1/4. Prevention of amputation caused by rheumatic diseases following a novel therapy of exposing bone marrow, occlusive dressing and subsequent epidermal grafting.BACKGROUND: Wounds with exposed bones caused by rheumatic diseases commonly result in amputation despite progress in our understanding of wound-healing mechanisms. OBJECTIVES: To determine whether an experimental therapy of bone marrow exposure, an occlusive dressing and subsequent grafting of epidermal sheets accelerates healing and reduces the need for amputation in patients with rheumatic diseases. methods: Fifteen patients, including those with rheumatoid arthritis or systemic sclerosis, who had wounds with exposed bones were treated either with the standard procedure, consisting of local wound care, debridement with a scalpel, bed rest and parenteral antibiotics (n = 8), or with a newly developed experimental procedure (n = 7). In that new procedure, the affected bone was initially exposed by debridement with a scalpel, followed by partial excision with a bone scraper until bleeding was observed from the exposed bone. The lesions were immediately covered with an occlusive dressing, and were eventually treated with epidermal grafts obtained from suction blisters. RESULTS: A comparison with standard therapy demonstrated that the time needed for wound healing was similar, but that the newly developed combination therapy reduced the risk of amputation (P = 0.020). No skin ulcers or erosions were observed for at least 1 year in five of seven patients (72%) due to the adoption of stable palmoplantar-type characteristics in grafts derived from the trunk epidermis. CONCLUSIONS: Our study indicates that exposure of bone marrow cells plus an occlusive dressing accelerates the healing of skin ulcers at least partly through the preparation of a healthy well-granulated wound bed and that subsequent epidermal grafting achieves site-specific differentiation through epithelial-mesenchymal interactions.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
2/4. Unusual presentation of B-cell lymphoma as a cutaneous abscess.Cutaneous abscesses can result from many conditions and are primarily managed with incision, drainage and antibiotics, without the need for extensive diagnostic workup. We herein report a case of a B-cell lymphoma manifesting as an abscess on the back of a 67-year-old female. Standard therapies failed to improve her condition, and, by the time of tissue diagnosis, a greater than palm-sized necrotic ulcer eroding through skin and fat, and into the psoas muscle had developed. Primary or secondary cutaneous B-cell lymphomas almost never lead to tissue necrosis but should be entertained in cases of abscesses or ulcers with unusual presentation.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
3/4. Ulceration of the palms and soles. An unusual feature of cutaneous T-cell lymphoma.Two patients, one with sezary syndrome and one with mycosis fungoides are described, in whom lesions on the palms and soles were associated with extensive ulceration and gave rise to diagnostic difficulty. Extensive ulceration of the palms and soles is uncommon; its presence should alert clinicians to the possibility of cutaneous T-cell lymphoma.- - - - - - - - - - ranking = 6keywords = palm (Clic here for more details about this article) |
4/4. Epithelioid sarcoma of the hand.A case of epithelioid sarcoma in a young man is described. At 16 years of age the patient had two skin ulcers removed from his hand, which were diagnosed as synovial sarcoma. At 21 years he underwent wide excision of the same area, including part of the thenar muscle, and a diagnosis was made of palmar fibromatosis with no confirmation of malignancy. Histological examination of biopsied growths three years later at age 24 showed the typical picture of epithelioid sarcoma. Following further excisions of local recurrences and removal of half the distal part of the forearm, the patient agreed to below-elbow amputation at age 27. He died within the year. The case presents the typical features of epithelioid sarcoma: apparently benign presentation on the hand in a yound man, a histological picture resembling other diseases resulting in misdiagnosis early in the disease, and local recurrences and metastasis. The misleading clinical and histological pictures of this insidious disease are discussed.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |