Notes on Practice

Necrotizing Fasciitis: A Diagnostic and Management Challenge

admin — Wed, 03 Sep 2008 10:25:23 -0400

Background

Necrotizing fasciitis has been defined as a rapidly progressive disease characterized by extensive necrosis of skin, fascia, and subcutaneous tissue.^1-3 If not diagnosed promptly, it can be severe and potentially life-threatening.^4-6 The first reportable cases of vulvar necrotizing fasciitis were found in 1972 in the obstetric and gynecologic literature.^7,8

Reducing Epibole Using Topical Hyperbaric Oxygen and Electrical Stimulation

admin — Wed, 03 Sep 2008 10:25:22 -0400

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.

Healing a Wound with an Exposed Herrington Rod: A Case Study

admin — Wed, 03 Sep 2008 10:25:22 -0400

T he development of chronic wounds in spinal cord patients represents a particularly challenging dilemma because of the high rate of wound recurrence. Initial surgical management limits the options for operative treatment of the recurrent wound. Traditional nonoperative management can preserve options for future surgery but requires frequent dressing changes.

An Interesting Side Effect of Home Oxygen Therapy

admin — Wed, 03 Sep 2008 10:25:14 -0400

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%.

Hemophilia and Maggots: From Hospital Admission to Healed Wound

admin — Wed, 03 Sep 2008 10:25:13 -0400

Background

Pyoderma Gangrenosum Treatment: A Steroid-Free Option

admin — Wed, 03 Sep 2008 10:25:13 -0400

Background

Living with a Necrotic Wound: A Clinician’s Personal Journey

admin — Wed, 03 Sep 2008 10:25:07 -0400

W ound care professionals deal with necrotic wounds daily. We instruct patients in self-care as a routine task in our management plan. The expectation is the patient will do as instructed and the wound will likely progress to healing. We are aware that the necrotic wound needs to be debrided or “cleaned up” — what we often do not acknowledge is how distressing necrotic tissue can be to the patient. As a wound care specialist, I decided to share my experience with a necrotic wound for two reasons. First, despite my education and training, when my body was involved I did not want to look

Management of a Complex Wound in a Challenging Home Health Care Patient

admin — Wed, 03 Sep 2008 10:25:06 -0400

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.

Managing Radiation Skin Injury

admin — Wed, 03 Sep 2008 10:25:04 -0400

D uring and after radiation therapy, patients may experience dryness, itching, erythema, hair loss, rash, and dry desquamation — ie, scaly, flaking skin. Wet desquamation, which resembles a second-degree burn, is seen less frequently. Transient erythema may appear as early as the first treatment; a lasting reaction generally appears during the second or third week of treatment. The early reaction is inflammatory and results from activation of proteolytic enzymes and increased capillary permeability. Radiation skin reactions are confined to the area of treatment, which may include the site o

Hyperbaric Oxygen Therapy Used to Treat Radiation Injury: Two Case Reports

admin — Wed, 03 Sep 2008 10:25:01 -0400

Radiation is widely used in medicine, industry, agriculture, and research. Despite improvements in radiation safety, accidents with serious health consequences still occur. The harmful effects of ionizing radiation are well documented. Radiological accidents due to radioactive substance contamination are rare; local acute reaction to radiation exposure (which can be acute, protracted, or fractioned) is seen more frequently than whole body radiation complications and may occur alone or together with other injury such as trauma or thermal burn. Symptoms observed within a few months following ra