Chronic Nonhealing Ulcers ‒ Garhwal Region (Etiopathology, Microbiology with Susceptibility, Managements & Outcomes)
Keshri Amit *
Department of General Surgery, Veer Chandra Singh Garhwali Government Institute of Medical Science and Research Srinagar, HNB Base Hospital, Srikot, Srinagar, Uttarakhand, 246178, India.
Mukul P. Bhatt
Department of General Surgery, Veer Chandra Singh Garhwali Government Institute of Medical Science and Research Srinagar, HNB Base Hospital, Srikot, Srinagar, Uttarakhand, 246178, India.
Santosh Kumar
Department of Pathology, Tata Motors Hospital, Jamshedpur, JH, India.
K. Punita
DPD & OCC, Bareilly-243006, UP, India.
*Author to whom correspondence should be addressed.
Abstract
Introduction: Chronic nonhealing ulcers, with varied etio-pathologies, are difficult to manage and warrant meticulous, early and prolonged directed treatment to prevent their development and complications.
Methods: Patients of chronic ulcers (>3 months’ duration), having undergone surgical management at our Institute, VCSGGMS&RI-UT, between January 2018 – August 2019, numbering one hundred twenty five (N= 125), were included in this concurrent observational study, aimed at identifying implicated microrganism (s) and their antibiotic susceptibility, for promoting wound healing, along with surgical measures.
Results: Male patients (M:F :: 87:38; 69.6% males) in the “20-50 year” age-group (74; 59.2%), with diabetic ulcers (35;28.0%), burns etc. (21;16.8%) and traumatic ulcers (18;14.4%) etc. predominated in the chronic non-healing state. Gram positive (68; 54.4%) organisms (including Staphylococcus) were the major isolates from the ulcers; organisms showing higher sensitivity to the newer generations/groups of antibiotics. Uncontrolled Diabetes, other prolonged illnesses &/or under-nutrition were important causative factors, requiring their remediations and also debridements ± skin/flap coverage (45; 36.0%) with prolonged course of antibiotics and occasional amputations (18; 14.4%) for adequate treatment.
Conclusion: Skilled intensive multidisciplinary effort is essential to achieve satisfactory healing and prevent disfigurement and to limit disability and death (11; 8.8%) among the patients.
Keywords: Antibiotic sensitivity, bacterial profile, chronic wound, diabetic ulcer, nonhealing ulcers.