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ECPB 2019, 86(2): 72–76
https://doi.org/10.25040/ecpb2019.02.072
Clinical case report

Successful Treatment of Multiple Chronic Leg Wounds - a Case Report

I.R. TERLETSKYI 2, Y.H. OREL 1, M.R. VERKHOLA 2, M.M. ANTONIV 2
Abstract

Inroduction. Lower-extremities ulcers, especially in individuals older than 65 years, are frequent cause for attending the podiatrist, wound care specialist, primary care physician, vascular surgeon or dermatologist. The bulk of vascular leg ulcers are chronic or recurrent. They can present significant complications among patients with peripheral vascular disease, including job incapacity. The management of vascular leg ulcers becomes a considerable burden to the patients and the health care system. Moreover, these non-healing ulcers increase the risk of lower extremity amputation. The systemic sclerosis (or scleroderma) is a rare autoimmune connective tissue disorder which is associated with a various degree of systemic manifestations. The organs most frequently affected by scleroderma are the skin, gastrointestinal tract, lungs, kidneys, skeletal muscle and pericardium. One of the challenging complications of systemic sclerosis is non-digital lower extremity ulcers both in limited and diffuse scleroderma, with not exactly clear etiology but with the reflection of chronic vasculopathy. The purpose. As the cases of nonhealing lower extremity ulcers in scleroderma have not specifically been studied, more researches are considered to be carried out. Materials and methods. The 73-year-old female patient V. was taken to the surgical department №1 of Lviv regional clinical hospital in 2013 due to ulcers on both legs, which had been developed 3 years before the clinic attendance. During the examination 4 ulcers were found on the left lower leg, the wound measurements varied from 5 to 8 cm2. On the right lower leg there were another 3 ulcers (from 4 to 22 cm2), one of which caused severe pain and forced the patient to seek medical treatment. After the examination, one part of bone tissue-like consistency fragments of the wound was removed while other fragments could not be removed because of their motionless. The fragments were interpreted as the sclerotic modification in the adipose tissue and lymphatic vessels. As a result of the additional medical examination the systemic sclerosis, Raynaud’s syndrome (with typical clinical manifestation but without fingers and toes destruction) and Parkinson’s disease were diagnosed. The patient refused from the glucocorticoids therapy. In addition, the patient suffered from the intermittent claudication after 300-400 m of walking. Results. By using Duplex sonography, we observed 60 % stenosis of the right posterior tibial artery, left anterior tibial artery occlusion, 70 % stenosis of the left posterior tibial artery and the same degree of stenosis of the left anterior tibial artery. The pathological reflux in superficial and deep veins was not detected. Conclusions. The process of medical treatment was very difficult and lasted for three years. The total wound epithelialization was noted after the massive debridement with the further auto-dermoplasty.

Recieved: 24.04.2019

Keywords: wound, ulcer, chronic, treatment

Full text: PDF (Eng) 3.70M

References
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