Successful Treatment of Multiple Chronic Leg Wounds - a Case Report

Abstract

Chronic wounds constitute a significant challenge confronting patients and health care professionals. In the USA approximately 5.7 million patients are currently suffering from chronic wounds. Expenses on their treatment are estimated at $20 billion annually [1,2]. Lower-extremities ulcers, especially in individuals older than 65 years, are a frequent cause for attending a podiatrist, wound care specialist, primary care physician, vascular surgeon or dermatologist. The bulk of vascular leg ulcers is chronic or recurrent. They can present significant complications among patients with the peripheral vascular disease, including work incapacity. The management of vascular leg ulcers puts a considerable burden on a patient and the health care system. Moreover, these non-healing ulcers increase the risk for lower extremity amputation [3]. Vascular leg ulcers are often multifactorial and can be caused by both arterial and venous diseases. Hypertension and atherosclerosis of peripheral vessels lead to the arterial disease associated with ischemic ulcers. In some cases, difficulties with determining the underlying cause of wound formation complicates treatment and prevents the recurrences. Systemic sclerosis (or scleroderma) is a rare autoimmune connective tissue disorder which is associated with a various degree of systemic manifestations [4]. The organs most frequently affected by scleroderma are skin, gastrointestinal tract, lungs, kidneys, skeletal muscle, and pericardium [5]. One of the challenging complications of systemic sclerosis are non-digital lower extremity ulcers seen both in limited and diffuse scleroderma, with not exactly clear etiology that tends to reflect chronic vasculopathy. They aggravate some pain and ability of the advanced disease. As the incidence of nonhealing lower extremity ulcers in scleroderma has not specifically been studied, more researches are considered to be appropriate in this field of study. The delayed wound healing is typical for systemic sclerosis and, likewise in other chronic leg ulcers, characterized by multifactorial etiology. A role of vascular disease has been proposed, but in spite of restoring the good blood flow and venous drainage, many scleroderma ulcers still remain refractory [6,7]. The 73-year-old female patient V. was sent to the surgical department No 1 of Lviv regional clinical hospital in 2013 due to ulcers on both legs, which she developed 3 years before the clinical attendance. Her medical history was remarkable for myocardial infarction which she suffered in 2009. She suffered from atrial fibrillation (treated by Varfarin 5 mg) and hypertension (treated by Valsartan 80 mg plus Hydrochlorothiazide