Non-healing leg ulcer dramatically responded to silver nitrate sticks

摘要

A 60-year-old woman presented to our clinic with 2.5 years history of left leg ulcer.On examination, there was ulcerative skin lesion of 15 x 25 cm. The bed of the ulcer covered by raised andpinkish granulation tissue surrounded by mild erythematous area (fig. la). Clinically, in view of the discoloration and the ulcer, the diagnosis was venous leg ulcer on a background stasis eczema. Doppler ultrasound excluded any vascular problem. A biopsy has been taken from the lesion shown pseudoepitheliomatous hyperplasia (fig. lc). She tried different kind of topical and systemic treatment without benefit including silver dressing.The patient was treated by silver nitrate sticks once a week for 2 weeks. Four silver nitrate sticks were used each time to cover all the affected area. Jelonet dressing covered by thin layer of Bactroban ointment was used. In the first 2 weeks, the ulcer showed dramatic clinical improvement, and 2 weeks later, the ulcer healed completely (fig. lb).Leg ulcer is a common problem in middle-aged and old-aged people, which is caused by many factors such as venous problem, ischemia, hypertension, infection, metabolic, blood disease, neuropathic, traumatic and tumours. Venous ulcer is the commonest form with half of patients is associated with venous thrombosis, whereas the other half with incompetence of superficial and/or communicating veins. Venous ulceration results of increase venous pressure with secondary effect on microvascular system. High venous pressure leads to capillary tortuous and increase permeability and pericapillary fibrin deposition. The fibrin causes a barrier layer to nutrients and oxygen diffusion resulting in ischemia and necrosis. Factors that precipitate necrosis include minor trauma and contact dermatitis.