Characteristics of lower extremity ulcers among patients treated at Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali



Luh Gede Melia Puspita Sari(1), Nyoman Suryawati(2*)

(1) Residency Program of Dermatology and Venereology Department, Faculty of Medicine, Universitas Udayana, Denpasar, Bali
(2) Dermatology and Venereology Department, Faculty of Medicine, Universitas Udayana Denpasar, Bali
(*) Corresponding Author

Abstract


Lower extremity ulcers are one of the ulcers that are difficult to heal. This condition causes significant morbidity, mortality, costs, and reduces the quality of life. Epidemiological studies in Indonesia often focus on diabetic foot ulcers, so a general description of lower extremity ulcers is still lacking. This study aimed to determine the characteristics of lower extremity ulcers in outpatients at the Dermatology and Venereology Outpatient Polyclinic, Prof. Dr. I.G.N.G Ngoerah General Hospital, Denpasar, Bali. The data were taken retrospectively from medical records from January 2018 until December 2021. A total of 15 subjects were enrolled in this study. Among the subjects, 8 (53.3%) were male and 7 (46.6%) were female. The age group of 40 yo and over dominated this study (60%). The common ulcer predilection was on the cruris (42.1%) and the wound culture results were dominated by Staphylococcus aureus (40%). Comorbidities were found in 7 subjects (46.7%) and the majority was hypertension (42.8%). Several subjects also had additional diagnoses at the time of the visit, including Morbus Hansen (60%), deep vein thrombosis (10%), cellulitis (10%), pyoderma gangrenosum (10%), and systemic lupus erythematosus (10%). In conclusion, the most characteristics of lower extremity ulcer patients at Prof. Dr. I.G.N.G Ngoerah General Hospital  are males, age group > 40 yr, with cruris as a predilection, and hypertension as the most common comorbid.


