34417 Buschke-Lowenstein Tumor Resection and Topical Care

Thursday, June 12, 2014: 7:00 AM
Dogwood B
Mariana Costa, Skin Group Consultant1, Andreia Oliveira, Supervisor2, Sayonara Scota, Supervisor2, Poliana Brito, student2, Renata Martins, student2, Sara Moura, student2 and Aline Gomes, student2, 1Continuous Education, Skin Group and Substitute supervisor at the Infectology Nursing Professional Upgrading Program, Infectology Institute Emílio Ribas, São Paulo, Brazil, 2Emilio Ribas Infectology Institute

Introduction: Buschke Lowenstein tumor (BLT) is a rare variant of anogenital condylomata acuminata, related to HPV1, 2. Lesion is large, vegetating, warty, exophilic2, 3. Best therapeutic strategy: not established2. Incidence: 0.1%1,2. Tumor rapid growth is associated with imunity deficiencies1.

Case Description: NGS, black, 55 years old, single, Nurse. Patient diagnosis HIV and TBL, topical treatment failled. 1st PO tumor resection, Skin Group assessment and management. Extensive raw area, involving penis body, extending to sacral region with points of necrosis. Topical care plan: PHMB solution, EFA, hydrofiber with silver, transparent film. Exchange daily to prevent secondary infection. 3rd PO: foul smell, necrosis, slough across lesion. Secretion culture positive for Morganella morganii. Replaced secondary coverage by hydropolymer with ibuprofen foam in scrotum due to pain and hydropolymer with silver foam accross lesion for infection control. After 5 days observed important score reduction for pain, adopting hydropolymer with silver across the lesion. 41st PO: pain resolution, no odor, granulation in whole extent of injury, edges contraction, no secondary infection. Programmed skin graft. Respected bioethical principles postulated by Resolution 196/96, National Research Council (CC No. 96/2012).

Discussion:  Despite the possible confusion bias, can be inferred that use of PHMB solution, EFA and coverage with hydropolymer in this case, controlled secondary infection, pain, removed unviable tissue, promoted the granulation tissue increase, contraction of edges and ideal conditions for wound bed to receive skin graft.