ABSTRACT
INTRODUCTION: Chronic plantar ulcers in leprosy are lesions resulting from motor and sensory alterations caused by Mycobacterium leprae. They are lesions refractory to conventional dressings and present high recurrence rates. OBJECTIVE: To evaluate the epidemiological clinical profile of patients with chronic plantar ulcers associated with bony prominences in the lesion bed and to evaluate the efficacy of orthopedic surgical treatment of these lesions. METHODS: This is a descriptive and analytical retrospective study with the evaluation of medical records of patients undergoing surgical treatment of chronic plantar ulcers from 2008 to 2018. The surgical technique applied consisted of corrective resection of bone prominences and the primary closure of the lesion with bipediculated local flap. RESULTS: 234 patients were submitted to surgery, 55.1% male with an average age of 69.5 years old. Of these, 82.9% were illiterate; and 88.5% with open lesions over 10 years. After surgical treatment, total wound healing occurred in an average time of 12 weeks. The variables that contributed to shorter healing time were: Patients' lower age group; regular use of orthopedic shoes and insoles and dressings performed by nurse aides in health units before surgery. Obesity was the factor that correlated with the delay of healing time. CONCLUSION: A higher incidence was observed in males and male and female illiterate patients. The regular use of shoes and insoles and dressings performed by nurse aides in health units contributed to shorter postoperative healing time. Orthopedic surgical treatment with corrective resection of bony prominences proved to be an efficient therapeutic method for the closure of chronic plantar ulcers. It is a reproducible method, justifying the importance of the orthopedic surgeon in the context of the multidisciplinary team to cope with these complex lesions.
Subject(s)
Diabetic Foot , Foot Ulcer , Leprosy , Orthopedic Procedures , Humans , Male , Female , Aged , Foot Ulcer/epidemiology , Foot Ulcer/etiology , Foot Ulcer/surgery , Retrospective Studies , Leprosy/complications , Leprosy/epidemiology , Leprosy/surgery , Orthopedic Procedures/adverse effects , Surgical Flaps/surgery , Diabetic Foot/surgeryABSTRACT
In Brazil, there is little information about the clinical and epidemiological characteristics of paucibacillary, single skin lesion leprosy patients (SSL-PB). Only recently has the official notification system distinguished leprosy patients with a single lesion as a clinical entity, for whom the single-dose ROM (rifampin, ofloxacin and minocycline) regimen has been recommended. In this paper, we describe the baseline clinical features and the immunological background of a multicenter cohort of SSL-PB leprosy cases enrolled between December 1997-1998. Patients were recruited at health centers located in the following regions: Southeast = Rio de Janeiro; North = Amazon and Rondônia states and Center-West = Goiás state. Eligible cases were newly detected, untreated single-lesion leprosy patients without thickened nerve involvement, and were assessed by clinical, bacilloscopic and histopathological exams. The Mitsuda skin test and anti-PGL-I serology (ELISA) were also performed. Of the 299 SSL-PB leprosy patients, 259 (86.6%) fulfilled the criteria for single-dose ROM intervention. Our results showed that patients recruited from different sites had similar features, considering the clinical and immunological profiles. There was a predominance of adults (mean age 32.4; S.D. = 16.0), and a BCG scar was detected in 76.7% of the children ( or = 5 mm) and seropositivity for anti-PGL-I was detected in 17.3% of the patients. These data are compatible with effective cell-mediated immunity and low bacillary load, suggesting favorable clinical outcomes for most SSL-PB participants of this cohort.
Subject(s)
Leprosy, Borderline/physiopathology , Leprosy, Tuberculoid/physiopathology , Leprosy, Lepromatous/physiopathology , Leprosy/physiopathologyABSTRACT
Após breve descriçäo da hanseníase, apresenta sua etiologia e os avanços no controle da doença. A seguir aborda sua história, epidemiologia e distribuiçäo no Estado do Amazonas e, particularmente, no município de Manaus.(MAM)
Subject(s)
Leprosy/history , Public Health/history , Brazil , Communicable Disease Control/history , Leprosy/epidemiologyABSTRACT
Após breve descriçäo da hanseníase, apresenta sua etiologia e os avanços no controle da doença. A seguir aborda sua história, epidemiologia e distribuiçäo no Estado do Amazonas e, particularmente, no município de Manaus.(MAM)
