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Objectives To test the hypothesis that photographs (in addition to self-reported data) can be collected daily by patients with SSc using a smartphone app designed specifically for digital lesions, and could provide an objective outcome measure for use in clinical trials. Methods An app was developed to collect images and patient-reported outcome measures including Pain score and the Hand Disability in Systemic Sclerosis-Digital Ulcers (HDISS-DU) questionnaire. Participants photographed their lesion(s) each day for 30 days and uploaded images to a secure repository. Lesions were analysed both manually and automatically, using a machine learning approach. Results Twenty-five patients with SSc-related digital lesions consented, of whom 19 completed the 30-day study, with evaluable data from 27 lesions. Mean (s. d.) baseline Pain score was 5.7 (2.4) and HDISS-DU 2.2 (0.9), indicating high lesion- and disease-related morbidity. A total of 506 images were used in the analysis [mean number of used images per lesion 18.7 (s. d. 8.3)]. Mean (s. d.) manual and automated lesion areas at day 1 were 11.6 (16.0) and 13.9 (16.7) mm2, respectively. Manual area decreased by 0.08 mm2 per day (2.4 mm2 over 30 days) and automated area by 0.1 mm2 (3.0 mm2 over 30 days). Average gradients of manual and automated measurements over 30 days correlated strongly (r = 0.81). Manual measurements were on average 40% lower than automated ones, with wide limits of agreement. Conclusion Even patients with significant hand disability were able to use the app. Automated measurement of finger lesions could be valuable as an outcome measure in clinical trials. [ABSTRACT FROM AUTHOR]

There are roughly 100 species of Ophioglossum, Helminthostachys, Cheiroglossa, and Botrychium in the family Ophioglossaceae, which consists of these four genera. Due to the numerous therapeutic benefits of the phytochemical compositions found in Ophioglossum species, these plants are frequently utilized to cure a variety of ailments. This review includes a thorough analysis of the Ethnomedicines, phytochemistry, and pharmacological uses of the genus Ophioglossum, a member of the Ophioglossaceae family that includes 45–50 recognized species and is well known for its wide range of traditional uses, including food, folk medicine, wound healing, menstrual disorders, tissue repair properties, skin ulcers, anti-wrinkling, epistaxis, aphrodisiac, eye blepharitis. A thorough literature search from this study was conducted using several web searches as well as online records, including PubMed, Web of Science, Scopus, and Google Scholar etc. This genus demonstrates distinct benefits in both medicine and food. Ophioglossum species have been found to contain bioactive substances like flavonoids, homoflavonoids, flavonols, rhamnopyranoside, kaempferol total phenolics, proxy fatty acids, thermalic acids, ophioglonol, glucopyranoside, and pedunculosumosides that are responsible for the spectacular biological activities that have been observed in them including antioxidant, antimicrobial, anti-inflammatory, anti-HBV activity, wound healing, Insecticidal property, Alopecia treatment antidiarrheal and spasmolytic effect. This review discusses the significance of various Ophioglossum species in terms of their traditional medicinal applications, phytochemical makeup, and prospective pharmacological activities. In terms of pharmacology, this genus is less studied than other ferns because some of its species are rare. Therefore, more research should concentrate on the preservation, cultivation, and sustainable use of Ophioglossum species. Additionally, there is a humungous need to investigate this genus' biological activities. [Display omitted] • Ferns bridge the gap between lower and higher plants and have been used historically for decoration, food, and crafts. • Ferns have been employed to treat various conditions, including ulcers, urinary tract infections, vomiting, hair loss, infertility, digestive issues, and wounds. • This review offers an in-depth analysis of the ethnomedicinal uses, phytochemical composition, and pharmacological properties of the genus Ophioglossum. • The review highlights that Ophioglossum species, many of which are rare, have been less studied pharmacologically compared to other ferns, emphasizing the need for further research. [ABSTRACT FROM AUTHOR]

Background: Inadvertent intra-arterial injection of sclerosants is an uncommon adverse event of both ultrasound-guided and direct vision sclerotherapy. This complication can result in significant tissue or limb loss and significant long-term morbidity. Objectives: To provide recommendations for diagnosis and immediate management of an unintentional intra-arterial injection of sclerosing agents. Methods: An international and multidisciplinary expert panel representing the endorsing societies and relevant specialities reviewed the published biomedical, scientific and legal literature and developed the consensus-based recommendations. Results: Actual and suspected cases of an intra-arterial sclerosant injection should be immediately transferred to a facility with a vascular/interventional unit. Digital Subtraction Angiography (DSA) is the key investigation to confirm the diagnosis and help select the appropriate intra-arterial therapy for tissue ischaemia. Emergency endovascular intervention will be required to manage the risk of major limb ischaemia. This includes intra-arterial administration of vasodilators to reduce vasospasm, and anticoagulants and thrombolytic agents to mitigate thrombosis. Mechanical thrombectomy, other endovascular interventions and even open surgery may be required. Lumbar sympathetic block may be considered but has a high risk of bleeding. Systemic anti-inflammatory agents, anticoagulants, and platelet inhibitors and modifiers would complement the intra-arterial endovascular procedures. For risk of minor ischaemia, systemic oral anti-inflammatory agents, anticoagulants, vasodilators and antiplatelet treatments are recommended. Conclusion: Inadvertent intra-arterial injection is an adverse event of both ultrasound-guided and direct vision sclerotherapy. Medical practitioners performing sclerotherapy must ensure completion of a course of formal training (specialty or subspecialty training, or equivalent recognition) in the management of venous and lymphatic disorders (phlebology), and be personally proficient in the use of duplex ultrasound in vascular (both arterial and venous) applications, to diagnose and provide image guidance to venous procedure. Expertise in diagnosis and immediate management of an intra-arterial injection is essential for all practitioners performing sclerotherapy. [ABSTRACT FROM AUTHOR]

Acute pneumonia is a respiratory disease characterized by inflammation within the lung tissue, exhibiting higher morbidity rates and mortality rates among immunocompromised children and older adults. Symplocos species have been traditionally used as herbal remedies for conditions like dysentery, skin ulcers, diarrhea, and dyspepsia. Contemporary research has employed various Symplocos species in the study of diverse diseases. However, the exact efficacy and mechanisms of action of Symplocos Prunifolia remain unknown. Therefore, this study investigated the anti-inflammatory mechanism of S. prunifolia extract (SPE) in A549 and RAW264.7 cells stimulated by lipopolysaccharide (LPS). SPE significantly reduced nitric oxide (NO) production and the protein expression levels of like inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) in LPS-stimulated RAW 264.7 cells. Furthermore, it reduced the protein expression levels of iNOS, COX-2 and the levels of pro-inflammatory cytokines in LPS-stimulated A549 cells. The mechanism underlying the anti-inflammatory effect of SPE was associated with the inhibition of LPS stimulated the phosphoinositide-3-kinase/protein kinase B (PI3K/Akt) and Mitogen-activated protein kinase (MAPK) phosphorylation. Moreover, we confirmed that SPE decreased the nuclear translocation of nuclear factor-κB (NF-κB)/p65 stimulated by LPS. In conclusion, these results demonstrate that SPE alleviates inflammatory responses by deactivating the PI3K/Akt, MAPK, and NF-κB signaling pathways. Our findings suggest that SPE is a potential candidate for acute pneumonia prevention. [ABSTRACT FROM AUTHOR]

