Sickle cell leg ulcers in Ghana.

Twenty five (17 male, 8 Female) sickle cell disease patients with 30 leg ulcers were studied over a 3 year period (January 1985 to December 1987) to provide information on the pathogenesis, course and management. There were 23 patients with homozygous sickle cell and 2 patients with sickle cell haemoglobin C disease. The mean age was 28 years (range 15-44 years). An antecedent history of trauma was obtained in 40% of the patients and 96% had a previous history of leg ulcer. The major site affected (93%) was the skin around the malleoli. In 68% of the patients a single organism was isolated and the commonest bacteria were Pseudomonas species, Staphylococcus aureus, Proteus species and B haemolytic streptococci. The major complications encountered were equinovarus deformity (36%) and chronic periosteitis (32%). The main topical antimicrobial used was Eusol either alone (52%) or in combination with Metronidazole (32%) or honey (12%). Complete healing occurred in 40% of patients, partial healing with deterioration in 16% and no significant change in 44%. Admission and bed rest were the best determinants of complete healing of the chronic ulcers.