For many years, there has been a push to increase the focus on treating the patient as a whole person, not just his or her medical condition—often referred to as “holistic care.” In recent years, there has been an increasing awareness of the amount of pain patients with chronic wounds experience while living with unresolved wounds. Quite understandably, much of the initial interest in pain in these patients has focused on pain at dressing change. However, clinicians must remember to place this pain experience within a full wound and pain assessment, to allow patients and clinicians to work together to resolve pain issues within the context of the whole pain experience, and thus to focus on the whole person, not just the wound.

Prilocaine (Citanest®, AstraZeneca Pharmaceuticals, Wilmington, Del) is a commonly used agent in infiltrative anesthesia, and its adverse effects are well known. The authors report a full-thickness skin necrosis after using prilocaine as a local anesthetic that resulted in a flap closure. To the authors’ knowledge, there have been no previously described cases of skin necrosis after use of the local anesthetic prilocaine. Possible adverse reactions to preservatives that are added to local anesthetics in pharmaceutical preparations may play a role in skin necrosis secondary to prilocaine usage. Multifactorial adverse effects may cause unexpected reactions with the use of prilocaine, a safe and frequently used pharmaceutical.

Objectives: L-carnitine [(CH₃)₃-N-CH₂-CHOH-CH₂-COO-] is an amino acid derivative found in high energy demanding tissues. It plays an active role under low oxygen conditions. The authors studied the effect of L-carnitine on wound healing by secondary intention on full-thickness surgical skin defects in an animal model. Materials and Methods: Twenty-two Sprague-Dawley rats were divided into 2 groups. A 4-cm diameter circular full-thickness surgical skin defect was created on the dorsum of each rat and was left to heal by secondary intention. L-carnitine was given intraperitoneally at a dose of 100mg/kg once daily to the study group for 10 days. The control group was injected intraperitoneally with saline (0.09% NaCl) only. On the 11th day, the skin defects were traced on a transparent sheet, and the unhealed areas were measured using planimetry. Results: The areas of skin defects measured at the end of the study were not significantly different