RESUMEN
Pyoderma gangrenosum is a rare, neutrophil-mediated, auto-inflammatory dermatosis that wound care specialists must be prepared to recognise. This condition has clinical features analogous to infectious processes. There is no specific diagnostic test and the diagnosis is usually obtained from exclusion. Its early recognition and proper management with prompt initiation of immunosuppressive therapy are essential to improve the quality of life and the prognosis of patients.
Asunto(s)
Piodermia Gangrenosa , Diagnóstico Diferencial , Humanos , Neutrófilos , Piodermia Gangrenosa/diagnóstico , Piodermia Gangrenosa/tratamiento farmacológico , Calidad de VidaRESUMEN
The aim of this study was to translate into Mexican Spanish, cross-culturally adapt and validate the wound-specific quality of life (QoL) instrument Cardiff wound impact schedule (CWIS) for Mexican patients. This instrument went through the full linguistic translation process based on the guidelines of Beaton et al (Beaton DE, Bombardier C, Guillemin F, Ferraz MB, Guidelines for the process of cross-cultural adaptation of self-report measures, Spine Phila Pa, 1976, 2000, 318-391). We included a total of 500 patients with chronic leg ulcers. The expert committee evaluated the Face validity and they agreed unanimously that the instrument was adequate to assess the QoL of these patients, covering all relevant areas presented by them. The content validity index obtained was of 0.95. The construct validity demonstrated moderately significant correlations between related sub-scales of CWIS and SF-36 (P = .010 to P < .001). The instrument was able to discriminate between healed and unhealed ulcers. The instrument obtained an overall Cronbach's alpha of .952, corresponding to an excellent internal consistency (.903-.771 alpha range for domains). The CWIS can be appropriately used to assess the health-related QoL of Mexican patients with chronic leg ulcers.
Asunto(s)
Comparación Transcultural , Úlcera de la Pierna/psicología , Úlcera de la Pierna/terapia , Satisfacción del Paciente , Calidad de Vida/psicología , Evaluación de Síntomas/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , México , Persona de Mediana Edad , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Traducciones , Adulto JovenRESUMEN
Foreign modelling agent reactions (FMAR) are the result of the injection of unapproved high-viscosity fluids with the purpose of cosmetic body modelling. Its consequences lead to ulceration, disfigurement and even death, and it has reached epidemic proportions in several regions of the world. We describe a series of patients treated for FMARs in a specialised wound care centre and a thorough review of the literature. A retrospective chart review was performed from January 1999 to September 2015 of patients who had been injected with non-medical foreign agents and who developed cutaneous ulceration needing treatment at the dermatology wound care centre. This study involved 23 patients whose ages ranged from 22 to 67 years with higher proportion of women and homosexual men. The most commonly injected sites were the buttocks (38·5%), legs (18%), thighs (15·4%) and breasts (11·8%). Mineral oil (39%) and other unknown substances (30·4%) were the most commonly injected. The latency period ranged from 1 week to 17 years. Complications included several skin changes such as sclerosis and ulceration as well as systemic complications. FMAR is a severe syndrome that may lead to deadly complications, and is still very common in Latin America.
