Background
Wound healing is a rapidly growing field of medicine. The treatment approach must be chosen and adjusted according to the nature of the wound and its response to the chosen treatment.
Case report
We present a polymorbid patient following an arterial reconstruction surgery on the left lower extremity, with surgical wounds hea­ling per secundam intentionem. The treatment included modern wound healing products, V.A.C. (Vacuum Assisted Closure) and a surgical necrectomy. The complete healing occurred in this patient in 3 months from the vascular surgery.
Discussion and summary
In every patient, the wound healing requires an individual approach, which is a basis of an optimal treatment plan determination. A combination of the modern wound healing methods with classical surgical necrectomy appears to be suitable.

Key words: by-pass, wound healing, V.A.C. (Vacuum Assisted Closure), Hyiodine

Nowadays, infectious complications represent a dominant proportion in the mortality of severely burnt patients. Currently, it is slightly omitted, that not only bacteria and fungi, but also viruses represent a real threat that could have fatal consequences in these patients. In the case report we present a case of a severely burnt patient with a diagnosed herpetic infection, in whom, despite of an intensive care, multiorgan failure developed and death occurred.

Key words: herpes simplex virus, burns

Background
The burns belong to frequent injuries in the child age. Deep burns may potentially complicate the growth and development of the burnt parts of the body, subsequently also their function, and may have serious negative impact on the psychological status of the patient. The surgical treatment of deep burns is based on a removal of the necrotic skin (necrectomy) and a closure of an emerged defect most frequently by an autologous skin graft. Worldwide, the necrectomy is most frequently performed by a tangential excision. However, the Clinic of Burns and Reconstructive Surgery in Brno has gained an excellent long term experience with chemical necrectomy performed by a 40% solution of benzoic acid. In this paper we present outcomes of the chemical necrectomy, as an alternative to established methods for removal of devitalized tissues in the treatment of deep burns in pediatric patients.
Material and methods
The project was performed as a retrospective clinical trial. Children at the age of 0–14 hospitalized in our clinic between 2006 and 2009 were included. The main inclusion criteria were a presence of a deep burn injury and a need of necrectomy. In all children, predefined epidemiological indicators, such as age, the extent of burnt area, duration of hospitalization, success of the chemical necrectomy, time from the injury to the autologous transplantation, etc., were monitored and subsequently evaluated.
Results
Between 01 Jan 2006 and 31 Dec 2009, a total of 633 children were hospitalized due to a thermal injury. In 116 children (18.3 %) the necrectomy had to be performed. The average age of the patients in the cohort, thus those undergoing necrectomy, was 4,7 years (11 months–19 years), the average area of the burnt was 12.8 % TBSA (0.5–75 %). The average duration of hospitalization of patients included in the cohort was 20.9 days (12–132 days). The average time from the injury to the chemical necrectomy and the closure of the defect by a dermo-epidermal (D-E) graft was 9.2 days (8–13 days). Only in 8 children the surgical necrectomy had to be performed. In 108 children (93.1 %) we chose the chemical necrectomy. The success rate of the chemical necrectomy (thus removal of the necrotic tissues) was 94.4 % in our cohort.
Discussion
The number of children hospitalized due to burn injury has been increasing year by year. Luckily, the number of critical burn injuries and therefore the need of necrectomy have been decreasing. In the Clinic of Burns and Reconstructive Surgery, the chemical necrectomy is highly favored over the tangential excision. In the extensive burn injuries both methods are successfully combined, which enables to perform the necrectomy of the affected areas in a shorter time and to reduce the extent of blood loss. There has been a general trend for an early excision of deep necrotic tissues in the burn injury medicine over the last decades. Some centers perform the necrectomy directly at the admission of a patient to the department. The truth is that in our department the necrectomy is performed later than is usual, on the other hand, in majority of pediatric patients the defect is closed definitely immediately after the necrectomy. In contrast with statements of the very early excision supporters, we have observed neither increased incidence of infectious complications nor increased incidence of the hypertrophic healing of the burnt areas following the autologous transplantation with the D-E grafts.
The efficacy of the chemical necrectomy by benzoic acid in children is very good, nevertheless, sporadic cases, in which the method fails even in pediatric patients, can be found. The cause of this phenomenon remains unknown. In our opinion, it is associated with the likely mode of action of the benzoic acid itself in the separation of necrosis.
For eschars and injuries affecting the whole width of the skin including subcutaneous structures that we see in high-voltage electric injuries, the surgical necrectomy is indicated unambiguously. In these cases, the effect of the benzoic acid is usually insufficient. The reason is known: the benzoic acid works ideally only within the depth of the burn injury up to the grade III; in deeper burn injuries it is ineffective.
Summary
The benzoic acid in the process of the chemical necrectomy has been firmly established in our clinic especially due to its excellent activity in a selective removal of the necrotic skin tissues.

Key words: burns injuries, chemical necrectomy, benzoic acid

The paper informs about recent literary data on the lymphangiogenesis and its relationship to wound healing. The discovery of specific biomarkers enabling to detect tiny lymphatic vessels in the histopathological examination started a rapid development of new findings about the lymphatic system and its role in the pathogenesis of different medical conditions. The results of experiments focused in the lymphangiogenesis in wound healing in both healthy and diabetic subjects have been recently presented in the foreign literature. It has been found out that the specific macrophages that produce a growth factor stimulating a growth of existing lymphatic vessels and having a potential to converse into new lymphatic endothelial cells are essential in this process. In diabetic animals both the lymphangiogenesis and hemangiogenesis stagnates after injury. The effect of hyperglycemia limits the functioning of macrophages, which are necessary for the lymphangiogenesis. It may be restored by the effect of interleukin 1ß. These new findings could, in some way, explain the well known favourable effect of systemic enzymotherapy (Wobenzyme) in chronic wounds and diabetic defects.

Key words: edema, lymphangiogenesis, healing, systemic enzymotherapy

The case report demonstrates that the change of the client’s approach to his own life may bring not only his satisfaction, but also, with optimal treatment approach, healing of a diabetic defect. At the same time it documents a polymorbidity of the elderly client and its interdiscipline management.

Key words: type 2 diabetes mellitus, diabetic foot syndrome, Wagner classification, chronic complications of diabetes, motivation