Effects of comprehensive treatment of infected wounds in patients with iatrogenic Cushing<i>'</i>s syndrome

Li Shuntang; Lin Yuan; Ou Binxian; Liu Da'en; Li Dehui; Nong Qingwen; Wu Yajun; Qiu Shumei; Huang Zhenxing

doi:10.3760/cma.j.cn501225-20220329-00106

Volume 38 Issue 6

Jun. 2022

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Article Navigation > CHINESE JOURNAL OF BURNS AND WOUNDS > 2022 > 38(6): 512-519

Li ST,Lin Y,Ou BX,et al.Effects of comprehensive treatment of infected wounds in patients with iatrogenic Cushing's syndrome[J].Chin J Burns Wounds,2022,38(6):512-519.DOI: 10.3760/cma.j.cn501225-20220329-00106.

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Effects of comprehensive treatment of infected wounds in patients with iatrogenic Cushing's syndrome

doi: 10.3760/cma.j.cn501225-20220329-00106

1.
Department of Burns and Plastic Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
2.
Department of Endocrinology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China

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Open Project of Key Laboratory of Guangxi Regenerative Medicine 1704

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Corresponding author: Liu Da'en, Email: liudaen@126.com
Received Date: 2022-03-29

Abstract

Abstract

Objective To investigate the characteristics and comprehensive treatment of infected wounds in patients with iatrogenic Cushing's syndrome. Methods A retrospective observational study was conducted. From May 2012 to December 2021, the data of 19 patients with iatrogenic Cushing's syndrome discharged from the Department of Burns and Plastic Surgery of the First Affiliated Hospital of Guangxi Medical University were collected, including 8 males and 11 females, aged 28-71 (56±11) years, with 12 cases of infected acute wounds and 7 cases of infected chronic wounds. The lesions were located in the limbs, perianal, and sacrococcygeal regions, with original infection ranging from 9 cm×5 cm to 85 cm×45 cm. After admission, the patients were performed with multidisciplinary assisted diagnosis and treatment, and the wounds were treated with debridement and vacuum sealing drainage, according to the size, severity of infection, suture tension, and bone and tendon tissue exposure of wounds, direct suture or autologous skin and/or artificial dermis and/or autologous tissue flap transplantation was selected for wound repair. The levels of cortisol and adrenocorticotropic hormone (ACTH) of patients at 8:00, 16:00, and 24:00 within 24 h after admission were counted. After admission, the number of operations, wound repair methods, and wound and skin/flap donor site healing of patients were recorded. During follow-up, the wounds were observed for recurrent infection. Results The cortisol levels of 16 patients at 8:00, 16:00, and 24:00 within 24 h after admission were (130±54), (80±16), and (109±39) nmol/L, respectively, and ACTH levels were (7.2±2.8), (4.1±1.8), and (6.0±3.0) pg/mL, respectively; and the other 3 patients had no such statistical results. After admission, the number of surgical operation for patients was 3.4±0.9. The following methods were used for wound repair, including direct suturing in 4 cases and autologous skin and/or artificial dermis grafting in 9 cases, of which 2 cases underwent stage Ⅱ autologous skin grafting after artificial dermis grafting in stage Ⅰ, and 6 cases had pedicled retrograde island flap+autologous skin grafting. The wound healing was observed, showing that all directly sutured wounds healed well; the wounds in 6 cases of autologous skin and/or artificial dermis grafting healed well, and the wounds in 3 cases also healed well after the secondary skin grafting; the flaps in 4 cases survived well with the wounds in 2 cases with distal perforators flap arteries circumfluence obstacle of posterior leg healed after stage Ⅱ debridement and autologous skin grafting. The healing status of skin/flap donor sites was followed showing that the donor sites of medium-thickness skin grafts in the thigh of 4 cases were well healed after transplanted with autologous split-thickness grafts from scalp; the donor sites of medium-thickness skin grafts in 3 cases did not undergo split-thickness skin grafting, of which 2 cases had poor healing but healed well after secondary skin grafting 2 weeks after surgery; the donor sites of split-thickness skin grafts in the head of 2 patients healed well; and all donor sites of flaps healed well after autologous skin grafting. During follow-up of more than half a year, 3 gout patients were hospitalized again for surgical treatment due to gout stone rupture, 4 patients were hospitalized again for surgical treatment due to infection, and no recurrent infection was found in the rest of patients. Conclusions The infected wounds in patients with iatrogenic Cushing's syndrome have poor ability to regenerate and are prone to repeated infection. Local wound treatment together with multidisciplinary comprehensive treatment should be performed to control infection and close wounds in a timely manner, so as to maximize the benefits of patients.
- Autoimmune diseases,
- Infection,
- Wound healing,
- Adrenocorticotropic hormone,
- Skin transplantation,
- Surgical flaps,
- Cushing's syndrome