Asunto(s)
Cosméticos/efectos adversos , Cuerpos Extraños/inmunología , Reacción a Cuerpo Extraño/complicaciones , Aceite Mineral/efectos adversos , Úlcera Cutánea/etiología , Úlcera Cutánea/terapia , Adulto , Anciano , Mama/fisiopatología , Nalgas/fisiopatología , Cosméticos/administración & dosificación , Femenino , Homosexualidad Masculina/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Aceite Mineral/administración & dosificación , Estudios Retrospectivos , Piel/fisiopatología , Adulto JovenRESUMEN
PURPOSE: Preseptal cellulitis (PC) may be locally complicated with abscess formation and necrotizing fasciitis. If not treated promptly and adequately, it may result in further complications. The authors report a series of patients where negative pressure wound therapy (NPWT) proved a safe and valuable adjunct therapy in avoiding complications of PC and in accelerating wound healing. METHODS: A 4 patient case series. Four male patients (11 months to 58 years old) with unilateral complicated PC. INTERVENTIONS: Patients were admitted with PC and treated initially with specific intravenous antibiotic therapy. These patients did not respond adequately; therefore, surgical drainage and/or debridement were performed. After surgery, persistent edema and purulent discharge was observed prompting the need for adjunct NPWT every 48 to 72 hours. NPWT is the use of vacuum through a wound filler material covered with an airtight drape connected to a pump. Complete ophthalmologic examination was performed after each 48-hour cycle. Length of hospital stay, days from surgery to discharge, days from start of NPWT to discharge, clinical improvement, and safety. RESULTS: Four patients were diagnosed with PC between 2 and 5 days of evolution. Two diabetic adults developed the condition secondary to trauma, the adolescent as a result of a cosmetic piercing, and the infant associated to sinusitis. NPWT reached -125 mm·Hg, except for the infant who received -75 mm·Hg. The average number of days necessary for improvement with NPWT was 6.7 days. Only 2 patients required surgical reconstruction. Time from debridement to discharge was in average 13.5 days. No ocular complications were observed, and follow up was satisfactory with normal eyelid function and aesthetics and preserved visual acuity. CONCLUSIONS: NPWT proved to be safe and effective for treating locally complicated PC as an adjuvant therapy to antibiotic and surgical treatment that decreased the length of hospital stay, and the time for recovery in patients that were slow responders. No ocular complications were observed in any of these patients' follow up ranging from 1 to 4 years.
Asunto(s)
Absceso/terapia , Infecciones Bacterianas del Ojo/terapia , Fascitis Necrotizante/terapia , Terapia de Presión Negativa para Heridas/métodos , Celulitis Orbitaria/terapia , Infecciones Estafilocócicas/terapia , Staphylococcus epidermidis/aislamiento & purificación , Absceso/diagnóstico , Absceso/microbiología , Adolescente , Antibacterianos/uso terapéutico , Ceftriaxona/uso terapéutico , Ciprofloxacina/uso terapéutico , Clindamicina/uso terapéutico , Desbridamiento , Quimioterapia Combinada , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/microbiología , Fascitis Necrotizante/diagnóstico , Fascitis Necrotizante/microbiología , Humanos , Lactante , Tiempo de Internación , Masculino , Resistencia a la Meticilina , Persona de Mediana Edad , Celulitis Orbitaria/diagnóstico , Celulitis Orbitaria/microbiología , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/microbiología , Tomografía Computarizada por Rayos X , Cicatrización de HeridasRESUMEN
The healing process in diabetic foot ulcer (DFU) is hindered by factors such as chronic inflammation, defects in fibroblast function, poor angiogenesis, and lack of cell migration. Recombinant human epidermal growth factor (rhEGF) has been shown to enhance extracellular matrix formation, cellular proliferation, and angiogenesis. Therefore, intralesional application of rhEGF in DFU could accelerate wound healing. Our objective was to determine the efficacy and safety of rhEGF in patients with DFU. A randomized, double-blinded, placebo-controlled study was conducted comparing a thrice-per-week intralesional application of rhEGF (75 µg) or placebo in patients with DFU for 8 weeks. The number of completely healed ulcers, size, and wound bed characteristics were evaluated to determine the efficacy of rhEGF. Adverse events were recorded and analyzed to establish its safety. A total of 34 patients were recruited for the study. After three dropouts, we were able to follow and analyze 16 patients in the placebo group and 15 patients in the rhEGF study to the end of the trial. Baseline testing showed that both groups were similar. Compared to the placebo group, more ulcers achieved complete healing in the rhEGF group (rhEGF, n = 4; placebo, n = 0; p = 0.033); ulcers in the rhEGF group decreased in area size (12.5 cm2 [rhEGF] vs. 5.2 cm2 [placebo]; p = 0.049); and more epithelial islands in the wound bed were present (28% vs. 3%; p = 0.025). Mild transitory dizziness was the only side effect that was more frequently noted in the rhEGF group. Our results showed that in patients with DFU who received standard care, intralesional rhEGF application resulted in complete healing in more patients, promoted the epithelialization of the wound bed, and significantly reduced the area of the DFU treated. Therefore, rhEGF resulted in better outcomes for patients suffering from DFU.
