1/20. Frozen allogeneic human epidermal cultured sheets for the cure of complicated leg ulcers.BACKGROUND: skin ulcers due to venous stasis or diabetes are common among the elderly and are difficult to treat. Repeated applications of cell-based products have been reported to result in cure or improvement of leg ulcers of small size in a fraction of patients. OBJECTIVE: To examine the effects of frozen human allogeneic epidermal cultures for the treatment of acute and chronic ulcers. methods: We treated a series of 10 consecutive patients with leg ulcers of different etiology and duration with frozen human allogeneic epidermal cultures stored frozen and thawed for 5-10 minutes at room temperature before application. Three patients had ulcers with exposed Achilles or extensor tendon. The ulcers treated were as large as 160 cm2 in area and of up to 20-years' duration. After preliminary preparation of the wounds by debridement to remove necrotic tissue and application of silver sulfadiazine to control infection, thawed cultures were applied biweekly from 2 to 15 times depending on the size and complexity of the ulcer. RESULTS: All ulcers healed, including those with tendon exposure. After the first few applications, granulation tissue formed in the ulcer bed and on exposed tendons, and epidermal healing took place through proliferation and migration of cells from the margins of the wound. The time required for complete healing ranged from 1 to 31 weeks after the first application. CONCLUSION: The use of frozen human allogeneic epidermal cultures is a safe and effective treatment for venous or diabetic ulcers, even those with tendon exposure. It seems possible that any leg ulcer will be amenable to successful treatment by this method.- - - - - - - - - - ranking = 1keywords = stasis (Clic here for more details about this article) |
2/20. Infiltrating basal cell carcinoma in the setting of a venous ulcer.A 77-year-old man was referred with a 5-year history of an intermittently painful, nonhealing right medial ankle ulcer. The ulcer had not responded to multiple treatment modalities, including Unna boots, compression therapy, sclerotherapy, and split-thickness skin grafting. The past medical history was significant for a deep venous thrombosis in the right leg 30 years earlier (treated with warfarin for 3 months) and a history of greater saphenous vein harvesting for coronary bypass grafting 28 years previously. After the vein stripping, the patient had suffered from increasing right leg edema and stasis changes in the right leg. His history was also remarkable for coronary artery disease, dyslipidemia, and lymphoma treated with chemotherapy 8 years before presentation, with no evidence of recurrence. He had stopped smoking approximately 20 years earlier. Medications included atenolol, simvastatin, nicardipine, nitroglycerin, and aspirin. skin examination revealed a 3.0 x 3.5-cm ulcer adjacent to the medial malleolus. The edges of the ulcer appeared raised and rolled (Fig. 1). Centrally, there was granulation tissue, which appeared healthy. There were surrounding dermatitic changes. Dorsalis pedis and the posterior tibial pulses were normal. Noninvasive vascular studies revealed severe venous incompetence of the right popliteal and superficial veins. Arterial studies and transcutaneous oximetry were normal. Computed tomographic scan of the pelvis did not reveal any adenopathy, and radiographic imaging did not reveal any bony changes suggestive of osteomyelitis. biopsy of the ulcer edge and base showed infiltrating basal cell carcinoma (Fig. 2). Mohs' micrographic surgery required three layers; the final extent of the ulcer was 7.8 x 6.9 cm. A split-thickness skin graft was placed.- - - - - - - - - - ranking = 1keywords = stasis (Clic here for more details about this article) |
3/20. Adjuvant anabolic agents: a case report on the successful use of oxandrolone in an hiv-positive patient with chronic stasis ulceration.Chronic venous stasis ulcers and hiv represent 2 prevalent disease processes in the urban wound care setting. To best serve our patients, it is important that the wound care team carefully consider the impact of comorbidities and consider use of nutritional interventions. In this article we report the use of the anabolic agent oxandrolone to successfully treat an hiv-positive man with stasis ulceration.- - - - - - - - - - ranking = 6keywords = stasis (Clic here for more details about this article) |
4/20. Additional follow-up with microvascular transfer in the treatment of chronic venous stasis ulcers.Nine patients presented with non-healing venous ulcers of the lower limb. All had failed both non-surgical and surgical therapies. Following wide wound excision, perforator ligation, and microsurgical reconstruction, all wounds were healed. In two instances, separation at the flap/wound perimeter interface occurred and required additional dressing care to obtain wound closure. This was probably the result of incomplete excision of surrounding liposclerotic soft tissue. At 26 postoperative months, all wounds remained healed. Microsurgical transfer for properly selected patients can achieve healing of recalcitrant venous wounds, both over the intermediate and long term.- - - - - - - - - - ranking = 4keywords = stasis (Clic here for more details about this article) |
5/20. Venous stasis ulcers due to primary, isolated deep venous insufficiency in a patient with systemic lupus erythematosus: report of a case.Primary, isolated deep venous incompetence is rare, difficult to diagnose, and can lead to the development of venous stasis ulcers. We herein report a case demonstrating chronic venous stasis ulcers due to primary, isolated deep venous incompetence, which was misdiagnosed as vasculitis ulcers associated with systemic lupus erythematosus (SLE). Although primary, isolated deep venous incompetence is rare, it is important to bear this possibility in mind when a patient presents with leg ulcers.- - - - - - - - - - ranking = 6keywords = stasis (Clic here for more details about this article) |
