ABSTRACT
BACKGROUND: Chronic leg ulcers affect a large portion of the adult population and cause a significant social and economic impact, related to outpatient and hospital care, absence from work, social security expenses, and reduced quality of life. The correct diagnosis and therapeutic approach are essential for a favorable evolution. OBJECTIVE: To gather the experience of Brazilian dermatologists, reviewing the specialized literature to prepare recommendations for the diagnosis and treatment of the main types of chronic leg ulcers. METHODS: Seven specialists from six university centers with experience in chronic leg ulcers were appointed by the Brazilian Society of Dermatology to reach a consensus on the diagnosis and therapeutic management of these ulcers. Based on the adapted DELPHI methodology, relevant elements were considered in the diagnosis and treatment of chronic leg ulcers of the most common causes; then, the recent literature was analyzed using the best scientific evidence. RESULTS: The following themes were defined as relevant for this consensus - the most prevalent differential etiological diagnoses of chronic leg ulcers (venous, arterial, neuropathic, and hypertensive ulcers), as well as the management of each one. It also included the topic of general principles for local management, common to chronic ulcers, regardless of the etiology. CONCLUSION: This consensus addressed the main etiologies of chronic leg ulcers and their management based on scientific evidence to assist dermatologists and other health professionals and benefit the greatest number of patients with this condition.
Subject(s)
Dermatology , Leg Ulcer , Varicose Ulcer , Adult , Brazil , Consensus , Humans , Leg Ulcer/diagnosis , Leg Ulcer/therapy , Quality of Life , Varicose Ulcer/diagnosis , Varicose Ulcer/therapyABSTRACT
Abstract Background: Chronic leg ulcers affect a large portion of the adult population and cause a significant social and economic impact, related to outpatient and hospital care, absence from work, social security expenses, and reduced quality of life. The correct diagnosis and therapeutic approach are essential for a favorable evolution. Objective: To gather the experience of Brazilian dermatologists, reviewing the specialized literature to prepare recommendations for the diagnosis and treatment of the main types of chronic leg ulcers. Methods: Seven specialists from six university centers with experience in chronic leg ulcers were appointed by the Brazilian Society of Dermatology to reach a consensus on the diagnosis and therapeutic management of these ulcers. Based on the adapted DELPHI methodology, relevant elements were considered in the diagnosis and treatment of chronic leg ulcers of the most common causes; then, the recent literature was analyzed using the best scientific evidence. Results: The following themes were defined as relevant for this consensus - the most prevalent differential etiological diagnoses of chronic leg ulcers (venous, arterial, neuropathic, and hypertensive ulcers), as well as the management of each one. It also included the topic of general principles for local management, common to chronic ulcers, regardless of the etiology. Conclusion: This consensus addressed the main etiologies of chronic leg ulcers and their management based on scientific evidence to assist dermatologists and other health professionals and benefit the greatest number of patients with this condition.
Subject(s)
Humans , Child , Varicose Ulcer , Varicose Ulcer/therapy , Dermatology , Leg Ulcer/diagnosis , Leg Ulcer/therapy , Quality of Life , Brazil , ConsensusSubject(s)
Granulomatous Disease, Chronic/diagnosis , Leg Ulcer/diagnosis , Lymphoma, B-Cell/diagnosis , Necrobiosis Lipoidica/diagnosis , Adult , Granulomatous Disease, Chronic/complications , Humans , Leg Ulcer/complications , Lymphoma, B-Cell/complications , Male , Necrobiosis Lipoidica/complicationsABSTRACT
BACKGROUND: Lucio's phenomenon is a rare leprosy reaction characterised by bizarrely-shaped, purpuric skin lesions and ulceration. It occurs in diffuse lepromatous leprosy and it is mainly reported in patients from Mexico and the Caribbean. CASE DESCRIPTION: We describe the case of a 90-year-old Aruban man with recurrent leg ulcers and flexion contractures of the lower extremities. Occurrence of Lucio's phenomenon led to a diagnosis of diffuse lepromatous leprosy. Presence of Mycobacterium leprae was demonstrated in skin, bone marrow and lymph nodes. CONCLUSION: Lucio's phenomenon led to a diagnosis of leprosy. Leprosy is still endemic in Aruba.
