Application of Artificial Dermis Combined With a Medial Flap From the Second Toe to Repair Degloving Injury of the Fingertip.

There is no standard technique for repairing degloving injuries of the fingertip. Nail bed flap transplantation is a common surgical technique to address this injury, but this procedure inevitably damages the donor site in the toe. This article describes a surgical technique that can restore the appearance of the injured fingernail and preserve the length and function of the injured finger without damaging the toenail.

Immediate foot reconstruction and revascularization of toes using an interposition superficial circumflex iliac artery perforator flow-through flap: A case report.

Foot injuries, particularly degloving injuries, can lead to segmental loss of neurovascular structures in the toes, making simultaneous reconstruction of both the foot and toes challenging. This case report presents a technique using the superficial circumflex iliac artery perforator (SCIP) flap for immediate reconstruction of the dorsal foot and revascularization of multiple toes. A 28-year-old man suffered a degloving injury on the dorsum of his foot resulting in a 9 × 6cm skin defect, open fracture dislocations, exposure of tendons, and neurovascular injury, which included a 6-7.5 cm segmental defect of the vessels supplying the first, second, and third toes leaving all three toes ischemic. Immediate reconstruction was performed by harvesting a 12.5 × 5cm SCIP flap including both the superficial and deep branches and incorporating the superficial inferior epigastric vein (SIEV). The SCIP deep branch was used to revascularize the third and second toes and the SIEV vein graft used for the first toe. The patient recovered well, no complications were observed at the 2-year follow-up, preserving all three toes and regaining mobility. The use of the SCIP flap as a flow-through flap provides thin skin flap cover, good vessel caliber size match with digital vessels and reduces the need for vein grafts from distant sites improving surgical efficiency. These attributes make the flow-through interposition SCIP flap an excellent choice for reconstructing foot defects and revascularizing toes. We report this case to demonstrate the utility of the SCIP flap in immediate soft tissue cover and digit revascularization.

Honey dressing for penile skin avulsion caused by traditional circumcision: a case report.

OBJECTIVE: Penile skin avulsion is a rare complication of circumcision but commonly encountered as the result of traditional practice. We aimed to present the use of honey dressing and the benefit of its wound healing properties for management of such a complex wound. CASE: A 24-year-old male patient with penile bleeding presented to the emergency department after undergoing traditional circumcision. Complete degloving of the penis with active bleeding and foul odour, along with heavy contamination of chewed betel leaves and powdered amoxicillin was found. Honey (Madu Nusantara, PT. Madu Nusantara, Indonesia) was used as dressing after copious irrigation using saline and povidone-iodine with bleeding control. RESULTS: Honey dressing was shown to be effective for secondary wound healing of such a complicated and contaminated wound-in this case due to its antimicrobial, anti-inflammatory, immunostimulatory and autolytic debridement properties. A complete re-epithelialisation of the wound was achieved without progression to the hard-to-heal state by day 43. Suboptimal sexual function and aesthetic result due to wound contracture were observed as surgical reconstruction via split-thickness skin graft was refused due to cost. CONCLUSION: In this case report, honey dressing was shown to be effective for wound healing, even in a penile avulsion with complete skin loss and heavy contamination. In rural settings, where penile avulsion due to traditional circumcision is common, honey should be considered as one of the dressing choices.

Synergistic clinical application of synthetic electrospun fiber wound matrix in the management of a complex traumatic wound: degloving left groin and thigh auger injury.

BACKGROUND: Managing complex traumatic soft tissue wounds involving a large surface area while attempting to optimize healing, avoid infection, and promote favorable cosmetic outcomes is challenging. Regenerative materials such as ECMs are typically used in wound care to enhance the wound healing response and proliferative phase of tissue formation. CASE REPORT: The case reported herein is an example of the efficacious use of an SEFM in the surgical management of a large complex traumatic wound involving the left lower extremity and lower abdominal region. The wound bed was successfully prepared for skin grafting over an area of 1200 cm2, making this among the largest applications of the SEFM reported in the literature. CONCLUSION: This case report demonstrates the clinical versatility of the SEFM and a synergistic approach to complex traumatic wound care. The SEFM was successfully used to achieve tissue granulation for a successful skin graft across a large surface in an anatomic region with complex topography.

Management of a large traumatic hemipelvectomy defect following a truck crush injury: a case report.

