Here - EWMA 2013

POSTER: CASE STUDY
Poster: Case Study
P 402
PYODERMA GANGRENOSUM – STILL CHALLENGING IN DIAGNOSIS AND
TREATMENT
Cornelia Erfurt-Berge 1 , Juergen Bauerschmitz 1
1 University Hospital Erlangen, Department of Dermatology (Erlangen, Germany).
Aim: Pyoderma gangraenosum is a painful, ulcerating skin disease of unknown
aetiology. Diagnosis is generally based on clinical signs and histological examination is
nonspecific. Associations with numerous systemic diseases have been described in the
literature. Due to pathergy surgical measures can provoke an increase of the ulcers.
Methods: A 79-year-old woman was referred to our department for evaluation of chronic
leg ulcers which first appeared in 2007 on the right dorsal and the left lateral lower leg.
Before first admission to our clinic, the patient was treated by her general practitioner
under the diagnosis of venous leg ulcers. Several surgical interventions did not show
any effort. Taken together the clinical findings with two deep ulcerated lesions with
raised and undermined borders and a medical history of ulcers recalcitrant to
phlebosurgical interventions and failure of skin grafts the diagnosis of pyoderma
gangrenosum was taken into account and an immunosuppressive treatment was
started. No underlying disease associated with pyoderma gangrenosum was detected.
Results: After immunosuppressive medication with corticosteroids and dapsone was
started the progress of the ulcerations stopped and after sufficient granulation tissue had
developed by negative pressure therapy the wounds were provided successfully with
split-thickness skin grafts.
Conclusions: Although the clinical findings in cases of pyoderma gangrenosum may be
very clear, the diagnosis remains complicated since histological findings are imprecise
and many other diseases with similar appearance have to be excluded at first. Not
before the inflammation is stopped by immunosuppressive medication more invasive
strategies like surgical interventions should be performed.
P 403
EVALUATION OF A SILVER PRODUCT IN WOUND MANAGEMENT
Poster: Case Study
Jane Preece 1
1 Whittington Hospital (London, United Kingdom).
Aim: This poster aims to present two case studies evaluating the use of a Silver Alginate
Dressing*.
Method: Patient A: A 67 year old male presented with a lower leg ulcer to his left leg
after it had been healed for 2 years. The wound measured 10cm x 12cm the wound bed
was covered with healthy granulation tissue, but there was a large amount of exudate
and clinical signs of infection.
Patient B: A female with a 5 year history of bilateral venous disease presented with
ulcers on both lower legs. It was decided to use the silver alginate dressing* only on the
right leg for a two week period, to compare the treatment results between the legs.
Results: Patient A: The ionic silver dressing* was used for a 2 week period, this resulted
in a reduction in exudate now been to a minimal and no clinical signs of infection. After a
3 week period the wound was completely healed, the patient was very pleased with the
result.
Patient B: Within a 2 week period the wound on the right leg had reduced in size by
50%. The use of the silver alginate dressing* had kick started healing, a clear difference
was observed between the right and the left leg. The wound on the left leg made no
improvement and stayed the same.
Conclusion: Silver has been commonly used as part of wound management for several
years. Recently the use of silver has been questioned, since evaluating this specific
silver product and introducing a protocol for use, the author has seen positive results in
the progression and healing of wounds.
*B.Braun Medical, Askina Calgitrol Ag
EWMA 2013
COPENHAGEN
15-17 May · 2013
Danish Wound
Healing Society
231