Interleukin‐33 (IL‐33) is an alarmin released upon epithelial tissue damage. It functions as a nuclear factor for regulating gene expression. We hypothesised that IL‐33 is involved in the formation of decubitus ulcers through damaged epidermis. Therefore, this study aimed to clarify the mechanism of IL‐33 action in decubitus ulcer formation. IL‐33 knockout (KO), soluble stimulation‐2 (ST2) transgenic, and wild‐type (WT) mice were used to construct an ischemia–reperfusion (I/R) injury as a decubitus model. The ulcer area was significantly reduced in IL‐33 KO mice compared to WT mice but was not reduced in ST2 transgenic mice. Anti‐IL‐33 receptor (transmembrane ST2) antibodies effectively prevented ulcer formation; however, an anti‐IL‐33 neutralising antibody was ineffective. The number of infiltrating macrophages was higher, while that of neutrophils and mast cells was lower in IL‐33 KO mice than in WT mice. The number of M2 macrophages increased in IL‐33 KO mice. Characterisation of gene expression levels revealed significantly reduced interleukin‐1 beta (IL‐1β) and increased C‐C motif chemokine ligand 17 expression in IL‐33 KO mice. Macrophages isolated from ulcers in WT or IL‐33 KO mice stimulated with exogenous IL‐33 produced comparable amounts of IL‐1β. In conclusion, our study indicates that IL‐33 is released in response to I/R injury in the skin, contributing to inflammatory macrophage and mast cell infiltration and stimulation, resulting in IL‐1β production and the massive infiltration of effector cells, including neutrophils, which finally induces decubitus ulcer formation. These results suggest that suppressing IL‐33 expression could be beneficial for treating early‐phase decubitus ulcers. [ABSTRACT FROM AUTHOR]

Scleroderma or systemic sclerosis (SSc)‐associated digital ischaemic complications, such as digital ulcers (SSc‐DUs), appear relatively early during the disease course and are a major burden with substantial deterioration of quality of life. Expert rheumatologist and wound specialists have defined a DU; however, international application of the definition is still disorganised. Appearance of SSc‐DUs is secondary to the onset of Raynaud's phenomenon and as a consequence, recommended first‐line of treatment mainly includes vasodilators; however, many DUs are refractory to this treatment. Despite important practical issues, such as a lack of well‐characterised SSc‐wound healing animal model, significant efforts are needed to mechanistically understand the pathogenesis of SSc‐DUs for developing clinically targetable disease modifying therapies. [ABSTRACT FROM AUTHOR]

Background Cutaneous polyarteritis nodosa (cPN) is a necrotizing arteritis of medium-sized vessels limited to the skin. Because of its rarity and the diversity of its clinical manifestations, there is no consensus treatment. Moreover, there are no established indicators that predict disease severity or its outcome. Objectives To investigate clinicolaboratory features that predict patients requiring systemic therapy, including corticosteroids, to control disease activity. Methods Thirty-six patients with cPN who had not received systemic corticosteroids at their initial visit were retrospectively analysed by correlating the treatment and its response with clinicolaboratory findings. Results The major medications administered were antiplatelet agents [64% (23/36)], vasodilators [39% (14/36)] and prednisolone (PSL) [36% (13/36)]. In total, 23 patients achieved remission without PSL, 5 were managed with compression therapy alone or even observation and 18 received antiplatelet monotherapy or combined with vasodilator/dapsone whereas 13 required PSL. Of the 13 who required PSL, 10 achieved remission with PSL monotherapy or PSL and single/multiple medications and 3 with PSL and multiple drugs then failed to achieve remission and underwent limb amputation. There were more skin ulcers and an elevated peripheral white blood cell (WBC) count and erythrocyte sedimentation rate (ESR) before corticosteroid induction in patients requiring PSL. Three patients with treatment failure had a markedly elevated ESR (> 50 mm h–1). Conclusions More than half of patients with cPN can achieve remission without corticosteroids. An elevated WBC, an elevated ESR and the presence of skin ulcers predict the need for PSL. A high ESR before corticosteroid induction predicts treatment resistance, even with PSL. [ABSTRACT FROM AUTHOR]

Objective: Unusual setting of medical care Background: Giant cell tumors of bone typically occur in early adulthood, when the growth plate has closed. The distal radius is the second most common location affected, accounting for 10% to 12% of cases. Complications of poor soft tissue healing are rare in the distal radius, owing to its rich blood supply. However, the curettage procedure and use of bone cement and external fixation can affect the local blood supply. Case Report: We present a rare case of a 24-year-old woman with no significant medical history who underwent surgery at a local hospital to treat a giant cell tumor of the radius. During postoperative wound dressing changes, a 4×3-cm area of flushed skin color with a small blister and reduced local sensation was found on the dorsal side of the wrist. The skin condition worsened despite treatment at the surgical outpatient clinic, leading to referral to scar specialist outpatient treatment. Examination revealed a well-healed surgical scar on the palmar side of the wrist, but a skin defect with necrotic tissue and tendon exposure on the dorsal side. The diagnosis was postoperative soft tissue necrosis of the skin with a giant cell tumor of the bone. Conclusions: This case report discusses the management of chronic non-healing postoperative wounds in giant cell tumors of the distal radius. It emphasizes the importance of appropriate dressing changes, selecting suitable dressings, nutritional support, and effective nurse-patient communication. The case serves as an example of best practices for managing these types of wounds. [ABSTRACT FROM AUTHOR]

This narrative review aims specifically to explore the relationship between tobacco exposure and systemic sclerosis (SSc), idiopathic inflammatory myositis (IIM), and systemic lupus erythematosus (SLE). Relevant articles were obtained by searching key terms such as "tobacco," "smoking," "scleroderma," "myositis," "lupus," and "Sjögren's" in PubMed and Google Scholar databases. The selected articles ranged from the years 2010 to 2023. Inclusion criteria were based on the relevance and contribution to the field of study. Systemic sclerosis is a complex condition involving multiple immune cell lines that can be influenced by tobacco. However, the existing literature does not provide sufficient evidence to support an increased risk of SSc in smokers or the impact on treatment options. Cigarette smoking does increase the risk of skin ulcerations in SSc patients. In addition, cigarette smoking has been associated with IIM through genetic and molecular mechanisms. Smokers with dermatomyositis or polymyositis are at an elevated risk of atherosclerosis and interstitial lung disease. Similarly, smoking in patients with SLE increases the risk of organ damage, thrombosis, and disease severity compared with non-smokers. Smokers with SLE also have more difficulty in controlling disease flares compared with non-smokers. Tobacco exposure can lead to secondary complications in patients with IIM and SLE, although the course of treatment may not differ significantly. No definitive conclusions can be drawn to the clear relationship between tobacco smoking and Sjögren's's syndrome. [ABSTRACT FROM AUTHOR]

