[Application of negative-pressure wound therapy in complex therapy of open tibia fractures IIIB and IIIC with massive soft tissue loss]. / Zastosowanie opatrunków podcisnieniowych VAC w kompleksowym leczeniu otwartych zlaman IIIB i IIIC podudzia z masywnym ubytkiem tkanek miekkich.

Patients with high-grade open tibia fractures and massive soft tissue damage pose a demanding clinical challenge, requiring a complex inter-disciplinary approach and multiple orthopedic, vascular and plastic-reconstructive procedures. These types of fractures still have a 50% risk of loss, although amputation remains a treatment method of last resort. In our experience negative-pressure wound therapy (NPWT), used in the form of the vacuum assisted closure - VAC System (KCI, USA) improves healing of excessive soft tissue damage with exposure of the bone accompanying open fracture of the tibia. VAC seals the wound with a foam dressing and applies negative pressure to the wound bed. The removal of exudate and infectious material supports the cleaning of the wound. Together with the reduction of oedema and the increase in blood flow, this promotes formation of granulation tissue and eventually wound closure by split skin graft. Utilizing this method as part of a multi directional approach VAC System not only helps the patient to recover faster but also in some cases can replace microsurgical soft-tissue transfer and thus allows salvage of the leg in orthopaedic teams lacking advanced reconstructive experience.

PNF-based rehabilitation in patients with severe haemophilic arthropathy--case study.

Haemophilia is a congenital haemorrhagic diathesis that in its most severe form leads to a seriously disabling arthropathy as a result of recurring intraarticular bleeding. Within the last couple of years there have been significant advances in the treatment of haemophiliacs that are helping to prevent crippling musculoskeletal deformities, but a relatively large number of young adults still present with advanced arthropathic changes when treatment was started too late or has failed to prevent changes from taking place. We present the case of a 44-year-old male with advanced haemophilic arthropathy of the knee and ankle joints, who, during 8 weeks of therapy that consisted of physical therapy and rehabilitation using PNF techniques (Proprioceptive Neuromuscular Facilitation), achieved mobility improvement according to the SPPB scale (Short Physical Performance Battery Test) and a reduction of pain in the knee and ankle joints, according to a VAS scale. The therapeutic regimen proved to be an effective method improving the locomotor function of the patient.