Oncology wounds - recommendations for care based on multidisciplinary cooperation.

BACKGROUND: Oncology wounds and wounds of other etiology are rare but serious complications, which significantly impair patients quality of life. Preventive and curative interventions and education of healthcare personnel and patients reduce the risk of either their occurrence or their impact and consequences. A working group of authors from professional groups (the Supportive Care Group of the Czech Society for Oncology, the Czech Society for Wound Healing, the Society for Radiation Oncology, Biology and Physics, and the Czech Nurses Association) prepared recommendations for care. A comprehensive approach to the treatment of oncological wounds, including symptomatic treatment of associated healing complications, prevention, early detection, interdisciplinary cooperation and education are essential to deal with wounds related to chemotherapy administration, radiotherapy and oncological treatment in general. The proper choice of local care products and the eventuality of active oncological treatment are important elements of care in ulcerating tumors. PURPOSE: A basic summary of recommended interventions to prevent and treat oncology wounds in daily practice, defined based on expert societies guidelines, trials and literature data, proven practice and on the consensus opinions of the authors group members. The recommended procedures contribute to the reduction of the development, severity and consequences of oncological wounds and wounds of other etiology in oncological  patients.

[Necrotizing infectious complications in diabetic foot syndrome and their solutions]. / Nekrotizující infekcní komplikace u syndromu diabetické nohy a jejich resení.

BACKGROUND: Diabetic foot syndrome affects an increasing percentage of the population as the incidence and prevalence of diabetes increases. In some cases of the disease, acute necrotizing infectious complications can be observed to the extent that they require acute and extensive surgery debridement, often across anatomical structures. Local treatment is always preceded by vascular examination, possibly limb revascularization. METHODS: After open necrectomy, which frees the patient from infectious focus and necrotic tissue, and which, in some cases, is the last resort to preserve the limb's length, there is, in the second period (after the acquisition of granulation tissue in the defect), a need to close the defect. It is possible to let small areas heal spontaneously through epithelialisation from the edges of the wound, however, major defects have to be close either operationally with secondary suture or with dermoepidermal skin-grafting. Secondary suture requires a local shift or additional resection of the bone to obtain sufficient material for wound closure. Skin graft respects the requirement to preserve the maximum of healthy tissue while not slowing down the closure of the wound in large defects. RESULTS: Autotransplantation of secondary wound with dermoepidermal skin-graft after the debridement of necrotic tissue was performed in 16 patients. The average age was 58 years, the average surface of skin-grafting was 100 cm2, the interval between transplantation and debridement was on average 21 days and from skin-grafting to the healing, of 62 days. 14 patients were completely healed; one patient suffers chronic osteomyelitis, and another one a smack chronic defect in the periphery of the graft. Transplants affecting the plant were localized outside the zone of the foot that bears the most of the body's weight. CONCLUSION: Local treatment of infectious complications in necrotizing diabetic foot syndrome is important for managing the acute condition and preservation of limb function. It is appropriate to centralize the treatment to podiatric centers cooperating closely with the surgeon specializing on wound healing and diabetic foot.

[Surgical management of varicose ulcers]. / Chirurgická léba zilních bércových viedu.

One of the most often diseases of the European population is the venous chronic leg ulcer. It requires a long-term and expensive therapy. Basic elements of the therapy are elastic banding of the leg, diuretics, antibiotics and local treatment. In some cases a profit can be acquired from surgical procedure, which includes the stripping and/or crossectomy of the saphenous vein or the subfascial ligation of insufficient perforators and skin grafting (two phases operation). This procedure shorts the time of therapy and prevents the ulcer recurrence, because it resolves the reason and the results of the disease. We present 22 patients treated by this cure during the last 3 years at our surgery department of the 3rd faculty of medicine Charles University in Prague. 21 patients (95.5%) are healed.

[Postoperative fasciitis after laparotomy]. / Pooperacní fasciitis po laparotomii.

Postoperative infectious and necrotizing abdominal wall fasciitis is a serious wound complication. Authors present own analysis of their experience with the treatment of this disease. They refer a possibility to accelerate the healing with active approach using the combination of surgical debridement with a suitable local therapeutic witch results in better healing shortening the interval between the drainage of the pus and the secondary wound suture, bettering the cosmetic look of the scar and the earlier start of postoperative chemo/radiotherapy.