Undiagnosed Hard-to-Heal Wound Cases: A Case Series

Abstract

Introduction: The aim of this study is to raise awareness in our colleagues who read the article by addressing hard-to-heal wound cases that have been misdiagnosed or undiagnosed in the outpatient wound care clinics. The common feature of these cases is the diseases that can be found in the etiology of all and can be fatal. Many of the cases in this article were evaluated in various hospitals and different branch outpatient wound care clinics before admission and were followed up with standard wound care with different diagnoses, but there was no improvement in their wounds. Methods: The wounds evaluated in this study are calciphylaxis, Antiphospholipid Syndrome (APS), Amelanotic Melanoma (AM), Basosquamous Cell Carcinoma (BSC) and Factor V Leiden (FVL) mutation. The oldest of the 5 cases is 68 years old and the youngest is 8 years old. 4 cases were referred to our outpatient clinic by the centers where they were followed up, to receive wound care and, if indicated, Hyperbaric Oxygen (HBO) therapy. 1 case applied without any referral as a result of her own research. Results: Among the adult cases, patients with calciphylaxis and basosquamous carcinoma passed away respectively on the ninth day and the eleventh month after admission due to the underlying diseases that caused their injuries. 1 child received the appropriate treatment after the correct diagnosis and approach. In 3 cases, surgical intervention was required during the follow-up process (debridement, amputation, wide resection). Conclusion: In the evaluation of chronic wounds, it is necessary to look at them from a wide perspective. If a wound does not heal, another underlying disease should be investigated. In treatment-resistant atypical cases, the clinician should take a biopsy in the slightest doubt and the diseases that cause thrombophilia in etiology should be evaluated. Early and accurate diagnosis is essential in cases of chronic wounds. These diseases can cause loss of limb or even death. A doctor evaluating chronic wounds should be informed about the diseases mentioned in this study.