Finja Jockenhöfer

Bacteriological pathogen spectrum of chronic leg ulcers: Results of a multicenter trial in dermatologic wound care centers differentiated by regions

In almost every chronic wound different bacteria species can be detected.

Aetiology, comorbidities and cofactors of chronic leg ulcers: retrospective evaluation of 1 000 patients from 10 specialised dermatological wound care centers in Germany

Numerous comorbidities and cofactors have been known to influence wound healing processes. In this multicentre study, clinical data of 1 000 patients with chronic leg ulcers from ten specialised dermatological wound care centers were analysed. The patient cohort comprised 567 females and 433 males with an average age of 69·9 years. The wounds persisted on average for 40·8 months and had a mean size of 43·7 cm2. Venous leg ulcers represented the most common entity accounting for 51·3% of all chronic wounds, followed by mixed‐type ulcers in 12·9% and arterial ulcerations in 11·0% of the patients. Vasculitis was diagnosed in 4·5%, trauma in 3·2%, pyoderma gangrenosum in 2·8%, lymphoedema in 1·7%, neoplasia in 1·0% and delayed post‐surgical wound healing in 0·6% of the included patients. In total, 70·5% of patients suffered from arterial hypertension, 45·2% were obese, 27·2% had non‐insulin dependent diabetes, and 24·4% dyslipidaemia. Altogether 18·4% suffered from metabolic syndrome. Cofactors and comorbidities of patients with chronic leg ulcers have previously been studied but not in detail. Here, we were able to demonstrate the existence of several potentially relevant cofactors, comorbidities of their associations and geographical distributions, which should be routinely examined in patients with chronic leg ulcers and – if possible – treated.

Cofactors and comorbidities of necrobiosis lipoidica: analysis of the German DRG data from 2012

Necrobiosis lipoidica (NL) is a rare granulomatous inflammatory skin disease of unknown pathophysiology. Its potential association with diabetes mellitus is well known. Other relevant cofactors and comorbidities are subject to controversial debate.

Bacterial spectrum colonizing chronic leg ulcers: A 10-year comparison from a German wound care center

Chronic wounds are colonized by many different bacteria.

Patients with pyoderma gangrenosum: analyses of the German DRG data from 2012

Pyoderma gangrenosum (PG) is a rarely diagnosed non‐infectious neutrophil ulcerative dermatosis with only limited knowledge on the underlying auto‐inflammatory process. To unravel common cofactors and comorbidities in patients with PG we analysed Diagnosis Related Groups (DRG) cases of all inpatients diagnosed with PG in German hospitals in 2012. We received data of 1227 inpatient cases having PG as primary diagnosis and 985 inpatient cases with PG as secondary diagnosis. The ratio of women to men was 2:1, and the most often registered age was 75–79 years. Common comorbidities were arterial hypertension (50·3%), non‐insulin‐dependent diabetes mellitus (25·1%) and dysfunction of lipid metabolism (10·8%). In sum, 94·8% of the patients suffered from aspects of metabolic syndrome. Other comorbidities were Crohns disease (4·5%), ulcerative colitis (4·2%), chronic polyarthritis (5·2%), monoclonal gammopathy or myelodysplastic syndrome (2·5%), leukaemia (1·1%) and lymphoma (0·4%). DRG data do not reflect individual patients, but rather patient cases. We described the worldwide largest PG population and confirmed a wide range of potentially relevant and partly not yet described cofactors and comorbidities such as metabolic syndrome.

The PARACELSUS score: a novel diagnostic tool for pyoderma gangrenosum

The lack of objective diagnostic criteria renders pyoderma gangrenosum (PG) a diagnosis of exclusion. The diagnostic approaches proposed to date have not been systematically evaluated. Thus, PG remains a challenging and frequently misdiagnosed disorder.

