USE OF A COMBINATION OF TWO IPSILATERAL FLAPS TO COVER POST TRAUMATIC LEG DEFECTS

INTRODUCTION-With advancement in the microsurgical techniques the free tissue transfer has become the rst choice to manage large leg defects which cannot be covered with a local ap.The other option is the cross leg ap.Free aps need an expert team, expensive instruments and plenty of time. Cross leg aps lead to a difcult postoperative period for the patient. When the tissues surrounding the defect are healthy and a careful planning is done, a combination of two local aps which are otherwise used singly for smaller defects may obviate the need for a free or cross leg ap in certain cases.In this study we evaluated the patients who had undergone a combination of gastrocnemius muscle and fasciocutaneous aps for covering the large leg defects. AIMS AND OBJECTIVES-The aim is to study the role of a combination of two local aps to provide cover for the large leg defects. MATERIAL AND METHODS-A retrospective analysis of 30 patients operated from June 2016 to July 2021 for the leg defects rd involving the upper 2/3 of the leg was done.In these patients the upper half of the defects was covered with gastrocnemius muscle ap and the lower half was covered with inferiorly based fasciocutaneous ap. All patients had been followed till the wound cover became stable. RESULTS-All patients were males between the age group of 16 to 46 years. Leg defects were exposed tibia or implant and were post-traumatic in all the cases. Size of the defects ranged from 16cm to 18cm. In all the patients both aps survived well. Two patients had marginal necrosis of fasciocutaneous ap and one had discharge from underneath the muscle ap but were managed conservatively. CONCLUSION- A combination of gastrocnemius muscle and fasciocutaneous aps is a safeoption for covering large leg rd defects involving the upper 2/3 where surrounding skin and muscles are healthy

Dermoscopy Images Enhancement via Multi-Scale Morphological Operations

Skin dermoscopy images frequently lack contrast caused by varying light conditions. Indeed, often low contrast is seen in dermoscopy images of melanoma, causing the lesion to blend in with the surrounding skin. In addition, the low contrast prevents certain details from being seen in the image. Therefore, it is necessary to design an approach that can enhance the contrast and details of dermoscopic images. In this work, we propose a multi-scale morphological approach to reduce the impacts of lack of contrast and to enhance the quality of the images. By top-hat reconstruction, the local bright and dark features are extracted from the image. The local bright features are added and the dark features are subtracted from the image. In this way, images with higher contrast and detail are obtained. The proposed approach was applied to a database of 236 color images of benign and malignant melanocytic lesions. The results show that the multi-scale morphological approach by reconstruction is a competitive algorithm since it achieved a very satisfactory level of contrast enhancement and detail enhancement in dermoscopy images.

INFECTED URACHAL CYST IN AN ADULT

Urachus is a tubular formation originating from the top of the urinary bladder and directed to the umbilicus between the peritoneum and the transverse fascia of the abdomen. In an embryo, it serves to divert primary urine to the amniotic fluid. In case, if obliteration of the duct does not occur until the birth, various pathological processes can develop in it. The most common abnomalies of urachus reported in adults are an infected urachal cyst and urachal carcinoma. These diagnoses are not always easy to make due to atypical symptoms of their manifestation and the rarity of these diseases - just two cases per 100,000 hospitalizations of adults. A 22-year-old man with a subcutaneous abscess and anexternal fistula located in theumbilical region with redness of the surrounding skin. 16 hours after dissection and drainaging of the abscess, the patient’s condition worsened, pain in the lower parts of the abdomen began, muscle tension of the anterior abdominal wall and inflammatory changes in blood tests were revealed. The patient was operated on for peritonitis. A two-chambered urachus cyst of the «hourglass» type, with the formation of a dense consistency calculus in one of the cavities, which perforated into the abdominal cavity This clinical case is of the great interest from the point of view of the atypical course and the treatment of a rather rare anomaly in adults. The publication will remind emergency medicine physicians about the possibility of infected urachus in patients with symptoms of acute abdomen.

Dermatoscopy of Facial Non-Pigmented Actinic Keratosis and Intraepidermal Carcinoma

Dermatoscopy improves the diagnostic accuracy of non-pigmented facial lesions, including actinic keratosis (AK) and intraepidermal carcinoma (IEC) and helps to differentiate them from common invasive malignancies such as basal cell carcinoma and invasive squamous cell carcinoma. The most common dermatoscopic features characterizing AK are background erythema/erythematous pseudonetwork, white follicular openings/targetoid hair follicles, surface scales, rosettes, fine, linear, wavy vessels, microerosions and sun-damaged surrounding skin. In comparison, the most common dermatoscopic features of IEC are background erythema, red starburst pattern, surface scale, dotted/glomerular vessels, hairpin vessels, microerosions/ulcerations and targetoid hair follicles. The practice of recognizing these features in dermatoscopic images is a useful tool in the armamentarium of a clinician examining skin lesions.

A Case Report on Autoimmune Thyroid Disease (ATD) Associated with Chronic Angioedema

Angioedema may be a rare condition that manifests itself by abrupt localized edema caused by the fluid outflow from blood vessels into surrounding skin and tissue. This case report presents a 54-year old male patient with chronic angioedema (lip) for one year without urticaria. Six months ago, he approached the local clinic and used regular antihistamines by the physician advice. Still, there was no improvement in patient condition. Then he came to the outpatient department of internal medicine of our hospital. Therefore, we have done a series of investigations, in then he diagnosed with Hypothyroidism (TSH 8.05UIu/ml). Then he has prescribed levothyroxine 25mcg. After one month's review, he examined for Anti-thyroid peroxidase antibodies (Anti-TPO). In that examination, those were positive or elevated (mild). According to our research, this may probably be the first autoimmune thyroid disease associated with chronic angioedema without urticaria or hives.

