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.