Differences in treatment with synthetic patches and amnion in a period of two months.

Here we can see clearly, and in a longer time, the benefit in the use of amnion on the use of synthetic patches. These comparisons, more prolonged in two weeks time as we shown above results confirm the superiority of the implementation of the amnion of the placenta. However, the small number of patients evolved with such severity of injury, not in any way we can ensure that results are equal at all the patient. Clearly, like any treatment, important factors involved, such as the psychological characteristics of patients, their deso of overcoming trauma, physical and psychological resistance wing traumatic injury which means the accident, and even the surgery. This patient and others who had other diseases present no noteworthy .. It is here that communication with the patient, sincere, direct and comprehensive becomes a cornerstone in this treatment, prolonged in time and craft features. You must generate a lot of confidence in both directions, between doctor and patient, being aware that it is a complex situation and that may require sudden changes in direction of treatment. Any practitioner who was involved in the treatment of open fractures is well aware of these possibilities, which may require emergency amputation. Thus, the basic pillar so often mentioned, and sometimes forgotten by us is basic. Communication with the patient and the perfect understanding of the goals of treatment. Numbers of photos and translate.
fig. 1.- February 20, 2009, surgery number 13. Bone graft and graft of muscle, Dr. Cuculic and Dr. Gomez. Healing is performed with synthetic patches as soon after surgery.
fig. 2.- Photo of 9 March 09. March 9 to remove the synthetic patch.
fig. 3.- March 11 continued with synthetic patch.
fig. 4.- March 16 continued with synthetic patch.
fig. 5.- April 8, removed the synthetic patch, we started with placenta.
fig. 6.- Continue April 30 with placenta.
fig. 7.- 7 May, just days before closing the wound.
fig. 8.- Continue May 21 with placenta, there is considerable evolution. External fixators are removed.
fig. 9.- May 21, situation by removing the external fixator and functional cast treatment.

Diferencias en el tratamiento con los parches sintéticos y Amnios en un período de dos meses.

Acá podemos ver claramente, y en un tiempo mas prolongado, el beneficio en la utilización de Amnios sobre la utilización de parches sintéticos.

Estas comparaciones, mas prolongadas en el tiempo que las dos semanas mostradas anteriormente nos confirman la superioridad de resultados con la aplicación del amnios de la placenta.

No obstante, por la poca cantidad de pacientes evolucionados con tal gravedad de lesiones, no podemos de ninguna manera asegurar que los resultados serán iguales en todo los paciente.

Es claro, como en todo tratamiento, que intervienen factores muy importantes, tales como las características psicológicas de los pacientes, su deso de superación del trauma, su resistencia física y psicológica ala agresión traumática que significa el accidente, y aún las quirúrgicas.

Esta paciente y los otros que presentaremos no presentaban otras patologías dignas de mencionar..

Es aquí que la comunicación con el paciente, sincera directa y comprensiva se transforma en un pilar fundamental en este tipo de tratamiento, prolongados en el tiempo y con características artesanales.

Se debe generar mucha confianza en ambos sentidos, entre médico y paciente, teniendo conciencia de que es una situación compleja y que puede requerir de cambios bruscos en la dirección del tratamiento.

Cualquier profesional que haya intervenido en el tratamiento de fracturas expuestas conoce muy bien esas posibilidades, que pueden llegar a requerir de una amputación de urgencia.

Es así que ese pilar básico tantas veces mencionado, y a veces olvidado por nosotros se hace básico. La comunicación con el paciente y el perfecto entendimiento de los objetivos del tratamiento.

Paso a mostrar algunas imágenes:

20 de febrero del 2009, cirugía numero 13. Injerto óseo e injerto de músculo, Dr. Cuculic y Dr. Gómez.



Se realiza curaciones con parches sintéticos desde el momento postoperatorio. Fotografía del 9 de marzo 09.

9 de marzo al retirar el parche sintético.

11 de marzo continuamos con parche sintético.

16 de marzo continuamos con parche sintético.

8 de abril, retiramos el parche sintético, iniciamos con placenta.



30 de abril continuamos con placenta.



7 de mayo, a pocos días de cerrar la herida.


21 de mayo continuamos con placenta, se observa gran evolución. Se retiran los fijadores externos.


21 de mayo, situación al retirar los fijadores externos, y tratamiento con yeso funcional.

THE AMNIOS, VASCULARIZATION PROTECTIVE, REGENERETAROR OR BOTH ??

Orthopedics and Traumatology. DR. JUAN CARLOS CUCULIC Monday July 27 2009 The amnion acts as a protective agent for the vascularization of bone, as the regenerator, or both ways? Reached the point where it was possible without maintaining the lower limb amputation, was the difficulty of time needed for tissue regeneration and to maintain bone viavilidad, the latter being the factor that generated more uncertainty. This was the situation when deciding to continue as: Photos of the leg and foot of 25 September 2008 which clearly show what was the situation. The first application of amnion: We performed the first application of amnion on October 17, 2008 with the assistance of Dr. Cesar Suarez, Dermatologist of the Hospital Regional de Salto, nurses Diego Hernandez, who has been and remains one of the key partners in all procedures healing, and the nurse Juan Aguirre of dermtología. In February 2009 the situation was as follows, progress had been made in the soft parts of regenración but left two concerns, the vascularization of bone, primarily with the need for bone graft and it had achieved a breakthrough in the coverage bone was a small area to cover. Photos from February 2 2009. Enlarged the wound and bone exposure on the left. On February 13th 2009 it was decided to make a centellograma to determine whether or not there was bone vascularisation or whether the necrotic bone by the long period of exposure, almost six months. Centellograma whole body with Tg99, there is a focus of increased uptake in the left leg fracture. In greater detail shows that the vascularization persisted after six months exposure of bone with external fixators, and with four months of treatment with amnion applications. The empty spaces that may seem to correspond to the tube external fixator. On February 20 and based on this study decided to carry out bone grafting, which was taken from the leg itself and the tibial plateau, as the patient has a large number of scars on the one hand, and what effect that the iliac crest the event of a failure of the graft and requiring other. Dr. Gomez also, Plastic Surgeon's Hospital Salto, underwent an anterior tibial rotation with a small flap of skin to cover the bone completely and simultaneously with bone grafting, with the following situation: Postoperative period. You can see the flap of skin and the external approach was performed to rotate the anterior tibial, which was conducted on a pre-existing scar, where there had been a fasciotomía wide, through the technology outside of the leg in an emergency procedure to prevent a compartment syndrome. Photo of 09 March 2009. Status of bone exposure after 19 days of realñizado the bone graft and anterior tibial rotation. In three weeks of bone transport from the previous crest of the tibia and the spongy bone of the tibial plateau. Deserve separate consideration the differences in healing using synthetic patch versus amnion applications, where we can see the difference in this longer period of observation to reach a month.