Simple Summary: The skin microclimate can be defined as the relationship between temperature and moisture of the skin surface, being considered a risk factor for the development of pressure injuries. The objective was to evaluate the effect of pressure loading on skin temperature and moisture in the heel region of healthy adults. The study was performed at the University of Passo Fundo, Brazil, in October 2022. Ten individuals were evaluated. The pressure loading leads to a decrease in temperature and changes the skin moisture of the heels of healthy individuals. Recent studies emphasize the significance of skin microclimate in the prevention of pressure injuries (PI). The objective was to evaluate the effect of pressure loading on skin temperature and moisture in the heels of healthy adults. This is a before-and-after study performed at Brazil, in October 2022. Skin temperature (°C) was measured by an infrared digital thermometer, and skin moisture (%) using electrical bioimpedance. Ten individuals/twenty heels were evaluated. The average temperature of the right and left heel was the same at baseline (27.2 °C). It was recognized that after 30 min of pressure loading on the heels, there was a decrease in temperature, and after 15 min of pressure offloading, the temperature decreased again. It was found that at t0, the moisture of the right heel (12.6%) was lower than the left heel (15.6%). The median moisture in the right heel increased from t0 to t1 and decreased in t2, while in the left heel, there was a small variation of the median from t0 to t1, as well as to t2. The pressure loading leads to a decrease in temperature and changes the skin moisture of the heels of healthy individuals. [ABSTRACT FROM AUTHOR]

Musculoskeletal infections consist of different clinical conditions that are commonly encountered in daily clinical settings. As clinical findings and even laboratory tests cannot always be specific, imaging plays a crucial role in the diagnosis and treatment of these cases. Musculoskeletal infections most commonly occur secondary to direct inoculation into the skin involuntarily affected by trauma, microorganism, foreign bodies, or in diabetic ulcers; direct infections can also occur from voluntary causes due to surgery, vaccinations, or other iatrogenic procedures. Hematogenous spread of infection from a remote focus can also be a cause for musculoskeletal infections. Risk factors for soft tissue and bone infections include immunosuppression, old age, corticosteroid use, systemic illnesses, malnutrition, obesity, and burns. Most literature discusses musculoskeletal infections according to the diagnostic tools or forms of infection seen in different soft tissue anatomical planes or bones. This review article aims to evaluate musculoskeletal infections that occur due to direct inoculation to the musculoskeletal tissues, by focusing on the traumatic mechanism with emphasis on the radiological findings. [ABSTRACT FROM AUTHOR]

Radiation-induced skin ulcer following cancer and/or tumour is well-documented in the literature. However, radiation-induced skin ulcer following the excision of keloid is yet to be reported. Here, we report the case of a 33-year-old female patient with a suprapubic skin ulcer of five months' duration following keloid treatment with electron beam therapy at recommended dosage. Various examinations, including a skin biopsy, metagenomic sequencing, magnetic resonance imaging and immunochemistry, indicated that the skin ulcer was induced by radiotherapy. While postoperative radiotherapy has been recommended immediately following keloid excision to reduce the risk of recurrence, the present case highlights the risk of skin refractory ulcer following keloid radiotherapy. [ABSTRACT FROM AUTHOR]

Background: Mucous membrane pemphigoid (MMP) is an autoimmune blistering disease (AIBD). Some reports suggest that it has a drug-related pathogenesis especially anti-hypertensive drug. Case presentation: A 67-year-old man with a 7-year history of essential hypertension was prescribed enalapril maleate for 5 months. He presented at our department with pain, ulcers, and blisters on the oral mucosa. We performed clinical, histopathology, and direct immunofluorescence examinations, and findings were consistent with the diagnostic criteria for MMP. Consequently, we consulted with the cardiovascular physician and agreed to discontinue the enalapril maleate replacing it with irbesartan/hydrochlorothiazide tablets and topical corticosteroid therapies instead. The lesions healed without recurrence. Conclusions: ABID induced by antihypertensive drugs have been reported, and enalapril maleate has been implicated as an antihypertensive agent that may trigger AIBDs, such as MMP. This case highlights the potential relationship between antihypertensive drugs and MMP, of which clinicians should be aware to accurately diagnose and promptly relieve patients' pain. [ABSTRACT FROM AUTHOR]

Introduction and purpose Botulinum toxin has been used in medicine since the 1970s, although many years earlier it was known only as a biological weapon. Originally, it was used in medicine to treat strabismus in children. Over time, it has been used in the treatment of neurological disorders, excessive sweating of the armpits, wrinkles, and bladder disorders. In recent years, botulinum toxin has also begun to be used in wound healing. The paralyzing effect of botulinum toxin on the muscles within the wound eliminates micro-injuries caused by tension in these muscles. The aim of the article is to summarize information on the effects of botulinum toxin on the wound, its impact on inflammation, and the type of scar formation. Materials and methods The literature included in the PubMed databases is searched through the words such as botulinum toxin, wounds, and scars. Description of the state of knowledge: The literature review shows the breadth of the issue. Scientific studies showing the effect of using botulinum toxin on wounds emphasize its beneficial effects. However, it should be remembered that wound healing has a complex, dynamic course supported by numerous cellular processes that must be closely coordinated to effectively repair damaged tissues. Determinants influencing the course of wound healing include both local and systemic factors. Important factors influencing the process of proper wound healing are specialized wound preparation, pharmacotherapy, and other aspects of therapeutic intervention. Conclusions The range of applications of botulinum toxin is constantly expanding. In addition to reducing muscle tension within the wound, it also inhibits the production of inflammatory transmitters, limiting its development, and also reduces the development of microcirculation by preventing the development of vessels in hypertrophic scars. [ABSTRACT FROM AUTHOR]

Calcification refers to the deposition of calcium-containing crystals either intracellularly or within the extracellular matrix. Physiologic calcification is a normal process occurring during bone and tooth development and growth. In contrast, pathologic calcification occurs in soft tissues that typically do not undergo mineralization, such as blood vessels, cartilage, tendons, and skin. Pathological calcification is significantly associated with tissue impairment and the development of secondary diseases, such as atherosclerosis, osteoarthritis, tendinopathy, and skin ulcers. Aging, a natural process linked to numerous pathologic conditions, is one of the most recognized risk factors for pathological calcification. In this manuscript, we review the current state of knowledge regarding the role of aging in calcification across different tissues. We focus on the mechanisms activated during normal aging, including cellular senescence, decreased pyrophosphate levels, increased secretion of extracellular vesicles, elevated oxidative stress, and higher levels of pro-mineralizing cytokines, all of which can contribute to pathological calcification. Finally, we discuss the available animal models used to study the impact of aging on calcification. [ABSTRACT FROM AUTHOR]

