Mycobacterium ulcerans skin ulcers: review of surgical management

Abstract

Mycobacterium ulcerans infection causes debilitating ulceration of the skin and subcutaneous tissue. Until 1993, this infection was not a major health problem in Ghana. In 1993, there was a major outbreak in the Ashanti Region of Ghana, in the Amansie West District in the village communities of Tontonkrom [1, 2]. Unfortunately, pharmacological treatment of this disease is not effective. Traditional methods of wound care such as the use of Eusol or Acriflavine lotion do not promote healing. Surgical management involves radical excision of the ulcer with meticulous haemostasis and coverage with a split-thickness skin graft (STSG) or local skin subcutaneous flap. Successful covering of the ulcers, proper splinting and physiotherapeutic exercises in the affected limbs prevented the contracture deformities other associated with the disease. This report reviews the management of 240 patients surgically treated at the Komfo Anokye Teaching Hospital (KATH) and at two nearby hospitals from 1994 to 1997 with a 2- to 5-year follow-up.