Lower Extremity Wounds in Patients With Idiopathic Thrombocytopenic Purpura and Systemic Lupus Erythematosus.
Infections in lower extremities are sometimes concerned with systemic immunological disorders such as idiopathic thrombocytopenic purpura and systemic lupus erythematosus, which are treated with systemic steroids. Steroid therapy impairs the epithelial wound healing and with systemic condition, espe...
| Publicado en: | International Journal of Lower Extremity Wounds Vol. 14; no. 3; pp. 224 - 231 |
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| Autor principal: | |
| Formato: | pictorial review Journal Article |
| Publicado: |
Sage Publications Inc.
Sep2015
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=110506583&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 110506583 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 15347346 IYG jtl: International Journal of Lower Extremity Wounds issn: 15347346 maglogo: Y pubinfo: dt: Sep2015 vid: 14 iid: 3 pid: 344 pub: Sage Publications Inc. place: Thousand Oaks, California artinfo: ui: 110506583 110506583 110506583 10.1177/1534734615604776 NLM26353824 110506583 ppf: 224 ppct: 7 formats: tig: atl: Lower Extremity Wounds in Patients With Idiopathic Thrombocytopenic Purpura and Systemic Lupus Erythematosus. aug: au: Akita, Sadanori affil: Nagasaki University Hospital, Nagasaki, Japan sug: subj: Purpura, Thrombocytopenic Chemically Induced Lower Extremity Wounds and Injuries Lupus Erythematosus, Systemic Complications Steroids Adverse Effects Fasciitis, Necrotizing Symptoms Fasciitis, Necrotizing Diagnosis Fasciitis, Necrotizing Surgery ab: Infections in lower extremities are sometimes concerned with systemic immunological disorders such as idiopathic thrombocytopenic purpura and systemic lupus erythematosus, which are treated with systemic steroids. Steroid therapy impairs the epithelial wound healing and with systemic condition, especially with systemic lupus erythematosus, the wound is susceptible for infection. Even a pyoderma gangrenosum sometimes occurs in a patient with idiopathic thrombocytopenic purpura with an incisional wound of hernia. The severe signs and symptoms are the deep skin and soft tissue infections, mainly caused by group A streptococcus, composed of necrotizing fasciitis and muscle necrosis. Medically suspected necrotizing fasciitis patients should be empirically and immediately administered with broad-spectrum antibiotics, which may cover the common suspected pathogens. In type I (polymicrobial) infection, the selection of antimicrobial should be based on medical history and Gram staining and culture. The coverage against anaerobes is important in type I infection. Metronidazole, clindamycin, or beta-lactams with beta-lactamase inhibitor or carbapenems are the treatment of choice against anaerobes, while early surgical debridement—wide enough and deep enough—is the core treatment of necrotizing fasciitis and results in significantly better mortality compared with those who underwent surgery after a few hours of delay. When necrotizing fasciitis is considered and the patient is brought to the operation room, aggressive and extensive surgical debridement is explored. Tissue involved should be completely removed until no further evidence of infection is seen. When further debridement is required, the patient must return to the operating room immediately. In this context, the temporal coverage using the artificial dermis after debridement is useful because there is no loss of the patient’s own tissue and yet it is easier for “second-look” surgery or secondary reconstruction, and extensive enough debridement is always the mainstay of the therapy. pubtype: Academic Journal doctype: pictorial review Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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