Trizentrische Analyse von Kofaktoren und Komorbidität des Pyoderma gangraenosum

Das Pyoderma gangraenosum (PG) ist eine seltene, inflammatorische destruktiv‐ulzerierende neutrophile Erkrankung mit weitgehend unklarer Pathophysiologie.

Tricenter analysis of cofactors and comorbidity in patients with pyoderma gangrenosum

Pyoderma gangrenosum (PG) is a rare neutrophilic, ulcerative skin disease of largely unknown pathophysiology.

Erregerspektrum des chronischen Ulcus cruris: Ergebnisse einer multizentrischen Untersuchung dermatologischer Wundzentren im regionalen Vergleich

Zusammenfassung Hintergrund: In chronischen Wunden werden nahezu obligat Bakterien nachgewiesen. Patienten und Methodik: Retrospektiv wurden die Resultate der bakteriologischen Abstriche aus den Jahren 2010 und 2011 von Patienten mit chronischem Ulcus cruris aus 10 dermatologischen Wundambulanzen, differenziert in 5 Regionen Deutschlands ausgewertet. Ergebnisse: Insgesamt konnten die Daten von 970 Patienten erhoben werden. Staphylococcus aureus fand sich bei 47,6 % der Patienten; bei 8,6 % der Patienten zeigte sich eine Methicillin-Resistenz (MRSA). Pseudomonas aeruginosa wurde bei 31,1 %, Enterobakterien bei 28,6 % und Proteus mirabilis bei 13,7 % der Patienten nachgewiesen. Bei dem regionalen Vergleich fand sich ein signifikantes Süd-Nord-Gefälle für Staphylococcus aureus, Pseudomonas aeruginosa und Enterobakterien. Zudem zeigte sich ein hochsignifikantes West-Ost-Gefälle für MRSA mit Nachweisraten von 13,5 % im Westen gegenüber 4,0 % im Osten. Es ergab sich bundesweit eine signifikante negative Korrelation zwischen Staphylococcus aureus und Pseudomonas aeruginosa bzw. Proteus mirabilis, sowie eine positive Korrelation für die Wundgröße und Bestehensdauer der Wunde mit dem Nachweis von Pseudomonas aeruginosa. Als mögliche Gründe für die regional signifikant unterschiedlichen Nachweisraten in den verschiedenen Regionen kommen neben unterschiedlichen klimatischen und therapeutischen Bedingungen insbesondere verschiedene regionale Versorgungsstrukturen in Betracht. Schlussfolgerungen: Unsere Daten zeigen das regionale, teils signifikant unterschiedliche Verteilungsmuster der Bakterien bei Patienten mit chronischem Ulcus cruris in Deutschland. Finja Jockenhöfer1, Harald Gollnick2, Katharina Herberger3, Georg Isbary4, Regina Renner5, Markus Stücker6, Eva Valesky7, Uwe Wollina8, Michael Weichenthal9, Sigrid Karrer10, Joachim Klode1, Joachim Dissemond1

Postsurgical Treatment of Split Skin Graft Donor Sites in Dermatological Departments

The surgical removal of split skin grafts (SSGs) leads to superficial wounds that can be covered with different wound dressings. Currently, international guidelines that recommend a standard treatment of the donor sites are not yet established. We developed a questionnaire to evaluate the treatment of SSG donor sites and sent it to all dermatological departments in Germany. Altogether 78 of the 115 contacted departments in Germany participated in our cross-sectional trial. Our analysis reveals that multiple wound dressings with different frequencies of replacement are used. On an average, complete reepithelialization of the donor site takes 14-21 days. Foams and coated gauzes are used in 73% of all surgical procedures for postsurgical treatment of SSG donor sites. Still, neither a significant faster reepithelialization nor a lower rate of wound healing disorders can be assigned to any of the wound dressings. The results of our study indicate that a large number of wound care products and treatment strategies are currently applied on SSG donor sites in dermatological departments in Germany. The selection of the wound dressing is not based on scientific data but rather on the experience of individual experts.