Cath Lab Digest

Dr. Greco is a dermatologist and Chief of the Centre of Specialization for Treatment and Prevention of Cutaneous Ulcers, Frosinone ASL, Italy; email: firstauthor-greco@yahoo.com.

  One of the key challenges in wound management is infection prevention. This can be achieved through control of the superficial bioburden — ie, wound microbial colonization. One consideration in infection prevention is that antimicrobial effectiveness may be a factor of the different physical properties of dressings.¹ The ability of a dressing to conform to the wound surface appears to be a factor in the prevention of wound infection as a result of the antimicrobial protection provided at the wound-dressing interface.² However, the choice of the optimal dressing for skin ulcers, diabetic lesions, or surgical wounds remains controversial.³

History

Seventy-seven-year-old Ms. G was admitted to Manor Oak Life Center, Buffalo, NY, on July 24, 2000 with a diagnosis of sacral pressure ulcer, anemia, reflex sympathetic dystrophy, hypertension, and fractured left forearm. She had fallen at home and remained in a decubitus position for a prolonged period until she was hospitalized June 15, 2000 through July 24, 2000. The acute injuries were treated (including surgical debridement of the Stage IV pressure ulcer) in the hospital through July 24 by her attending physician and various consulting specialists.

When she

T he concept of oxygen as a therapeutic agent was initially proposed by Alvin Barach in the 1920s.¹ Well-conducted clinical trials have clearly demonstrated major therapeutic benefit for patients with chronic obstructive pulmonary disease.^2,3 Currently, long-term oxygen therapy is recommended for patients with hypoxemia, defined as a PaO₂ of less than or equal to 55 mm Hg or an oxygen saturation of <88%. Patients with a PaO₂ of 56 to 59 mm Hg or an oxygen saturation of 89% with either cor pulmonale or polycythemia also should receive continuous oxyge

Background

Pyoderma gangrenosum (PG), a rare clinical lesion, is a morpholic description of an inflammatory response presenting as a reaction pattern in the skin. The lesions usually present on the lower extremities but also may appear on the trunk, upper extremities, face, and mouth. The papules, pustules, and plaques can evolve and resolve without passing through an ulcerative stage. Before ulceration, aspiration from these lesions shows no bacterial growth; the role of bacteria cultured from ulcerated lesions is that of secondary invaders or colonizers. Salient clinical fe

P roviding care to a patient with a complex wound can be challenging. When a history of diabetes, drug abuse, and apathetic self-care are factored into the wound management equation, hope for a positive outcome is further compromised. In this case, in addition to clinical management of the wound, the treatment plan required teaching related to wound care — early development and recognition of wounds, management of diabetes and its effects on wound healing, self care, nutrition, position changes, and referral to other social services for drug-related issues. An aggressive care regimen allowed