heroin and Pressure-Ulcer

Topics: Aged; Aged, 80 and over; Analgesics, Opioid; Bandages; Drug Combinations; Female; Heroin; Humans; Hydrogels; Male; Middle Aged; Pain; Pressure Ulcer; Retrospective Studies; Treatment Outcome

Pressure ulcer pain, a common problem among palliative care patients, does not respond well to oral analgesics. There have been case reports in the medical literature describing the successful use of topical opioids for painful skin conditions. So far, these topical opioids have not been compared to placebo. To determine the effectiveness of diamorphine gel to control pressure ulcer pain and compare it with placebo, a randomized, double blind, placebo-controlled crossover trial was conducted in 13 patients with painful grade II or III pressure ulcers. Patients resided on the inpatient unit at St. Christopher's Hospice, London, UK. Seven patients completed the study and provided pain scores before and after diamorphine or placebo gel application. Pain scores improved significantly after diamorphine gel application compared with placebo (P<0.05). Diamorphine gel appears to be an effective treatment for pain caused by stage II or III pressure ulcers. It is probably as safe as placebo in regards to side effects, but a larger study would be required to confirm these results.

Topics: Administration, Topical; Aged; Aged, 80 and over; Analgesics, Opioid; Cross-Over Studies; Double-Blind Method; Female; Gels; Heroin; Humans; Male; Middle Aged; Pain; Pain Measurement; Pilot Projects; Pressure Ulcer

Nested graft is a surgical technique that allows to manage difficult-to-treat medical conditions such as chronic cutaneous ulcers, thanks to the high efficacy it has in reverting the fibroblasts senescence. Because of its peculiar regenerative property, nested graft is a surgical technique suitable also for the treatment of cutaneous ulcers developing on fibrotic scar tissue.. We reported the case of a 45-year-old man, drug-addict, with a large ulcer on the back of the right forearm in the context of scar fibrotic tissue. This lesion resulted from a previous heroin extravasation treated with a dermo-epidermal skin graft, that was accidentally scratched away by mechanical trauma. After several therapeutic failures with topical medications, we decided to treat the ulcer performing a skin graft using the nested graft technique. No adverse events were reported by the patient during or after the surgery. At the clinical evaluation performed three years later the wound was completely healed.. Nested graft represents a safe and easy-to-use technique that can be successfully used to treat ulcers on scar tissue, ensuring the achievement and the long-term maintenance of optimal resistance and aesthetic results.

Topics: Chronic Disease; Cicatrix; Heroin; Humans; Male; Middle Aged; Pressure Ulcer; Skin Transplantation; Substance-Related Disorders; Wounds and Injuries

Topics: Acute Kidney Injury; Adult; Coma; Contracture; Female; Heroin; Humans; Ischemia; Male; Muscles; Muscular Diseases; Pressure; Pressure Ulcer; Secobarbital; Skin Diseases; Substance-Related Disorders