Sevoflurano tópico e injertos en sello precoces secuenciales en úlceras arterioloscleróticas en las piernas: una serie de casos

Abstract

Introduction: Leg ulcers secondary to arteriolosclerosis may be included in the clinic- histopathological spectrum of Martorell hypertensive ischemic ulcer. Consequently, they could be considered to benefit from the same treatment. Early punch grafting is an effective technique for pain control and healing promotion in Martorell ulcer. Moreover, the off-label use of topical sevoflurane has been described to be beneficial both in pain control and wound epithelization. We present the first case series of arteriolosclerotic ulcers managed with combined use of topical sevoflurane and early and sequential punch grafting. Patients and methods: Patients with arteriolosclerotic ulcers treated with topical sevoflurane and punch grafting and adapted compression therapy at Hospital Virgen de la Torre from July 2021 to January 2022 were included in a case series. The primary endpoint was time to complete epithelialization and several secondary variables were registered. A Likert scale was used to measure pain. The presentation of the results is descriptive. Results: Five patients were recruited, all of them female sex, aged between 67 and 84 years. They associated comorbidities such as hypertension, diabetes mellitus and chronic venous insufficiency, with an evolution time from 2 weeks and 8 months. Hospital admission was performed in all cases and all of them received at least two treatment sessions with punch grafting. The time interval until complete epithelialisation of the ulcers ranged from 6 weeks to 6 months. When asked, all patients reported that pain had decreased significantly since the grafting were placed, even the next day. Discussion: The results of our study show how the combination of irrigated sevoflurane, compression therapy and stamp grafts is an effective combination to reduce pain and promote epithelialization of arteriolosclerosis ulcers. This treatment, which can be performed on an outpatient basis, is well tolerated by patients and can be repeated several times if necessary.