Winter ulcer disease (WUD) is widely recognized as a serious threat to animal welfare and a major contributor to revenue loss within the aquaculture sector, particularly affecting the salmon-farming industry. This highlights the significant impact of WUD on both animal well-being and the economic sustainability of fish farming. WUD causes hemorrhagic signs and results in dermal lesions and ulcers. This disease can lead to higher mortality rates and a considerable decline in the fish's market value. Moritella viscosa, a Gram-negative bacterium, is predominantly, but not exclusively, correlated with the emergence of WUD, mostly during the colder seasons. Waterborne transmission is the primary way for spreading the bacterium within a population. However, there is remarkable variation in the prevalence and characteristics of WUD in different regions. In Europe, this disease often occurs in the winter, and the intensity and occurrence of outbreaks are influenced by water temperature and salinity. In contrast, outbreaks are typically observed in the summer and mid-autumn in Eastern Canada. Despite the administration of various polyvalent vaccines, outbreaks of skin ulcers have been documented in Canada, and studies have highlighted the possible roles of other bacterial pathogens in Atlantic salmon. This review discusses the etiology, pathogenesis, and potential mitigation or prevention strategies for WUD, mainly in Atlantic salmon. Moreover, it underscores the necessity of conducting further investigations to discover the potential unknown causative agents of ulcerative disease and design appropriate vaccines or preventive strategies for these pathogens. [ABSTRACT FROM AUTHOR]

Woman's breast cancer has always been among the top ten causes of cancer death, and nearly 2% to 5% of locally advanced breast cancers develop a fungating breast wound. Fungal breast cancer leads to skin ulcers, wound ruptures, and other bacterial infections in patients. Ursolic acid (UA), a natural pentacyclic triterpene compound, is widely distributed in many fruits. Previous studies demonstrated that UA has anti-breast cancer, antifungal, and improved wound-healing effects. UA, however, had poor water solubility and low bioavailability, restricting its clinical application. Nanofibers have the advantages of rapid dissolution, improved stability, and bioavailability of active ingredients. We had successfully prepared ursolic acid nanofibers (UANFs) and effectively improved their water solubility and skin penetration. UANFs can increase water solubility by improving the physicochemical properties, including increased surface area, intermolecular bonding with excipients, and amorphous transformation. Furthermore, UANFs had better anti-breast cancer activity than raw UA. UANFs inhibited the expression of phospho-signal transducer and activator of transcription 3 (STAT3) and phospho-extracellular regulated protein kinases (ERK)1/2, and induced cleaved caspase-3 protein expression, but had no effect on the raw UA treatment. In summary, UANFs enhanced the skin absorption of UA and improved its anti-breast cancer efficacy. We expect that UANFs can be used as an anti-breast cancer treatment and reduce the discomfort of breast cancer patients during dressing changes, but more detailed efficacy and safety trials still need to be conducted in further studies. [ABSTRACT FROM AUTHOR]

STING‐associated vasculopathy with onset in infancy (SAVI) is caused by pathogenic gain‐of‐function variants in the gene TMEM173 (also named stimulator of interferon genes, STING1). This report details the case of an 11‐year‐old girl with SAVI who presented with skin‐limited symptoms and discusses the phenotype–genotype correlations of the TMEM173 variant present in our patient. Treatment of SAVI focuses on preventing the development or progression of organ damage by reducing systemic inflammation. We summarize the available treatments for this syndrome. [ABSTRACT FROM AUTHOR]

Background: A skin ulcer is an open sore caused by poor blood supply. Adequate blood flow is necessary for wound healing. But if we have any circulation problems, minor injuries won’t heal properly. Over time, an injury can turn into an ulcer. If an ulcer becomes infected, it should be treated quickly Objective: To study the outcome of healing between dermatotraction versus vacuum assisted dressing in diabetic wounds. Materials and Methods: This randomized interventional study was conducted on inpatient basis at S.S.Institute of Medical Sciences, Davangere, Katnataka India.Institutional ethical committee clearance was taken prior to the start of study. Results: Average size of the wound to which dermatotraction was applied was length 9.4cms and width of 4.76cms, whereas vacuum dressing was done to the wound of average size length 12.2cms and width 7.1cms. It was difficult in our study to apply dermatotraction for wounds with bigger size than for vacuum dressing. The most common primary procedure performed was debridement of the infected wound which was done in about 60% in the people in dermatotraction group and 82.5% in people undergoing vacuum assisted dressing. Average duration for complete closure of the wound was studied and compared between the two groups, which took dermatotraction an average of 22.725 days and vacuum dressing 26.550 days indicating complete closure is faster in cases of dermatotraction. Conclusions: Dermatotraction in one of the effective ways of closure of infected wounds. One of the major advantages of dermatotraction is anaesthesia. In our study all the study population undergoing dermatotraction were given local anaesthesia which is readily available, easily, quick and safe and can be repeated safely if needed. Dermatotraction is a simple and easy technique which can be done in a minor OT procedure room unlike vacuum dressing where it requires another procedure for closure of wound like grafting or flap in major operation theater. [ABSTRACT FROM AUTHOR]

Background: Buruli ulcer (BU) is caused by Mycobacterium ulcerans, an environmental pathogen that causes severe skin and soft-tissue necrosis. In Australia, cases of BU are acquired in endemic regions, which include Victoria and Far North Queensland, but those who have visited these regions can present to health practitioners anywhere. Objective: This article provides Australian general practitioners with an overview of BU, including its epidemiology, transmission, clinical features, diagnosis and management. Discussion: BU can manifest as an ulcer or as a nonulcerated skin lesion, such as a plaque, nodule or oedema. Diagnosis can be achieved with a dedicated Mycobacterium ulcerans polymerase chain reaction (PCR) test performed on a wound swab. Swabs on non-ulcerated disease have a high false negative rate, and a PCR test should be performed on a tissue biopsy to confirm disease. Most cases are managed with prolonged antibiotic therapy - commonly a combination of oral rifampicin and clarithromycin or fluroquinolone (moxifloxacin or ciprofloxac. [ABSTRACT FROM AUTHOR]

Here, we report the simultaneous isolation of Pseudomonas straminea from blood cultures and from a skin ulcer in an elderly woman who suffered from atopic dermatitis and psoriasis and developed acute cellulitis of both arms requiring hospital treatment. To the best of our knowledge, P. straminea has not been previously reported to cause invasive infections in humans. This case highlights how chronic diseases and older age increase the susceptibility to bacterial infections with environmental bacteria of low virulence. Our study describes the microbiological identification of the blood culture isolate, including morpho-molecular characterization and virulence demonstration in a Galleria mellonella model. [ABSTRACT FROM AUTHOR]

