RESUMEN

INTRODUCTION: Chronic plantar ulcers in leprosy are lesions resulting from motor and sensory alterations caused by Mycobacterium leprae. They are lesions refractory to conventional dressings and present high recurrence rates. OBJECTIVE: To evaluate the epidemiological clinical profile of patients with chronic plantar ulcers associated with bony prominences in the lesion bed and to evaluate the efficacy of orthopedic surgical treatment of these lesions. METHODS: This is a descriptive and analytical retrospective study with the evaluation of medical records of patients undergoing surgical treatment of chronic plantar ulcers from 2008 to 2018. The surgical technique applied consisted of corrective resection of bone prominences and the primary closure of the lesion with bipediculated local flap. RESULTS: 234 patients were submitted to surgery, 55.1% male with an average age of 69.5 years old. Of these, 82.9% were illiterate; and 88.5% with open lesions over 10 years. After surgical treatment, total wound healing occurred in an average time of 12 weeks. The variables that contributed to shorter healing time were: Patients' lower age group; regular use of orthopedic shoes and insoles and dressings performed by nurse aides in health units before surgery. Obesity was the factor that correlated with the delay of healing time. CONCLUSION: A higher incidence was observed in males and male and female illiterate patients. The regular use of shoes and insoles and dressings performed by nurse aides in health units contributed to shorter postoperative healing time. Orthopedic surgical treatment with corrective resection of bony prominences proved to be an efficient therapeutic method for the closure of chronic plantar ulcers. It is a reproducible method, justifying the importance of the orthopedic surgeon in the context of the multidisciplinary team to cope with these complex lesions.

Asunto(s)

Pie Diabético , Úlcera del Pie , Lepra , Procedimientos Ortopédicos , Humanos , Masculino , Femenino , Anciano , Úlcera del Pie/epidemiología , Úlcera del Pie/etiología , Úlcera del Pie/cirugía , Estudios Retrospectivos , Lepra/complicaciones , Lepra/epidemiología , Lepra/cirugía , Procedimientos Ortopédicos/efectos adversos , Colgajos Quirúrgicos/cirugía , Pie Diabético/cirugía

RESUMEN

Introdução: A úlcera plantar por hanseníase é uma lesão no pé resultante da falta de sensibilidade plantar. O objetivo é descrever o tratamento realizado em portadores de úlceras plantares por hanseníase. Métodos: Estudo de prontuários de portadores de úlcera plantar atendidos no Hospital Sarah em Brasília, de 2006 a 2016, quanto ao sexo, idade, etiologia, localização e tratamento. Resultados: Foram atendidos 27 pacientes, 17(62,96%) homens e 10 (37,04%) mulheres, procedentes de Goiás e DF, na faixa etária de 41 a 60 anos (40,74%). Todos necessitaram de um ou mais procedimentos cirúrgicos. Conclusão: Observou-se maior frequência no sexo masculino, grau avançado, localizadas no primeiro artelho. Todos necessitaram de procedimentos cirúrgicos e não cirúrgicos, evoluindo com cicatrização completa da ferida, amputação transtibial em um caso e de artelhos em sete casos, e 90% dos casos apresentaram recorrência da úlcera após um ano.

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Introduction: Leprosy-induced plantar ulcers result from a lack of plantar sensitivity. Objective: This study aimed to describe the treatment provided to patients with leprosy-induced plantar ulcers. Methods: We retrospectively reviewed the medical records of patients with plantar ulcers treated at Sarah Hospital in Brasilia from 2006 to 2016 and collected information about sex, age, etiology, location, and treatment. Results: A total of 27 patients (17 [62.96%] men, 10 [37.04%] women; 40.74% were aged 41­60 years) were treated from Goiás and the Federal District. All required ≥1 surgical procedure. Conclusion: A higher frequency of advanced grade was observed in men, primarily on the first toe. All needed surgical and non-surgical procedures and achieved complete wound healing. Transtibial amputation was required in 1 case and toe amputation in 7 cases; 90% patients developed ulcer recurrence after 1 year.

