Chronic ulcer with rejected skin graft in a female: Pentazocine-induced skin ulcers revisited

Abstract. The primary goal of therapy is to reduce the frequency and intensity of Raynaud’s attacks and to minimize the related morbidity rather than to cure the underlying condition. Treatment strategies depend on whether Raynaud’s phenomenon (RP) is primary or secondary. All patients should be instructed about general measures to maintain body warmth and to avoid triggers of RP attacks. Pharmacologic intervention can be useful for patients with severe and frequent RP episodes that impair the patient’s quality of life. Calcium channel blockers are currently the most prescribed and studied medications for this purpose. There has been limited evidence for the efficacy of alpha-1-adrenergic receptor antagonists, angiotensin receptor blockers, topical nitrates or fluoxetine to treat RP. The intravenously administered prostacyclin analogue iloprost can reduce the frequency and severity of RP attacks and is considered a second-line therapy in patients with markedly impaired quality of life, critical digital ischaemia and skin ulcers who are at risk for substantial tissue loss and amputation. Phosphodiesterase inhibitors (e.g., sildenafil) can also improve RP symptoms and ulcer healing whereas endothelin-1 receptor antagonists (e.g., bosentan) are mainly considered treatment options in secondary prevention for patients with digital skin ulcers related to systemic sclerosis. However, their use in clinical practice has been limited by their high cost. Antiplatelet therapy with low-dose aspirin is recommended for all patients who suffer from secondary RP due to ischaemia caused by structural vessel damage. Anticoagulant therapy can be considered during the acute phase of digital ischaemia in patients with suspected vascular occlusive disease attributed to the occurrence of new thromboses. In patients with critical digital ischaemia, consideration should be given to hospitalisation, optimisation of medical treatment in accordance with the underlying disease and evaluation for a secondary, possibly reversible process that is causing or aggravating the clinical symptoms.

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Improving Outcomes in Anterolateral Thigh Flap Donor-Site Reconstruction Using Propeller Flaps: A Retrospective Comparative Study with Skin Grafting

Journal of Reconstructive Microsurgery ◽

10.1055/s-0040-1718550 ◽

2020 ◽

Author(s):

Domenico Pagliara ◽

Maria Lucia Mangialardi ◽

Stefano Vitagliano ◽

Valentina Pino ◽

Marzia Salgarello

Keyword(s):

Comparative Study ◽

Skin Graft ◽

Donor Site ◽

Split Thickness Skin Graft ◽

Tactile Sensitivity ◽

Aesthetic Outcome ◽

Propeller Flap ◽

Thickness Skin ◽

Anterolateral Thigh ◽

Alt Flap

Abstract Background After anterolateral thigh (ALT) flap harvesting, skin graft of the donor site is commonly performed. When the defect width exceeds 8 cm or 16% of thigh circumference, it can determine lower limb function impairment and poor aesthetic outcomes. In our comparative study, we assessed the functional and aesthetic outcomes related to ALT donor-site closure with split-thickness skin graft compared with thigh propeller flap. Methods We enrolled 60 patients with ALT flap donor sites. We considered two groups of ALT donor-site reconstructions: graft group (30 patients) with split-thickness skin graft and flap group (30 patients) with local perforator-based propeller flap. We assessed for each patient the range of motion (ROM) at the hip and knee, tension, numbness, paresthesia, tactile sensitivity, and gait. Regarding the impact on daily life activities, patients completed the lower extremity functional scale (LEFS) questionnaire. Patient satisfaction for aesthetic outcome was obtained with a 5-point Likert scale (from very poor to excellent). Results In the propeller flap group, the ROMs of hip and knee and the LEFS score were significantly higher. At 12-month follow-up, in the graft group, 23 patients reported tension, 19 numbness, 16 paresthesia, 22 reduction of tactile sensitivity, and 5 alteration of gait versus only 5 patients experienced paresthesia and 7 reduction of tactile sensitivity in the propeller flap group. The satisfaction for aesthetic outcome was significantly higher in the propeller flap group. Conclusion In high-tension ALT donor-site closure, the propeller perforator flap should always be considered to avoid split-thickness skin graft with related functional and aesthetic poor results.

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First isolation of Miamiensis avidus (Ciliophora: Scuticociliatida) associated with skin ulcers from reared pharaoh cuttlefish Sepia pharaonis

Diseases of Aquatic Organisms ◽

10.3354/dao03067 ◽

2016 ◽

Vol 122 (1) ◽

pp. 67-71 ◽

Cited By ~ 2

Author(s):

Z Tao ◽

L Liu ◽

X Chen ◽

S Zhou ◽

G Wang

Keyword(s):

Sepia Pharaonis ◽

Skin Ulcers ◽

Miamiensis Avidus

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KARSINOMA SEL BASAL NODULOULSERATIF YANG DITERAPI DENGAN EKSISI, FLAP ROTASI DAN SKIN GRAFT

Media Dermato Venereologica Indonesiana ◽

10.33820/mdvi.v46i4.82 ◽

2019 ◽

Vol 46 (4) ◽

Author(s):

Hayra Diah Avianggi ◽

Intan Nurmawati Putri ◽

Muslimin ◽

Retno Indar Widayati

Keyword(s):

Skin Graft

Karsinoma sel basal (KSB) tercatat sebanyak 75% dari semua kanker kulit. Data epidemiologis dunia menunjukkan peningkatan insidensi KSB 3-10% dalam setahun, hal ini diduga berkaitan dengan penipisan lapisan ozon (2% dalam 20 tahun terakhir) dan perubahan gaya hidup. Karsinoma sel basal (KSB) dapat menyebabkan cacat kosmetik maupun cacat fungsional sehingga diperlukan diagnosis dini dan penatalaksanaan yang tepat. Seorang perempuan 72 tahun, dengan keluhan benjolan yang semakin membesar kemudian menjadi borok di pelipis kiri sejak satu tahun. Riwayat sering terpajan sinar matahari. Pada pemeriksaan fisik ditemukan ulkus dengan diameter 3 cm dan krusta. Temuan histopatologik menunjukkan sel ganas dengan inti hiperkromatik dan tepi palisade. Penatalaksanaan dengan bedah eksisi, flap rotasi dan skin graft. KSB jarang bermetastasis, namun dapat mendestruksi jaringan di dekatnya. Studi epidemiologi memberikan fakta bahwa patogenesis KSB dapat terjadi melalui efek imunologik dan karsinogenik. Gambaran histopatologik penting untuk menentukan varian KSB. Prognosis quo ad vitam bonam, ad sanam dubia ad bonam, ad kosmetikam dubia ad bonam.Kata kunci: Bedah eksisi, flap rotasi, karsinoma sel basal, skin graft

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