April 30, 2019
If any EUBS member can help out, please contact him !
May 20, 2019
Peter Germonpré is Medical Director of the Centre for Hyperbaric Oxygen Therapy of the Military Hospital Brussels, and writes the following:
We are currently following a young male person (born 1981) who suffers since 6 years from severe wound healing problems after implantation of an ICD for diagnosed Brugada disease. On three occasions, the ICD has had to be removed for non-healing implantation site, and even now (no ICD in place anymore), the last implantation site has become a chronic, easily bleeding, extended skin and subcutaneous tissue defect, without signs of proper granulation let alone successful skin grafting and flap surgery. He has been followed consecutively at two university plastic surgery departments who basically “gave up” after multiple surgeries, including DIEP flap, multiple skin grafts, as well as NPWT, PGF, keratinocytes,…).
Diagnosis of Ehlers-Danlos Disease was suspected but not confirmed (genetic test negative, Beighton score 5/9). Electron-microscopic examination of the skin has been performed in the past and showed disturbed collagen pattern, with reduced fibre content and cauliflower aspect. No specific diagnosis suggested. A recent suggestion of Pyoderma Granulosum was not confirmed by biopsy.
Hyperbaric oxygen treatment has been performed before (2015 – 30 treatments with limited effect and no final healing; up to May 20, 2019 20 more treatments with clinically no effect. Serial biopsies no significant evolution). Anemic, needs blood transfusions every 2 weeks as blood loss from wound dressings is significant.
No other known pathology. No medication. No blood or coagulation disorder identified. No other family members affected (except maybe 6 year old son, who seems to be “healing small wounds with some difficulty”). Psychiatric evaluation negative for possible auto-affliction.
See small pictures below. If any EUBS member can help identifying this disease of can offer other suggestions, please contact me for further clinical info and pictures.