This case report explores the management of a traumatic hemipelvectomy-a rare and devastating injury characterized by a high mortality rate. The patient, a 12-year-old male, suffered right lower extremity amputation and right hemipelvectomy due to a deglov-ing injury from a non-vehicle-related accident at another institution. Initially, an urgent reconstruction of the right pelvic region and suprapubic tissue defects was performed using a posterior-based fasciocutaneous flap. Following this, the patient was transferred to the pediatric intensive care unit at our hospital with a suspected diagnosis of necrotizing fasciitis. Treatment included broad spectrum antibiotics and multiple debridements to avert the onset of sepsis. Eventually, reconstruction of a 60 x 25 cm defect covering the lower back, abdomen, gluteal, and pubic regions was achieved through serial split-thickness skin grafts and a pedicled anterolateral thigh flap. The patient made a remarkable recovery, regained mobility with the aid of a walker, and was discharged in good health 22 weeks after the initial accident. This case report underscores the importance of serial debridements in preventing sepsis, the use of negative pres-sure vacuum dressing changes, the initiation of broad-spectrum antibiotics based on culture results during debridements, and prompt closure of the defect to ensure survival after traumatic hemipelvectomy. Familiarization with the principles discussed here is crucial to minimizing mortality rates and optimizing outcomes for this rare injury.

Post-operative osteopathic manipulative treatment of Morel-Lavallee syndrome assessed using infrared thermal imaging: A case report.

INTRODUCTION: The Morel-Lavallee lesion (MLL) is a closed, degloving soft-tissue injury, wherein the skin and subcutaneous tissue are separated from the underlying fascia. This syndrome causes disruption of wound healing. Infrared thermography is a noninvasive and pain-free tool that can be used to evaluate scar and the influence of osteopathic manipulative treatment. OBJECTIVE: To evaluate the influence of post-operative osteopathic manipulative treatment (OMT) of Morel-Lavallee lesions (MLL). METHODS: During four osteopathic sessions on one volunteer patient, 28-year-old male, resulting in MLL of the left knee after motorcycle accident. The effects of OMT were assessed using an infrared thermal imaging camera and qualitative palpation examination of osteopathic dysfunction, scored on a scale of 1-4. RESULTS: and discussion: Both scar and peri-scar area temperatures increased after OMT. The difference in temperature between the scar and the peri-scar area decreased after OMT. Increase in temperature was greater when the OMT was applied around the scar than when applied at a distance from the scar site. The palpation score for dysfunction of the MLL scar site decreased from 4/4 to 2/4 after the final session. CONCLUSION: Several OMT sessions focusing on the MLL scar site appear necessary to obtain noteworthy results. OMT improved mobility and increased the temperature of the scar and the peri-scar area.

Mid-term prognosis of endoscopic debridement combined with percutaneous cutaneo-fascial suture for the treatment of Morel-Lavallée lesion: a minimum 3-year follow-up study.

PURPOSE: Morel-Lavallée lesion (MLL) is a closed soft-tissue degloving injurie resulting from shear forces. With the advent of endoscopic technology and advancements in surgical techniques, innovative solutions are now available. However, there are few data on mid-term results after treatment of MLL, especially regarding arthroscopic method. The objective of this study is to evaluate the clinical outcomes of endoscopic debridement combined with percutaneous cutaneo-fascial suture in treating MLL. METHODS: A single-center retrospective study was conducted at a university teaching hospital investigating patients who underwent arthroscopic management of Morel-Lavallée lesion between 2014 and 2020.Patient demographics, postoperative recovery time, peri- and postoperative complications were investigated. Mid-term follow up clinical and radiological examinations were performed. RESULTS: The retrospective study included 38 patients aged between 11 and 90 years, with an average age of 50.9 ± 16.9 years. These patients waited an average of 36.6±23.5days to return to work after operation. The average time to follow-up was from 3 to 9 years, averaging 5.0 ± 1.8 years. At the end of follow-up, only one complication of superficial skin necrosis occurred, accounting for 2.6%. The imaging assessment at the final follow-up indicated improvement over the postoperative period for all 38patients. CONCLUSION: In mid-term experience, endoscopic debridement combined with percutaneous cutaneo-fascial suture for MLL management is a safe and effective option.

Lesiones cutáneas específicas en pacientes con neurosarcoidosis / Specific Cutaneous Lesions in Patients With Neurosarcoidosis

La sarcoidosis del sistema nervioso (neurosarcoidosis [NS]) es poco frecuente, pero puede ser grave y producir secuelas importantes. Analizamos los tipos de lesión cutánea específica en pacientes con NS y su utilidad para el diagnóstico de la enfermedad. De un total de 58, 16 presentaron lesiones cutáneas específicas (27,6%). De ellos, 14 eran mujeres y dos varones (edad mediana 50 años [rango 20-84]), que presentaron 24 tipos de lesiones neurológicas (siete neuropatía craneal, cuatro parenquimatosa, tres meníngea, tres mielopatía, uno hipofisaria, dos hidrocefalia y cuatro neuropatía periférica) y 20 lesiones cutáneas específicas (seis máculo-pápulas, nueve placas, uno lupus pernio y cuatro sarcoidosis de las cicatrices [dos pacientes con máculo-pápulas y dos con placas presentaron también sarcoidosis de las cicatrices]. Las lesiones cutáneas estaban presentes al diagnóstico de la NS en 13 casos. Ante la sospecha de esta enfermedad hay que descartar la presencia de lesiones cutáneas específicas cuya biopsia puede acelerar el diagnóstico. (AU)

Neurosarcoidosis is an uncommon but potentially serious disease of the central nervous system that can cause major sequelae. We analyzed the presence and diagnostic usefulness of specific cutaneous lesions in 58 patients with neurosarcoidosis. Sixteen patients (27.6%) had specific cutaneous lesions (14 men and 2 women; mean age, 50 years [range, 20-84 years]). Twenty-four types of neurological lesions were observed: cranial neuropathy (n=7), parenchymal lesions (n=4), meningeal lesions (n=3), myelopathy (n=3), pituitary lesions (n=1), hydrocephalus (n=2), and peripheral neuropathy (n=4). Twenty types of specific cutaneous lesions were observed: maculopapular lesions (n=6), plaques (n=9), lupus pernio (n=1), and scar sarcoidosis (n=4). These last lesions coexisted with maculopapular lesions in 2 patients and plaques in another 2. Specific cutaneous lesions were present at diagnosis of neurosarcoidosis in 13 patients. Recognition of specific cutaneous lesions in a patient with suspected neurosarcoidosis is important as biopsy can accelerate diagnosis. (AU)

[Translated article] Specific Cutaneous Lesions in Patients With Neurosarcoidosis / Lesiones cutáneas específicas en pacientes con neurosarcoidosis

Neurosarcoidosis is an uncommon but potentially serious disease of the central nervous system that can cause major sequelae. We analyzed the presence and diagnostic usefulness of specific cutaneous lesions in 58 patients with neurosarcoidosis. Sixteen patients (27.6%) had specific cutaneous lesions (14 men and 2 women; mean age, 50 years [range, 20-84 years]). Twenty-four types of neurological lesions were observed: cranial neuropathy (n=7), parenchymal lesions (n=4), meningeal lesions (n=3), myelopathy (n=3), pituitary lesions (n=1), hydrocephalus (n=2), and peripheral neuropathy (n=4). Twenty types of specific cutaneous lesions were observed: maculopapular lesions (n=6), plaques (n=9), lupus pernio (n=1), and scar sarcoidosis (n=4). These last lesions coexisted with maculopapular lesions in 2 patients and plaques in another 2. Specific cutaneous lesions were present at diagnosis of neurosarcoidosis in 13 patients. Recognition of specific cutaneous lesions in a patient with suspected neurosarcoidosis is important as biopsy can accelerate diagnosis. (AU)

La sarcoidosis del sistema nervioso (neurosarcoidosis [NS]) es poco frecuente, pero puede ser grave y producir secuelas importantes. Analizamos los tipos de lesión cutánea específica en pacientes con NS y su utilidad para el diagnóstico de la enfermedad. De un total de 58, 16 presentaron lesiones cutáneas específicas (27,6%). De ellos, 14 eran mujeres y dos varones (edad mediana 50 años [rango 20-84]), que presentaron 24 tipos de lesiones neurológicas (siete neuropatía craneal, cuatro parenquimatosa, tres meníngea, tres mielopatía, uno hipofisaria, dos hidrocefalia y cuatro neuropatía periférica) y 20 lesiones cutáneas específicas (seis máculo-pápulas, nueve placas, uno lupus pernio y cuatro sarcoidosis de las cicatrices [dos pacientes con máculo-pápulas y dos con placas presentaron también sarcoidosis de las cicatrices]. Las lesiones cutáneas estaban presentes al diagnóstico de la NS en 13 casos. Ante la sospecha de esta enfermedad hay que descartar la presencia de lesiones cutáneas específicas cuya biopsia puede acelerar el diagnóstico. (AU)

Prevalencia de las lesiones cutáneas relacionadas con la dependencia en residencias de mayores y centros sociosanitarios de España: resultados del 6º Estudio Nacional del GNEAUPP 2022 / Prevalence of dependence-related skin lesions in nursing home in Spain: Results of the 6th GNEAUPP National Study 2022