Asunto(s)

Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Historia del Siglo XXI , Rehabilitación , Terapéutica , Tratamiento Terciario , Registros Médicos , Úlcera del Pie , Lepra , Rehabilitación/métodos , Rehabilitación/estadística & datos numéricos , Terapéutica/métodos , Terapéutica/estadística & datos numéricos , Tratamiento Terciario/métodos , Tratamiento Terciario/estadística & datos numéricos , Registros Médicos/normas , Registros Médicos/estadística & datos numéricos , Úlcera del Pie/cirugía , Úlcera del Pie/complicaciones , Úlcera del Pie/terapia , Lepra/cirugía , Lepra/complicaciones , Lepra/terapia

RESUMEN

Objective: to evaluate whether bacterial genus is a risk factor for major amputation in patients with diabetic foot and infected ulcer. Methods: we conducted a case-control, observational study of 189 patients with infected ulcers in diabetic feet admitted to the Vascular Surgery Service of the Risoleta Tolentino Neves Hospital, from January 2007 to December 2012. The bacteriological evaluation was performed in deep tissue cultures from the lesions and amputation was considered major when performed above the foot'smiddle tarsus. Results: the patients'mean age was 61.9±12.7 years; 122 (64.6%) were men. The cultures were positive in 86.8%, being monomicrobial in 72% of the cases. In patients with major amputation, Acinetobacter spp. (24.4%), Morganella spp. (24.4%), Proteus spp. (23.1%) and Enterococcus spp. (19.2%) were the most frequent types of bacteria. The most commonly isolated species were Acinetobacter baumannii, Morganella morganii, Pseudomonas aeruginosa and Proteus mirabilis. As predictors of major amputation, we identified the isolation of the generaAcinetobacter spp. and Klebsiella spp., serum creatinine ≥1.3mg/dl and hemoglobin <11g/dl. Conclusion: the bacterial genera Acinetobacter spp. and Klebsiella spp. identified in infected ulcers of patients with diabetic foot were associated with a higher incidence of major amputation.

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Objetivo: avaliar se gênero bacteriano é fator de risco para amputação maior em pacientes com pé diabético e úlcera infectada. Método: estudo observacional do tipo caso-controle de 189 pacientes com úlcera infectada em pé diabético admitidos pelo Serviço de Cirurgia Vascular do Hospital Risoleta Tolentino Neves, no período de janeiro de 2007 a dezembro de 2012. A avaliação bacteriológica foi realizada em cultura de tecido profundo das lesões e a amputação foi considerada como maior quando realizada acima do médio tarso do pé. Resultados: a média de idade dos pacientes foi 61,9±12,7 anos e 122 (64,6%) eram homens. As culturas foram positivas em 86,8%, sendo monomicrobianas em 72% dos casos. Nos pacientes com amputação maior, os gêneros de bactérias mais frequentes foram Acinetobacter spp. (24,4%), Morganella spp. (24,4%), Proteus spp. (23,1%) e Enterococcus spp. (19,2%) e as espécies mais isoladas foram Acinetobacter baumannii, Morganella morganii, Pseudomonas aeruginosa e Proteus mirabilis. Identificou-se como fatores preditivos para amputação maior o isolamento dos gêneros Acinetobacter spp. e Klebsiella spp.,e níveis séricos de creatinina ≥1,3mg/dl e de hemoglobina <11g/dl. Conclusão: os gêneros bacterianos Acinetobacter spp. e Klebsiella spp. identificados nas úlceras infectadas dos pacientes com pé diabético associaram-se a maior incidência de amputação maior.

Asunto(s)

Amputación Quirúrgica , Bacterias/clasificación , Pie Diabético/microbiología , Pie Diabético/cirugía , Úlcera del Pie/microbiología , Úlcera del Pie/cirugía , Bacterias/aislamiento & purificación , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo

RESUMEN

ABSTRACT Objective: to evaluate whether bacterial genus is a risk factor for major amputation in patients with diabetic foot and infected ulcer. Methods: we conducted a case-control, observational study of 189 patients with infected ulcers in diabetic feet admitted to the Vascular Surgery Service of the Risoleta Tolentino Neves Hospital, from January 2007 to December 2012. The bacteriological evaluation was performed in deep tissue cultures from the lesions and amputation was considered major when performed above the foot'smiddle tarsus. Results: the patients'mean age was 61.9±12.7 years; 122 (64.6%) were men. The cultures were positive in 86.8%, being monomicrobial in 72% of the cases. In patients with major amputation, Acinetobacter spp. (24.4%), Morganella spp. (24.4%), Proteus spp. (23.1%) and Enterococcus spp. (19.2%) were the most frequent types of bacteria. The most commonly isolated species were Acinetobacter baumannii, Morganella morganii, Pseudomonas aeruginosa and Proteus mirabilis. As predictors of major amputation, we identified the isolation of the generaAcinetobacter spp. and Klebsiella spp., serum creatinine ≥1.3mg/dl and hemoglobin <11g/dl. Conclusion: the bacterial genera Acinetobacter spp. and Klebsiella spp. identified in infected ulcers of patients with diabetic foot were associated with a higher incidence of major amputation.

