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Case Study
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Nephrogenic fibrosing dermopathy: lower extremity wounds respond to hyperbaric oxygen therapy L. Corbett, C. Anderson, B. Magliato, M. Powers, C. Tray, A. Babigian, G. Perdrizet, Center for Wound Healing and Hyperbaric Medicine and Dept. of Nephrology and Plastic Surgery at Hartford Hospital and the University of Connecticut Health Center, Hartfor Introduction: Nephrogenic Fibrosing Dermopathy (NFD) is a recently recognized and poorly understood systemic disease associated with end-stage renal disease (ESRD)(Cowper, 2003). NFD is characterized as a scleroderma-like fibrosing skin condition. We report the successful use of adjunctive HBO2 therapy to treat non-healing wounds in a patient with NFD..Methods: Case report of a 69yo AAF with DM and ESRD secondary to multiple myeloma currently in remission. The diagnosis of NFD was confirmed by skin biopsy. Patient presented with painful necrotic full thickness ulcerations of the right tibia. Comprehensive evaluation was initiated, including vascular and nutritional evaluations, standard moist wound care, serial sharp debridement, and application of topical antimicrobial agents and compression. Wounds failed to respond with 6 weeks of treatment. Transcutaneous oxygen measurements (TCOM) were performed (prox. tibia 10mmHg, dorsal foot 9mmHg at 21%, 1 ATA) and found to be inadequate for healing. HBO therapy (2.4ATA, 90 min 100%, 5x/week) was initiated..Results: The patient received a total of 40 HBO treatments over 13 weeks without complications. The wound bed responded, negative pressure wound therapy was added at week 10 followed by placement of a split thickness skin graft and additional 10 HBO treatments. Improvements in TCOM measurements were observed post-HBO (prox. tibia 59mmHg, dorsal foot 29mmHg at 21%, 1 ATA)..Conclusion: Non-healing wounds developing in association with NFD respond to adjunctive HBO therapy.. |
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