Wendemagegn Enbiale1,2, Kristien Verdonck3, Melesse Gebeyehu1, Johan van Griensven3, Henry J C de Vries2,4. 1. Bahir Dar University, college of Medicine and Health sciences, Bahir Dar, Ethiopia. 2. Amsterdam UMC, University of Amsterdam, department of dermatology, Amsterdam Institute for Infection and Immunity (AII), location Academic Medical Centre, Amsterdam, The Netherlands. 3. Institute of Tropical Medicine, Antwerp, Belgium. 4. STI outpatient clinic, Department of Infectious Diseases, Public Health Service Amsterdam, The Netherlands.
Abstract
BACKGROUND: In Ethiopia, severe lymphedema and acute dermato-lymphangio-adenitis (ADLA) of the legs as a consequence of podoconiosis affects approximately 1.5 million people. In some this condition may lead to woody-hard fibrotic nodules, which are resistant to conventional treatment. We present a series of patients who underwent surgical nodulectomy in a resource-limited setting and their outcome. METHODS: In two teaching hospitals, we offered surgical nodulectomies under local anaesthesia to patients with persisting significant fibrotic nodules due to podoconiosis. Excisions after nodulectomy were left to heal by secondary intention with compression bandaging. As outcome, we recorded time to re-epithelialization after surgery, change in number of ADLA episodes, change in quality of life measured with the Dermatology Quality of Live Index (DQLI) questionnaire, and recurrence rate one year after surgery. RESULTS: 37nodulectomy operations were performed on 21 patients. All wounds re-reepithelialised within 21 days (range 17-42). 4 patients developed clinically relevant wound infections. The DLQI values were significantly better six months after surgery than before surgery (P<0.0001). Also the number of ADLA episodes per three months was significantly lower six months after surgery than before surgery (P<0.0001). CONCLUSION: Nodulectomy in podoconiosis patients leads to a significant improvement in the quality of life with no serious complications, and we recommend this to be a standard procedure in resource-poor settings.
BACKGROUND: In Ethiopia, severe lymphedema and acute dermato-lymphangio-adenitis (ADLA) of the legs as a consequence of podoconiosis affects approximately 1.5 million people. In some this condition may lead to woody-hard fibrotic nodules, which are resistant to conventional treatment. We present a series of patients who underwent surgical nodulectomy in a resource-limited setting and their outcome. METHODS: In two teaching hospitals, we offered surgical nodulectomies under local anaesthesia to patients with persisting significant fibrotic nodules due to podoconiosis. Excisions after nodulectomy were left to heal by secondary intention with compression bandaging. As outcome, we recorded time to re-epithelialization after surgery, change in number of ADLA episodes, change in quality of life measured with the Dermatology Quality of Live Index (DQLI) questionnaire, and recurrence rate one year after surgery. RESULTS: 37nodulectomy operations were performed on 21 patients. All wounds re-reepithelialised within 21 days (range 17-42). 4 patients developed clinically relevant wound infections. The DLQI values were significantly better six months after surgery than before surgery (P<0.0001). Also the number of ADLA episodes per three months was significantly lower six months after surgery than before surgery (P<0.0001). CONCLUSION: Nodulectomy in podoconiosis patients leads to a significant improvement in the quality of life with no serious complications, and we recommend this to be a standard procedure in resource-poor settings.
Authors: Fasil Tekola Ayele; Adebowale Adeyemo; Chris Finan; Elena Hailu; Paul Sinnott; Natalia Diaz Burlinson; Abraham Aseffa; Charles N Rotimi; Melanie J Newport; Gail Davey Journal: N Engl J Med Date: 2012-03-29 Impact factor: 91.245
Authors: Kebede Deribe; Jorge Cano; Emanuele Giorgi; David M Pigott; Nick Golding; Rachel L Pullan; Abdisalan M Noor; Elizabeth A Cromwell; Aaron Osgood-Zimmerman; Fikre Enquselassie; Asrat Hailu; Christopher J L Murray; Melanie J Newport; Simon J Brooker; Simon I Hay; Gail Davey Journal: Wellcome Open Res Date: 2017-09-04
Authors: Wendemagegn Enbiale; Almut Böer-Auer; Bereket Amare; Kristien Verdonck; Gail Davey; Johan van Griensven; Henry J C de Vries Journal: PLoS Negl Trop Dis Date: 2022-05-23