Asunto(s)
Inductores de la Angiogénesis/uso terapéutico , Pie Diabético/tratamiento farmacológico , Factor de Crecimiento Epidérmico/uso terapéutico , Cicatrización de Heridas/efectos de los fármacos , Adulto , Amputación Quirúrgica , Proliferación Celular/efectos de los fármacos , Pie Diabético/patología , Pie Diabético/fisiopatología , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Femenino , Tejido de Granulación/efectos de los fármacos , Humanos , Inyecciones Intralesiones , Masculino , México/epidemiología , Proteínas Recombinantes/uso terapéutico , Resultado del TratamientoRESUMEN
In patients with diabetes, foot complications remain one of the main health issues, with ulcers representing one of the most common. These ulcerations originate from repetitive trauma on a foot with neuropathy. Inadequate care of the diabetic foot may lead to one of the gravest complications of the diabetic foot: amputation. The key to the treatment of the diabetic foot is the control of comorbidities (glucose levels and vascular disease), debridement, exudate control with the available modern dressings, treatment of infection, and offloading the affected foot. A common error in this basic treatment is the method used for offloading, leading to delayed healing as a result, and maybe even amputation. For this purpose we propose the total contact cast considered the "gold standard" in diabetic foot offloading. The objective of the present review is to present the existing evidence in the medical literature on the effectiveness of its use for healing diabetic foot ulcers and hence preventing amputations.
Asunto(s)
Moldes Quirúrgicos , Pie Diabético/terapia , HumanosRESUMEN
Pressure ulcers (PU) are the source of multiple complications and even death. To our knowledge, there is no available data about PU prevalence in Mexico. The objective of this study was to determine the point prevalence of PU in three second-level hospitals in Mexico. Every adult hospitalised patient was included in each hospital. Age, gender, hospitalisation ward, Braden score, and the number, location and stage of the ulcers encountered were recorded, as well as any pressure relief measures. In total, 294 patients were examined (127 were male); of these, 63 were considered to be at risk. The average age was 48·6 years. The overall prevalence of the PU was 17%. The service with the highest prevalence was the ICU. The most frequent stage was II (32%) and they were most commonly found in the sacrum (74%). The average Braden score of the patients with ulcers was 10, and 21·4% of the patients obtained moderate- to high-risk Braden scores. Of them, 60·3% had ulcers and only 46% had any preventive measures. The prevalence of PU in three hospitals in Mexico is 17%. The most common stage is II and the most commonly affected site is the sacrum. Only 46% of patients with PU had at least one pressure release measure.
Asunto(s)
Úlcera por Presión/epidemiología , Adulto , Anciano , Femenino , Hospitalización/estadística & datos numéricos , Hospitales Generales , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Úlcera por Presión/patología , Úlcera por Presión/terapia , Prevalencia , Riesgo , Centros de Atención Secundaria , Índice de Severidad de la EnfermedadRESUMEN
Pyoderma gangrenosum (PD) is a rare, chronic, relapsing, ulcerative, neutrophilic cutaneous disease and may be difficult to recognize. It is not uncommon for PD to be mistakenly diagnosed as vascular occlusive or venous disease, vasculitis, cancer, infection, exogenous tissue injury, or other inflammatory disorders. A 55-year-old woman with a 5-year history of a very painful and enlarging ulcer presented at the authors' clinic. Previously, based on an original diagnosis of venous ulcer, the wound had been surgically debrided and managed with saline-soaked gauze and compression therapy. After the authors secured a complete history (which included rheumatoid arthritis) and assessment, PD was suspected. A biopsy was performed for histological confirmation. Pyoderma gangrenosum treatment, including oral corticosteroids and topical 0.01% tacrolimus twice daily covered with nonadhesive gauze and compression wrapping, was started. After 4 weeks, the wound had improved noticeably and pain medications to manage wound pain were discontinued. The wound was completely healed after 4 months. The presence or absence of PD must be ascertained in all patients who present with a history of painful lower leg ulcers and PD risk factors, such as rheumatoid arthritis.