| Description |
Pressure ulcers are chronic wounds that represent a potential lifelong complication. They can interfere with the patient’s physical, psychological, and social well-being and affect significantly quality of patient’s life. In some cases, even life-threatening complications occur (infection - sepsis, depletion of proteins, etc.). Optimal surgical treatment can lead to healing up of pressure ulcer. Operative debridement of pressure ulcers is safe, despite the medical co-morbidities in patients with severe pressure ulcers. Several techniques and approaches, such as chemical debridement or maggot therapy have been introduced. Out of them, sharp surgical debridement and hydro-debridement are much effective than other types. Sharp surgical necrectomy is considered as a „gold“ standard in debridement of deep ulcers. Next to it, the VersajetTM hydrosurgery system has become popular during the last decade as a tool for tangential excision in surgery. It has several advantages. The small size of the cutting nozzle and the ability of easier manoeuvre the water dissector into small spaces makes it a potentially useful tool for debridement of areas difficult to treat - face, neck, lips, fingers, interdigital spaces, convex and concave areas. With the Versajet System, tissue excision is precise; moreover, it helps to avoid the damage of viable tissue and its vascular supply. Hydrosurgical debridement is therefore safe and effective, reducing the number of bandages and length of healing. Reactive oxygen species are closely connected with nitric oxide and other reactive nitrogen species, mainly nitric oxide. Nitric oxide itself is implicated in cellular and molecular events of aspects of wound healing that is vasodilation, angiogenesis, inflammation, tissue fibrosis, or immune responses. The results of studies overall suggest that nitric oxide synthesis is essential to the uncomplicated cutaneous wound healing. This work compares two debridement techniques (sharp/surgical and hydrosurgery) regarding both macroscopic and microscopic evaluation - objective analysis of healing process and microscopically focusing on oxidative stress parameters in systemic (plasma and urine) and local (wound site) samples. Changes of these parameters in patients suffering with pressure ulcer(s) were studied. The results of this pilot study indicate that wound healing is closely connected with amounts of reactive oxygen and nitrogen species as well as total antioxidant capacity in corresponding tissue. In addition, these changes are in a close relation with changes in ROS and RNS detected in samples of blood plasma, which may indicate predictive value of their levels in would healing and possible therapeutic strategy in the patients suffering from pressure ulcers.
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