Keywords


lower extremity;retrospective;ulcers

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References


1.Agale SV. Chronic leg ulcers: epidemiology, aetiopathogenesis, and management. Ulcers 2013; 1-9.
https://doi.org/10.1155/2013/413604
2.Schneider C, Stratman S, Kirsner RS. Lower extremity ulcers. Med Clin North Am 2021; 105(4):663-79.
https://doi.org/10.1016/j.mcna.2021.04.006
3.Danwang C, Tochie JN, Mazou TN, Nzalie RNT, Bigna JJ. Contemporary occurrence and aetiology of chronic leg ulcers in Africa: a systematic review and meta-analysis protocol. BMJ Open 2019; 9(5):e026868.
https://doi.org/10.1136/bmjopen-2018-026868
4.NWCSP. Lower Limb Recommendations. National Wound Care Strategy Programme. 2020.
https://www.nationalwoundcarestrategy.net/wp-content/uploads/2021/04/Lower-Limb-Recommendations-WEB-25Feb21.pdf
5.Baker SR, Stacey MC. Epidemiologu of chronic leg ulcers in Australia. Aus N Z J Surg 1994; 64(4):258-61. https://doi.org/10.1111/j.1445-2197.1994.tb02196.x
6.Wardhana M, Windari M, Sissy, Dewi H, Karna V, Rusyati LM. Clinical presentation and risk factor of cruris ulcer in Sanglah General Hospital, Denpasar, Indonesia. Ictromi 2019; 445-8. https://doi.org/10.5220/0009991204450448
7.Mayrovitz HN, Wong S, Mancuso C. Venous, arterial, and neuropathic leg ulcers with emphasis on the geriatric population. Cureus 2023; 15(4):e38123. https://doi.org/10.7759/cureus.38123
8.Magalhães MG, Gragnani A, Veiga DF, Blanes L, Galhardo VA, Kállas H, et al. Risk factors for pressure ulcers in hospitalized elderly without significant cognitive impairment. Wounds 2007; 19(1):20-4.
9.Raffetto JD, Ligi D, Maniscalco R, Khalil RA, Mannello F. Why venous leg ulcers have difficulty healing: overview on pathophysiology, clinical consequences, and treatment. J Clin Med 2021; 10(1):29. https://doi.org/10.3390/jcm10010029
10.Isoherranen K, Kallio M, O’Brien JJ, Lagus H. Clinical characteristics of lower extremity ulcers. JWM 2020; 21(1):51-8. https://doi.org/10.35279/jewma202011.08
11.Gamus A, Keren E, Kaufman H, Chodick G. Synchronous video telemedicine in lower extremities ulcers treatment: a real-world data study. Int J Med Inform 2019; 124(10):31-6. https://doi.org/10.1016/j.ijmedinf.2019.01.009
12.Alam W, Hasson J, Reed M. Clinical approach to chronic wound management in older adults. J Am Geriatr Soc 2021; 69(8):2327-34. https://doi.org/10.1111/jgs.17177
13.Say M, Tella E, Boccara O, Sauvage M, Bourrat E, Tian Y, et al. Leg ulcers in childhood: a multicenter study in France. Ann Dermatol Venereol 2022; 149(1):51-5. https://doi.org/ 10.1016/j.annder.2021.05.004
14.Borges EL, de Fonseca Domingos SR, de Carvalho Campos LP, Spira JAO. Patients who experience systemic lupus erythematosus and leg ulcer: phenomenological approach. Rev Bras Enferm 2020; 75(2):e20200081. https://doi.org/10.1590/0034-7167-2020-0081
15.Leone P, Prete M, Malerba E, Bray A, Susca N, Ingravallo G, et al. Lupus vasculitis: An overview. Biomedicines 2021; 9(11):1626. https://doi.org/10.3390/biomedicines9111626
16.Singer AJ, Tassiopoulos A, Kirsner RS. Evaluation and management of lower-extremity ulcers. N Engl J Med 2017; 377(16):1559-67. https://doi.org/10.1056/NEJMra1615243
17.Augey F, Pinet A, Renaudier P. Heart failure and stasis ulcer: a significant association (prospective study of 100 cases). Ann Dermatol Venereol 2010; 137(5):353-8. https://doi.org/10.1016/j.annder.2010.03.022
18.Rodgers S, Leslie KS. Skin infections in HIV-infected individuals in the era of HAART. Curr Opin Infect Dis 2011; 24(2):124-9. https://doi.org/10.1097/QCO.0b013e328342cb31
19.Fernandes TRMDO, Lopes RRDM, Dos Santos TSS. Leg ulcer in lepromatous leprosy - case report. An Bras Dermatol 2016; 91(5):673-5. https://doi.org/10.1590/abd1806-4841.20164149
20.Miyashiro D, Cardona C, Valente NYS, Avancini J, Benard G, Trindade MAB. Ulcers in leprosy patients, an unrecognized clinical manifestation: A report of 8 cases. BMC Infect Dis 2019; 19(1):1013. https://doi.org/10.1186/s12879-019-4639-2
21.Walker N, Rodgers A, Birchall N, Norton R, MacMahon S. Leg ulceration as a long-term complication of deep vein thrombosis. J Vasc Surg 2003; 38(6):1331-5. https://doi.org/10.1016/s0741-5214(03)00917-0
22.Mouawad NJ. Chronic venous ulcer resolution and post-thrombotic syndrome improvement after percutaneous mechanical thrombectomy of a 42-year-old deep vein thrombosis. J Vasc Surg Cases Innov Tech 2022; 8(2):196-200. https://doi.org/10.1016/j.jvscit.2022.03.001
23.Verdon A. Cellulitis of the lower limb. NHS 2021; 2(1):1-8.
24.Park J, Jeong GJ, Hong JY, Park KY, Kim BJ, Kim WS. Pyoderma gangrenosum overlying venous insufficiency: an inevitable misdiagnosis. J Wound Manag Res 2019; 15(1):48-51. https://doi.org/10.22467/jwmr.2019.00626
25.Studdiford JS, Trayes KY. Urgent care dermatology: symptom-based siagnosis. Skinmed 2018; 16(4):288.
26.Bui UT, Edwards H, Finlayson K. Identifying risk factors associated with infection in patients with chronic leg ulcers. Int Wound J 2018; 15(2):283-90. https://doi.org/10.1111/iwj.12867
27.Cwajda‐białasik J, Mościcka P, Jawień A, Szewczyk MT. Microbiological status of venous leg ulcers and its predictors: a single‐center cross‐sectional study. Int J Environ Res Public Health 2021; 18(24):12965. https://doi.org/10.3390/ijerph182412965
28.Gjødsbøl K, Skindersoe ME, Skov RL, Krogfelt KA. Cross-contamination: comparison of nasal and chronic leg ulcer Staphylococcus aureus strains isolated from the same patient. Open Microbiol J 2013; 7:6-8. https://doi.org/10.2174/1874285801307010006
29.Garcia TF, Borges EL, Junho TOC, Spira JAO. Microbiological profile of leg ulcer infections: review study. Rev Bras Enferm 2021; 74(3):e20190763. https://doi.org/10.1590/0034-7167-2019-0763
30.Gajda M, Załugowicz E, Pomorska-Wesołowska M, Bochenek T, Gryglewska B, Romaniszyn D, et al. Virulence and drug-resistance of Staphylococcus aureus strains isolated from venous ulcers in polish patients. Int J Environ Res Public Health 2021; 18(9):4662. https://doi.org/10.3390/ijerph18094662
31.Jha P, Kim CM, Kim DM, Chung JH, Yoon NR, Jha B, et al. Transmission of Enterobacter aerogenes septicemia in healthcare workers. Springerplus 2016; 5(1):1397. https://doi.org/10.1186/s40064-016-3011-x
32.Donastin A and Aisyah. Microbial pattern of diabetic foot ulcer patient in Jemursari Islamic Hospital Surabaya Period 2012-2016. Indon J Med Lab Sci Technol 2019; 1(1):22-32.
33.Habib S, Fuca N, Azam M, Siddiqui AH, Rajdev K, Chalhoub M. Achromobacter xylosoxidans/denitrificans bacteremia and subsequent fatal Escherichia coli/Streptococcus anginosus pleural empyema. Respir Med Case Rep 2018; 25:311-3. https://doi.org/10.1016/j.rmcr.2018.10.010
34.Tena D, Martínez NM, Losa C, Solís S. Skin and soft tissue infection caused by Achromobacter xylosoxidans: report of 14 cases. Scand J Infect Dis 2014; 46(2):130-5. https://doi.org/10.3109/00365548.2013.857043
35.Vali L, Dashti AA, El-Shazly S, Jadaon MM. Klebsiella oxytoca with reduced sensitivity to chlorhexidine isolated from a diabetic foot ulcer. Int J Infect Dis 2015; 34:112-6. https://doi.org/10.1016/j.ijid.2015.03.021
36.Fadeyi A, Adigun I, Rahman G. Bacteriological pattern of wound swab isolates in patients with chronic leg ulcer. Int J Health Res 2010; 1(4):1-8. https://doi.org/10.4314/ijhr.v1i4.55375
37.Chaplin S. NICE on antimicrobial prescribing for leg ulcer infection. Prescriber 2020; 31(7-8):27-30. https://doi.org/10.1002/psb.1858




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Journal of the Medical Sciences (Berkala Ilmu Kedokteran) by  Universitas Gadjah Mada is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
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