6/20. Measured improvement in rate of healing of venous ulceration.This case study describes a pivotal intervention associated with improved wound appearance and healing rate in a young, active woman with extensive venous stasis ulcers. These extensive ulcerations were heavily exudative and covered by a layer of yellow eschar. Yellow eschar and drainage were successfully managed with a capillary dressing (Vacutex), which promoted therapeutic compression as applied by standard dressings. This case provides data in favour of wound care protocols featuring Vacutex, specifically designed to address the consequences that wound drainage and eschar have in dramatically large venous stasis ulcers.- - - - - - - - - - ranking = 2keywords = stasis (Clic here for more details about this article) |
7/20. proteus syndrome.A 34-year-old male patient was referred with a recalcitrant leg ulcer overlying an extensive vascular malformation, which had led several times to septic soft tissue infections. During his infancy he had been diagnosed to have Klippel-Trenaunay syndrome. Clinical examination revealed asymmetric hypertrophy of the lower extremities, an extensive portwine stain on the more severely affected left limb as well as prominent venous varicosities of both legs. Hands and feet showed striking cerebriform palmoplantar hypertrophy, and macrodactily with syndactily of several fingers. All toes had been amputated in early childhood due to extreme overgrowth and currently the patient walked on his forefeet in a prominent pes equinus deformity. Further symptoms consisted in several lipomas at both arms, another portwine stain at the left hemithorax and a single cafe-au-lait spot at the left scapula. Angio-magnetic resonance imaging scans of both legs showed an extensive venous-lymphatic vascular malformation involving the whole subcutis and infiltrating the muscle. The chronic wound was interpreted as venous stasis ulceration. Local percutaneous sclerotherapy of the dilated veins underneath the ulcer was discussed, but considered to carry a relevant risk of skin necrosis with consecutive progression of the wound. A conventional split-skin graft led to complete wound healing. Since, the patient consequently wears custom-made compression stockings and remained free from recurrences. The syndromatic constellation of palmoplantar overgrowth, multiple lipomas, giant fingers and toes, limb overgrowth, venous-lymphatic malformation and a cafe-au-lait spot led to the diagnosis of proteus syndrome. The possible aetiology, clinical manifestations, differential diagnosis and management of this rare disorder are discussed.- - - - - - - - - - ranking = 1keywords = stasis (Clic here for more details about this article) |
8/20. Successful treatment of stasis dermatitis with topical tacrolimus.Stasis dermatitis is a common dermatologic disorder as a consequence of impaired venous drainage and often accompanied by chronic leg ulcers. Until today the standard in acute therapy represents the topical administration of highly potent corticosteroids and if possible a consequent long-term compression therapy. The macrolide tacrolimus represents a new selective inflammatory cytokine release inhibitor by binding to macrophilin-12 and inhibiting calcineurin. Beside the resulting anti-inflammation and immunosuppression an antipruritic effect have been discussed as further clinical benefits of tacrolimus. Here we report for the first time about a 81-year old patient suffering from an ulcus cruris mixtum and stasis dermatitis treated with topical 0.1% tacrolimus ointment twice daily for 5 days. Until now tacrolimus is available for topical treatment as a fatty ointment only. Although we would have preferred a more hydrophilic base for treatment of acute stasis dermatitis we achieved complete healing. As this is only a case report about one single patient further clinical investigations are needed to confirm this observation in more individuals with stasis dermatitis.- - - - - - - - - - ranking = 7keywords = stasis (Clic here for more details about this article) |
9/20. Massive spouting bleeding from chronic stasis ulceration caused by arteriovenous communication of the lower extremity.We report a case of massive bleeding from a varicose vein in a calf. A 56-year-old man was brought into the emergency unit of our hospital with massive bleeding from an ulcer on his left calf. A duplex scan and arteriography revealed arteriovenous communication at the site of stasis ulceration. After primary hemostasis, coil embolization of the feeding artery to the arteriovenous communication was successfully performed, followed by stripping of the greater saphenous vein. Careful attention thus needs to be paid to arteriovenous communication that can cause life-threatening bleeding from stasis ulceration. Coil embolization of the feeding arterial branch can safely and effectively treat this disease.- - - - - - - - - - ranking = 7keywords = stasis (Clic here for more details about this article) |
10/20. A successful bypass operation for long-standing venous stasis ulcer of the leg.A case of long-standing venous stasis ulcer after thrombophlebitis of the deep vein system is reported that was treated successfully by transferring a pedicled greater saphenous vein and its branches from the healthy side.- - - - - - - - - - ranking = 5keywords = stasis (Clic here for more details about this article) |
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