Objetivos: Obtener las cifras de prevalencia de las lesiones cutáneasrelacionadas con la dependencia en centros residenciales para mayores ycentros sociosanitarios españoles. Analizar las características demográficasy clínicas de las personas con lesiones cutáneas relacionadas con ladependencia y de las lesiones. Metodología: Estudio observacional,transversal, tipo encuesta epidemiológica (6.º Estudio Nacional dePrevalencia), dirigido a todas las residencias y centros sociosanitariosde España. Recogida de datos mediante formulario seguro online.Variables: características de los hospitales y de las unidades, pacientesingresados, pacientes con cada tipo de lesiones cutáneas relacionadascon la dependencia, clasificación de las lesiones. Se estimó la prevalenciacruda global y ajustada por hospitales y por tipo de unidades. Resultados:Se han obtenido datos de 74 centros sociosanitarios y residencias demayores. Solo un 9,5% de los centros declararon no tener ningunapersona con lesiones cutáneas relacionadas con la dependencia atendidaen el momento de obtener los datos. La prevalencia global de lesionescutáneas relacionadas con la dependencia fue del 9,28% (IC95%,5,45-6,71), un 3% más que en el anterior. Las cifras de prevalencia decada tipo de lesión fueron: presión, 6,05%; humedad, 2,35%; fricción,1,35%; desgarros cutáneos, 2,38%, y combinadas, 0,61%. Esto suponeun incremento en todas las lesiones menos las combinadas. La prevalenciade todas las lesiones cutáneas relacionadas con la dependencia fue mayoren los centros públicos que en los concertados y privados. En un 85,2%,las lesiones cutáneas relacionadas con la dependencia eran de origennosocomial (originadas en la residencia u otra institución residencial)y solo un 10,9% se originaron en los domicilios. (AU)

Objectives: To obtain the prevalence figures ofdependence-related skin lesions (DRSL) in Spanish nursinghomes and long term care centres (NH-LTCC). To analysethe demographic and clinical characteristics of peoplewith DRSL and lesions. Methodology: Observational,cross-sectional, epidemiological survey-type study (6thNational Prevalence Study), aimed at all NHC-LTCC inSpain. Data collection by means of a secure on-line form.Variables: characteristics of hospitals and units, patientsadmitted, patients with each type of DRSL, classificationof lesions. Overall and adjusted crude prevalence wasestimated by hospital and by type of unit. Results: Datawere obtained from 74 NHC-LTCC. Only 9.5% of thecentres reported not having any person with DRSL in theircare at the time of data collection. The overall prevalenceof DRSL was 9.28% (95%IC, 5.45-6.71); 3% higher thanin the previous study. The prevalence figures for each typeof injury were: pressure 6.05%, moisture 2.35%, friction1.35%, skin tears 2.38%. combined 0.61%. Thisrepresents an increase in all but combined injuries. Theprevalence of all DRSLs was higher in the public centresthan in the state and private centres. The 85.2% ofthe DRSLs were of nosocomial origin (originating in anursing home or other residential institution) and only10.9% originated at home. Conclusions: The prevalenceof DRSL in nursing homes is among the highest in thistype of centre in the historical series of studies carriedout in Spain by the GNEAUPP. This higher prevalencecould be explained by the situation in which many havebeen left after the COVID pandemic and a relaxation in the prevention programmes implemented. (AU)

Prevalencia de las lesiones cutáneas relacionadas con la dependencia en adultos hospitalizados en España: resultados del 6º Estudio Nacional del GNEAUPP 2022 / Prevalence of dependencerelated skin lesions in hospitalised adult population in Spain: Results of the 6th GNEAUPP National Study 2022

Objetivos: Obtener indicadores epidemiológicos actualizados paralas lesiones cutáneas relacionadas con la dependencia en unidades dehospitalización de adultos de hospitales españoles, tanto globales comoajustados. Analizar las características demográficas y clínicas de laspersonas con lesiones cutáneas relacionadas con la dependencia, y de laslesiones. Metodología: Estudio observacional, transversal, tipo encuestaepidemiológica (6.º Estudio Nacional de Prevalencia), dirigido a todos loshospitales de España. Recogida de datos mediante formulario seguro online.Variables: características de los hospitales y de las unidades, pacientesingresados, pacientes con cada tipo de lesiones cutáneas relacionadascon la dependencia, clasificación de las lesiones. Se estimó la prevalenciacruda global y ajustada por hospitales y por tipo de unidades. Resultados:Participaron 470 unidades de hospitalización de adultos pertenecientesa 67 hospitales de todo el territorio nacional. La prevalencia global delesiones cutáneas relacionadas con la dependencia fue del 8,4%. Segúnel tipo de lesiones, las prevalencias fueron: lesiones por presión 7,7%;combinadas 0,9%; humedad 1,5%; por fricción 0,9%, y desgarros 0,8%.Los hospitales pequeños, de menos de 200 camas, son los que presentanprevalencias mayores. Las unidades con prevalencias más altas fueron:cuidados paliativos (24,2%), UCI (21,5%) y unidades posquirúrgicas y dereanimación (14,8%). La mayoría de las lesiones son de origen nosocomial(80%), producidas en el mismo o en otro hospital. Siguen faltando laimplementación de medidas preventivas en los centros y la dotación derecursos de prevención. Conclusiones: La prevalencia de lesiones cutáneasrelacionadas con la dependencia se mantiene en cifras similares a la deestudios anteriores en hospitales españoles, con gran variabilidad en función del tamaño del centro y las unidades en las que ingresa el paciente. (AU)

