Surgical Excision and Reconstruction of Tattoo Following Hypersensitivity.

Background: Hypersensitivity reaction in a tattoo secondary to red ink is a relatively rare complication, particularly as the biochemical composition of tattoo dye has been refined. Most hypersensitivity reactions are amenable to conservative management, but less common is the necessity for full surgical excision and reconstruction. Methods: A 50-year-old female patient with a chronic tattoo granuloma causing excessive pruritus, erythema, and ulceration, refractory to conservative and minimally invasive techniques, underwent full surgical excision and skin-graft reconstruction of the areas affected by the red dye. Additionally, literature was reviewed for similar reports requiring excision. Results: The patient reports complete symptomatic resolution and satisfaction with the result. The literature reveals a small set of cases reporting a necessity for surgical excision following red-ink hypersensitivity. Conclusions: Tattoo hypersensitivity secondary to a red ink-induced allergic reaction is relatively rare. Most cases are amenable to conservative treatment; however, surgical excision and reconstruction provides a viable option in cases refractory to traditional and less invasive management.

Infection in Venous Leg Ulcers: Considerations for Optimal Management in the Elderly.

Venous leg ulcers are the most common cause of chronic leg wounds, accounting for up to 70 % of all chronic leg ulcers and carrying with them a significant morbidity, especially for elderly patients. Among people aged 65 years and older, the annual prevalence is 1.7 %. Billions of dollars per year are spent caring for patients with these often difficult-to-heal and sometimes recurrent chronic wounds. Chronic non-healing wounds of the lower extremities are susceptible to microbial invasion and can lead to serious complications, such as delayed healing, cellulitis, enlargement of wound size, debilitating pain, and deeper wound infections causing systemic illness. Recognition and treatment of the infected venous leg ulcer is an essential skill set for any physician caring for geriatric patients. Most physicians rely on subjective clinical signs and patient-reported symptoms in the evaluation of infected chronic wounds. The conventional bacterial culture is a widely available tool for the diagnosis of bacterial infection but can have limitations. Systemic antibiotics, as well as topical antiseptics and antibiotics, can be employed to treat and control infection and critical colonization. Better understanding of microbial biofilms in the wound environment have caused them to emerge as an important reason for non-healing and infection due to their increased resistance to antimicrobial, immunological, and chemical attack. A sound understanding of the microbial-host environment and its complexities, as well as the pathophysiology of venous hypertension, must be appreciated to understand the need for a multimodality approach to treating an infected venous leg ulcer. Other treatment measures are often required, in addition to systemic and topical antibiotics, such as the application of wound bandages, compression therapy, and wound debridement, which can hasten clearance of the infection and help to promote healing.