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The negative pressure wound therapy (NPWT) is an effective local treatment method of many non-healing wounds. NPWT is routinely used for inpatient treatment in the Czech Republic; however, no clinical data is available for systematic outpatient treatment.The prospective non-randomized study was used to compare the clinical impact and cost-effectiveness of diabetic leg-ulcer and foot-ulcer negative pressure treatment in outpatient and inpatient settings. The aim of the study was to assess the effectiveness of outpatient NPWT on the basis of wound bed evaluation, to detect and quantify pre-expected reductions in the total costs of the therapy, and to compare the efficacy of both treatment options. Enrolled subjects included inpatients (n=36, NPWT systems RENASYS GO or PICO) and outpatients (n=28, PICO system). NPWT was concluded when the wound bed had been totally covered by granulation tissue, or when serious health problems occurred. We monitored the ulcer area, wound bed trait, number of NPWT dressing changes, length of NPWT, intensity of pain (VAS scale), presence of complications, and treatment costs.We found comparable clinical efficacy of outpatient (n=28)/inpatient (n=36; statistically non-significant differences in healing of ulcers verified based on wound bed development and reduction of ulcer areas in time) NPWT, the same risk of complications associated with NPWT (statistically non-significant differences in the function of both technologies and in complications developed during follow-up) as well as similar long-term results (statistically non-significant differences in the count of amputations). The total costs for outpatient wound treatment were statistically significantly lower (EUR 600 versus EUR 1300, p=0.001), and so were the average one-day-NPWT costs (EUR 30 versus EUR 120, p=0.001).We demonstrated that outpatient diabetic-foot-ulcer NPWT provided the same clinical efficiency as inpatient NPWT, while outpatient NPWT was less expensive, less painful and better tolerated than inpatient NPWT.

Current medical knowledge has provided us with a wide range of possibilities of treating chronic wounds. Over the recent decades, in particular, significant progress has been made in this field. The authors present an overview of current knowledge of chronic wound healing, pointing out the surgeons role in the process of chronic wound management. Using surgical therapy, we are able to heal a chronic wound in a shorter period of time, particularly if the treatment is accelerated by the application of platelet-rich plasma (PRP) as a source of growth factors.The pilot randomized prospective study included four patients with chronic wounds of the lower leg after previous failure of conservative therapy who were indicated for skin transplantation. Following previous vacuum-assisted closure therapy, the patients undergoing skin transplantation were prospectively randomized into two groups. Autologous PRP was used in one of the groups and standard skin transplantation without PRP was performed in the other one.In the PRP group, 99% of the wound areas were healed on the 15th day after the operation. In the other group, 90% of the areas were healed on the 15th day following the operation. In the PRP group, complete healing of the defect occurred in both patients at 15 and 20 days post-surgery. In the second group, one patient completely healed within 28 days; the other one was not fully healed even at 3 months post-surgery.Most patient groups at great risk may benefit from the method using PRP, as well as patients with chronic wounds who have failed conventional methods available for both general and local therapy. This fact has been confirmed by the authors initial experience presented.Key words: platelet-rich plasma (PRP) - platelets wound healing chronic wound.

The topic of this thesis is "Knowledge of nurses about methods of treatment of the leg ulcer". The purpose of this thesis was to document current methods of treatment of the leg ulcer and to evaluate nurse's knowledge of this area. The thesis is divided into two sections - a theoretical and an empirical one. The theoretical section is devoted to the leg ulcer as a term and its causes, then it concerns wound healing and factors, which it is influenced by. It also describes the currently used methods of treatment of the leg ulcer and other chronic wounds. The empirical section is based on a quantitative research performed as a questionnaire study, which has been carried out in medical and surgical wards in three teaching hospitals in Prague. The goal of this research was to determine nurse's knowledge of chronic wounds, the leg ulcer, its risk factors and prevention, of wound healing, compression therapy and to find out, in which ways nurses get access to information on wound healing and treatment of the leg ulcer. This goal was met. The findings of the research are summarized in the conclusion of the thesis. Key words: moist wound healing; leg ulcer; wound; chronic wound; debridement; compression therapy; nursing care

A 29-year-old male patient with the anamnesis of inflammatory bowel disease and Grave-Basedowov disease was hospitalized because of rapidly spreading skin defect with affected muscle on the left shin. This skin defect appeared after the significant decreasing of corticoids. The small skin trauma preceded the pyoderma gangrenosum. First the skin disease was not right diagnosed and patient was cured by the excision of the defect. It caused tissue disintegration, muscle necrosis and extension of the defect. The whole leg was endangered. Patient was cured with corticoids and cyclosporin A after the right diagnosis. The defect healed and laboratory inflammatory markers decreased. The immunosuppresive therapy was changed to azathioprin, the corticoid therapy was interrupted. After three months the defect was healed.

