Kadia Benjamin Momo, Dimala Christian Akem, Aroke Desmond, Ekabe Cyril Jabea, Kadia Reine Suzanne Mengue, Mefire Alain Chichom
Presbyterian General Hospital Acha-Tugi, Acha-Tugi, Cameroon.
Grace Community Health and Development Association, Kumba, Cameroon.
BMC Dermatol. 2017 Mar 20;17(1):4. doi: 10.1186/s12895-017-0056-7.
Chronic leg ulcers (CLUs) pose serious public health concerns worldwide. They mainly affect the elderly population. Pinch grafting (PG) could be used to treat a variety of CLUs. However, in Cameroon, there is scarce data on the outcome of PG of CLUs in elderly patients in rural hospitals where most of these patients seek for medical attention and where clinicians rely on unconventional wound dressing methods to treat CLUs. Our objective was to describe the outcome of PG of CLUs in elderly patients in rural Cameroon.
This was a prospective study conducted in a rural hospital of North West Cameroon. From February 2015 to January 2016, comprehensive historical and clinical data were collected per elderly patient who presented with a chronic leg ulcer necessitating PG. PG was done using a simple procedure and each patient followed up for 8 months. Outcome was described in terms of ulcer healing and pain and donor site complications.
Our series included 13 patients: 8 males (61.54%; 95% CI: 31.58-86.14) and 5 females (38.46%; 95% CI: 13.86-68.42) aged from 69 to 88 years (mean: 77.54 ± 5.70 years). Three patients (23.08%; 95% CI: 5.04-53.81) had associated co-morbidities. All the ulcers were unilateral with durations ranging from 7 to 41 months (mean: 19.46 ± 11.03 months). The ulcers ranged in size from 9.0 to 38.1 cm (mean: 17.66 ± 8.35 cm ). We registered one (7.69%; 95% CI: 0.19-36.03) graft rejection. Concerning the other ulcers, ten (83.33%; 95% CI: 51.59-97.91) had healed after 12 postoperative weeks while 2 (16.67%; 95% CI: 2.09%-48.41) had healed after 14 postoperative weeks and the mean healing time was 12.33 ± 0.78 weeks. Patients with healed ulcers had reduced ulcer site pain from the immediate postoperative period but there was no significant difference in the mean pain scores before and after graft (6.77 against 4.23, p = 0.13). These ulcers remained healed after 8 postoperative months. Each donor site had healed 2 weeks after PG. Donor site problems were minimal and included hypopigmentation.
The outcome of PG of CLUs in our series of older patients was satisfactory. This finding does not discount the role of conservative therapy, but we encourage clinicians in rural Cameroon to consider PG over long-term unconventional conservative therapy in the elderly.
慢性腿部溃疡（CLUs）在全球范围内引发了严重的公共卫生问题。它们主要影响老年人群。捏皮移植（PG）可用于治疗多种CLUs。然而，在喀麦隆，关于农村医院老年患者CLUs的PG治疗结果的数据稀缺，而大多数此类患者在农村医院寻求医疗救治，且临床医生依赖非常规伤口敷料方法治疗CLUs。我们的目的是描述喀麦隆农村老年患者CLUs的PG治疗结果。
这是一项在喀麦隆西北部一家农村医院进行的前瞻性研究。2015年2月至2016年1月，收集了每例因慢性腿部溃疡需要进行PG治疗的老年患者的全面病史和临床数据。PG采用简单程序进行，每位患者随访8个月。从溃疡愈合情况、疼痛情况以及供皮区并发症方面描述治疗结果。
我们的研究系列包括13例患者：8例男性（61.54%；95%置信区间：31.58 - 86.）和5例女性（38.46%；95%置信区间：13.86 - 68.42），年龄在69至88岁之间（平均：77.54 ± 5.70岁）。3例患者（23.08%；95%置信区间：5.04 - 53.81）有合并症。所有溃疡均为单侧，病程从7个月至41个月不等（平均：19.46 ± 11.03个月）。溃疡大小从9.0厘米至38.1厘米不等（平均：17.66 ± 8.35厘米）。我们记录到1例（7.69%；95%置信区间：0.19 - 36.03）移植排斥反应。关于其他溃疡，10例（83.33%；95%置信区间：51.59 - 97.91）在术后12周愈合，2例（16.67%；95%置信区间：2.09% - 48.41）在术后14周愈合，平均愈合时间为12.33 ± 0.78周。溃疡愈合的患者从术后即刻起溃疡部位疼痛减轻，但移植前后平均疼痛评分无显著差异（6.77对4.23，p = 0.13）。这些溃疡在术后8个月仍保持愈合状态。每个供皮区在PG后2周愈合。供皮区问题极少，包括色素减退。
我们系列老年患者CLUs的PG治疗结果令人满意。这一发现并不否定保守治疗的作用，但我们鼓励喀麦隆农村的临床医生在老年患者中考虑PG而非长期非常规保守治疗。
