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Amber is 42 jaar en moeder van 3 prachtige kinderen. Van kleins af aan was ze al redelijk gezet en dat bleef zo ondanks veel pogingen om af te vallen. Haar vader is overleden vlak na haar geboorte, ook hij was veel te zwaar en had te hoge cholesterol waarden. Amber dacht: dit gaat mij niet gebeuren en ik ga hulp zoeken om af te vallen. Ze kwam in 2016 in het ziekenhuis in Almelo bij de internist terecht en kreeg daar allerlei onderzoeken inclusief een erfelijkheidsonderzoek in verband met haar vader. Tijdens de tweede afspraak bij de internist werd ze goed met haar neus op de feiten gedrukt. Amber: ‘Hij zei, er moet gauw iets gebeuren want anders wordt u geen 38 jaar oud. Hier schrok ik dus behoorlijk van. Mijn bloeddruk was te hoog, ik rookte, had diabetes en een super hoog cholesterol gehalte.’ Al snel kreeg Amber groen licht voor een gastric bypass. ‘Maar daarvoor moest ik wel een jaar lang een voorbereidend traject volgen’. De operatie vond uiteindelijk plaats in april 2017.

BACKGROUND

Application of controlled in vitro techniques can be used as a screening tool for the development of new hemostatic agents allowing quantitative assessment of overall hemostatic potential.

MATERIALS AND METHODS

Several tests were selected to evaluate the efficacy of cotton gauze, collagen, and oxidized regenerated cellulose for enhancing blood clotting, coagulation, and platelet activation.

RESULTS

Visual inspection of dressings after blood contact proved the formation of blood clots. Scanning electron microscopy demonstrated the adsorption of blood cells and plasma proteins. Significantly enhanced blood clot formation was observed for collagen together with β-thromboglobulin increase and platelet count reduction. Oxidized regenerated cellulose demonstrated slower clotting rates not yielding any thrombin generation; yet, led to significantly increased thrombin-anti-thrombin-III complex levels compared to the other dressings. As hemostyptica ought to function without triggering any adverse events, induction of hemolysis, instigation of inflammatory reactions, and initiation of the innate complement system were also tested. Here, cotton gauze provoked high PMN elastase and elevated SC5b-9 concentrations.

CONCLUSIONS

A range of tests for desired and undesired effects of materials need to be combined to gain some degree of predictability of the in vivo situation. Collagen-based dressings demonstrated the highest hemostyptic properties with lowest adverse reactions whereas gauze did not induce high coagulation activation but rather activated leukocytes and complement.

Aim:

Complex case management in a fragile elderly patient to achieve an optimal outcome.

Method:

The 96 year-old female had a deep wound infection after osteosynthesis of her left ankle. In the hospital she was treated with negative pressure wound therapy (NPWT). Upon arrival on March 2, 2017 in the rehabilitation centre the wound surface was 8 x 3 cm, the wound bed contained 10% yellow and 90% granulation tissue with some hyper-granulation present. The wound edges were non vital and there was oedema in her left ankle. The surrounding skin was slightly red.

Results:

The patient received nutritional supplements twice daily. NPWT was discontinued and the treatment regime now comprised: Debridement using a monofilament1 pad, followed by cleansing with water and disinfection with an antiseptic. The peri-wound skin was protected with a spray on film, a collagen2 and an alginate3 dressing were covered with a superabsorbent pad fixed with an adhesive film dressing.4 Dressing changes were on average twice weekly. For compression 2 layers (20 mmHg) of a tubular compression5 system were applied during the day and reduced to one layer at night. Wound closure was achieved after 41 days of treatment. The patient continued with the compression system for another 6 weeks to protect the fragile area and to prevent oedema from reoccurring.

Conclusion:

Complex wound closure was achieved in a comfortable fashion that suited the individual needs of this elderly fragile patient.