Costs of conventional and advanced treatments of leg ulcers are compared. Conventional treatment consisted in the application of calcaria solution and camphor ointment onto the wound and an indifferent pasta onto the surrounding skin. The advanced treatments included the use of the novel dressings Granuflex, Actisorb and Inadine. The latter treatments consider the sequence of healing phases and at the same time shorten the healing period by up one half. Comparisons of treatment costs have shown marked benefits of the novel dressings. The costs of complete healing of an ulcer with an area of 8 x 8 cm at the healing duration of 4 weeks were 503.48 CZK, 432.38 CZK and 329.62 CZK for Granuflex, Actisorb and Inadine, respectively. Direct costs of the conventional treatment of an ulcer with the same size were 863.28 CZK and the healing period extended to 6 weeks. The use of the novel dressing is apparently less expensive and affords more comfort to the patient.

The authors present an account on a successful cure of a mixed crural ulcer using combined therapy by a classical vascular surgical method and endoscopic surgery of the venous perforators of the leg. In the described case this combined treatment is the method of choice because it was not possible to use the classical Linton operation and also to protect a vascular prosthesis from infection.

Current methods of topical treatment of leg ulcers are reviewed. Leg ulcers are chronic wounds in a trophically altered tissue that affects the healing capacity. Complete healing requires prolonged and rather expensive treatment and the patient is often disabled during this period. The conventional methods of treatment of leg ulcers, including various compresses, ointments, pastes and other topical drugs, that may possess a considerable sensitizing potential, are to an increasing extent replaced by updated therapy consisting in the use of a new generation of dressings. The latter include a number of materials that have been developed on the basis of recent knowledge of wound healing, such as hydrogels, hydrocolloids, xerogels, hydropolymer dressings, polyurethane foam sheets, alginate dressings, and non-adherent, non-woven cloth impregnated with silver and activated charcoal. The selection of the available materials must depend on the character and stage of the healing process. Each group of dressings exerts specific effects and none of them can recommended generally for the treatment of any types of ulceration. A brief survey of indications is given for each group to avoid their abuse.

Retrograde intravenous perfusion (RIP), so-called Bier's blockade is a relatively new method of treatment of critical ischaemia of the extremities. It is based on the principle of retrograde, i.e. transvenous perfusion of the capillary circulation during which at the time of artificially discontinued circulation in the extremities a high concentration of effective substances in the target tissues is achieved. In addition to the mentioned critical ischaemia Bier's blockade can be successfully used in the treatment of so-called "diabetic foot". It is also possible to implement by this method a local medicamentously induced block of the sympathetic nerves by administration of Guanethidine. In patients with contraindications of systemic fibrinolytic treatment local thrombolysis can be made in phlebothromboses and acral vascular occlusions. In the treatment of tumours on the extremities, e.g. melanoblastome, it is possible to achieve by local administration of cytostatics comparable results, while the incidence of undesirable effects is smaller. The objective of the present work was to make the professional public familiar with this method. On the example of four patients with trophic defects of the lower extremities which developed as a result of primary thrombocythemia the application of Bier's method was demonstrated.

The author describes a special inflammatory rheumatic disease in a 48-year-old female patient with Crouzon's syndrome which most probably could be included among seronegative spondarthritis. The author discusses the possible ratio of inborn disease in the atypical course of the rheumatic disease.

The authors describe the case of a 60-year-old woman patient with a crural ulcer with a traumatic, arterial, venous and lymphatic aetiology. After three-year unsuccessful treatment by conventional methods and surgery a combination of hyperbaric oxygen therapy and plastic surgery was used. This rational therapeutic approach was very effective and the authors recommend its introduction into routine practice.