Objectives: To obtain updated epidemiological indicators fordependence-related skin lesions (DSRL) in adult inpatientunits of Spanish hospitals, both global and adjusted. Toanalyse the demographic and clinical characteristics of personswith DRSLs and lesions. Methodology: Observational,cross-sectional, epidemiological survey-type study (6thNational Prevalence Study), aimed at all hospitals in Spain.Data collection by means of a secure online form. Variables:characteristics of hospitals and units, patients admitted,patients with each type of DRSL, classification of lesions.Overall and adjusted crude prevalence was estimated byhospital and by type of unit. Results: A total of 470 adultinpatient units from 67 hospitals nationwide participated.The overall prevalence of DRSL was 8.4%. According totype of injury, the prevalences were: pressure injuries 7.7%;combined injuries 1.5%; moisture 1.4%; friction 0.9%; andtears 0.8%. Small hospitals with less than 200 beds haveshigher prevalence. The units with the highest prevalencewere: palliative care (24.2%), ICU (21.5%), and post-surgicaland resuscitation units (14.8%). Most of the injuries are ofnosocomial origin (80%), produced in this or other hospitals.The implementation of preventive measures in the centresand the provision of resources are still lacking. Conclusions:The prevalence of DRSL remains similar to that of previousstudies in Spanish hospitals, with great variability dependingon the size of the centre and the units to which the patient isadmitted. (AU)

Effect of ethanolic extracts from Piperaceae leaves on the reduction of skin necrosis and wound healing in an animal model of degloving injuries

Purpose: To assess the effect of the ethanolic extract of the leaves of three species of plants from the Piperaceae family on reducing necrosis and enhancing wound healing in an animal model of degloving injuries. Methods: The animals were divided into six groups, each consisting of six animals: sham, negative control, EEPA (Piper amalago ethanolic extract), EEPG (Piper glabratum ethanolic extract), EEPV (Piper vicosanum ethanolic extract), and positive control receiving hyperbaric oxygenation. The animals underwent surgery to induce excision wounds, and the extent of cutaneous necrosis was evaluated using graphic software, while wound healing was assessed through histopathology. Results: Skin necrosis percentage area was: sham group = 62.84% 6.38; negative control group = 63.03% 4.11; P. vicosanum = 40.80% 4.76 p < 0.05; P. glabratum 32.97% 4.01 p < 0.01; P. amalago = 32.40% 4.61 p < 0.01; hyperbaric oxygenation = 33.21% 4.29 p < 0.01. All treated groups showed higher collagen deposition and less intense, plus predominantly mononuclear inflammatory infiltrate, suggesting improved healing process. Conclusions: The three tested extracts demonstrated efficacy in reducing the extent of cutaneous necrosis caused by degloving injuries and also showed evidence of improvement in the wound healing process.

Prevalencia de las lesiones cutáneas relacionadas con la dependencia en centros de atención primaria de salud de España: resultados del 6º Estudio Nacional del GNEAUPP 2022 / Prevalence of pressure injuries and other dependence-related skin lesions in primary healthcare centers in Spain: Results of the 6th GNEAUPP National Study 2022

Objetivos: Obtener indicadores epidemiológicos actualizados para laslesiones cutáneas relacionadas con la dependencia en centros de atenciónprimaria de salud españoles, tanto globales como ajustados. Analizarlas características demográficas y clínicas de las personas con lesionescutáneas relacionadas con la dependencia y de las lesiones. Metodología:Estudio observacional, transversal, tipo encuesta epidemiológica (6.ºEstudio Nacional de Prevalencia), dirigido a todos los centros deatención primaria de salud en España. Recogida de datos medianteformulario seguro online. Variables: características de los centros deatención primaria, población total, población mayor de 65 años ypoblación en programas de atención domiciliaria, pacientes con cadatipo de lesiones cutáneas relacionadas con la dependencia, clasificaciónde las lesiones. Se estimó la prevalencia cruda global poblacional yajustada en mayores de 65 años y en personas en programas de atencióndomiciliaria. Resultados: Se han obtenido datos de una población de1.754.228 personas atendidas en 131 centros de atención primaria desalud españoles. La prevalencia de lesiones cutáneas relacionadas conla dependencia en las personas en pacientes atendidos en programasde atención domiciliaria (ATDOM) fue del 5,82%. Solo un 7,7% delos centros declararon no tener ninguna persona con lesiones cutáneasrelacionadas con la dependencia atendida en el momento de obtenerlos datos. La prevalencia casi se duplica en los centros rurales (7,1%)y mixtos (6,0%) respecto a los centros urbanos (3,9%). Las lesiones seoriginaron en el mismo domicilio del paciente en un 79,8% de los casos,y solo un 18,7% se originaron durante el ingreso del paciente en unainstitución. (AU)

