Marjolin’s ulcer in an ischial pressure sore presented with necrotizing soft tissue infection: A case report

Medicine, 2023 · DOI: http://dx.doi.org/10.1097/MD.0000000000033450 · Published: March 15, 2023

Simple Explanation

Marjolin's ulcer (MU) is a rare cancer that develops in chronic wounds. This case report discusses a patient with a pressure sore that developed into MU and initially presented as a severe soft tissue infection. The patient, who had a history of spinal cord injury, underwent multiple surgeries and treatments, including hip disarticulation, to manage the condition and prevent recurrence. Early diagnosis and aggressive treatment, including limb sacrifice in severe cases, are crucial for improving outcomes in patients with pressure sore-related MU.

Study Duration

34 months

Participants

A 45-year-old male patient with spinal cord injury

Evidence Level

Level 4, Case Report

Key Findings

1
Marjolin's ulcer can mimic necrotizing soft tissue infection, making diagnosis challenging.
2
Limb sacrifice may be necessary in cases of extensive involvement or bone involvement in pressure sore-related MU.
3
Pedicled fillet flaps can provide good wound coverage in reconstruction after extensive resections.

Research Summary

This case report highlights the diagnostic challenges and treatment strategies for Marjolin's ulcer (MU) arising from a pressure sore, initially presenting as necrotizing soft tissue infection (NSTI). The patient underwent multiple interventions, including debridement, wide excision, hip disarticulation, and adjuvant radiotherapy, resulting in a favorable outcome with no recurrence after 34 months. The report emphasizes the importance of considering malignancy in chronic wounds and the potential need for radical surgical approaches, such as limb sacrifice, to achieve long-term survival.

Practical Implications

Increased Clinical Suspicion

Clinicians should maintain a high index of suspicion for malignant transformation in chronic wounds, especially pressure ulcers, even when infection is present.

Early and Repeated Biopsies

Repeated or deeper biopsies should be performed on suspected lesions to minimize false-negative results and ensure early diagnosis of Marjolin's ulcer.

Radical Surgical Approach

In cases of advanced Marjolin's ulcer with bone involvement or deep infiltration, a radical surgical approach, including limb sacrifice, should be considered to improve long-term survival.

Marjolin’s ulcer in an ischial pressure sore presented with necrotizing soft tissue infection: A case report

Simple Explanation

Key Findings

Research Summary

Practical Implications

Increased Clinical Suspicion

Early and Repeated Biopsies

Radical Surgical Approach

Study Limitations

Your Feedback

Was this summary helpful?

Marjolin’s ulcer in an ischial pressure sore presented with necrotizing soft tissue infection: A case report

Simple Explanation

Key Findings

Research Summary

Practical Implications

Increased Clinical Suspicion

Early and Repeated Biopsies

Radical Surgical Approach

Study Limitations

Your Feedback

Was this summary helpful?