A. xylosoxidans infection can result in potentially severe sequelae, especially in unhealthy populations. We present a rare case of infectious skin ulceration with scar contracture due to A. xylosoxidans in a healthy patient. A 53-year-old male patient without underlying disease and trauma history visited our department for an irritating skin ulcer with purulent discharge on the right lower leg. The chronic wound on the leg exists since he got contact burn 30 years ago. The wound did not respond to treatment, and the wound culture results indicated A. xylosoxidans. Given the incurable character of A. xylosoxidans, we performed a wide excision and split thickness skin graft with collagen-elastin matrix (Matriderm(R)). A. xylosoxidans is an opportunistic, aerobic, gram-negative, rod-shaped bacterium that is oxidase positive. According to reports, A. xylosoxidans is not sensitive to many antibiotics and can cause bacteremia. It is suggested that the blood supply is compromised near a scar lesion despite the fact that blood flow is rather increased during the initial scar formation phase. Therefore, we presumed that the infection was most likely caused by low blood circulation due to scar contracture. Thus, when a scar contracture is present, A. xylosoxidans infection can manifest in a healthy patient.
Alcaligenes* ; Anti-Bacterial Agents ; Bacteremia ; Blood Circulation ; Burns ; Cicatrix ; Contracture ; Humans ; Leg ; Male ; Middle Aged ; Oxidoreductases ; Skin ; Skin Ulcer* ; Transplants ; Wounds and Injuries

PURPOSE: Electric saw is widely used and patients involved with the tool are increasing. We made efforts to analyze data of saw-related hand injuries. METHODS: Electric saw-related hand injuries that required operation were analyzed retrospectively by reviewing medical charts, clinical photographs and X-ray films from 2009 through 2013. Additionally, we interviewed patients regarding the type of electric saw involved (hand-held/table-mounted) and how the hand was injured. RESULTS: There were 16 male patients with 19 injured fingers and 22 injured tendons. Due to the damaging mechanism of the electric saw, injuries were severe and complex such as tendon, bone defects, fractures and amputations. 4 fingers had open fractures. Separately, 4 were amputated. Non-dominant hands were injured more by hand-held saw, while, dominant hands were damaged more by table-mounted saw. The thumb and index fingers were injured mostly by electric saw. Probability of dominant and non-dominant hand injury depends on the types of electric saw because of the working position when using this tool. CONCLUSION: Hand injuries can be classified according to the type of electronic saw used. Complete understanding of a specific trauma mechanism and the resulting injury patterns is important especially for hand surgeons. Surgeons should take into account the type of electric saw when examining patients. However, the most important step to prevent these types of injuries is to provide all workers with appropriate training and precautions before using the electric saw.
Amputation ; Finger Injuries ; Fingers ; Fractures, Open ; Hand Injuries* ; Hand* ; Humans ; Korea* ; Male ; Retrospective Studies ; Rupture ; Tendon Injuries ; Tendons ; Thumb ; X-Ray Film