31/95. Cohesive short stretch bandages in the treatment of venous leg ulceration. These two case studies report how a cohesive short-stretch bandage was employed to promote venous leg ulcer healing. The two patients were obese and in addition had champagne bottle shaped legs. The cohesive short-stretch bandage was applied following the shape of the leg. By using a cohesive short-stretch bandage this provided bandage stability. This sustained compression resulted in oedema and pain reduction and promoted wound healing. ( info) |
| Venous ulcers are the most common type of leg ulcers, accounting for 80% to 90% of cases. We report a large, therapy-resistant ulcer present for three months on the right leg of a 44-year-old woman who also had a huge uterine myoma. Without any other treatment, the leg ulcer regressed spontaneously three months after a hysterectomy for the uterine myoma that had been demonstrated in a CT image to be compressing the right common iliac vein in the pelvis. Uterine myoma can become the cause of venous insufficiency of the leg, when it is big enough to disturb the blood circulation in the pelvis in individuals who have incompetent perforating veins. ( info) |
33/95. Use of a pedicled fascial flap based on septocutaneous perforators of the posterior tibial artery for repair of distal lower limb defects. A distally based fascial flap raised on perforating vessels of the posterior tibial artery is described. Its successful application in the repair of distal soft tissue defects of the lower limb in two patients is reported. ( info) |
| A 34-year-old male patient was referred with a recalcitrant leg ulcer overlying an extensive vascular malformation, which had led several times to septic soft tissue infections. During his infancy he had been diagnosed to have Klippel-Trenaunay syndrome. Clinical examination revealed asymmetric hypertrophy of the lower extremities, an extensive portwine stain on the more severely affected left limb as well as prominent venous varicosities of both legs. Hands and feet showed striking cerebriform palmoplantar hypertrophy, and macrodactily with syndactily of several fingers. All toes had been amputated in early childhood due to extreme overgrowth and currently the patient walked on his forefeet in a prominent pes equinus deformity. Further symptoms consisted in several lipomas at both arms, another portwine stain at the left hemithorax and a single cafe-au-lait spot at the left scapula. Angio-magnetic resonance imaging scans of both legs showed an extensive venous-lymphatic vascular malformation involving the whole subcutis and infiltrating the muscle. The chronic wound was interpreted as venous stasis ulceration. Local percutaneous sclerotherapy of the dilated veins underneath the ulcer was discussed, but considered to carry a relevant risk of skin necrosis with consecutive progression of the wound. A conventional split-skin graft led to complete wound healing. Since, the patient consequently wears custom-made compression stockings and remained free from recurrences. The syndromatic constellation of palmoplantar overgrowth, multiple lipomas, giant fingers and toes, limb overgrowth, venous-lymphatic malformation and a cafe-au-lait spot led to the diagnosis of proteus syndrome. The possible aetiology, clinical manifestations, differential diagnosis and management of this rare disorder are discussed. ( info) |
35/95. fibrinogen adsorption--a new treatment option for venous leg ulcers? The initial element in the causation of venous ulceration is a disturbance of venous blood flow that leads to an increase in venous pressure. Eventually, however, it is the microcirculatory consequences of venous hypertension that lead to trophic skin changes and finally to ulceration. A reduction in blood viscosity results in an improvement at the microcirculatory level. The elimination of fibrinogen from plasma improves blood viscosity. This case report concerns a 75-year-old woman with venous ulcers of both legs (left lower leg: deep ulceration with a surface area of 3 x 5 cm; right lower leg: superficial, confluent ulceration with a total surface area of 5 x 10 cm). The patient underwent 20 sessions of fibrinogen adsorption, while simultaneously continuing with a regimen of conservative measures (activated charcoal cloth dressing with silver, calcium alginate dressings and short-stretch compression bandages). Following binding to a peptide (Gly-Pro-Arg-Pro-Lys), fibrinogen and fibrin were specifically removed from the patient's plasma: her fibrinogen concentration was lowered from an original mean level of 310 mg/dl (SD /- 104 mg/dl) to 136 mg/dl (SD /- 54 mg/dl), and there was no return to the baseline concentration by the time of the next fibrinogen adsorption session. In response to this treatment the patient's ulcers healed rapidly within 9 weeks. dizziness and hematomas at the vascular access sites in both antecubital fossae were reported as adverse effects. A fall in hematocrit was also noted (before treatment 37% /- 1%; after treatment 35% /- 2%). This may have been caused by hemodilution due to the procedure and to cell losses during blood-plasma separation, a phenomenon that is known to occur during apheresis. This case report suggests that fibrinogen adsorption is low in adverse effects and is a useful addition to the range of treatments available for ulcers of venous etiology. ( info) |
