The advantages of the application of amnion membrane in the treatment of burns.

A crucial and important factor for successful treatment of burns is the early covering of the burned area with skin substitutes. The covering of the burn requires material that restores the epidermal function and integrates itself into the process of healing. Biological dressings are the golden standard for the temporary covering of burns. All biological skin substitutes are susceptible to early graft reaction and the only exception is the amnion membrane. The importance of the amnion membrane as a biological dressing for burns amounts to: a barrier to bacterial colonization, hastens the epithelisation, and control of water loss. Amnioplasty is a method of application of amnion membrane on the recipient site. In this comparative study, 60 patients with dermal and sub-dermal burns were included. Research was made on an examination group of 30 patients with burns where the method of amnioplasty was applied, and for this amnion membrane conserved in 76% alcohol was used. The control group was made up of 30 patients with burns treated conventionally, and standard methods for the local treatment of burns were applied: exposition, occlusive dressing and initial excision with skin grafting. Pathohistological and microbiological analyses of the bioptical material were made. The degree of the burns was determined through a pathohistological analysis of the bioptical material taken the third day, and in some of the subjects where re-epithelialization was determined on the seventh day, the further re-epithelialization was observed clinically. Pathohistological examination enabled discrimination between bacterial colonization and the invasive bacterial infection. Furthermore, the type of bacterial colonization and infection was determined, which was confirmed with microbiological analysis. The analysis of the results from the microbiological and pathohistological researches of the bioptical material according to the bacterial colonization and infection showed that, although between the examined and the control group there was no statistically important difference, the value of p = 0.067 is close to the statistically important value of p < 0.05. The results of the pathohistological examination of the bioptical material taken the seventh day and analysed according to the re-epithelialization showed that there was a significant difference between the two groups of p < 0.035. It should be mentioned that, although according to the microbiological examinations of the bioptical material a statistically significant difference was not achieved, clinical significance was achieved. The obtained significance of p < 0.035 compared to the re-epithelialization in both groups approved the application of the method of amnioplasty. The histological analysis of the bioptical material not only determines the degree of the burns specifically, but facilitates the choice of method for further treatment, observes the speed of the re-epithelialization and plays an important part in the correct diagnosis and the early start of the specific therapy, important in preventing sepsis. The application of amnion membrane as a biological dressing speeds the re-epithelialization and prevents invasive bacterial infection. Pathohistological examination of the burns is recommended to be established as a standard method in clinical practice.

High-grade surface osteosarcoma - chondroblastic type.

We present the case of an 8-year-old boy with pain in the distal part of the right thigh that occurred after a ball injury, without haematoma or oedema. The plain film showed exostosis of the distal part of the right femur. In another institution the "exostosis-like" formation was surgically removed and the histological finding was an aggressive type of chondroblastoma. A few months later, on the site of the surgical intervention, a significantly enlarged painful solid mass appeared. Radiography showed a large dense mass at the level of distal femoral metadiaphysis with tumour matrix mineralization, and Codman's sign. Computed tomography showed a large soft tissue mass, which arose from the surface of the underlying cortical bone and signs of high-grade malignancy. CT is a valuable method in predicting high-grade malignancy. Arteriography was also done. After operative treatment - seq. Campanacci, histology showed high-grade surface osteosarcoma of chondroblastic type. Pre- and post-operative chemotherapy was carried out. The boy died 2 years after diagnosis because of recurrent disease. High-grade surface osteosarcoma has the worst prognosis, compared with other surface osteosarcomas. Therefore, timely diagnosis is indispensable.