Open wounds

   

Sambuca burn 

This man played a drunken party game that involved putting out a glass of burning sambuca on his buttock. He did not achieve a tight seal and burnt his buttock rather more than he expected, but having consumed a significant amount of alcohol, he suffered only minimal pain. No specific action was required.

 

Lupus

This 49-year-old woman developed a number of open ulcerated lesions that did not respond to normal measures, including moisturisers and topical antiseptic creams. They were all on her legs, and she initially thought they were infected insect bites. She was eventually referred to a dermatologist who investigated her further and diagnosed lupus.

   

Burn

This man burnt his leg on the exhaust pipe of his lawn mower. Injuries from the occasional use of specialist equipment by keen amateurs are common. Proper safety equipment is often not used leading to unnecessary injury. This wound was clean and healed well without any problems.

 

Varicose ulcer

This common condition is seen on a regular basis. Often started by a minor injury in a susceptible patient with poor venous circulation, ulceration needs careful assessment and management. Infection is common and sometimes needs antibiotic treatment. Rest and elevation are also a crucial part of this process, but this sometimes requires hospital admission to achieve.

 
   

Flap laceration

This elderly woman, who was on steroids for polymyalgia rheumatica, sustained this nasty injury through her trousers following a fall. This picture was two weeks later. The skin on the shin is extremely delicate, and when this problem is aggravated by the chronic use of oral steroids, relatively trivial injuries can lead to months of regular nursing care before healing finally occurs.

 

Head injury

This patient with Alzheimer's fell and sustained this superficial graze on his head. There is often a concern in the elderly with a head injury that some more serious injury may have occurred. A sub-dural haematoma may be very hard to diagnose, especially in a difficult patient like this. This patient did not even seem to be aware of the injury. No further action was taken on this occasion and all was well.

Contributed by Dr Philip Marazzi, a GP in East Horsley, Surrey.

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