Skin necrosis of scrotum due to endovascular embolisation: a case report

Systematic review of warfarin-induced skin necrosis case reports and secondary analysis of factors associated with mortality

OBJECTIVE

Warfarin-induced skin necrosis (WSN) is a rare (0.0.1%-0.1%) and severe adverse reaction. The clinical characteristics of this reaction and its mortality rate have not been explored in a large population. Therefore, we present the case of a Peruvian patient who developed WSN and perform a systematic review of case reports of WSN.

METHODS

A systematic search was performed using the Pubmed/Medline, Scopus, Web of Science and Embase databases. Patient clinical data were collected and extracted from every case report. Furthermore, we analysed the factors associated with mortality because of WSN using the Poisson regression model with robust variations, obtaining risk ratios (RR) and their respective confidence intervals (95% CI).

RESULTS

We identified 90 case reports that included a total of 111 patients with WSN (mean age 52.5 years), 20.72% of whom died of complications because of WSN. Being male (RR: 2.87; 95% CI 1.21-6.83) and having three or more affected regions (RR: 6.81; 95% CI 2.62-17.74) were associated with an increased risk of death caused by WSN.

CONCLUSION

This systematic review identified 90 case reports of WSN with three or more affected body regions. Male sex was associated with an increased risk of death. Further studies are needed to analyse and confirm these results.

Case report of a successful multidisciplinary approach to a giant scrotal malformation

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Giant arterio-venous malformations in the pelvic region are rare.

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Selective angiography is mandatory for diagnosis and treatment to define the extent and limits of the malformation.

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Skin necrosis can by managed jointly by vascular and plastic surgeons.

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Azoospermia is frequent in the postoperative period.

Introduction

Congenital pelvic malformations are rare and represent a difficult therapeutic challenge. Scrotal arteriovenous malformations are quite unusual, with only a few such cases reported in the literature. Only one case of scrotal malformation? due to an arteriovenous fistula resulting in azoospermia has been described.

Presentation of case

The two-phase strategy adopted in that case permitted complete treatment of a large-sized malformation that was served by 4 main blood confluences.

Discussion

Angio-CT performed using reconstructions with MIP and SSD algorithms provided more detailed data about the extension of the afferents and efferents of the arteriovenous malformation, thus enabling us to plan the endovascular treatment of the lesion.

Conclusion

A multidisciplinary approach is mandatory to achieve good results in these cases.

Chronic ulcers: MATRIDERM(®) system in smoker, cardiopathic, and diabetic patients

Diabetic ulcers and pressure ulcers represent a more frequent cause of chronic wounds in aging populations. It is estimated that approximately 15% of the diabetic population will develop diabetic ulcers during their life and over half of these patients develop an infection, often osteomyelitis, with 20% requiring amputation.

The authors report a case of a 65-year-old woman affected by a post-traumatic loss of substance due to road accidents with soft tissue exposure (comprising muscle tendon) of the left knee combined with the fracture of the right fibula previously subjected to surgery and reconstruction of muscle tendon.

The patient was affected by diabetes type II, hypertension, and ischemic heart disease.

In 2008, she underwent a double bypass surgery and coronary angioplasty.

Initially, the patient was treated with cycles of advanced dressings, with fibrinolytic ointments, hydrocolloid, and subsequently, when the bottom began granulated with fibrinolytic and idrocellulosa, Hydrofibra-Ag, and Ag-alginate, three times a week for 30 days.

In the second step, the authors decided to treat the ulcer with the MATRIDERM system and auto skin graft.

Following the first treatment, 7 days after the procedure, the authors found the reduction of the loss of substance until its complete closure.

The wound’s infection was evaluated by a buffer negative confirmation performed every 2 weeks four times. We obtained decrease of limb edema and full functional rehabilitation. The skin appeared renovated, with volume restoration and an improvement of the texture.