RESUMEN
This retrospective study compared the clinical outcomes of negative pressure wound therapy with reticulated open cell foam (NPWT/ROCF) as delivered by Vacuum-Assisted Therapy(®) (V.A.C.(®) Therapy, KCI Licensing Inc., San Antonio, TX) to non-NPWT/ROCF conventional therapy (CT) in split-thickness skin graft (STSG) survival in all patients to determine whether NPWT/ROCF affects the outcome of the graft survival, in terms of overall graft take, duration of graft take, repeated grafts and complications. The authors conducted a 10-year retrospective review of 142 patients admitted to a level I trauma centre and treated with an STSG in foot and ankle reconstructive surgeries. Demographic data, wound etiology, dressing type used, time to graft take, NPWT/ROCF duration, complications and outpatient treatments were analysed. There were significantly fewer repeated STSGs required in the NPWT/ROCF group compared to CT [n = 3 (3·5%) versus n = 9 (16%); P = 0·006]. In assessing safety, there were fewer complications in graft failure (seroma, hematoma and infection) in the NPWT/ROCF group as compared to the CT group at 8·9 months (range: 1-12 months). NPWT/ROCF is an excellent alternative for securing an STSG and is associated with improved graft survival as measured by a reduction in the number of repeated STSGs and graft failure complications.
Asunto(s)
Úlcera del Pie/cirugía , Terapia de Presión Negativa para Heridas/métodos , Cuidados Posoperatorios/métodos , Cuidados de la Piel/métodos , Trasplante de Piel , Cicatrización de Heridas , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Investigación en Enfermería Clínica , Femenino , Úlcera del Pie/etiología , Supervivencia de Injerto , Humanos , Masculino , Persona de Mediana Edad , Terapia de Presión Negativa para Heridas/enfermería , Cuidados Posoperatorios/enfermería , Estudios Retrospectivos , Cuidados de la Piel/enfermería , Trasplante de Piel/efectos adversos , Trasplante de Piel/enfermería , Dehiscencia de la Herida Operatoria/etiología , Dehiscencia de la Herida Operatoria/prevención & control , Resultado del TratamientoRESUMEN
Mrs. M.S. is a 67-year-old African American woman with a history of rheumatoid arthritis and psoriatic arthritis who presented to the emergency room with complaint of new-onset rash, chills, and fatigue after she started taking ramipril (5 mg orally every day) for her hypertension. The rash involved entire upper chest, both arms, palms, and soles and was characterized as exfoliating with scattered small pustules of 1-2 mm in size. Patient was admitted with a differential diagnosis of exfoliative dermatitis versus adverse drug reaction for which her ramipril was stopped. After admission, the patient spiked a temperature of 102 degrees F with chills, the entire workup for which was negative, including blood cultures, chest x-ray, and urine analysis. She underwent skin biopsy to find the cause of her rash. With her given clinical characteristics, she was presumed to have generalized pustular psoriasis (GPP), which was later confirmed by biopsy results. She was treated with methylprednisolone to which she responded dramatically with much improvement in her rash and her fever subsided. The flare of GPP was considered to be secondary to ramipril. After reviewing the published literature, there are no published cases of ramipril-induced GPP. Captopril, a different angiotensin converting enzyme (ACE) inhibitor, is known to cause flare of GPP. We presented this case as apart from being the first reported case of ramipril-induced GPP; clinicians and dermatologist should also be aware of this potentially serious complication of psoriasis when they start ramipril in patients with psoriasis.