Multidisciplinary approach in a patient with an iatrogenic arterial ulcer

Abstract

Iatrogenesis is a negative alteration of the health estatus induced inadvertently by the performance of health professionals after medical treatment, and iatrogenic ulcer the lesion that leads to loss of skin integrity caused, among other reasons, by different devices used for diagnostic or therapeutic purposes. We present the case of a 91-year-old woman, a mild dependent in activities of daily living, without cognitive impairment, and with an iatrogenic ulcer in the right lower extremity. As a result of an accidental fall, she suffered a bimalleolar ankle fracture, surgical manipulation under anesthesia was performed for closed reduction, and then treated with an orthopaedic cast. At week four, she presented a clinical picture of fever that required hospital admission for four weeks, removing orthosis and revealing a large external supramalleolar ulcer at that moment. Being discharged and in follow-up by Ambulatory Care, she presented a torpid evolution of the ulcer and associated arterial pathology, for which reason she was urgently referred to Vascular Surgery, where they indicated admission for angioplasty and surgical skin lesion removal. After hospital discharge, her Certified Nurse Practitioner established a nursing care plan aimed at unifying criteria and reducing therapeutic variability, achieving epithelialization of a complex lesion in a fragile, multipathological and polymedicated patient in ten months of treatment. Thus, a multidisciplinary and interdisciplinary approach was necessary to solve the problem, providing the patient with comprehensive care, programming the transition between levels of care and communication between professionals.