Objectives: To obtain updated epidemiological indicatorsfor dependence-related skin lesions (DRSL) in SpanishPrimary Health Care (PHC) centres, both global andadjusted. To analyse the demographic and clinicalcharacteristics of people with DRSL and lesions. and thelesions. Methodology: Observational, cross-sectional,epidemiological survey-type study (6th NationalPrevalence Study), aimed at all PHC centres in Spain. Datacollection by means of a secure on-line form. Variables:characteristics of primary care centres, total population,population over 65 years of age and population in homecare programmes, patients with each type of DRSL,classification of lesions. We estimated the overall crudeprevalence in the population and adjusted prevalence,in people over 65 years of age and in people in homecare programmes. Results: Data were obtained from apopulation of 1,754,228 people cared for in Spanish PHCcentres in 131 centres. The prevalence of DRSL in personsin patients attended in home care programmes (HCP) was5.82%. Only 7.7% of the centres reported not having anypersons with DRSL in care at the time of data collection.The prevalence almost doubles in rural (7.1%) and mixed(6.0%) centres compared to urban centres (3.9%). Injuriesoriginated in the patient’s own home in 79.8% of cases,and only 18.7% originated during the patient’s admissionto an institution. The profile is that of an 83-year-oldwoman with mixed incontinence and using a staticmattress surface. Conclusions: The prevalence of primary care DRSL in Spain remains similar to previous studies,with great variability depending on the location of thecentre. Four out of 5 lesions develop in the patient’shome. (AU)

Lesiones cutáneas en probable relación con calcifilaxis no urémica en paciente octogenaria: caso clínico y revisión de la literatura / Skin lesions in probable relation to non-uremic calciphylaxis in an octogenarian patient: Clinical case and review of the literature

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Ácaro Sarcoptes scabiei en movimiento / Sarcoptes scabiei mite moving

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Deterioro de la piel asociado con aseguramiento del dispositivo de acceso intravascular / Skin breakdown associated with securing of the intravascular access device / Ruptura da pele associada à fixação do dispositivo de acesso intravascular

El deterioro de la piel asociado con adhesivos de uso médico en dispositivos de acceso intra-vascular es un evento adverso que puede contribuir a la interrupción de la terapia de infusión intravascular. La Sociedad de enfermeras de infusión recomienda usar tecnologías de protec-ción como apósito estéril para aseguramiento del catéter y cinta quirúrgica para aseguramien-to complementario. Objetivo: Analizar las causas y prevalencia del deterioro de la piel aso-ciado con aseguramiento del dispositivo de acceso intravascular. Métodos: Estudio analítico, de corte transversal. Para recolectar datos se empleó un formato digital y observación directa a pacientes hospitalizados (n=813) con algún dispositivo de aseguramiento en acceso intra-vascular central o periférico, y aseguramiento complementario con cinta quirúrgica, dando seguimiento durante 7 días en febrero 2020. Resultados: El deterioro de la piel incluyó de-sprendimiento de epidermis, maceración, dermatitis irritativa por contacto y alérgica, con prevalencia de 2.2%. Se atribuyeron a catéter venoso central (f=8), catéter venoso periférico (f=7) y cinta quirúrgica para aseguramiento complementario del apósito transparente (f=3). Discusión: Las causas de deterioro de la piel se debieron al tipo de dispositivo y material implementado para aseguramiento; en la mayoría de casos las lesiones se encontraron en accesos venosos periféricos, seguida de accesos venosos centrales, siendo el aseguramiento complementario la menor causa de deterioro de la piel. Conclusiones: La técnica correcta de aplicación y retiro de insumos adhesivos de estabilización y aseguramiento del catéter intravascular evitará el desprendimiento de los mismos, lesiones de piel e interrupción de la terapia de infusión intravascular

Deterioration of the skin associated with medical adhesives in intravascular access devices is an adverse event that can contribute to the discontinuation of intravascular infusion ther-apy. The Society of Infusion Nurses recommends the use of protective technologies such as sterile dressing for catheter securing and surgical tape for supplemental securing. Objective: To analyze the causes and prevalence of skin deterioration associated with securing the intravascular access device. Methods: Analytical, cross-sectional study. To collect data, a digital format and direct observation of hospitalized patients (n = 813) were used with some device for securing in central or peripheral intravascular access, and complementary securing with surgical tape, with follow-up for 7 days in February 2020. Results: The Skin deterioration included epidermal detachment, maceration, irritant contact and allergic dermatitis, with a prevalence of 2.2%. They were attributed to central venous catheter (f = 8), peripheral venous catheter (f = 7) and surgical tape for complementary securing of the transparent dressing (f = 3). Discussion: The causes of skin deterioration were due to the type of device and mate-rial implemented for belaying; In the majority of cases, the lesions were found in peripheral venous accesses, followed by central venous accesses, with supplementary insurance being the least cause of skin deterioration. Conclusions: The correct technique for applying and removing adhesive supplies for stabilization and securing of the intravascular catheter will avoid their detachment, skin lesions and interruption of intravascular infusion therapy