Subject(s)
Leg Ulcer/etiology , Leprosy, Lepromatous/diagnosis , Aged, 80 and over , Fatal Outcome , Humans , Leg Ulcer/diagnosis , Leg Ulcer/drug therapy , Leg Ulcer/pathology , Leprostatic Agents/therapeutic use , Leprosy, Lepromatous/complications , Leprosy, Lepromatous/drug therapy , Leprosy, Lepromatous/pathology , Male , West IndiesABSTRACT
Chronic leg ulcers are rare in young adults and generally indicate a vascular cause. We report a case of a 26-year-old man with leg ulcers of eight months duration. Doppler study indicated venous incompetence and a postphlebitic limb. However, as the distribution and number of ulcers was not consistent with stasis alone and no features of collagen vascular disease were noted, a hyperviscosity state was considered and confirmed with significantly elevated homocysteine level in the serum. Administration of vitamins B1, B2, B6 and B12, trimethyl-glycine, mecobalamine, folic acid and povidone iodine dressings with culture-directed antibiotic therapy led to a satisfactory healing of ulcers over a period of one month. Hyperhomocysteinemia must be considered in the differential diagnosis of leg ulcers in young individuals.
Subject(s)
Hyperhomocysteinemia/complications , Hyperhomocysteinemia/diagnosis , Leg Ulcer/diagnosis , Leg Ulcer/etiology , Adult , Humans , Hyperhomocysteinemia/therapy , Leg Ulcer/therapy , MaleABSTRACT
The medial leg flap, based on the cutaneous branches of the posterior tibial artery is raised from the middle and lower regions of the medial aspect of the leg. It has a long pedicle, and it can be used as a free flap to reconstruct the distant soft tissue and also as an island flap. We have used this retrograde island flap for a surfacing ulcerated areas in six leprosy patients. The flap survived in all cases. At 24 to 60 months follow up examination, ulceration had not recurred in any for them. The medial knee flap consisting of the skin and subcutaneous tissu of lower part of the medial side of the thih and upper part the leg, is suitable for covering soft tissue cushion defects of the extremities because of the constant vessels, long pedicle, wide diameter, well recognizable sensory nerves and less subcutaneous fat. We have used the medial knee flap for the resurfacing sizeable raw areas due to ulceration in there leprosy patients. the flap survived in all cases there was no recurrence of ulceration duriong the 70-148 months follow up period
Subject(s)
Humans , Knee/abnormalities , Knee/surgery , Knee/innervation , Leg Ulcer/surgery , Leg Ulcer/diagnosis , Leg Ulcer/rehabilitationABSTRACT
The area of distribution of the superficial cicunflex iliac, superficial epigastric and superficial external pudental arteries is large and flaps based on them can meet the requirement of different recipient sites. We have transplanted free flaps based on the superficial epigastric artery for repairing plantar soft tissue defects in six leprosy patients. During the follow up examination 58 to 118 months later there has been no recurrence of ulceration in any of these cases. The latissimus dorsi muscle, is mainly nourished by the thoracadorsal artery and the latissimus dorsi musculocutaneous flap is a large sized, composite structure with abundant blood provision and strong anti infectious property. The latissimus dorsi flap can be used as a muscle graft. because ofits constant vascular position, wide outer diameter of the vessels and long pedicle. It can therefore be utilized for repairing soft tissue defect or replacement of paralyzed muscle. We have used the latissimus dorsi musculotacutaneous free flap for repairing large skin and soft tissue defects resulting from plantar ulceration in three leprosy patients. During the follow up period, one patient who had complete drop foot and had refused corrective surgery had recurrence of the ulcer in the 12 post operative month. No ulcers had recurred in the other two cases during the follow up at 48 and 114 months
Subject(s)
Humans , Foot/anatomy & histology , Foot/surgery , Leg Ulcer/surgery , Leg Ulcer/complications , Leg Ulcer/diagnosisSubject(s)
Humans , Ulcer , Leg Ulcer/diagnosis , Leg Ulcer/history , Leg Ulcer/psychology , Leg Ulcer/therapy , Leg Ulcer/epidemiologyABSTRACT
A leg ulcer in a 52-year-old renal transplant patient yielded foamy histiocytes containing acid-fast bacilli subsequently identified as a Runyon group III Mycobacterium. Skin infection with these organisms is unusual, and the histologic appearance in this case suggested lepromatous leprosy.
Subject(s)
Leg Ulcer/diagnosis , Leprosy/diagnosis , Mycobacterium Infections/diagnosis , Skin Diseases, Infectious/diagnosis , Diagnosis, Differential , Humans , Male , Middle Aged , Mycobacterium avium/isolation & purification , Mycobacterium lepraemuriumABSTRACT
Se estudiaraon 8 pacientes leprosos, de los cuales: 7 fueron lepromatosos y 1 indeterminado, portadores de úlceras de pierna, con una evolución promedio de 12 años, tomándose de cuenta además del estucio clínico, exámenes de laboratorio (hemoglobina, albúminas totales y parciales, colesterol, triglicéridos), actividad baciloscópica y bacteriología de las úlceras que fueron tratados con injertos laminares intermediariso.