Human mpox, which has spread worldwide since May 2022, is characterized by symptoms involving the genital area; however, its treatment methods and clinical course are not completely understood. Furthermore, penile swelling in human mpox can be difficult to differentiate from cellulitis and antibiotic use has been reported in such cases. Herein, we report a case of human mpox in Japan with prominent penile swelling and persistent penile ulcers that improved without specific treatment. The patient was a Japanese man in his 20s with a history of having sexual intercourse with men frequently. He visited Tokyo Metropolitan Toshima Hospital because of a fever and rash in the genital area. Physical examination revealed vesicles on the limbs, penile pigmentation, and significant penile swelling and redness. There were no signs of cellulitis and symptomatic treatment was initiated with outpatient follow-up. After 7 days, an improving trend in penile swelling, redness, and pain was observed. However, a partially black skin ulcer with exudate was observed at the left coronal sulcus of the penis. Therefore, the symptomatic treatment was continued. On illness day 28, the penile swelling completely improved; however, the penile ulcer and pain persisted, and the exudate was observed again. By illness day 63, the pain in his anogenital area had disappeared, and the penile skin ulcer had healed. The following observations were noted in this case: (i) human mpox can improve without specific treatment such as tecovirimat administration and (ii) skin lesions in the genital area may change over time. [ABSTRACT FROM AUTHOR]

Background: Distinguishing between Charcot Neuroarthropathy (CN), osteomyelitis (OM), and CN complicated with superimposed OM in diabetic patients is crucial for the treatment choice. Given that current diagnostic methods lack specificity, advanced techniques, e.g., magnetic resonance imaging (MRI) and 99mTc-HMPAO–WBC Single Photon Emission Computed Tomography (SPECT/CT), are needed. This study addresses the challenges in distinguishing OM and CN. Methods: We included diabetic patients with CN and soft tissue ulceration. MRI and 99mTc-HMPAO–WBC SPECT/CT were used for the diagnosis. The patients were classified into three probability levels for OM (i.e., Definite, Probable, and Unlikely) according to the Consensus Criteria for Diabetic Foot Osteomyelitis (CC-DFO). Results: Eight patients met the eligibility criteria. MRI, supported by SPECT-CT and CC-DFO, showed consistency with the OM diagnosis in three cases. The key diagnostic features included the location of signal abnormalities and secondary features such as skin ulcers, sinus tracts, and abscesses. Notably, cases with inconclusive MRI were clarified by SPECT/CT, emphasizing its efficacy in challenging scenarios. Conclusions: The primary objective of this study was to compare the results of MRI and 99mTc-HMPAO–WBC SPECT/CT with the CC-DFO score in the diabetic foot with CN and suspected OM. Advanced imaging offers a complementary approach to distinguish between CN and OM. This can help delineate the limits of the disease for presurgical planning. While MRI is valuable, 99mTc-HMPAO–WBC SPECT/CT provides additional clarity, especially in challenging cases or when metallic implants affect MRI accuracy. [ABSTRACT FROM AUTHOR]

Pressure ulcers (PUs) are a debilitating and often painful condition. They are localized lesions on the skin and/or underlying tissues and are common in the elderly, people with mobility difficulties, diabetics, and vascular disease or malnutrition, as well as in those requiring intensive or palliative care. The prevention and treatment of PUs involve strategies to optimize hydration, circulation, and nutrition. Nutrition plays a key role in pressure ulcer care because wounds require macronutrients and micronutrients to heal. Reports relating to the effectiveness of "Complementary Enzyme Therapy" also in the vulnological field led us to this study, the aim of which was to test the activity of a biodynamic food supplement (Citozym®) rich in carbohydrates, vitamins, and amylase and lactase and characterized by marked antioxidant activity. Citozym® administered topically and/or systemically, and in particular in both administrations, in patients suffering from Pus, has shown a marked reduction in bedsores and, in many cases, complete healing. Furthermore, it was possible to observe a lower incidence of side effects compared to conventional therapies. The results obtained, confirmed by various tests and recognized by the scientific community, allow us to conclude that treatment with Citozym® could represent a new and effective strategy for the treatment of PUs. [ABSTRACT FROM AUTHOR]

This article from the New England Journal of Medicine presents a case study of a 30-year-old woman who developed postpartum fever, abdominal pain, and skin ulcers. The patient's symptoms worsened over time, leading to further diagnostic tests. The article discusses the diagnosis of Sweet's syndrome, a rare condition characterized by skin lesions and inflammation. Treatment options for Sweet's syndrome include systemic glucocorticoids, and the prognosis is generally favorable. The text also highlights the importance of timely identification and management of Sweet's syndrome during pregnancy to prevent complications. The patient in the case study was successfully treated with intravenous methylprednisolone and oral nifedipine. [Extracted from the article]

Introduction: A rupture of the skin accompanied by erosion of the subcutaneous tissue beneath is called an ulcer. The adjacent muscle and bone may be further compromised by this breach. A full-thickness skin defect that has not significantly re-epithelialized for longer than four weeks is referred to be a chronic ulcer. Wounds with "full thickness depth" and a "slow healing tendency" are referred to as ulcerations. In general, the delayed healing tendency cannot be fully explained by depth and size alone. But brought on by a pathologic reality at the root that must be eliminated in order to promote recovery. Aims: To research the treatment of lower leg ulcers and their clinic pathological characteristics. Materials and methods: The present study was a Prospective observational study. This study was conducted from January 2023 to December 2023 at the Department of General Surgery, Private Medical Medical College & Hospital. Out of 80 patients, 65 patients were included in this study. Result: In our study, 8 patients presented with varicose veins the cause of ulcers is of venous etiology. The value of z is 1.002. The value of p is < .001. The result is significant at p < .05. In our study 5 patients had Raynaud's phenomena and the cause of ulcers are of arterial etiology. The value of z is 0.899. The value of p is < .001. The result is significant at p < .05. In our study out of 21 patients with loss of sensation the causes of ulcers are diabetic followed by arterial and venous etiology. The value of z is 1.074. The value of p is < .001. Conclusion: We draw the conclusion that, in addition to adding to the expanding body of information on lower leg ulcers, our clinic pathological investigation emphasizes the significance of a thorough, multidisciplinary approach to diagnosis and treatment. Through the implementation of evidence-based treatment options and an attention to the intricate interaction of variables that lead to ulcer formation, our goal is to enhance patient quality of life while mitigating the prevalence of chronic wounds in our communities. [ABSTRACT FROM AUTHOR]

Systemic sclerosis (SS) is a complex connective tissue disease characterized by vasculopathy and progressive fibrosis, primarily considered an autoimmune disorder. SS can affect multiple organs and tissues, including the skin, respiratory, gastrointestinal, genitourinary, cardiovascular, and musculoskeletal systems. Skin involvement is common, and SS-related ulcers, especially digital ulcers, occur in roughly 50% of patients. These ulcers not only cause pain but also significantly impact patients’ quality of life, and in severe cases, they can lead to infection, gangrene, and amputation. The search for novel therapies for scleroderma-related ulcers remains an ongoing research area. Platelet-rich plasma (PRP) has been investigated as a potential treatment for difficultto-heal ulcers, including diabetic, pressure, and vascular ulcers. In this study, we share our experience in treating scleroderma ulcers with PRP. Ten patients with confirmed SS and chronic skin ulcers lasting at least six weeks, which had not responded to conventional treatments, were selected for the study. Homologous PRP gel was prepared and applied once a week for up to eight weeks. The ulcers were documented photographically before and after PRP treatment, and pain levels were assessed using a visual analog scale (VAS). We also conducted a systematic review of the literature focusing on the use of PRP in the setting of SS. The results from our casuistry showed that the ten patients, including eight females and two males with a median age of 52.5 years, had ulcer sizes ranging from 0.78 cm² to 28.26 cm². The ulcers were located on fingers, legs, and heels, and they were associated with various forms of SS, including limited and diffuse cutaneous involvement. Raynaud’s phenomenon was prevalent, and two patients exhibited organ involvement. The average ulcer size at the end of PRP treatment decreased significantly, with a 78% reduction in ulcered area. Pain levels also markedly improved, as indicated by a reduction in VAS scores. With regards to systematic revision of literature, we retrieved 45 cases of SS treated with PRP-based therapeutic regimes. However, only a minority of them (n=16) underwent PRP treatment for the treatment of SS-related ulcers. An improvement in wound size and pain has been documented in all cases. Taken together, these data highlight the potential benefits of using homologous PRP in the treatment of scleroderma ulcers, emphasizing its positive impact on ulcer size reduction and pain relief. [ABSTRACT FROM AUTHOR]

