Cutaneous Sarcoidosis in Bilateral Carpal Tunnel Release Scars: A Case Report.

CASE: A 58-year-old woman with a history of systemic sarcoidosis, 2 years in remission, presented 6 years after bilateral carpal tunnel release with a 3-month history of nodularity, erythema, and tenderness to her bilateral incisions. Histopathology demonstrated noncaseating granulomas without evidence of foreign material or organisms, consistent with infiltrative scar sarcoidosis. Treatment included 4 intralesional corticosteroid injections over 5 months, with progressive resolution of symptoms and no evidence of systemic sarcoidosis reoccurrence. CONCLUSION: Sarcoidosis should be considered when presented with a cutaneous lesion in association with an incisional scar, either as primary presentation or as disease recurrence.

Biodebridement in the Surgical Intensive Care Unit: Unique Therapy for Unique Patients.

Acute care surgery has evolved to encompass the advanced management of complex nonhealing wounds. Biodebridement has the potential to improve the care of chronic wounds for acute care surgery patients, particularly for patients in the surgical intensive care unit (SICU) with hospital-acquired pressure injuries. A case report of biodebridement using larval maggot therapy in the SICU is presented to illustrate real-world application and progression in wound healing. A review of current research involving biodebridement was conducted. A septuagenarian gentleman sustained a fall resulting in cervical spine fractures with neurological deficits. The patient had a prolonged hospital course in the SICU, complicated by myocardial infarction, respiratory failure requiring tracheostomy, and development of a Stage IV sacral pressure ulcer. The wound base was sharply debrided several times and became refractory to conventional mechanical/chemical debridement techniques. The patient had a prohibitively high risk for the operating room but remained too sensate for further effective bedside debridement. Biodebridement was utilized to create a viable wound base, with improved appearance noted within 2 weeks. A review of the current literature shows biodebridement has numerous benefits in the management of chronic wounds. Biodebridement is a unique therapy that possesses great value for select patients in the SICU. In particular, patients who are too high risk for further operative intervention, but too sensate for ongoing bedside debridement and dressing changes, benefit significantly from this underutilized approach. Further research is needed to solidify the place of biodebridement in the surgical management of chronic nonhealing wounds.