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RESUMO Objetivo: avaliar se gênero bacteriano é fator de risco para amputação maior em pacientes com pé diabético e úlcera infectada. Método: estudo observacional do tipo caso-controle de 189 pacientes com úlcera infectada em pé diabético admitidos pelo Serviço de Cirurgia Vascular do Hospital Risoleta Tolentino Neves, no período de janeiro de 2007 a dezembro de 2012. A avaliação bacteriológica foi realizada em cultura de tecido profundo das lesões e a amputação foi considerada como maior quando realizada acima do médio tarso do pé. Resultados: a média de idade dos pacientes foi 61,9±12,7 anos e 122 (64,6%) eram homens. As culturas foram positivas em 86,8%, sendo monomicrobianas em 72% dos casos. Nos pacientes com amputação maior, os gêneros de bactérias mais frequentes foram Acinetobacter spp. (24,4%), Morganella spp. (24,4%), Proteus spp. (23,1%) e Enterococcus spp. (19,2%) e as espécies mais isoladas foram Acinetobacter baumannii, Morganella morganii, Pseudomonas aeruginosa e Proteus mirabilis. Identificou-se como fatores preditivos para amputação maior o isolamento dos gêneros Acinetobacter spp. e Klebsiella spp.,e níveis séricos de creatinina ≥1,3mg/dl e de hemoglobina <11g/dl. Conclusão: os gêneros bacterianos Acinetobacter spp. e Klebsiella spp. identificados nas úlceras infectadas dos pacientes com pé diabético associaram-se a maior incidência de amputação maior.

Asunto(s)

Humanos , Masculino , Femenino , Bacterias/clasificación , Úlcera del Pie/cirugía , Úlcera del Pie/microbiología , Pie Diabético/cirugía , Pie Diabético/microbiología , Amputación Quirúrgica , Bacterias/aislamiento & purificación , Estudios de Casos y Controles , Factores de Riesgo , Persona de Mediana Edad

RESUMEN

BACKGROUND: Marjolin's ulcer is defined as the appearance of a neoplasm within a chronic wound. The most common histological type is squamous. A total of 2 cases treated in our hospital are presented. CLINICAL CASE: Case 1. A 71 year old man who presented with redness and suppuration from the wounds he had in his right foot after an electric shock 40 years earlier. The radiology showed involvement of the 4° and 5° metatarsal. Supracondylar amputation was performed, showing a well-differentiated invasive squamous cell carcinoma. CASE 2: A 56 year old male, paraplegic for 20 years. He was treated due to an infected right heel ulcer, with partial improvement, but the ulcers persisted. Biopsy was performed, reporting as epidermoid carcinoma. Infracondylar amputation was performed. The diagnosis was a well-differentiated squamous cell carcinoma infiltrating the dermis. CONCLUSION: The prevalence of Marjolin's ulcer is 1.3-2.2% of all ulcers. Diagnosis is difficult, so biopsy is recommended on any suspicious lesion or ulcer that has received conservative treatment for one month without improvement, although this time limit is not clear. The treatment is the surgery. Local excision with a margin of an inch is enough. If the ulcer is extensive, amputation is required. Survival is estimated between 66 and 80% at 2 years, with recurrence rates of 23%. Unfavourable factors are poor tumour differentiation and metástasis, appearing in 20% of cases.

Asunto(s)

Quemaduras por Electricidad/complicaciones , Carcinoma de Células Escamosas/etiología , Traumatismos de los Pies/complicaciones , Úlcera del Pie/etiología , Neoplasias Cutáneas/etiología , Anciano , Amputación Quirúrgica , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/epidemiología , Carcinoma de Células Escamosas/cirugía , Pie Diabético , Úlcera del Pie/epidemiología , Úlcera del Pie/cirugía , Unidades Hospitalarias , Humanos , Masculino , México/epidemiología , Paraplejía/complicaciones , Pronóstico , Estudios Retrospectivos , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/epidemiología , Neoplasias Cutáneas/cirugía

