RESUMEN
UNLABELLED: A trial of living amniotic membrane is suggested as a suitable dressing for certain indolent ulcers. The type of ulcer which is large and chronic both in rate of healing as well as time since onset is well known to everyone. After eliminating any venous defect, oedema, cellulitis, correction of stiff joints, anaemia, we are left with a local indolent problem. What is the ideal dressing? Comfortable or relieves pain; harmless to the tissues and encourages removal of slough; encourages vascularity of the granulation tissue. Method of application: Amnion is applied for five days prior to skin grafting. RESULTS: Better results in those ulcers which have a venous origin rather than arterial. In most cases a clean delicate layer of granulation tissue forms. Histopathology: biopsy of the ulcer base: before application of amnion - dense fibrous tissue, few thick-walled vessels; after application of amnion - more delicate connective tissue, numerous vessels, with thinner walls. The formation of an amnion bank: To facilitate the availability of living amnion. To investigate the possibility of an extract of amnion which would produce the same results as the membrane itself.
Asunto(s)
Vendajes , Apósitos Biológicos , Úlcera Varicosa/terapia , Capilares/patología , Enfermedad Crónica , Humanos , Úlcera de la Pierna/patología , Cicatrización de HeridasRESUMEN
Simple factors which may serve as predictors of the success or failure of amputations in the feet were examined in 59 consecutive diabetics. Age, sex, method of diabetic control, smoling, presence of neuropathy or peripheral pulses, preoperative blood-urea, and temperature did not correlate with success of amuptations. The average preoperative white-cell count and blood-sugar were higher in the failure group (p less than 0.01 and p less than 0.05 respectively), but there was considerable overlap between the groups. By contrast, the preoperative haemoglobin level was significantly lower (p less than 0.001) in patients whose amputations healed than in those with failure of healing, both at the digital and metatarsal or transmetatarsal levels; also, there was very little overlap in haemoglobin levels between the success and failure groups. All 18 amputations done in patients with a preoperative haemoglobin less than 12.0 g/dl were successful, whilst all 30 amputations in those with a preoperative level greater than 13.0 g/dl failed.