Recessive dystrophic epidermolysis bullosa (RDEB) is a severe skin fragility disorder caused by mutations in the COL7A1 gene, which encodes type VII collagen (COL7), the main constituent of anchoring fibrils for attaching the epidermis to the dermis. Persistent skin erosions frequently result in intractable ulcers in RDEB patients. Adipose-derived mesenchymal stromal cells (AD-MSCs) are easily harvested in large quantities and have low immunogenicity. Therefore, they are suitable for clinical use, including applications involving allogeneic cell transplantation. Keratinocyte-like cells transdifferentiated from AD-MSCs (KC-AD-MSCs) express more COL7 than undifferentiated AD-MSCs and facilitate skin wound healing with less contracture. Therefore, these cells can be used for skin ulcer treatment in RDEB patients. We investigated whether KC-AD-MSCs transplantation ameliorated the RDEB phenotype severity in the grafted skin of a RDEB mouse model (col7a1 -null) on the back of the immunodeficient mouse. KC-AD-MSCs were intradermally injected into the region surrounding the skin grafts, and this procedure was repeated after 7 days. After a further 7-day interval, the skin grafts were harvested. Neodeposition of COL7 and generation of anchoring fibrils at the dermal-epidermal junction were observed, although experiments were based on qualitative. KC-AD-MSCs may correct the COL7 insufficiency, repair defective/reduced anchoring fibrils, and improve skin integrity in RDEB patients. • KC-AD-MSCs are shown to be stratified and adhere each other by expressing desmosome-like structures. • KC-AD-MSCs-injected skin demonstrated predominantly suppressed blister formation. • Intradermal KC-AD-MSCs injection deposited COL7 at the dermal-epidermal junction. • KC-AD-MSCs have therapeutic potential for RDEB treatment. [ABSTRACT FROM AUTHOR]

Health professionals working in rural areas where leech infestation is common should be aware that people are at risk for leech bites. The bite develops infected and wounds or ulcers may cause a reaction to an allergen. The experimental plant Lagerstroemia speciosa is commonly called Queen crape myrtle. Medicinal plants as effective and affordable treatments for cutaneous wounds. The objective of the present study was to investigate the wound healing effect of acetone flower extract of L. speciosa against Haemadipsa sylvestris bite. Group I control. They didn’t receive any drug treatment. Group II and III received commercial ointment, betadine and herbal ointment, respectively. Group IV and V are the topical application of LAFE 1 and 2% formulated ointments. The results revealed that the topically applied herbal ointment-treated groups had a rate of wound contraction of 94.4%. The topically applied LAFE 1% and LAFE 2% treated groups had rates of wound contraction of 94.5 and 95.3% (p <0.05), respectively at day 21. The present research finds the LAFE1% treated group has equal contraction to the herbal ointment applied group and the LAFE2% treated group has the highest contraction rate compared to the control. The study revealed that the acetone flower extract of L. speciosa was capable of promoting wound healing and functional recovery in a dose-dependent way. [ABSTRACT FROM AUTHOR]

In 2023, Rana dybowskii exhibiting characteristic skin ulcers were found on a farm in northeastern China. Subsequently, two dominant bacteria, Aeromonas hydrophila Rd001 and Acinetobacter johnsonii Rd002, were isolated from naturally infected R. dybowskii. Experimental infection confirmed that Rd001 was the primary pathogen responsible for the disease in R. dybowskii, with a mean lethal dose (LD50) of 6.25 × 102 CFU/g. The virulence genotype of Rd001 was identified as ser+/aha+/lip+/nuc+/hlyA+/aer+/alt+/ast+/act+. Antimicrobial susceptibility testing indicated that Rd001 was sensitive to enrofloxacin, flumequine, and neomycin. MLST analysis showed that Rd001 belonged to a new sequence type of A. hydrophila, named ST2378. This study offered the first comprehensive investigation into the pathogenicity, virulence genotypes, antimicrobial resistance, and genetic traits of A. hydrophila isolated from R. dybowskii, providing a theoretical foundation for preventing and controlling A. hydrophila infections. [ABSTRACT FROM AUTHOR]

AbstractBromoacetic acid is an alkylating agent that can cause chemical burns after dermal exposure. We describe a case of chemical burns resulting from dermal exposure to bromoacetic acid, a toxic chemical commonly used in pharmaceutical and industrial settings. A 54-year-old female chemist presented to the emergency department with skin lesions on her right hand. She reported they appeared a day after exposure to bromoacetic acid through a hole in her protective glove. On exam, she had multiple partial thickness burns to the first, second, third, and fourth digits. Her wounds were managed with bedside debridement by the burn service followed by daily wound care. A four-week follow-up visit in clinic revealed well-healing wounds. Dermal exposure to bromoacetic acid cause delayed chemical burns managed with debridement and local wound care.

The article in the Clinical & Experimental Dermatology journal discusses epithelioid sarcoma (ES), a rare type of soft tissue sarcoma that accounts for less than 1% of all cases. The text presents two cases of patients with chronic skin ulcers that were initially misdiagnosed before being correctly identified as ES. The article emphasizes the importance of early diagnosis and treatment to reduce morbidity and mortality associated with this rare but fatal tumor. It also provides insights into the histopathological and immunohistochemical characteristics of ES for accurate diagnosis. [Extracted from the article]

The article presents a case study of a 40-year-old woman diagnosed with cutaneous leishmaniasis after returning from a trip to Costa Rica. Topics discussed include the clinical presentation and diagnostic challenges of leishmaniasis, treatment options such as miltefosine, and the importance of preventing sand fly bites in endemic areas.

Introduction: Prosthetic liners are widely used for a variety of indications such as improving prosthetic socket fit and suspension. However, these are associated with complications affecting the skin, including skin rubs, breakdown, and ulceration. Methods and Discussion: We outline the splinting effect of prosthetic liners as a possible contributing factor that results in increased shear during joint motion and propose a simple liner donning technique to minimize these shear forces by spreading liner/skin tension over the whole range of motion of the proximal joint. Clinical Relevance: The proposed dynamic donning technique would minimize the risk of skin ulcerations and improve joint range of motion in prosthetic limb users. [ABSTRACT FROM AUTHOR]

The article focuses on identifying factors that contribute to a lack of clinical improvement following vein ablation in patients with chronic venous disease. Topics include the characteristics of patients who experienced no improvement, the role of compression therapy prior to intervention, and the relationship between CEAP classification and treatment outcomes.