RESUMEN

BACKGROUND: Guidelines of the International Consensus on the Diabetic Foot state that "Amputation of the lower extremity or part of it is usually preceded by a foot ulcer". The authors' impression has been that this statement might not be applicable among patients treated in our institution. A prospective cohort study was designed to determine the frequency distribution of antecedents of lower limb infection or gangrene and amputation among adult diabetics admitted to a Regional Hospital in western Jamaica. METHODS: Adult diabetics admitted to Hospital with a primary diagnosis of lower limb infection and/or gangrene were eligible for recruitment for a target sample size of 126. Thirty five variables were assessed for each patient-episode of infection and/or gangrene, main outcome variable being amputation during admission or 6-months follow-up. Primary statistical output is the frequency distribution of antecedents/precipitants of lower limb infection and/or gangrene. The data is interrogated by univariate and multivariable logistic regression for variables statistically associated with the main antecedent/precipitant events. RESULTS: Data for 128 patient-episodes were recorded. Most common antecedents/precipitants, in order of decreasing frequency, were idiopathic acute soft tissue infection/ulceration (30.5%, CI; 22.6-39.2%), chronic neuropathic ulcer (23.4%, CI; 16.4-31.7%), closed puncture wounds (19.5%, CI; 13.1-27.5%) and critical limb ischemia (7.8%, CI; 3.8-13.9%). Variables positively associated with non-traumatic antecedents/precipitants at the 5% level of significance were male gender and non-ulcerative foot deformity for idiopathic acute soft tissue infection/ulcer; diabetes >5 years, previous infection either limb, insulin dependence and peripheral sensory neuropathy for chronic neuropathic ulcer and older age, diabetes >5 years, hypertension, non-palpable distal pulses and ankle-brachial index ≤0.4 for critical limb ischemia. CONCLUSIONS: Chronic neuropathic ulcer accounted for only 23.4 % of lower limb infections and 27.7% of amputations in this population of diabetics, making it the second most common antecedent of either after acute idiopathic soft tissue infection/ulcer at 30.5 and 34.7% respectively. Trauma as a group (defined as closed puncture wounds, lacerations, contusion/blunt trauma and burns) also accounted for a greater number of lower limb infections but fewer amputations than chronic neuropathic ulcer, at 32 and 19.5% respectively.

Asunto(s)

Amputación Quirúrgica/estadística & datos numéricos , Úlcera del Pie/cirugía , Infecciones/epidemiología , Extremidad Inferior/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Úlcera del Pie/complicaciones , Úlcera del Pie/epidemiología , Humanos , Incidencia , Infecciones/complicaciones , Jamaica/epidemiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Tiempo

RESUMEN

BACKGROUND: Diabetes mellitus 2 has become a global problem. It is estimated that 15% to 25% of patients could develop a chronic ulcer in their life, and nearly 33% of direct care costs of the diabetes mellitus 2 is spent on treating these ulcers. Mesenchymal stem cells have emerged as a promising cell source for the treatment of these ulcers. CLINICAL CASE: The case is presented of a 67 year-old male with a history of diabetes mellitus, acute myocardial infarction, and food ulcer chronic involving right foot and part of his leg. He was treated with mesenchymal stem cell management, resulting in skin graft integration and full coverage of the lesion. CONCLUSION: The implementation of mesenchymal stem cell techniques for treatment of chronic ulcer is feasible. The impact on the population would lead to a significant improvement in their quality of life and reduce healthcare spending.

Asunto(s)

Diabetes Mellitus Tipo 2/complicaciones , Pie Diabético/cirugía , Úlcera del Pie/cirugía , Úlcera de la Pierna/cirugía , Trasplante de Células Madre Mesenquimatosas , Trasplante de Piel , Anciano , Amputación Quirúrgica , Antibacterianos/uso terapéutico , Células de la Médula Ósea , Desbridamiento , Pie Diabético/etiología , Infecciones por Escherichia coli/tratamiento farmacológico , Infecciones por Escherichia coli/etiología , Infecciones por Escherichia coli/cirugía , Úlcera del Pie/etiología , Úlcera del Pie/microbiología , Humanos , Úlcera de la Pierna/etiología , Úlcera de la Pierna/microbiología , Masculino , Infecciones Cutáneas Estafilocócicas/tratamiento farmacológico , Infecciones Cutáneas Estafilocócicas/etiología , Infecciones Cutáneas Estafilocócicas/cirugía , Recolección de Tejidos y Órganos/métodos , Dedos del Pie/cirugía , Trasplante Autólogo , Infección de Heridas/etiología