A deterioração da pele associada a adesivos médicos em dispositivos de acesso intravascular é um evento adverso que pode contribuir para a descontinuação da terapia de infusão intra-vascular. A Society of Infusion Nurses recomenda o uso de tecnologias de proteção, como curativo estéril para fixação do cateter e esparadrapo para fixação suplementar. Objetivo: Analisar as causas e a prevalência da deterioração da pele associada à fixação do dispositivo de acesso intravascular. Métodos: Estudo analítico, transversal. Para a coleta de dados, uti-lizou-se o formato digital e observação direta dos pacientes internados (n = 813) com algum dispositivo de fixação em acesso intravascular central ou periférico e a fixação complementar com esparadrapo, com seguimento de 7 dias em fevereiro de 2020. Resultados: A deterio-ração da pele incluiu descolamento epidérmico, maceração, contato com irritante e dermatite alérgica, com prevalência de 2,2%. Foram atribuídos a cateter venoso central (f = 8), cateter venoso periférico (f = 7) e esparadrapo para fixação complementar do curativo transparente (f = 3). Discussão: As causas da deterioração da pele foram devido ao tipo de dispositivo e material implementado para amarração; Na maioria dos casos, as lesões foram encontradas em acessos venosos periféricos, seguidos de acessos venosos centrais, sendo a amarração suplementar a menor causa de deterioração da pele. Conclusões: A técnica correta de apli-cação e retirada de suprimentos adesivos para estabilização e fixação do cateter intravascular evitará seu descolamento, lesões cutâneas e interrupção da terapia de infusão intravascular

Lymphocintilographic evaluation of lymphatic circulation in victims of circuferential degloving injuries of the lower limbs / Avaliação linfocintilográfica da circulação linfática em pacientes vítimas de desenluvamentos circunferenciais dos membros inferiores

ABSTRACT Introduction: secondary forms of lymphedema may occur as consequence of tumors, surgeries, radiotherapy, trauma and infections. Degloving injuries are severe and infrequent forms of trauma, with avulsion at the level of muscular fascia, and consequent injury of the lymphatic system. Objective: to evaluate the alterations in lymphatic circulation in patients being victims of circumferential degloving injuries in the lower limbs, using lymphoscintigraphic. Patients and Methods: retrospective analysis of the cases treated in the period from 2010 to 2016. Segmental, circumferential and unilateral injuries with involvement of the lower limbs were included. Lymphoscintigraphy was performed after a minimum interval of 12 months after the end of treatment. The non-injured lower limb was used as control. The Kleinhans Semiquantitative Index (KSI) was used for the semiquantitative evaluation of the lymphoscintigraphic findings. Results: eighteen patients were evaluated, six of whom were female and 12 were male. The mean age was 28.11 years. The average vertical extension of the circumferential traumatized segment was 29.33cm. The injured area presented variations of 5 to 15% of the body surface, with an average of 8.95%. Lymphoscintigraphy was performed after an average interval of 22.55 months. Alterations were observed on the traumatized limb (TL) in 13 patients. All control limbs (CL) were normal. The mean KSI observed in TL was 8.32, while in CL, the average value was 0.58 (p<0.001). Conclusion: patients with circumferential degloving injuries in the lower limbs present compromised lymphatic circulation and high probability to develop lymphedema.

RESUMO Introdução: as formas secundárias de linfedema podem ocorrer em consequência de tumores, cirurgias, radioterapia, traumas e infecções. Os desenluvamentos são formas graves e infrequentes de trauma, sendo observada avulsão no plano da fáscia muscular, com consequente lesão do sistema linfático. Objetivo: avaliar as alterações na circulação linfática nos pacientes vítimas de desenluvamentos circunferenciais nos membros inferiores, a partir da análise linfocintilográfica. Pacientes e Métodos: análise retrospectiva dos casos atendidos no período de 2010 a 2016. Foram incluídos os casos com acometimento segmentar, circunferencial e unilateral em membros inferiores. A linfocintilografia foi realizada após um intervalo mínimo de 12 meses do término do tratamento. O membro inferior não traumatizado foi utilizado como controle. Para a avaliação semiquantitativa dos achados linfocintilográficos, utilizou-se o Índice de Kleinhans (ISQTK). Resultados: foram avaliados 18 pacientes, sendo seis do gênero feminino e 12 do masculino. A média de idade foi de 28,11 anos. A extensão vertical do segmento traumatizado circunferencial foi em média de 29,33cm. O segmento traumatizado apresentou variações de 5 a 15% da superfície corporal, com média de 8,95%. A linfocintilografia foi realizada após intervalo médio de 22,55 meses. Foram observadas alterações no exame linfocintilográfico do membro traumatizado (MT) em 13 pacientes. Todos os exames dos membros controle (MC) foram normais. O ISQTK médio observado no MT foi 8,32 (0,3-20,75). No MC o valor médio foi de 0,58 (0,15-0,75). Conclusão: os pacientes com desenluvamentos circunferenciais nos membros inferiores apresentam circulação linfática comprometida e alta probabilidade para o desenvolvimento de linfedema.