The Bork-Baykal Phenomenon in Congenital Melanocytic Nevus

The Bork-Baykal phenomenon is a new entity that was first reported in large congenital melanocytic nevus 2015 and classified as a specific variant of congenital melanocytic nevus (CMN). Afterward, this rare feature was reported in other skin disorders reflecting the different embryologic developmental periods of the nipple-areola complex (NAC) with the surrounding skin. Preserving of the NAC appears to bowl over the clinicians both in congenital and acquired skin disorders.

The hemostatic and wound healing effects of autologous fibrin adhesive in experimental animals

Objectives: Evaluate the hemostasis and skin graft wound healing effect of autologous fibrin adhesive in experimental animals. Methods: experimental method, conducted on 6 rabbits to determine the role of fibrin glue in hemostasis, ability to heal skin graft in experimental rabbits through assessment of graft status: size, swelling, color, boundary between the puzzle piece and the surrounding skin. Results: 1/ Effective hemostasis: fibrin glue transplant: hemostasis time is 129.33±42.01 seconds, transplant time is 128.33±41.87 seconds; suture stitching: hemostasis time is 475.17±59.97 seconds, stitching time is 350.67±52.23 seconds. At times after 1 day, 3 days, 7 days, 10 days, 14 days, 20 days and 30 days there is an earlier phenomenon of wound healing, the flattened and scarred patch is more beautiful than the skin graft with sewing thread. Conclusions: Using autologous fibrin glue in skin grafting has the ability to stop bleeding, heal wounds and achieve better aesthetics than skin grafting with sutures.

Allergic contact versus irritant contact dermatitis in patients with hard-to-heal leg ulcer: clinical and diagnostic approach

Background: Dermatitis of surrounding skin may complicate hard-to-heal leg ulcers, delaying wound healing. The coexistence of hard-to-heal leg ulcers and irritant or allergic contact dermatitis may create difficulties for both diagnostic and therapeutic management. Objective: The aim of our study was to evaluate the incidence of dermatitis occurring in the surrounding skin in a population affected by hard-to-heal leg ulcers during treatment, and to differentiate between allergic contact dermatitis (ACD) and irritant contact dermatitis (ICD) with the use of a patch test. Furthermore, we investigated which medications were most probably related to these conditions. Method: We conducted an observational study from 21 February to 21 July 2017, enlisting all patients affected by hard-to-heal leg ulcers who attended the Wound Care Service of the Dermatologic Department of ASST, Spedali Civili, Brescia, Italy. Results: We enrolled 95 patients; 81 patients did not develop dermatitis, while 14 patients developed dermatitis of the surrounding skin. These patients underwent a patch test which gave a positive result in seven patients, permitting the diagnosis of ACD. Conclusion: Our study confirmed the incidence of dermatitis of the surrounding skin reported in the literature but reassessed the incidence of ACD as opposed to ICD.

Correlation of Melanin Content with Collagen Density in Keloid Patients

BACKGROUND: Keloid is a form of wound healing that results from fibrous tissue activity. It can develop beyond the boundaries of the original wound, extends into the dermis layer, and disrupting the appearance. Previously, no studies have revealed a correlation between melanin pigment and keloid. AIM: This research aimed to describe the correlation between melanin concentration and collagen deposition in keloid tissue. MATERIALS AND METHODS: A prospective study conducted through the application of a cross-sectional analytic survey method. The color of the skin was measured using a chromameter, and a histopathologic examination was performed on the skin surrounding the keloid, as well as the keloid tissue. Data were analyzed using a t-test, correlation, and linear regression statistics. RESULTS: The results showed a significant difference between melanin concentration and collagen deposition in the skin surrounding the keloid tissue. No significant difference was observed between melanin concentration in the surrounding skin of keloid and those in the keloid tissue, as well as collagen deposition. Meanwhile, the melanin concentration in the surrounding skin of keloid and keloid tissue had a significant relationship with fibrocytes number. CONCLUSION: There is a significant correlation between melanin concentrations and collagen density in the keloid tissue.

A Segmentation of Melanocytic Skin Lesions in Dermoscopic and Standard Images Using a Hybrid Two-Stage Approach

The segmentation of a skin lesion is regarded as very challenging because of the low contrast between the lesion and the surrounding skin, the existence of various artifacts, and different imaging acquisition conditions. The purpose of this study is to segment melanocytic skin lesions in dermoscopic and standard images by using a hybrid model combining a new hierarchical K -means and level set approach, called HK-LS. Although the level set method is usually sensitive to initial estimation, it is widely used in biomedical image segmentation because it can segment more complex images and does not require a large number of manually labelled images. The preprocessing step is used for the proposed model to be less sensitive to intensity inhomogeneity. The proposed method was evaluated on medical skin images from two publicly available datasets including the PH2 database and the Dermofit database. All skin lesions were segmented with high accuracies (>94%) and Dice coefficients (>0.91) of the ground truth on two databases. The quantitative experimental results reveal that the proposed method yielded significantly better results compared to other traditional level set models and has a certain advantage over the segmentation results of U-net in standard images. The proposed method had high clinical applicability for the segmentation of melanocytic skin lesions in dermoscopic and standard images.