RESUMEN

BACKGROUND: In recent years, first-line therapy for Mycobacterium ulcerans infection in French Guiana has consisted of antibiotics active against this organism. Two regimens are used comprising rifampicin associated with clarithromycin or amikacin. PATIENTS AND METHODS: We describe four patients presenting apparent worsening of their lesions during treatment: ulceration of a nodular lesion in a 32-year-old woman and worsening of an ulcerated lesion in three patients aged 16, 27 and 79 years. DISCUSSION: In these 4 patients, we concluded that the symptoms were caused by a paradoxical response or a reaction, a phenomenon already described in tuberculosis and leprosy. Such worsening is transient and must not be misinterpreted as failure to respond to treatment. The most plausible pathophysiological hypothesis involves the re-emergence of potentially necrotizing cellular immunity secondary to the loss of mycolactone, a necrotizing and immunosuppressive toxin produced by M. ulcerans, resulting from the action of the antibiotics.

Asunto(s)

Amicacina/efectos adversos , Antibacterianos/efectos adversos , Úlcera de Buruli/tratamiento farmacológico , Claritromicina/efectos adversos , Rifampin/efectos adversos , Adolescente , Adulto , Anciano , Amicacina/administración & dosificación , Amicacina/farmacología , Amicacina/uso terapéutico , Antibacterianos/administración & dosificación , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Asia/etnología , Brasil/etnología , Úlcera de Buruli/patología , Úlcera de Buruli/cirugía , Claritromicina/administración & dosificación , Claritromicina/farmacología , Claritromicina/uso terapéutico , Terapia Combinada , Desbridamiento , Quimioterapia Combinada , Europa (Continente)/etnología , Femenino , Úlcera del Pie/tratamiento farmacológico , Úlcera del Pie/etiología , Úlcera del Pie/cirugía , Guyana Francesa , Humanos , Inmunidad Celular/efectos de los fármacos , Macrólidos/metabolismo , Masculino , Mycobacterium ulcerans/efectos de los fármacos , Mycobacterium ulcerans/metabolismo , Rifampin/administración & dosificación , Rifampin/farmacología , Rifampin/uso terapéutico , Cicatrización de Heridas

RESUMEN

OBJECTIVE: To determine whether regional variation in the rate of lower-extremity amputation (LEA) is associated with health behaviors. RESEARCH DESIGN AND METHODS: This was a cross-sectional prevalence study of merged data from the U.S. Census, Medicare parts A and B, and the Behavioral Risk Factor Surveillance System. We used regression models to determine whether previously described regional variation in LEA incidence was associated with responses to the Behavioral Risk Factor Surveillance System. Regions were created using Dartmouth Atlas Health Referral Regions. RESULTS: The mean and median incidence of LEA was 4.5 per 1,000 persons with diabetes; the rate varied from 2.4 to 7.9 LEA per 1,000 persons by health referral region. Statistically significant inverse associations were found between LEA and the rate of patients reporting colorectal screening (P < 0.0001) or the participation in diabetes management classes (P = 0.018). Most other factors, including daily foot evaluations, were not associated with a decreased risk of LEA. These findings were also found to be associated with geographically clustered regions known for increased risk of LEA. CONCLUSIONS: LEA is known to vary by region in the U.S., and regions with higher rates of LEA tend to be clustered together. Some of this variation may be explained by health behaviors in those regions, such as attending diabetes education classes or better health prevention habits (e.g., colon cancer screening). It should be possible to prevent unwanted LEAs by educating individuals with diabetes and foot ulcers about the need for participation in foot ulcer treatment.

Asunto(s)

Amputación Quirúrgica/estadística & datos numéricos , Sistema de Vigilancia de Factor de Riesgo Conductual , Conductas Relacionadas con la Salud , Extremidad Inferior/cirugía , Asunción de Riesgos , Anciano , Estudios Transversales , Diabetes Mellitus/epidemiología , Diabetes Mellitus/cirugía , Pie Diabético/epidemiología , Pie Diabético/cirugía , Femenino , Úlcera del Pie/epidemiología , Úlcera del Pie/cirugía , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Prevalencia , Estados Unidos/epidemiología

RESUMEN

Raynaud, digital ulcers and calcinosis are frequent manifestations of patients with systemic sclerosis. Digital ulcers are seen in more than half of the patients with scleroderma. Hospitalizations, ischemic complications and impairment of hand function are frequently observed in patients with digital ulcers, especially if treatment is delayed. Rapid and intensive treatment escalation in patients with scleroderma and refractory Raynaud's phenomenon is one of the most effective preventive action available in order to avoid the development of digital ulcers and tissue loss.

