Topical steroids for chronic wounds displaying abnormal inflammation

Introduction

Chronic, non-healing wounds are often characterised by an excessive, and detrimental, inflammatory response. We review our experience of using a combined topical steroid, antibiotic and antifungal preparation in the treatment of chronic wounds displaying abnormal and excessive inflammation.

Methods

A retrospective review was undertaken of all patients being treated with a topical preparation containing a steroid (clobetasone butyrate 0.05%), antibiotic and antifungal at a tertiary wound healing centre over a ten-year period. Patients were selected as the primary treating physician felt the wounds were displaying excessive inflammation. Healing rates were calculated for before and during this treatment period for each patient. Changes in symptom burden (pain, odour and exudate levels) following topical application were also calculated.

Results

Overall, 34 ulcers were identified from 25 individual patients (mean age: 65 years, range: 37–97 years) and 331 clinic visits were analysed, spanning a total time of 14,670 days (7,721 days ‘before treatment’ time, 6,949 days ‘during treatment’ time). Following treatment, 24 ulcers demonstrated faster rates of healing, 3 ulcers showed no significant change in healing rates and 7 were healing more slowly (p=0.0006). Treatment generally reduced the burden of pain and exudate, without affecting odour.

Conclusions

In normal wound healing, inflammation represents a transient but essential phase of tissue repair. In selected cases, direct application of a steroid containing agent has been shown to improve healing rates, presumably by curtailing this phase. Further evaluation is required to establish the role of preparations containing topical steroids without antimicrobials in the management of chronic wounds.     

Anterior commissure: anatomic-MR correlation and use as a landmark in three orthogonal planes

Correlation of cryomicrotomic and myelin-stained sections of human cadaver heads with spin-echo magnetic resonance (MR) images documents that MR imaging routinely displays the anterior commissure in three orthogonal planes as a distinct white-matter tract that resembles bicycle handlebars. The anterior commissure crosses the midline at the upper end of the lamina terminalis, just anterior to the anterior columns of the fornices. To each side of midline, it curves antero-inferolaterally and then postero-inferolaterally through the lateral nucleus of the globus pallidus to course with the white matter of the external and extreme capsules toward the middle and inferior temporal gyri. Because the anterior commissure is easily recognizable in all three planes at differing pulse sequences, the commissure has proved to be a major landmark for identification of the complex anatomy of this region, especially in sagittal sections.