[Clinical and nursing protocol in the treatment of the decubital ulcers]. / Protocollo clinico-assistenziale nel trattamento delle ulcere da decubito.

The decubital ulcers treatment needs a complex clinical approach. The ulcer healing and the absence of recurrences are not only the result of a correct surgical operation. The purpose of this work is to identify all the clinical and nursing parameters that can provide long lasting healing. We treated 105 decubital ulcers in various body areas (sacralis, ischiatic, trochanteric and calcanear regions) and we defined a clinical protocol that starts from prevention, to the admission, till the convalescence. We obtained satisfactory results with few post-operative complications and recurrences. Our protocol is widely confirmed by various authors (the radical toilette, the use of fasciocutaneous and musculocutaneous flaps and the importance of nutrition. In particular, the use of easier flaps (cutaneous, fasciocutaneous), is preferred in the first surgical option to leave other more complex techniques (musculocutaneous flap) for the recurrences treatment. Our protocol follows the patient from the first visit till several months after dismission during convalescence. The pre-operative measures (nutritional state correction, infection care, detersion improvement) as well the post-operating ones (use of circulating fluid beds, rest in bed for at least one month) result to be mandatory for a successful outcome.

Pigmented epithelioid melanocytoma: report of a case with favourable outcome after a 4-year follow-up period.

BACKGROUND: Pigmented epitheliod melanocytoma (PEM) is a uncommon melanocytoma with unique histopathological features and possibly with a favourable prognosis, because, although sentinel lymph-node metastases may occur, in the great majority of cases described up to now there is no spread beyond regional lymph-nodes. The nature of PEM, its biologic behaviour and its relationships to naevi and melanoma, however, remain to be clearly established, and several Authors suggest that further cases of PEM with long follow-up should be published, in order to better assess the biologic/prognostic characteristics of PEM. METHODS AND RESULTS: We report a new case of PEM, dealing with an oval, regularly marginated, darkly pigmented, asymptomatic nodule. The dermoscopic pattern showed a homogeneous blue-black pigmentation, without any other dermoscopic sign. The histopathologic analysis showed both isolated and nested oval melanocytes at the junctional level, and a mixture of epitheliod and spindle melanocytes, heavily pigmented, together with numerous melanophages in the dermis, with tendency to periadnexal distribution; cellular atypia was pronounced, but only occasional mitoses were identified in the superficial dermis. After a 4-year follow-up period after excision, no persistent lesion or metastases occurred. CONCLUSIONS: The present case suggests that PEM has a distinct histopathologic/diagnostic identity among melanocytic tumours. Although the up-to-now favourable outcome, however, our patient needs a large period of observation, and further studies with long follow-up are needed to better define the biologic/prognostic identity of PEM.