Asunto(s)

Calcinosis/etiología , Enfermedad de Raynaud/etiología , Esclerodermia Sistémica/complicaciones , Úlcera Cutánea/etiología , Bosentán , Calcinosis/tratamiento farmacológico , Calcinosis/fisiopatología , Hipoxia de la Célula , Terapia Combinada , Endotelina-1/fisiología , Endotelio Vascular/patología , Endotelio Vascular/fisiopatología , Dedos/irrigación sanguínea , Dedos/patología , Úlcera del Pie/tratamiento farmacológico , Úlcera del Pie/etiología , Úlcera del Pie/fisiopatología , Úlcera del Pie/cirugía , Humanos , Isquemia/tratamiento farmacológico , Isquemia/etiología , Isquemia/fisiopatología , Isquemia/prevención & control , Estudios Multicéntricos como Asunto , Agregación Plaquetaria , Inhibidores de Agregación Plaquetaria/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto , Enfermedad de Raynaud/diagnóstico , Enfermedad de Raynaud/tratamiento farmacológico , Enfermedad de Raynaud/terapia , Esclerodermia Sistémica/diagnóstico , Esclerodermia Sistémica/tratamiento farmacológico , Esclerodermia Sistémica/fisiopatología , Úlcera Cutánea/tratamiento farmacológico , Úlcera Cutánea/fisiopatología , Úlcera Cutánea/cirugía , Sulfonamidas/uso terapéutico , Trombofilia/etiología , Trombosis/etiología , Trombosis/prevención & control , Dedos del Pie/irrigación sanguínea , Dedos del Pie/patología , Vasoconstricción/fisiología , Vasodilatadores/uso terapéutico

RESUMEN

Background: An adequate reconstruction of foot soft tissue, specially in the sole, is crucial to restore functional capacity. Aim: To report the experience with reconstruction of sole soft tissues. Material and Methods: Retrospective analysis of 12 patients aged 19 to 72 years (seven males), subjected to reconstruction of soft tissue defects in the sole. Results: The lesions were secondary to excisions of malignant melanomas in seven patients, old traumatisms in two patients, a burn lesion in one patient and a diabetic ulcer in one patient. The reconstruction techniques used were skin grafts in one patient, local flaps in eight and free flaps in three patients. Five patients experienced complications and one of these required a new reconstructive surgery. Functional recovery was adequate in 11 patients. Conclusions: Reconstructive surgery of the sole can achieve an adequate functional recovery in most operated patients.

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Se presenta una casuística de 12 pacientes que requirieron reconstrucción de la planta del pie en el Hospital de la Universidad Católica entre los años 2005 y 2008. La etiología principal fueron lesiones tumorales en 7 casos; las técnicas de reconstrucción fueron: injerto de piel (1 paciente), colgajos locales (8 pacientes) y colgajos libres (3 pacientes). Hubo complicaciones en 5 pacientes, uno de los cuales requirió una nueva cirugía reconstructiva. La recuperación funcional fue adecuada en 11 de los 12 pacientes.

Asunto(s)

Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Enfermedades del Pie/cirugía , Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos , Traumatismos de los Tejidos Blandos/cirugía , Melanoma/cirugía , Neoplasias Cutáneas/cirugía , Complicaciones Posoperatorias , Quemaduras/cirugía , Recuperación de la Función , Estudios Retrospectivos , Rabdomiosarcoma/cirugía , Trasplante de Piel , Úlcera del Pie/cirugía

RESUMEN

PURPOSE: Propose a new and alternative surgical procedure in order to aid on treatments of chronic ulcers with non-arterial etiology in the lower limbs, especially those that reoccurs and accomplish of dermatosclerosis and skin contractures determining ankle and foot limits. METHODS: It describes a medical case regarding a female, 54 years old, with a pre-existing ulcer (sixteen years) on her left leg. Despite of conventional treatments such as curatives, compressive therapy and surgeries, the ulcer on her leg was not cured for three years. The skin dermatosclerosis on her foot and ankle limited her mobility tremendously. The surgery involved the debridement of the ulcers, local phlebectomies and the correction of her scar contraction by a transversal escharotomies. Conventional procedures were applied in pre and post-surgery. RESULTS: After twelve weeks, the ulcer was completely healed by second intention. Despite the odds, she regained sustainable mobility in her foot and ankle, allowing this patient to wear medical elastic socks. Reoccurrences of the ulcer did not occur during the two years post-surgery. CONCLUSION: The transversal escharotomies may favor the healing of non-arterial chronic ulcers in the lower limbs, impeding perpetual mechanisms of this sort. For example, the ankle and foot limitation determinates in secondary scars, skin contractures, dermatosclerosis that produce the failure in the muscular calf-pump with deterioration in the ascending venous propulsion.(AU)