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[1]	WangAS, ArmstrongEJ, ArmstrongAW. Corticosteroids and wound healing: clinical considerations in the perioperative period[J]. Am J Surg, 2013,206(3):410-417. DOI: 10.1016/j.amjsurg.2012.11.018.
[2]	SchoepeS, SchäckeH, MayE, et al. Glucocorticoid therapy-induced skin atrophy[J]. Exp Dermatol, 2006,15(6):406-420. DOI: 10.1111/j.0906-6705.2006.00435.x.
[3]	BiswasM, GibbyO, Ivanova-StoilovaT, et al. Cushing's syndrome and chronic venous ulceration--a clinical challenge[J]. Int Wound J, 2011,8(1):99-102. DOI: 10.1111/j.1742-481X.2010.00746.x.
[4]	NiemanLK, BillerBM, FindlingJW, et al. Treatment of Cushing's syndrome: an endocrine society clinical practice guideline[J]. J Clin Endocrinol Metab, 2015,100(8):2807-2831. DOI: 10.1210/jc.2015-1818.
[5]	张洁, 郭立新. 库欣病的诊断及围手术期内分泌处理[J].中国实用内科杂志,2009,29(10):949-952.
[6]	FigueiredoJ, SerradoM, KhmelinskiiN, et al. Iatrogenic Cushing syndrome and multifocal osteonecrosis caused by the interaction between inhaled fluticasone and ritonavir[J].BMJ Case Rep,2020,13(5):e233712. DOI: 10.1136/bcr-2019-233712.
[7]	de GuiaRM. Stress, glucocorticoid signaling pathway, and metabolic disorders[J]. Diabetes Metab Syndr, 2020,14(5):1273-1280. DOI: 10.1016/j.dsx.2020.06.038.
[8]	厉瑶, 陈红波. 系统性红斑狼疮糖皮质激素抵抗的机制研究进展[J].中华风湿病学杂志,2021,25(12):832-837. DOI: 10.3760/cma.j.cn141217-20201214-00475-1.
[9]	尹明月, 肖园. 糖皮质激素所致生长障碍研究新进展[J].中华内分泌代谢杂志,2021,37(1):64-68. DOI: 10.3760/cma.j.cn311282-20200701-00487.
[10]	ValetteC, OfaicheJ, SeverinoM, et al. Fatal outcome of Netherton syndrome due to excessive use of topical corticosteroids in an adult patient[J]. Ann Dermatol Venereol, 2020,147(1):36-40. DOI: 10.1016/j.annder.2019.09.003.
[11]	陆树良. 把握创面修复的规律和特征促进创面愈合[J].中华烧伤杂志,2021,37(5):401-403. DOI: 10.3760/cma.j.cn501120-20210322-00100.
[12]	邓雪蓉,张卓莉. 阿达木单抗治疗类风湿关节炎合并下肢巨大溃疡一例[J]. 中华风湿病学杂志, 2012,16(7): 501-502,封3.DOI: 10.3760/cma.j.issn.1007-7480.2012.07.018.
[13]	王诗波, 冯彦华, 侯春林, 等. 伴下肢静脉曲张远端蒂腓肠神经营养血管皮瓣修复长期服激素患者足底创面一例[J].中华显微外科杂志,2012,35(6):520-521. DOI: 10.3760/cma.j.issn.1001-2036.2012.06.035.
[14]	赵海磊, 赵晓慧, 杨彬, 等. 综合治疗急性坏死性筋膜炎25例[J].中华烧伤杂志,2021,37(4):382-385. DOI: 10.3760/cma.j.cn501120-20200426-00238.
