title: Experiences with surgical treatment of chronic lower limb ulcers at a tertiary hospital in northwestern Tanzania: a prospective review of 300 cases.
abstract: BACKGROUND
  Chronic lower limb ulcers constitute a major public health problem of great important all over the world and contribute significantly to high morbidity and long-term disabilities. There is paucity of information regarding chronic lower limb ulcers in our setting; therefore it was necessary to conduct this study to establish the patterns and outcome of chronic lower limb ulcers and to identify predictors of outcome in our local setting.
  
  
  METHODS
  This was a descriptive prospective study of patients with chronic lower limb ulcers conducted at Bugando Medical Centre between November 2010 and April 2012. Ethical approval to conduct the study was sought from relevant authorities. Statistical data analysis was done using SPSS version 17.0 and STATA version 11.0.
  
  
  RESULTS
  A total of 300 patients were studied. Their ages ranged from 3 months to 85 years (median 32 years). The male to female ratio was 2:1. The median duration of illness was 44 days. Traumatic ulcer was the most frequent type of ulcer accounting for 60.3% of patients. The median duration of illness was 44 days. The leg was commonly affected in 33.7% of cases and the right side (48.7%) was frequently involved. Out of 300 patients, 212 (70.7%) had positive aerobic bacterial growth within 48 hours of incubation. Pseudomonas aeruginosa (25.5%) was the most frequent gram negative bacteria isolated, whereas gram positive bacteria commonly isolated was Staphylococcus aureus (13.7%). Twenty (6.7%) patients were HIV positive with a median CD4+ count of 350 cells/μl. Mycological investigation was not performed. Bony involvement was radiologically reported in 83.0% of cases. Histopathological examination performed in 56 patients revealed malignancy in 20 (35.7%) patients, of which malignant melanoma (45.0%) was the most common histopathological type. The vast majority of patients, 270 (90.0%) were treated surgically, and surgical debridement was the most common surgical procedure performed in 24.1% of cases. Limb amputation rate was 8.7%. Postoperative complication rate was 58.3% of which surgical site infection (77.5%) was the most common post-operative complications. The median length of hospital stay was 23 days. Mortality rate was 4.3%. Out of the two hundred and eighty-seven (95.7%) survivors, 253 (91.6%) were treated successfully and discharged well (healed). After discharge, only 35.5% of cases were available for follow up at the end of study period.
  
  
  CONCLUSIONS
  Chronic lower limb ulcers remain a major public health problem in this part of Tanzania. The majority of patients in our environment present late when the disease is already in advanced stages. Early recognition and aggressive treatment of the acute phase of chronic lower limb ulcers at the peripheral hospitals and close follow-up are urgently needed to improve outcomes of these patients in our environment.
authors.affiliation: Department of Surgery, Catholic University of Health and Allied Sciences- Bugando, Mwanza, Tanzania.
authors.forename: Fidelis
authors.initials: F
authors.lastname: Mbunda
authors.forename: Mabula D
authors.initials: MD
authors.lastname: McHembe
authors.forename: Phillipo L
authors.initials: PL
authors.lastname: Chalya
authors.forename: Peter
authors.initials: P
authors.lastname: Rambau
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Mshana
authors.forename: Benson R
authors.initials: BR
authors.lastname: Kidenya
authors.forename: Japhet M
authors.initials: JM
authors.lastname: Gilyoma
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D001419:Bacteria / Q000302:isolation & purification; D002648:Child; D002675:Child, Preschool; D003646:Debridement / Q000379:methods*; D005260:Female; D006679:HIV Seropositivity / Q000150:complications; D006801:Humans; D007223:Infant; D007871:Leg Ulcer / Q000382:microbiology / Q000601:surgery*; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D013636:Tanzania; D062606:Tertiary Care Centers; D055815:Young Adult