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OBJETIVO: Apresentar uma nova alternativa cirúrgica para auxiliar o tratamento de úlceras crônicas de etiologia não arterial em membros inferiores, especialmente aquelas com recidivas e complicadas por contraturas de pele, limitando movimentos do pé e tornozelo. MÉTODOS: Descrição de caso de uma paciente portadora de úlcera em perna esquerda com dezesseis anos de evolução, múltiplas recidivas, sem cicatrização há três anos apesar de curativos convencionais, terapias compressivas e cirurgias. As contraturas cicatriciais e a dermatoesclerose local limitavam a marcha pela redução da mobilidade do pé e tornozelo. A cirurgia realizada foi o debridamento tangencial da úlcera, flebectomias locais e a correção das contraturas de pele por meio das escarotomias transversais. Após a cirurgia foram mantidos os mesmos padrões de curativos e a terapia compressiva utilizada no pré-operatório. RESULTADOS: Houve cicatrização completa da úlcera, por segunda intenção, doze semanas após a cirurgia com ganho importante na amplitude dos movimentos do pé e tornozelo, permitindo normalização da marcha e adaptação ao uso de meias elásticas terapêuticas. Não houve recidiva em dois anos de acompanhamento pós-operatório. CONCLUSÃO: Esta técnica parece favorecer a cicatrização de úlceras crônicas de etiologia não arterial atuando em mecanismos perpetuadores do processo, como, por exemplo, a limitação da propulsão venosa pela musculatura da panturrilha determinada por contraturas cicatriciais e pela dermatoesclerose do pé e tornozelo.(AU)

Asunto(s)

Humanos , Enfermedades de la Piel/terapia , Enfermedades de la Piel/cirugía , Úlcera del Pie/terapia , Úlcera del Pie/cirugía , Cicatrización de Heridas/fisiología , Procedimientos Quirúrgicos Operativos/métodos

RESUMEN

Revisar las técnicas quirúrgicas realizadas en el mal perforante plantar y valorar los resultados de las mismas. Se realizó una investigación bibliográfica de las distintas técnicas quirúrgicas, que se realizan en el mal perforante plantar. Estas técnicas se agrupan, en la forma de actuar en relación a la úlcera, directas cuando se actúa sobre la úlcera o sobre tejidos vecinos e indirectas cuando no se actúa sobre la úlcera, ni sobre tejidos vecinos, pero se actúa para curar la úlcera. Se comparan los resultados de las técnicas quirúrgicas más utilizadas, observando las variables de tiempo de curación y porciento de recidivas. Se concluye que las técnicas que provocan pseudoartrosis, son las que mejor resultado logran, como la ostectomía, artroplastia y osteotomía(AU)

Asunto(s)

Úlcera del Pie/cirugía , Diabetes Mellitus

RESUMEN

En el presente trabajo se realiza una revisión bibliográfica del tratamiento médico según la literatura revisada, y se compara con la técnica quirúrgica de la ostectomia. (AU)

Asunto(s)

Humanos , Masculino , Femenino , Úlcera del Pie/cirugía

RESUMEN

In the neurologically impaired foot pressure ulcers are common. Pressure point reduction must always be addressed. Most ulcers, perhaps with the exception of huge heel ulcers, will heal by secondary intention if treated conservatively in the right manner. However, conservative treatment can be very time consuming and might sometimes leave unstable scars. For those with recurrent ulcers, the time taken off work to heal these ulcers can be economically debilitating. Skin grafting and flep coverage can be rewarding in selected cases. Follow up with proper footwear is of uttermost importance. Soft tissue coverage can only occur when all signs of infection have resolved and the foot has an adequate blood supply.

