.
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Acta chirurgiae plasticae · Jan 2008
Hemocoagulation disorders in extensively burned patients: pilot study for scoring of the DIC.
To apply results of the hemocoagulation parameters to the DIC (disseminated intravascular coagulation) score system. Compare parameters of the DIC score in patients with extensive burn trauma (hospitalized at the Intensive Care Unit, ICU) and patients with lesser extent of burn injury (hospitalized at the standard unit). To use these data within the evidence based medicine for the prediction of organ damage and multi-organ failure. ⋯ During the treatment of the patients with various extent of burn injury, none of the patients' scores reached values that would mean occurrence of obvious "overt" DIC.
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Acta chirurgiae plasticae · Jan 2008
Catheter-related infections in burn patients at the Burn Centre of the University Hospital in Ostrava.
We need central venous catheters (CVCs) in management of critically ill patients with severe burns, either for the administration of fluids or monitoring hemodynamic status. Central venous catheterization may cause different early or late complications, which depend on the physician's erudition, the quality of the catheters and quality of Intensive Care Unit (ICU) nursing care for insertion. 272 CVCs were inserted in 114 both adult and pediatric patients from 2004 to 2006 in the ICU of the Burn Centre in Ostrava. The average insertion length of the catheter was 10.2 days, and the average total length of catheterization was 24 days. ⋯ No exogenous catheter sepsis according to Maki's criteria occurred in our study group. Endogenous catheter colonization with positive peripheral blood culture and bacteraemia occurred in 4 cases, which means an incidence density of 1.44 endogenous colonizations per 1000 catheter-days. The quality of used catheters and particularly the technique of placement and maintenance of catheters are considered crucial for good results in the ICU of Burn centre in Ostrava.