HIV-negative Kaposi sarcoma manifesting as foot lesion in a patient with diabetes mellitus: a case study

Abstract: Kaposi’s sarcoma caused by Kaposi’s sarcoma-associated virus, is a rare malignancy in the general population with unique features. However, clinical presentation on the feet can mimic a diabetic foot ulcer. Here we describe the case of a 63-year-old male with type 2 diabetes, who presented with a lesion on the left 4th toe. Left foot radiograph in lateral and dorsoplantar views were normal. Full skin examination identified lesions with a similar morphology on the forearms. A HIV antigen/antibody test was negative, histology showed CD31 positive spindle cells and the presence of Kaposi’s sarcoma-associated virus confirming the diagnosis of Kaposi’s sarcoma. Kaposi’s sarcoma-associated virus’ lytic cycle can be triggered by the immunosuppressive state caused by tissue’s chronic exposure to a hyperglycaemic environment. A thorough general examination to identify lesions elsewhere in the body can help to identify the systemic nature of the disease. Pedal lesions in patients with diabetes with an atypical presentation that are refractory to standard treatment should prompt early histological examination. Early diagnosis and intervention can improve the chances of remission.

Farishta Khan,

Norfolk and Norwich University Hospitals NHS Foundation Trust

Dijon Millette,

Mersey and West Lancashire Teaching Hospitals NHS Trust

Roshan Siddique,

St George’s University of London

Haroon Siddique,

Russell Hall Hospital, Dudley Group NHS Trust

Key words

• AIDS
• Diabetes
• Diabetic foot ulcer
• Kaposi sarcoma
• Kaposi’s sarcoma-associated virus

Powdered porcine urinary bladder matrix for treating chronic diabetic wounds: clinical case studies

This article is based on a presentation by Professor Steven Jeffery at the annual Wounds UK conference in Harrogate, on 7 November 2023. Professor Jeffery presented clinical studies on how a bioengineered wound therapy with a porcine urinary bladder matrix (UBM) may facilitate healing of chronic wounds.

Steven LA Jeffery

Medical Director Pioneer Wound Telehealth and Professor of Wound Study, Birmingham City University

John McRobert

Clinical Research Director, Pioneer Wound Telehealth

Key words

• Chronic diabetic wounds

• Urinary bladder matrix
• Macrophages
• Wound healing
• Meeting report
• Wound care services

This meeting report has been funded by an educational grant from Integra

Managing wounds at risk of infection in difficult-to-dress areas

Steven Percival

BSc, PGCE, MSc, MSc, PhD, CEO, 5D Health Protection Group Ltd, Professor (hon), School of Medicine, University of Manchester, UK

Leanne Atkin

PhD MHSc, RGN, Vascular Nurse Consultant/Lecturer Practitioner, Mid Yorks NHS Trust, University of Huddersfield, UK

Key words

• Infection
• Flaminal®
• Antimicrobial resistance

• Meeting report

Declarations

The symposium and report were supported by Flen Health.

Evaluation of a technology lipido-colloid non-adherent dressing with silver in the management of burn patients — a case series from India

Management, as well as prevention, of wound infection is key in the promotion of the healing process. In India, over one million people are moderately or severely burnt every year, and managing the challenging burn wounds is a daily reality for clinicians in the country. Silver has been used as an antimicrobial in burn wound management for decades and modern advanced dressings can provide safe prevention and management of infection in these cases. This article reports the cases of two adults, an infant and a child with burns, at risk of infection and managed with a Technology Lipido-Colloid non-adherent dressing with silver (TLC-Ag; UrgoTul Ag/Silver). The main benefits observed when using the evaluated dressing in these patients included rapid wound healing but also patient-related outcomes, such as decrease in pain and atraumatic removal.

Clockwise from top left:

Dr Venkateswaran

Plastic Surgeon, Jupiter Hospital, Mumbai, India

Dr Ravichander Rao A

Plastic Surgeon, Care Hospital, Hyderabad, India

Dr Krishna Kumar

Plastic, Aesthetics, Burns, Hand and Reconstructive Microsurgeon, Kovai Medical Centre & Hospital, Coimbatore, India

Dr Sankamithra

Consultant Plastic Surgeon, Lakshmi Medical center, Pollachi, India

Key words

• Burns
• Lipido-colloid non-adherent dressing

• Silver

Declarations

All authors have no particular conflicts of interest to declare regarding these cases.

