Strategy for the treatment of chronic leg wounds: a new model in Poland.

AIM: The aim of the present study was to implement and evaluate a system of care for patients with chronic leg ulceration (CLU) in Poland. METHODS: All patients within two defined geographical areas in Poland were identified for inclusion in the study. A model of care was developed based on guidelines, including the appropriate education of health professionals treating patients, access to non-invasive methods to determine the ulcer aetiology, compression therapy in those with proven venous ulceration. RESULTS: In total 309 patients were identified with CLU at the start of the study (120 men, 189 women). Both regions had a similar profile of patients having a median (IQR) duration of ulceration of 96 (30-168) months. Most (75.7%) patients were assessed using clinical signs and symptoms alone, with a mean (SD) number of treatments per week at 1.8 (1.9) visits. Two years after implementation, the numbers of patients had reduced to 205 (86 men, 119 women) a reduction of 33%. Post implementation more patients were treated at home (49.3% versus 19.5%) with a corresponding reduction in those seen at health centres (35.6% versus 63.3%). The mean (SD) number of visits was reduced to 1.3 (0.7). During implementation the healing rate at 30 weeks improved from 73.3% to 82.9%, with a corresponding reduction in amputations from 6.3% to 2.1%. While the cost per patient was higher post-implementation, the overall cost of treating patients within the service reduced from €3847 to €2913 per week. CONCLUSION: The development and implementation of an evidence based system of care for patients with CLU in Poland is both clinically and cost effective. This may be used as a model for other regions of Poland.

[Apophyseal rupture of ischial bone tuberosity]. / Apophysenausrisse am Tuber ossis ischii.

The apophyses of the pelvic skeleton are the insertion zones of strong muscles and tendons and are soft points towards the end of growth. Apophyseal ruptures have quite often occurred as a consequence of overstressing in the context of certain athletic disciplines. Reported in this paper are two of the authors' own cases of apophyseal rupture of Tuber ossis ischii. Diagnosis is easy on the basis of case history, clinical manifestations, and X-ray. Treatment is conservative, with the patient hip-straightened confined to bed for three weeks. Surgery might be indicated in cases of continued seating problems or neurological failures.