Epidermolysis bullosa (EB) is a rare hereditary cutaneous disorder inherited mainly in an autosomal dominant fashion.1 It consists of a group of conditions that cause the skin to be fragile and blister easily. EB has been classified into three types namely; simplex, junctional and dystrophic2. Although all three types of EB have different causes, their symptoms are similar, manifesting as painful blisters and sores. Epidermolysis bullosa is a very rare condition but may probably be more common in clinical practice than reported in literature, especially in places like Nigeria where there is under reporting of clinical cases. To the knowledge of the authors, there are few reported cases in Nigeria. 3, 4, 5 and none from Bayelsa State in the delta region of the country. We herein present a case of epidermolysis bullosa simplex (Dowling Meara type) in a 35 day old infant. This case is reported with the aim of increasing awareness of its existence in Nigeria and Bayelsa State in particular.

Simple Summary: We conducted a study at the Melanoma Unit of the Hospital Clinic of Barcelona to investigate brain metastases in patients with cutaneous melanoma. We collected data from patients diagnosed between January 1998 and September 2023. Patients with melanoma in situ or those with prior lung or breast cancer were excluded. Our aim was to identify factors associated with the development and survival outcomes of brain metastases. We analyzed patient demographics, tumor characteristics, and survival data. The diagnosis of brain metastases was confirmed using imaging techniques, and biopsies were performed when feasible. Our study followed strict guidelines for reporting observational studies. We found that younger age and larger primary tumor thickness increased the risk of developing brain metastases. Additionally, the presence of ulceration and microscopic satellitosis in the primary tumor were associated with a higher risk. Melanomas located on the trunk had a higher risk compared to those on the extremities. Patients with brain metastases had a median survival of around six months. Neurological symptoms and leptomeningeal involvement were associated with poorer survival outcomes. Higher number of brain lesions and elevated levels of lactate dehydrogenase (LDH) also predicted worse survival. Our findings highlight the importance of early detection and monitoring of melanoma patients, especially those at higher risk of brain metastases. Understanding these factors can aid in personalized treatment approaches and improving patient outcomes. Background: Melanoma is the cancer with the highest risk of dissemination to the central nervous system (CNS), one of the leading causes of mortality from this cancer. Objective: To identify patients at higher risk of developing CNS metastases and to evaluate associated prognostic factors. Methods: A cohort study (1998–2023) assessed patients who developed CNS melanoma metastases. Multivariate logistic regression was used to identify predictive factors at melanoma diagnosis for CNS metastasis. Cox regression analysis evaluated the CNS-independent metastasis-related variables impacting survival. Results: Out of 4718 patients, 380 (8.05%) developed CNS metastases. Multivariate logistic regression showed that a higher Breslow index, mitotic rate ≥ 1 mm2, ulceration, and microscopic satellitosis were significant risk factors for CNS metastasis development. Higher patient age and the location of the primary tumor in the upper or lower extremities were protective factors. In survival analysis, post-CNS metastasis, symptomatic disease, prior non-CNS metastases, CNS debut with multiple metastases, elevated LDH levels, and leptomeningeal involvement correlated with poorer survival. Conclusion: Predictive factors in the primary tumor independently associated with brain metastases include microscopic satellitosis, ulceration, higher Breslow index, and trunk location. Prognostic factors for lower survival in CNS disease include symptomatic disease, multiple CNS metastases, and previous metastases from different sites. [ABSTRACT FROM AUTHOR]

Pathogenic and free-living Acanthamoeba are widely distributed in the environment and have been reported to cause keratitis and universally fatal encephalitis. Primary cutaneous acanthamoebiasis caused by Acanthamoeba is exceedingly rare and presents as isolated necrotic cutaneous lesions without involvement of the cornea or central nervous system. Cutaneous acanthamoebiasis often occurs in immunocompromised patients and is likely overlooked or even misdiagnosed only by cutaneous biopsy tissue histopathological analysis. Here, we report a HIV-infected 63-year-old female with oral leukoplakia for 4 months and scattered large skin ulcers all over the body for 2 months. The cause of the cutaneous lesions was unclear through cutaneous specimens histopathological analysis, and subsequently Acanthamoeba were detected by metagenomic next-generation sequencing (mNGS), which may be the cause of cutaneous lesions. Based on the mNGS results, a pathologist subsequently reviewed the previous pathological slides and found trophozoites of Acanthamoeba so that the cause was identified, and the skin ulcers improved significantly after treatment with multi-drug combination therapy. Acanthamoeba is also a host of pathogenic microorganisms. The presence of endosymbionts enhances the pathogenicity of Acanthamoeba, and no other pathogens were reported in this case. mNGS is helpful for rapidly diagnosing the etiology of rare skin diseases and can indicate the presence or absence of commensal microorganisms. [ABSTRACT FROM AUTHOR]

Background: Primary syphilis is characterized by painless ulcerative lesions in the genitalia, the aetiology of painless remains elusive. Objectives: To investigate the role of Treponema pallidum in painless ulcer of primary syphilis, and the mechanisms underlying painless ulcers caused by T. pallidum. Methods: An experimental rabbit model of primary syphilis was established to investigate its effects on peripheral nerve tissues. Human skin fibroblasts were used to examine the role of T. pallidum in modulating neurotransmitters associated with pain and to explore the signalling pathways related to neurotransmitter secretion by T. pallidum in vitro. Results: Treponema pallidum infection did not directly lead to neuronal damage or interfere with the neuronal resting potential. Instead, it facilitated the secretion of prostaglandin E2 (PGE2) through endoplasmic reticulum stress in both rabbit and human skin fibroblasts, and upregulation of PGE2 induced the hyperpolarization of neurones. Moreover, the IRE1α/COX‐2 signalling pathway was identified as the underlying mechanism by which T. pallidum induced the production of PGE2 in human skin fibroblasts. Conclusion: Treponema pallidum promotes PGE2 secretion in skin fibroblasts, leading to the excitation of neuronal hyperpolarization and potentially contributing to the pathogenesis of painless ulcers in syphilis. [ABSTRACT FROM AUTHOR]

Introduction: A novel LDL (low‐density lipoprotein) apheresis therapeutic option, Rheocarna, has garnered attention as an alternative therapy for chronic limb‐threating ischemia (CLTI). Bradykinin‐mediated vasodilation is involved in the effects of LDL apheresis and a decrease in blood pressure (BP), but the changes in bradykinin concentration during Rheocarna therapy are unknown. Methods: The study involved patients with CLTI treated with Rheocarna at our hospital, from April 2022 to August 2023. Results: After Rheocarna therapy, skin ulcers improved in 80% of the patients. Circuit coagulation was observed in two patients with high fibrinogen levels. A decrease in BP was observed at approximately the same time when the bradykinin concentration peaked. The peak bradykinin concentration in a patient undergoing hemodialysis at the same time was considerably lower than that in the other patients. Conclusion: This is the first report on the changes in bradykinin concentration under Rheocarna therapy. [ABSTRACT FROM AUTHOR]