Asunto(s)

Humanos , Articulación del Dedo del Pie/anomalías , Articulación del Dedo del Pie/cirugía , Articulación del Dedo del Pie/fisiopatología , Pie/anatomía & histología , Pie/crecimiento & desarrollo , Pie/fisiopatología , Úlcera del Pie/cirugía , Úlcera del Pie/diagnóstico , Úlcera del Pie/fisiopatología

RESUMEN

Treatment of wounds using conventional methods is frequently limited by inadequate local wound conditions, or by a poor systemic clinical situation. Vacuum system may promote faster granulation tissue formation, remove excessive exudate, increase blood flow in the wound, and attract the borders of the wound to the center, reducing its dimension. We present 3 cases of patients with difficult wounds, due to bad local conditions, or poor clinical situation, in whom we used a vacuum system to prepare the wound for the surgical closure. One patient had a pressure ulcer, another had a diabetic foot ulcer, and the third one had an open foot stump. In the 3 cases a significant improvement of the wound conditions was achieved after 7 to 8 days, allowing successful surgical treatment with flap or skin grafts.

Asunto(s)

Úlcera del Pie/terapia , Úlcera por Presión/terapia , Vacio , Cicatrización de Heridas , Anciano de 80 o más Años , Pie Diabético/cirugía , Pie Diabético/terapia , Femenino , Úlcera del Pie/cirugía , Humanos , Masculino , Persona de Mediana Edad , Úlcera por Presión/cirugía , Región Sacrococcígea

RESUMEN

Treatment of wounds using conventional methods is frequently limited by inadequate local wound conditions, or by a poor systemic clinical situation. Vacuum system may promote faster granulation tissue formation, remove excessive exudate, increase blood flow in the wound, and attract the borders of the wound to the center, reducing its dimension. We present 3 cases of patients with difficult wounds, due to bad local conditions, or poor clinical situation, in whom we used a vacuum system to prepare the wound for the surgical closure. One patient had a pressure ulcer, another had a diabetic foot ulcer, and the third one had an open foot stump. In the 3 cases a significant improvement of the wound conditions was achieved after 7 to 8 days, allowing successful surgical treatment with flap or skin grafts

Asunto(s)

Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Úlcera del Pie/terapia , Úlcera por Presión/terapia , Vacio , Cicatrización de Heridas , Pie Diabético/cirugía , Pie Diabético/terapia , Úlcera del Pie/cirugía , Úlcera por Presión/cirugía , Región Sacrococcígea

Asunto(s)

Lepra/cirugía , Lepra/complicaciones , Lepra/prevención & control , Lepra/rehabilitación , Cirugía General , Úlcera del Pie/cirugía , Úlcera del Pie/prevención & control , Úlcera del Pie/rehabilitación

RESUMEN

Recurrent plantar ulceration is a common and serious complication occuring consequent to impairment of the tibial nerve in leprosy patients. In spite of many therapies and long therapeutic course, it is extremely difficult to abolish this complication in many cases because of extensive skin and soft tissue cushion loss due to repeated infection. Since the early 70 we have been using microscopic surgical techniques to reconstruct the ulcerated area using eight types of the flaps. In this series of papers we review out experience. Post operatively, the flapes survived in all cases, the long term results have proved satisfactory, and recurrent ulceration occurred in only three patients

Asunto(s)

Humanos , Lepra/cirugía , Lepra/rehabilitación , Úlcera del Pie/cirugía , Úlcera del Pie/diagnóstico , Úlcera del Pie/rehabilitación

RESUMEN

The first toe web flap consists of th skin and subcutaneous tissues of the contiguous sides between the great and second toes. It is based on the first dorsal metatarsal artery or the common plantar digital artery. This flap was used as artery pedicled island graft to reconstruct losses of skin and soft tissue cushion in the ball of the foot in the first and second metatarsal head region in 16 cases. Follow up examination revealed that ulceration had recurred in one case due to dehiscence of the flap margin 12 months post operatively. The other 15 patients have done well without recurrence at 48 to 124 months follow up examination. The dorsal flap of the foot based on the dorsalis pedis artery, the corresponding veins and the deep peroneal nerve was designed in 1974 to resurface skin and soft tissue defects in the sole of the foot. This flap was used in 30 cases of leprosy with excellent results. During follow up 36 to 120 months after surgery the plantar ulcer had recurred in only one case. All the orthers have done well. The long term curative effect has thus proved satisfactory

Asunto(s)

Masculino , Femenino , Humanos , Lepra/cirugía , Úlcera del Pie/cirugía