Negative pressure wound therapy with vancomycin wound instillation: a case report

Negative pressure wound therapy (NPWT) supports the healing process by removing fluid and drawing out the infection from a wound, promoting the growth of new tissue. The device works by providing and distributing negative pressure evenly across the wound bed, either through the application of an open cell foam or a gauze dressing. NPWT provides a warm, moist wound bed while removing wound fluid that contains factors that inhibit cell growth, enhances wound oxygenation and improves the flow of blood and nutrients to the wound. NPWT also creates mechanical forces that influence the wound macroscopically, inducing cell proliferation, cell migration to the wound and angiogenesis. For infected wounds, the device can be used to instil antibiotics. In this article, a 57-year-old Caucasian woman with respiratory failure developed sepsis secondary to an intra-abdominal infection with abscess. Vancomycin 1mg/mL wound instillation, instilled as 100mL every 3 hours with a dwell time of 10 minutes, was administered concomitantly with intravenous vancomycin in the successful management of this patient.

Alison Bunnell

Doctor of Pharmacy Candidate 2022, North Dakota State University, Fargo, ND, USA

Erin Beauclair

Doctor of Pharmacy Candidate 2022, North Dakota State University, Fargo, ND, USA

Breanna Jones

Doctor of Pharmacy, Pharmacy Department, Sanford Medical Center Fargo, Fargo, ND, USA

Emily Greenstein

Advanced Practice Registered Nurse and Certified Nurse Practitioner, Wound Care, Sanford Medical Center Fargo, Fargo, ND, USA

Justin M Jones

Doctor of Pharmacy, Pharmacy Department, Sanford Medical Center Fargo, Fargo, ND, USA

Andrea R Clarens

Doctor of Pharmacy Pharmacy Department, Sanford Bemidji Medical Center, Bemidji, MN, USA

Key words

• Acute kidney injury
• Computed tomography

• Kidney Disease Improving Global Outcomes

• Negative pressure wound therapy

Declaration

Emily Greenstein reports she has been a consultant for Urgo medical, 3M and coloplast. 3M manufactures V.A.C.  VeraFlo. None of these manufacture or distribute vancomycin instillation described in this manuscript.

Do peripheral arterial disease and smoking impede diabetic ulcer healing?

Background: In some patients, diabetic foot ulcers may heal slowly despite tight control of blood glucose and normal limb circulation, implying the presence of multifactorial, unidentified factors to wound healing. Previous efforts to identify these factors using binary variables, such as amputation or specific healing timelines, inadequately reflect the complexities of wound healing capacity.

Aims: We aimed to identify factors associated with delayed diabetic foot ulcer healing.

Methods: Eight factors were assumed to affect diabetic foot ulcer healing; patient age, age at the onset of diabetes, sex, peripheral arterial disease (PAD), HbA1c, smoking as measured by the Brinkman index (BI), dialysis and bone infection. They were analysed using linear regression and multivariable analysis against three healing indices: total healing period (THP), granulation time (GT) and time to contraction onset (TCO).

Results: PAD and BI correlated positively with all three indices. Patients with PAD exhibited significantly extended THP, GT and TCO. An increase of 100 in BI corresponded with a 1.53 day increase in GT.

Conclusion: PAD was associated with delayed healing according to every measure analysed, while BI was linked with slower granulation. Besides THP, the measurements of GT — and possibly TCO — could evaluate some aspects of healing capacity of diabetic ulcers.

Kazufumi Tachi

Senior Lecturer, Division of Plastic Surgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan

Koichi Gonda

Professor, Division of Plastic Surgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan

Takashi Kochi

Chief Surgeon, Department of Plastic Surgery, Sendai City Hospital, Sendai, Japan

Jyunya Niwa

Research Associate, Division of Plastic Surgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan

Key words

● Diabetic foot ulcer

● New index of wound healing

● Brinkman index

Declarations

All authors have no conflicts of interest to declare.