Epidemiological, clinical, and etiological aspects and management of chronic ulcers at the University Hospital Center of Dermatology in Bamako, Mali

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Background: Chronic ulcers of the lower limb (CULL) are characterized by non-healing skin loss, often associated with vascular, neurological, infectious, traumatic, or tumoral factors. These ulcers are prevalent, recurrent, severe, and have significant socio-economic implications. While Western data show a higher prevalence among women and the elderly, with varying rates (0.10% to 0.80%), developing countries, especially in sub-Saharan Africa, report a higher prevalence among young men due to infectious causes. Despite their impact, CULL often lacks attention from health authorities, resulting in delays in medical consultation. This study aims to share experiences in understanding the epidemioclinical aspects and management of CULL. Objective: The objective was to offer a comprehensive overview of the epidemiological and clinical characteristics and treatment strategies for chronic lower limb ulcers observed at the University Hospital Center of Dermatology in Bamako. Patients and Methods: Conducted at the Dermatology and Venereology Department of the University Hospital Center of Dermatology in Bamako, this cross-sectional study spanned a period from January to December 2021. It included 520 patients, with 22.1% having chronic ulcers of the lower limbs. Males (52.2%) were predominant, with an average age of 42.4 years. Trauma triggered 73.0% of the cases, and more than half waited over a year before seeking medical help. Bacteriological examinations revealed microbial infections in 67.8% of the cases. Results: There was a 22.1% prevalence of chronic lower limb ulcers among the 520 patients. Males represented 52.2%, with a median age of 42.4 years. Trauma was the primary trigger in 73.0% of the cases. Bacteriological examinations identified various infections, with 67.8% being infectious in origin. There were diverse characteristics in size, shape, and edge conditions of the ulcers. Trauma was the leading factor in 73.0% of the cases. Bacteriological examinations identified Gram-negative bacilli, Staphylococcus aureus, Streptococcus, with 67.8% of the ulcers being infectious in origin. There was outpatient treatment in 64.3% of the cases. Therapies included postural drainage, venotonics, vasculoprotectors, analgesics, compression stockings, and surgical interventions. Antibiotic therapy based on antibiograms for infectious ulcers. There was maintenance treatment with delayed penicillin in recurrent cases; successful skin grafting in 80.9% of cases, with 40.8% achieving complete healing in less than three months. Key words: Chronic ulcers, Epidemiological, Clinical, Etiological, Management

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