key: cord-1008916-euhi3u6u
authors: Zagaria, Orlando; Ruggiero, Angelo; Cinelli, Eleonora; Marasca, Claudio; Monfrecola, Ambra; Fabbrocini, Gabriella
title: Chronic cutaneous ulcers management in dermatologic department during COVID‐19 era
date: 2020-04-28
journal: Int Wound J
DOI: 10.1111/iwj.13385
sha: 5a14b85b5087ccf8cca98318a9e5b8ffacf8cf29
doc_id: 1008916
cord_uid: euhi3u6u

nan

In the COVID-19 pandemic scenario, Italy had to face one of the most severe infectious cluster in the world 1 and, as all the international communities, hospital settings have been revised to guarantee assistance to patients minimising at maximum the risk of contagion for them and for the health care workers. Our dermatology department is part of this change and even fragile patients who weekly referred to our clinic because of medication for severe skin-ulcers had to be managed in a different way. Indeed, access to the dermatology department is still restricted to urgent visits after a complete triage at the hospital entry. In our department, a clinic for cutaneous ulcer medications has been provided since October 2018: a dermatologist and a plastic surgeon regularly assess patients with moderate-to-severe skin ulcers, perform biopsies when needed, apply specific dressing (hydrogel dressing, nonadherent detergent dressings, hydrofibre dressing with silver) with nursing assistance and prescribe home therapies. Often patients with chronic cutaneous ulcers are fragile subjects, 2 affected by comorbidities that impair wound healing (eg, diabetes, cardiovascular diseases, renal diseases, or immunocompromised status) and their quality of life. 3 As these patients frequently have walking impairment, they are often accompanied by caregivers, thus increasing the number of people moving from home to the hospital and subsequently the risk of contagion. Moreover, cutaneous ulcers are an entry door for secondary infections, 4 and during this period of special need for extreme hygiene and cleaning, prevention of possible secondary infections is a tougher challenge. Here, we report our Department's measures adopted to maintain a continuity of care in this particular group of patients. First of all, no patient has been allowed to the clinic, except for urgent and nondeferrable visit or surgery, and, in the event, only one caregiver per patient has been accepted. This method had drastically reduced the number of people referring to the clinic and so, the risk of contagion. However, the medical team provided prompt doctor-patient communications through other means of than face-to-face visit. In fact, patients can contact the medical team 24 hours per day, 7 days a week, thanks to telephone, email, and WhatsApp Messenger. Moreover, physicians by asking some questions to patients about erythema, odour, or exudation variations of skin ulcers, they are able to understand if the lesions are stable or worsening. Patients can also send clinical pictures to ask how to continue the dressings and the physician informs them how to do it (eg, if they have to change method or products or if they should carry on as usual). If there is any doubt in the dressing, the physician can help them showing the exact procedure on a video call or on a personalised tutorial video. Particularly in these videos are shown all the procedures with an explanation step by step in order to complete the needed dressing also at home with the aid of a familiar. On the other hand, through a video call the physician can also follow the dressing procedures, suggesting any corrections or changes in the procedures if an error is detected. Another important suggestion given to patients is to use elastic stocking compression for prevention of recurrences of venous ulcers due to the reduction of activity and movements during this period. In conclusion, the COVID-19 pandemic is challenging us on many medical aspects, regarding not only patients suffering from COVID-19 pneumonia but also non-COVID-19 ones. Dermatology departments all over the world are integral part of the COVID-19 fight and keep on guaranteeing continuity of care to all patients, including and especially the most fragile ones as those affected by chronic cutaneous ulcers could be. Moreover, due to the lacking of guidelines or official recommendations about clinical management of non-COVID-19 patients, we believe that the sharing of different experiences and strategies applied in different hospitals should be supported in order to find a common method well appreciated from both patients and physicians.

Eleonora Cinelli Claudio Marasca Ambra Monfrecola Gabriella Fabbrocini

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