Abstract

We present a case of lipomembranous changes in the biopsy of a non-healing traumatic wound from a 40-year-old Caucasian female with a history of well-controlled insulin dependent diabetes. The patient had allowed three months of secondary intention healing following a partial primary closure of a traumatic wound. The patient has been doing daily dressing changes with Vaseline as directed. The lesion was pain free and had initially began healing well at the surgical site, but healing for the previous 2 months had arrested, resulting in chronic non-healing shallow ulcer. The patient presented with a 13x10mm violaceous atrophic plaque with a slightly rolled rim and exuberant gray -yellow granulation tissue centrally. A single application of Silver Nitrate was administered to reduce hypergranulation and stimulate new growth. Tissue biopsy and wound cultures were obtained given high concern for infection. Histopathologic findings were negative for GMS and PAS stains; however, significant lipomembranous changes were noted. Lipomembranous changes are histological findings which consist of cystic cavities within adipose tissue lined by eosinophilic membranes. This condition has been reported to be a common finding in peripheral vascular diseases and trauma. However, there are no reported cases associated with the use of Silver Nitrate. Moreover, we report a diabetic patient with non-healing traumatic wound with possible iatrogenic lipomembranous changes. This unique finding suggests that lipomembranous findings could signify disease resulting from a multitude of variable pathophysiologic processes. and that these changes should be carefully considered as it may aid clinicians in investigating for potential associated clinical disorders.

Financial Disclosure:
No current or relevant financial relationships exist.