[15]	刘达恩, 李智贤, 黎信森, 等. 应用彩色多普勒影像技术设计轴型皮瓣[J].中国修复重建外科杂志,2001,15(3):150-152.
[16]	李秀, 张凤山, 于慧敏. 糖皮质激素受体与自身免疫性疾病[J].中华风湿病学杂志,2004,8(5):315-316. DOI: 10.3760/j:issn:1007-7480.2004.05.019.
[17]	FigueiredoJ, SerradoM, KhmelinskiiN, et al. Iatrogenic Cushing syndrome and multifocal osteonecrosis caused by the interaction between inhaled fluticasone and ritonavir[J]. BMJ Case Rep, 2020, 13(5):e233712.DOI: 10.1136/bcr-2019-233712.
[18]	ThakranP, AgrawalS, SingalA, et al. Iatrogenic Cushing's syndrome in patients with superficial dermatophytosis[J]. Indian Dermatol Online J, 2021,12(2):237-243. DOI: 10.4103/idoj.IDOJ_432_20.
[19]	WoodcockT, BarkerP, DanielS, et al. Guidelines for the management of glucocorticoids during the peri-operative period for patients with adrenal insufficiency: guidelines from the Association of Anaesthetists, the Royal College of Physicians and the Society for Endocrinology UK[J]. Anaesthesia,2020,75(5):654-663. DOI: 10.1111/anae.14963.
[20]	中华医学会内分泌学分会肥胖学组.肾上腺皮质功能减退症患者围手术期糖皮质激素管理专家共识[J]. 中华内分泌代谢杂志,2022,38(1):1-6. DOI: 10.3760/cma.j.cn311282-20210618-00386.
[21]	卢琳,陆召麟. 库欣综合征患者围手术期的糖皮质激素替代治疗现状及应用策略[J]. 中华医学杂志, 2020,100(36): 2801-2803.DOI: 10.3760/cma.j.cn112137-20200803-02272.
[22]	IgazP, RáczK, TóthM, et al. Treatment of iatrogenic Cushing syndrome: questions of glucocorticoid withdrawal [J]. Orv Hetil, 2007,148(5):195-202. DOI: 10.1556/OH.2007.27964.
[23]	刘毅. 建立多学科合作机制精准治疗特殊原因创面[J].中华烧伤杂志,2016,32(6):323-325. DOI: 10.3760/cma.j.issn.1009-2587.2016.06.002.
[24]	魏在荣, 黄广涛. 慢性创面的治疗进展及创面外科整合治疗模式探讨[J].中华烧伤杂志,2019,35(11):824-827. DOI: 10.3760/cma.j.issn.1009-2587.2019.11.012.
[25]	《多学科合作下糖尿病足防治专家共识(2020版)》编写组. 多学科合作下糖尿病足防治专家共识(2020版)精华版(Ⅱ)[J].中华烧伤杂志,2020,36(9):767-785. DOI: 10.3760/cma.j.cn501120-20200217-01000.

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Effects of comprehensive treatment of infected wounds in patients with iatrogenic Cushing's syndrome

doi: 10.3760/cma.j.cn501225-20220329-00106

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Effects of comprehensive treatment of infected wounds in patients with iatrogenic Cushing's syndrome

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