scholarly journals Martorell hypertensive ischemic leg ulcer: A case report

2020 ◽  
Vol 73 (5-6) ◽  
pp. 175-179
Author(s):  
Milan Matic ◽  
Aleksandra Matic ◽  
Nada Vuckovic ◽  
Mladen Jovanovic ◽  
Zoran Golusin
Keyword(s):  
Case Report ◽  
Arterial Hypertension ◽  
Pyoderma Gangrenosum ◽  
Skin Grafting ◽  
Lower Leg ◽  
Leg Ulcer ◽  
Response To Therapy ◽  
Pressure Therapy ◽  
Wound Debridement ◽  
Split Thickness Skin Grafting

Introduction. Hypertensive ischemic leg ulcer, also known as Martorell ulcer, is not very rare, but an under-recognized type of leg ulcer. It has specific clinical and histopathological characteristics. It occurs almost exclusively in patients with arterial hypertension. It is more common in women and in patients with type 2 diabetes. It is localized particularly in the laterodorsal distal third of the lower leg. This ulcer is extremely painful. Its clinical features may very much resemble pyoderma gangrenosum. Case Report. We are presenting a case of a 40-year-old obese male, who suffered from arterial hypertension during the past 26 years. His ulcer appeared spontaneously on the lateral aspect of the right lower leg and progressed gradually. From the very onset, the ulcer was extremely painful. At first, it was diagnosed as pyoderma gangrenosum and treated with systemic corticosteroids and immunosuppressants. Since the response to therapy was not satisfactory, the histopathology was revised and the diagnosis of hypertensive ischemic leg ulcer was made. After initial wound debridement and local negative pressure therapy, split-thickness skin grafting was performed. The pain disappeared right away almost completely and complete epithelization was achieved two weeks after skin grafting. Conclusion. It is important to consider Martorell ulcer in hypertensive patients with extremely painful ulcers of the lower leg. In order to establish the appropriate diagnosis, it is essential to take a deep skin biopsy and correlate the finding with a specific histopathological picture. It is the only way not to confuse hypertensive ischemic leg ulcer with pyoderma gangrenosum, since the management of the two conditions is completely different.

Application of pie-crusting technique to facilitate closure of open abdomen after decompressive laparotomy

2021 ◽  
Vol 14 (8) ◽  
pp. e244219
Author(s):  
Thomas J Martin ◽  
Tareq Kheirbek
Keyword(s):  
Abdominal Wall ◽  
Primary Closure ◽  
Open Abdomen ◽  
Abdominal Wall Reconstruction ◽  
Skin Grafting ◽  
Temporary Abdominal Closure ◽  
Pressure Therapy ◽  
Abdominal Closure ◽  
Decompressive Laparotomy ◽  
Split Thickness Skin Grafting

We present the case of a 23-year-old man who developed abdominal compartment syndrome secondary to severe pancreatitis and required decompressive laparotomy and pancreatic necrosectomy. Despite application of a temporary abdominal closure system (ABThera Open Abdomen Negative Pressure Therapy), extensive retroperitoneal oedema and inflammation continued to contribute to loss of domain and prevented primary closure of the skin and fascia. The usual course of action would have involved reapplication of ABThera system until primary closure could be achieved or sufficient granulation tissue permitted split-thickness skin grafting. Though a safe option for abdominal closure, application of a skin graft would delay return to baseline functional status and require eventual graft excision with abdominal wall reconstruction for this active labourer. Thus, we achieved primary closure of the skin through the novel application of abdominal wall ‘pie-crusting’, or tension-releasing multiple skin incisions, technique.

A case report: split thickness skin grafting on a transplanted liver

1998 ◽  
Vol 30 (7) ◽  
pp. 3211-3213
Author(s):  
N Ogawa ◽  
N Ohkohchi ◽  
H Kato ◽  
T Orii ◽  
S Simaoka ◽  
...  
Keyword(s):  
Case Report ◽  
Skin Grafting ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting

scholarly journals Degloving Penile Injury with Urethral Avulsion: A Case Report

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Sivanandhan S ◽  
Sivaneswaran L
Keyword(s):  
Skin Grafting ◽  
Urethral Injury ◽  
Wound Debridement ◽  
Degloving Injury ◽  
Thickness Skin ◽  
Operative Exploration ◽  
Split Thickness Skin Grafting ◽  
Delayed Complication ◽  
Skin Loss ◽  
Penile Injury

