Use of Amnion Transfer in Resistant Nonhealing Venous Leg Ulcers.

In the treatment of venous leg ulcers, after adopting many treatment modalities, at times we are still left with a local indolent problem, "the resistant nonhealing venous ulcer." With repeated surgical procedures failing to obtain a healed ulcer, constant pain, persistent discharging wound, infections, etc., many a patient turn hostile. Also, there comes a dimension of despair in the health feeling of the patient. This prospective study was conducted in 40 patients, who were within the inclusion criteria (January 2006-January 2010, 12 males and 28 females, mean age 45 years). A single amniotic membrane (AM) transfer was done after preparation of the wound, and the parameters were assessed periodically. Follow-up for a minimum period of 1 year in all cases and a maximum period of 3 years in many cases (38) was done. Significant clinical response was defined as an ulcer healing greater than 75 % of the original area. Treatment failure was taken as a persistence or recurrence of more than 25 % of the ulcer area in a 1-year follow-up period. The preliminary results of good ulcer healing and no recurrence are encouraging, even up to 3-year follow-up. This proof-of-concept study demonstrates that AM transfer is useful, safe, inexpensive, readily available, and well accepted by patients, with tremendous potential in promoting epithelial healing in "the resistant nonhealing chronic venous leg ulcer."

The outcome of surgical treatment of pressure sores at Mpilo Central Hospital, Zimbabwe.

OBJECTIVE: To analyze the results of surgical management of pressure sores at Mpilo Central Hospital and also to identify the characteristics of patients who develop pressure sores in our community. DESIGN: A retrospective study of 25 patients who were treated surgically for pressure sores at Mpilo Central Hospital between January 1991 and December 1994. SETTING: Mpilo Central Hospital, Bulawayo, Zimbabwe. SUBJECTS: Twenty five patients who under-went surgical treatment for pressure sores. MAIN OUTCOME MEASURES: Site of pressure sore, underlying cause of pressure sore, investigations, surgical procedures, complications, recurrence of pressure sores and length of hospital stay. RESULTS: The mean age of the patients was 35 years (standard deviation, SD 17). There were more patients with pressure sores from rural areas (n = 15) than from urban areas (n = 10). Most pressure sores occurred in the trochanteric region, 36pc (12/33), ischial region, 33pc (11/33) and in the sacral region, 21pc (7/33). The commonest condition predisposing to pressure sores was spinal cord trauma, 48pc (12/25). Most of the patients underwent excision and flap repair (58pc) and excision and direct closure of the pressure sore (35pc). The main post operative complication was wound infection which occurred in about half the cases (n = 12). The only death in this series occurred in one patient who developed a gram negative septicaemia. The mean hospital stay was 66 days (SD37). CONCLUSION: This study indicates that spinal cord trauma, 48pc (912/25), is the commonest condition predisposing to pressure sores in our community. The incidence of such injuries can be reduced by strict enforcement of Road Traffic Regulations and improving safety precautions at the work place. As shown in this study the use of suitable flaps reduces the recurrence rate of pressure sores.