Cuidados de enfermagem em pacientes queimados nas unidades de terapia intensiva / Nursing care in burned patients in intensive care units / Cuidados de enfermería en pacientes quemados en unidades de cuidados intensivos

Objetivo: evidenciar os cuidados de enfermagem descritos na literatura nacional e internacional que são aplicados em pacientes queimados em terapia intensiva. Método: revisão integrativa, realizada no período de fevereiro a dezembro de 2020, nas bases de dados eletrônicas US National Library of Medicine, Medical Literature Analysis and Retrieval System Online e Biblioteca Virtual em Saúde. Resultados: foram selecionados oito artigos, os quais foram categorizados em Cuidados de Enfermagem com a pele em pacientes queimados, Cuidados de Enfermagem com a mobilidade em pacientes queimados e Cuidados de Enfermagem em pacientes queimados em relação à dor, dispositivos e prevenção de complicações. Conclusão: os cuidados de enfermagem para pacientes queimados em terapia intensiva estão intensamente atrelados aos cuidados com as lesões de pele e seus desdobramentos, assim como a prevenção de infecções.

Objective: to highlight the nursing care described in the National and International Literature that is applied to burned patients in intensive care. Methods: integrative review, carried out from February to December, 2020, using the following electronic bases: US National Library of Medicine, Medical Literature Analysis and Retrieval System Online and Biblioteca Virtual em Saúde. Results: it was selected eight articles, which were categorized into Nursing Care for skin in burned patients, Nursing Care for mobility in burned patients and Nursing Care for burned patients in relation to pain, devices and prevention of complications. Conclusion: nursing care for burned patients in intensive care is associated to the care of skin lesions and their consequences, as well as the prevention of infections.

Objetivo: destacar los cuidados de enfermería descritos en la literatura nacional e internacional que se aplican en pacientes quemados en cuidados intensivos. Método: revisión integradora, realizada de febrero a diciembre de 2020, en las bases de datos electrónicas US National Library of Medicine, Medical Literature Analysis and Retrieval System Online y Virtual Health Library. Resultados: se seleccionaron ocho artículos, los cuales se clasificaron en Cuidados de Enfermería con la Pelea en Pacientes Enfermos, Cuidados de Enfermería con la Movilidad en Pacientes Enfermos y Cuidados de Enfermería en Pacientes Enfermos en relación con el dolor, los dispositivos y la prevención de complicaciones. Conclusión: los cuidados de enfermería a los pacientes quemados en cuidados intensivos están intensamente ligados al cuidado de las lesiones cutáneas y sus desdoblamientos, así como a la prevención de infecciones.

Osteomielite crônica como uma armadilha ao diagnóstico na prática do dermatologista / Chronic osteomyelitis as a diagnostic pitfall in the practice of the dermatologist: a case report

Na prática clínica da dermatologia não é incomum nos depararmos com situações desafiadoras, de difícil caracterização e que podem nos induzir ao erro diagnóstico. Quadros cutâneos com apresentações semelhantes entre si estão aqui inclusas e, neste caso, é de suma importância a atuação do médico dermatologista de forma a unir as informações da anamnese, exame físico e exames complementares, a fim de excluir condições de pior prognóstico e que requerem atuação mais agressiva de outras condições benignas e/ou com menor impacto negativo. Apresentamos abaixo uma dessas situações de desafio diagnóstico em que uma lesão cutânea secundária à osteomielite crônica foi inicialmente atribuída à causa inflamatória ou neoplásica (AU)

In the clinical practice of Dermatology, it is not uncommon to encounter challenging situations that are difficult to characterize and may lead to misdiagnosis. Skin conditions with similar presentations are included here and, in this case, it is of utmost importance that the dermatologist combines information from the medical history, physical examination and complementary tests in order to exclude conditions with worse prognosis and that require more aggressive action than other benign conditions and/or with less negative impac (AU)