Iatrogenic lesions

Common examples include:

• Tape applied to atrophic skin and ripped off

• Tight bandages. We have seen a 53-year-old woman with type 2 diabetes mellitus of 13 years' duration and oedematous feet, who sustained a burn to the dorsum of the foot. She applied a sterile dressing held in place by a bandage which completely encircled the foot and ankle, and made an appointment to be seen at the diabetic foot clinic. When the bandage was removed she had developed superficial necrosis from an over-tight bandage and fluctuant oedema. The bandage was replaced with a light tubular bandage and the foot healed in 2 weeks

• A further patient with cardiac failure developed a lesion in tight bandages (Fig. 4.38)

• Bulky dressings taking up too much space in unadjusted footwear

• Injection of cortisone into painful heels. Cortisone injection can lead to ulceration and full-thickness necrosis which will need surgical debridement. We have seen a case of extensive calcification of the soft tissues of the heel associated with pain and ulceration following a cortisone injection into the heel.

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