Leprosy Mailing List – December 3rd, 2012
Ref.: There are many other reasons for non-healing of chronic ulcers which must be managed before considering zinc.
From: T Ryan, Oxford, UK
Dear Salvatore,
There are many other reasons for non-healing of chronic ulcers which must be managed before considering zinc. In our manual written for the WHO "Wound and Lymphoedema Management" ed John Mac Donald and Mary Jo Geyer we emphasised five key points for wound healing, three key points for lymphoedema, and two for arterial disease. This arose from the fact that many diseases that are now treated by antibiotics or agents against causation of one kind or another also need to be understood in terms of what is necessary for tissue repair. We were alerted by experience of Buruli ulcer, leprosy and lymphatic filariasis.
Wound healing
1) Wounds will not heal if there are anaemia, diabetes or HIV and other systemic illness in the background.
2) Wounds will not heal if they are subject to trauma, Viz continuing pressure, scarification etc etc.
3) Wounds will not heal if space occupying debris is not removed and infection untreated.
4) Wounds need a moist environment but the surrounding skin does not.
5) Wounds will not heal if there is significant oedema.
Lymphoedema
1) The Contents of the Lymphatics must be emptied into the great veins of the thorax before peripheral lymphatics can empty. This requires
a sequence of coordinated breathing and body movement, tissue massage and corrected posture.
2) Reduction of lymphatic overload from skin penetration by infective or irritant agents causing inflammation. Viz footwear, washing and emollients.
3) Reduction of lymphatic overload by a dependent and immobile venous system of the lower parts of the body (elevation, ankle movement).
Arterial disease
1) Stop smoking.
2) Keep walking.
Attention to the above is so often forgotten but so commonly needed where ever tissues need to repair. The discussion by Grace Warren has turned to ulceration but I have found that some of the above is relevant in erythema nodosum. For example if there is erythema nodosum of the lower leg it is not helped by being totally immobile in a dependent position. It will be worse in the untreated obese diabetic. It is this kind of problem that is common, I have only twice in a long life had to provide zinc supplements.
Best regards,
Terence Ryan
Emeritus Professor of Dermatology Oxford University and Oxford Brookes University.
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML Archives: http://www.aifo.it/english/resources/online/lml-archives/index.htm
Contact:
Dr Salvatore Noto
Padiglione Dermatologia Sociale
Az. Ospedaliera Universitaria S. Martino
Largo R. Benzi, 10
16132 Genoa, Italy
Tel: (+39) 010 555 27 83 - Fax: (+39) 010 555 66 41 - E-mail: salvatore.noto@hsanmartino.it
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