Caso Clínico: Amputación Traumática, Manejo Conservador con Vendaje Suboclusivo. / Case Report: Traumatic Amputation, Conservative Treatment with Occlusive Bandage

INTRODUCCIÓN: Las lesiones de punta de dedo figuran entre las lesiones caseras y laborales más habituales de la extremidad superior y constituyen una causa frecuente de visita al servicio de urgencias. Por lo tanto es crucial implementar pautas de tratamiento factibles y oportunas que permitan definir un manejo inicial de la patología con buenos resultados a largo plazo. CASO CLÍNICO: Paciente de sexo masculino de 26 años de edad sin antecedentes patológicos de importancia, que acudió al Servicio de Emergencias por sufrir un trauma por aplastamiento en la falange distal del tercer dedo de la mano derecha. Al examen físico: se evidenció lesión en pulpejo de tercer dedo de mano derecha con exposición ósea, pérdida de piel y tejido celular subcutáneo y compromiso del lecho ungueal menor al 50%, que correspondió a la zona II de Allen. Se realizó manejo conservador con vendaje suboclusivo. EVOLUCIÓN: El paciente permaneció con vendaje suboclusivo durante 6 semanas, evidenciándose posteriormente cicatrización adecuada con recuperación de piel y uña; recuperó los arcos de movilidad interfalángicos proximales y distales, no presentó alteración sensorial como intolerancia al frio ni neuralgia posterior; el resultado estético fue satisfactorio. CONCLUSIÓN: El tratamiento conservador de las amputaciones de punta de dedo con exposición ósea es una opción válida de tratamiento. Los resultados indicaron que el enfoque conservador conduce a una excelente cobertura, sensibilidad normal, ausencia de dolor, piel estable, adecuado rango funcional de movimiento y un resultado estético aceptable. (au)

BACKGROUND: Fingertip injuries are very common among upper limb wounds; they are usually derived from domestic and labor activities which are a frequent reason to attend emergency departments. It is crucial to enforce feasible and timely treatment regimens which allow define an appropriate intervention with good long-term results. CASE REPORT: A 26-years old male patient with no pathological precedentes attended to emergency department because of a crushing trauma at distal phalanx of the right hand's third finger. Physical examination evidenced bone exposition at finger pad, skin and cellular tissues loss; 50% of nail bed compromised which was considered as Allen's II zone affectation. Conservative treatment with occlusive bandage was performed. EVOLUTION: The occlusive bandage was kept for 6 weeks. Appropriate wound healing with skin and nail recovery was evidenced; distal and proximal interphalangeal mobility arches were recovered. There was not a sensory disorder as intolerance to cold not even neuralgia; aesthetic results was satisfying. CONCLUSION: Conservative treatment of fingertip amputations with bone exposure is a valid choice as definitive treatment. Results showed that conservative treatment aid to an excellent coverage, normal sensitivity, absence of pain, stable skin growth, an adequate functional mobility range and acceptable aesthetic results. (au)

Alkaline Cellulase Production by Penicillium mallochii LMB-HP37 Isolated from Soils of a Peruvian Rainforest.

Alkaline cellulases are demanded by the textile industry for several purposes but commercial preparations showing activity at alkaline conditions are very scarce. Aim: To characterize a Penicillium strain isolated form soils of a Peruvian rainforest showing alkaline cellulase activity that may be useful for the textile industry. Methodology: The molecular identification was based on the DNA sequence of its ITS region using ITS1 and ITS4 primers after PCR amplification. Cellulase production was evaluated in shaken flasks by using either lactose or microcrystalline cellulose. Total cellulase (as FPA) and endoglucanase activities were evaluated by the standard methods at several pH levels. Also, the cellulase activity of culture filtrates was tested for antipilling activity as compared to a commercial neutral cellulase preparation. Results: After raw data of ITS DNA sequence was processed, multiple alignment and phylogenetic analysis confirmed that our strain can be named as Penicillium mallochii LMB-HP37. Higher activity was attained for neutral total cellulase on lactose (3371±108 U/l at pH 7.4) and alkaline cellulases attained similar activity levels than the acid cellulase (2978±151 U/l at pH 8.4 and 2910±42 U/l at pH 9.4). FPA and endoglucanase activities were produced at high volumetric (46.8±1.5 and 13.5±1.0 U/l.h, respectively) and specific (32.9±1.1 and 9.5±0.7 U/gbiomass.h, respectively) productivities at the same pHs which indicate that this strain may be suitable for commercial development. The enzyme of P. mallochii LMB-HP37 had slightly better results than the commercial enzyme as an anti-pilling agent even though is a crude preparation. Conclusion: Penicillium mallochii LMB-HP37 produced high total cellulase activity on lactose which compares to well-known cellulase producers but at neutral to alkaline pH levels. Data obtained reveal that the crude enzyme is suitable for anti-pilling process (biopolishing) and may be also useful for biostoning.