RESUMO
Chronic wounds on the dorsum of the hand are often challenging to treat. Vacuum-assisted closure has enjoyed widespread use in recent years for many difficult chronic wounds as an alternative to surgery. Unfortunately, owing to the unique anatomy of the hand, it is usually very difficult to get a seal without significantly immobilising the hand. We report a case of a chronic wound on the dorsum of the hand as a result of osteomyelitis in a 37-year-old man, which was treated with Single Use Negative Pressure Wound Therapy, 'PICO' (Smith and Nephew Co, UK). We combined the PICO dressing with a rubber glove to get a good seal enabling appropriate suction without immobilising the hand. Once the wound bed was ready, the defect was covered with a reverse forearm flap.
Assuntos
Luvas Protetoras , Traumatismos da Mão/etiologia , Tratamento de Ferimentos com Pressão Negativa/métodos , Osteomielite/complicações , Adulto , Traumatismos da Mão/diagnóstico , Traumatismos da Mão/terapia , Humanos , Imageamento por Ressonância Magnética , Masculino , Ossos Metacarpais/diagnóstico por imagem , RadiografiaAssuntos
Complicações na Gravidez/etiologia , Complicações na Gravidez/patologia , Deiscência da Ferida Operatória/etiologia , Deiscência da Ferida Operatória/patologia , Traumatismos dos Tendões/cirurgia , Polegar , Adulto , Feminino , Humanos , Gravidez , Complicações na Gravidez/cirurgia , Recidiva , Reoperação , Ruptura , Deiscência da Ferida Operatória/cirurgia , Traumatismos dos Tendões/etiologia , Traumatismos dos Tendões/patologiaRESUMO
The authors report the outcomes of patients with keloid scars treated with a protocol of extralesional excision and immediate single-fraction adjuvant radiotherapy. The design of the study was a retrospective analysis with up to 5-year outcome data. The setting was a single treatment team, University Teaching Hospital in London, United Kingdom. Participants (n = 80) were treated for 80 keloid scars (59 percent female patients, 76 percent nonwhite), and 44 percent of keloids were located on earlobes. For all patients, prior treatment without radiotherapy had failed. The salvage treatment reported in this article is combined extralesional excision and immediate postoperative external-beam radiotherapy. A 10-Gy dose of superficial 60-kV or 100-kV photon irradiation was given within 24 hours of the operation. The main outcome measure was freedom from recurrence of keloid scars. Results were that all keloid scars were controlled at 4-week follow-up. Probability of relapse at 1 year was 9 percent; at 5 years, probability of relapse was 16 percent. The earlobe showed no greater chance of relapse than other sites on the body. The authors' report shows that extralesional excision of keloid followed by early, single-fraction, postoperative radiotherapy is both simple and effective in preventing recurrence at excision sites.