Treatment response time in a patient with hard-to-heal ulcers: a case report

Approximately 1% of skin cancers occur secondary to chronic inflammation, and approximately 95% of these are squamous cell carcinomas (SCC) with a metastasis rate of 20-30%. This case report describes the treatment of a 38-year-old male patient with paraplegia and with a history of operated meningomyelocele and congenital hip dysplasia who was admitted to the emergency service of the Basaksehir Cam ve Sakura City Hospital (Istanbul, Turkey) with complaints of bleeding, discharge and pain from a hard-to-heal (chronic) pressure ulcer (PU) in the right gluteal region. The patient had a haemorrhagic and ulcero-vegetant mass/wound of approximately 20×20cm with vegetative satellite lesions located in the right gluteal region extending to the sacral region. Acinetobacter baumannii was growing in the wound culture and appropriate antibiotherapy was initiated followng the recommendation of the infectious diseases clinic. The patient was started on a protein-rich diet, with parenteral paracetamol and non-steroid anti-inflammatory drugs for wound care and pain relief. Pathological examination of the tissue biopsy detected SCCs. According to the pelvic magnetic resonance imaging and positron emission tomography-computed tomography results, the mass was considered inoperable and radiotherapy was administered for wound palliation with the help of the radiation oncology clinic. After 13 sessions of radiotherapy, haemorrhage of the ulcer ceased and the mass showed minor regression. This case report demonstrates that it is important to follow-up on patients with hard-to-heal PUs who are fully or partially bedbound. This can be performed by home health services or family physicians in primary care. If the treatment process is prolonged in palliative care patients with hard-to-heal wounds, requesting further examinations when malignant transformations are observed may create the opportunity for an early diagnosis, which can improve their quality of life. Declaration of interest: The authors have no conflict of interest.