36/95. acupuncture for chronic venous ulceration. acupuncture was used to treat a 69-year-old man for bilateral ankle pain related to his rheumatoid arthritis. This led to a dramatic improvement in one of his chronic venous leg ulcers. There is very little recent literature on such cases, where acupuncture may be a useful additional treatment. ( info) |
37/95. A non-adhesive foam dressing for exuding venous leg ulcers and pressure ulcers: six case studies. Six patients had their wounds dressed with 3M Foam Dressing, a highly absorbent polyurethane foam covered with a breathable layer, for up to four weeks. The dressing was assessed for its effect on the wound and patient comfort, with promising results. ( info) |
38/95. Promogran and complex surgical lesions: a case report. Surgical excision of a venous malformation on a young girl's thigh left a large and deep ulcerative wound. Treatment of the lesion with Promogran dressings suited this patient's specific needs and produced substantial healing within five weeks. ( info) |
39/95. An ideal and versatile material for soft-tissue coverage: experiences with most modifications of the anterolateral thigh flap. Free anterolateral thigh flaps are a popular flap used for the reconstruction of various soft-tissue defects. From April, 2002 to June, 2003, 32 free anterolateral thigh flaps were used to reconstruct soft-tissue defects. Twenty-three of these flaps were used for lower extremity reconstruction, and nine were used for head and neck reconstruction. There were 24 male and eight female patients, with ages between nine and 82 years. The size of the flaps ranged from 11 to 32 cm in length and 6 to 18 cm in width. Five flaps required reoperation for vascular compromise in four patients and for twisting of the pedicle in another patient. While four of these were salvaged, one flap was lost due to recipient vessel problems. Musculocutaneous perforators were found in 23 cases, and septocutaneous perforators were found in nine cases. In four cases, thinning of the flap was performed. The flap was used as a flow-through type for lower extremity reconstruction in three patients. In two patients, the flap was used as a neurosensory type for foot reconstruction. Eighteen cases underwent split-thickness skin grafting of the donor site and, in the remaining cases, the donor sites were closed primarily. In three patients, the donor areas required a partial skin regrafting procedure. No infections or hematomas were observed. Despite some variations in its vascular anatomy, the anterolateral thigh flap offers the following advantages: 1) it has a long and large-caliber vascular pedicle; 2) it has a wide, reliable skin paddle; 3) it may be harvested as a neurosensory flap; 4) it can be harvested whether its pedicle is septocutaneous or musculocutaneous; 5) it can be designed as a flow-through flap; 6) it can be elevated as a thin or musculocutaneous flap; and 7) the procedure can be performed by two teams working simultaneously, and no positional changes are required. ( info) |
40/95. Successful treatment of stasis dermatitis with topical tacrolimus. Stasis dermatitis is a common dermatologic disorder as a consequence of impaired venous drainage and often accompanied by chronic leg ulcers. Until today the standard in acute therapy represents the topical administration of highly potent corticosteroids and if possible a consequent long-term compression therapy. The macrolide tacrolimus represents a new selective inflammatory cytokine release inhibitor by binding to macrophilin-12 and inhibiting calcineurin. Beside the resulting anti-inflammation and immunosuppression an antipruritic effect have been discussed as further clinical benefits of tacrolimus. Here we report for the first time about a 81-year old patient suffering from an ulcus cruris mixtum and stasis dermatitis treated with topical 0.1% tacrolimus ointment twice daily for 5 days. Until now tacrolimus is available for topical treatment as a fatty ointment only. Although we would have preferred a more hydrophilic base for treatment of acute stasis dermatitis we achieved complete healing. As this is only a case report about one single patient further clinical investigations are needed to confirm this observation in more individuals with stasis dermatitis. ( info) |