Accidental male genital injuries represent a serious urological disorder that demands immediate urological treatment due to risk of infection and need for fertility preservation. We reported a 30- year-old gentleman who presented with an extensive penile degloving injury, right open pneumothorax and right thigh laceration following a buffalo attack. Examination under anesthesia (EUA) demonstrated ruptured penis with tearing up to penile base and partially avulsed right testis. Right orchidectomy, wound debridement and suprapubic catheter insertion performed before being referred to Penang General Hospital. Repeated EUA revealed avulsed penile urethra 3cm from the meatus with interposing granulation tissue of 2cm in length. He underwent serial wound debridement and eventually required a split skin graft to the penis. Patient was reported to be able to achieve penile erection by 2 months post-operative and planned for urethroplasty later. This is the first paper that reports an incident of buffalo attack resulting in degloving injury of penis. Management depends on severity of trauma and prompt intervention essential to prevent immediate as well as delayed complication. Urethral injury must be considered in any extensive penile injury. Despite multiple modality for traumatic penile skin loss repair, split thickness skin grafting (SSG) was chosen for this patient. Conclusion: External injuries of the genitals, particularly caused by animal attack, should be followed by immediate operative exploration and if necessary, to reparative measures. Care must be taken with goal of optimizing long term sexual, cosmetic and voiding outcomes.

scholarly journals Collaural Fistula: A Case Report

2016 ◽  
Vol 24 (3) ◽  
pp. 157-160
Author(s):  
Kalyan Pal ◽  
Dipanjan Chakraborty ◽  
Sohag Kundu ◽  
Subrata Mukhopadhyay
Keyword(s):  
Case Report ◽  
External Auditory Canal ◽  
Skin Grafting ◽  
Definitive Treatment ◽  
Facial Nerve Paralysis ◽  
Nerve Paralysis ◽  
Thickness Skin ◽  
Inappropriate Treatment ◽  
Split Thickness Skin Grafting ◽  
Branchial Cleft Anomalies

Introduction Collaural fistula or cervico-aural fistula is rare and accounts for less than 8% of branchial cleft anomalies. Their rarity and diverse presentations have frequently led to misdiagnosis and inappropriate treatment. Case Report We report one such case of a 7 year old girl who presented to us with two discharging cutaneous openings on the left side; one in the floor of the left external auditory canal and another in the upper neck and lower face (infra-auricular region). Discussion Surgical exploration and excision is the definitive treatment of a collaural fistula. A sinus/ fistula opening into the external auditory canal, should be removed with skin and cartilage. If more than 30% of the circumference of the external auditory canal is denuded, split thickness skin grafting and stenting are recommended. The potential post-operative complications are facial nerve paralysis and recurrence of the lesion. Fistulogram is a useful diagnostic tool.

Coverage of Exposed Bones and Joints in Critically Ill Patients: Lower Extremity Salvage with Topical Negative Pressure Therapy

2008 ◽  
Vol 12 (5) ◽  
pp. 223-229 ◽  
Author(s):  
Raymund E. Horch ◽  
Adrian Dragu ◽  
Werner Lang ◽  
Paul Banwell ◽  
Mareike Leffler ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Negative Pressure ◽  
Critically Ill Patients ◽  
Skin Grafting ◽  
Negative Pressure Therapy ◽  
Pressure Therapy ◽  
Topical Negative Pressure ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting ◽  
Extremity Amputation

Background: Soft tissue defects of the limb with exposure of tendons and bones in critically ill patients usually lead to extremity amputation. A potential treatment with topical negative pressure may allow split-thickness skin grafting to the bone, which leads to limb salvage. Materials and Methods: We report on 21 multimorbid patients, 46 to 80 years of age, with severe lower limb soft tissue loss and infection with exposed bone following débridement with critical limb ischemia. Attempts to salvage the extremities were undertaken with repeated surgical débridement followed by vacuum-assisted closure therapy and subsequent split-thickness skin grafting procedures. Results: Infection control and limb salvage were achieved in all cases with multiple débridements, topical negative pressure therapy, and skin grafts. In all patients, the exposure of tendons and bones was reversible by this strategy without a free flap transfer. Discussion: The patients described in this study were severely compromised by systemic and vascular disorders, so extremity amputation had been considered owing to the overall condition and the exposure of tendons and bones. Since it was possible to salvage the affected limbs with this straightforward and simple procedure, this type of treatment should be considered as a last attempt to prevent amputation.

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