Vasculitic and pyoderma gangrenosum ulcers are traditionally treated with immunosuppressants, and the role of surgery in the treatment of these atypical ulcers remains unclear. This study aimed to investigate the need for surgical intervention as well as the outcome and safety of skin grafting in the treatment of 46 patients with vasculitic ulcers and 34 with pyoderma gangrenosum ulcers using data recorded in the validated Wound Registry. Of the 80 patients with atypical ulcers, 14% (n = 11) were treated surgically; these patients were older (p = 0.039), had lower mobility status (p = 0.002), and more often pulmonary diseases, rheumatoid arthritis, and previous arterial procedures (p = 0.007; p = 0.031; p = 0.031, respectively) than those treated conservatively. Of 181 ulcers, 15% (n = 27) were surgically treated, 78% once and 22% multiple times. During follow‐up, 92.3% of both surgically and conservatively treated ulcers with available data healed. Of the surgically treated ulcers, median healing time after first surgical procedure was 96 days, and post‐surgical complications were considered mild or unrelated to surgery. Our results suggest that if surgery is indicated, skin grafting is a safe and efficient treatment method provided that multidisciplinary approach is applied. [ABSTRACT FROM AUTHOR]

Background: The keystone island flap can be utilized in various sizes and locations to reconstruct different skin defects in any location of the body. It can provide an excellent reconstruction alternative for skin deficiencies, in which microsurgical reconstruction is not possible. We aimed to determine the feasibility and safety of immediate keystone island flaps in managing various soft tissue defects in a variety of anatomical locations and to assess the influence of comorbidities on flap survival and surgical complications. Methods: A hundred prospective immediate consecutive keystone flaps employed to cover skin defects in various sizes and anatomical locations, following wide local excision of malignant tumors and benign skin lesions, trauma, chronic ulcer and soft tissue infection were executed. Results: Eighty eight (88%) of the keystone flap were of type IIA (direct closure with division of the deep fascia). Five flaps (5%) were considered as major complications, i.e. complete flap necrosis (one flap) and four partial flap necrosis over bony prominence as tibia and scalp. Soft tissue defect size, BMI over 30 kg/m2, active smoking, diabetes and hypertension had no correlation with complications. The employment of keystone flaps over joints at their flexion aspects (elbow, popliteal fossa), nape and Achilles have proved to maintain functionality. Conclusions: It is recommend to use with caution keystone flaps to cover soft tissue defects over bony prominences (tibia and scalp) due to limited skin laxity and unique vascular anatomy in these areas. The keystone flap can be employed in the presence of comorbidities such BMI over 30 kg/m2, active smoking, diabetes and hypertension without the increased risk of complications. The keystone flap island flap is feasible and safe in managing various soft tissue defects, it maintains functionality over joints, is reproducible and obtains local tissue aesthetic similarities i.e. color and contour match, and might be included as a fundamental first-line immediate soft tissue reconstructive tool. Level of Evidence: Level IV, risk / prognostic study [ABSTRACT FROM AUTHOR]

Yaws affects children in tropical regions, while syphilis primarily affects sexually active adults worldwide. Despite various campaigns towards the eradication of yaws and elimination of syphilis, these two diseases are still present in Ghana. The aetiological agents of both diseases, two Treponema pallidum subspecies, are genetically similar. This study aimed to assess the prevalence of these treponematoses and the occurrence of pathogens causing similar skin lesions in the Ashanti region of Ghana. A point-of-care test was used to determine the seroprevalence of the treponematoses. Both yaws and syphilis were identified in the Ashanti region of Ghana. Multiplex PCR was used to identify treponemes and other pathogens that cause similar skin lesions. The results indicated that the seroprevalences of T. pallidum in individuals with yaws-like and syphilis-like lesions were 17.2% and 10.8%, respectively. Multiplex PCR results showed that 9.1%, 1.8% and 0.9% of yaws-like lesions were positive for Haemophilus ducreyi, herpes simplex virus-1 (HSV-1) and T. pallidum respectively. Among syphilis-like lesions, 28.3% were positive for herpes simplex virus -2 (HSV-2) by PCR. To our knowledge, this is the first time HSV-I and HSV-2 have been reported from yaws-like and syphilis-like lesions, respectively, in Ghana. The presence of other organisms apart from T. pallidum in yaws-like and syphilis-like lesions could impede the total healing of these lesions and the full recovery of patients. This may complicate efforts to achieve yaws eradication by 2030 and the elimination of syphilis and warrants updated empirical treatment guidelines for skin ulcer diseases. [ABSTRACT FROM AUTHOR]

BACKGROUND: Clinical application of autologous platelet-rich plasma is limited by the condition of patients and by the quantity and activity of platelets. Transfusable platelet component blood platelet concentrates, collected and prepared by blood collection and supply agencies, are widely available, can be standardized and are effective in the clinic. OBJECTIVE: To review the factors influencing the preparation of platelet concentrate by the buffy-coat method for the treatment of chronic refractory wounds. METHODS: A computer search of the PubMed, CNKI, and WanFang databases for platelet-related articles from January 2000 to April 2023 was conducted using the Chinese and English search terms “allogeneic platelets(concentrate), buffy-coat method, skin ulcer, refractory wounds”. The titles and abstracts were screened, and the full text was reviewed, resulting in the inclusion of 51 articles that met the subject criteria. RESULTS AND CONCLUSION: (1) Platelet concentrates supplied by blood collection and supply agencies are effective in the treatment of diabetic foot wounds, pressure sores, lower limb venous ulcers and other chronic refractory wounds: reducing the size of the ulcer and shortening the wound healing time, especially in the first two weeks, with significant healing-promoting effects. (2) The storage conditions of the raw material used to prepare platelet concentrates (whole blood overnight/buffy-coat overnight, shaking/resting (time)), centrifugation conditions (centrifugation parameters, canning method) and the structure of the blood bag can affect the concentration of platelet concentrates, indirectly affecting the efficacy of allogeneic platelet concentrates. (3) There are also some problems with studies of allogeneic platelet concentrates for the treatment of chronic refractory wounds, such as the sample size of the available evidence is small, the results lack the optimal preparation parameters, optimal dose and treatment regimen for platelet concentrates to promote healing of different wounds are unknown, so more randomized multicenter clinical studies are needed. [ABSTRACT FROM AUTHOR]

Both cutaneous radiation injury and radiation combined injury (RCI) could have serious skin traumas, which are collectively referred to as radiation‐associated skin injuries in this paper. These two types of skin injuries require special managements of wounds, and the therapeutic effects still need to be further improved. Cutaneous radiation injuries are common in both radiotherapy patients and victims of radioactive source accidents, which could lead to skin necrosis and ulcers in serious conditions. At present, there are still many challenges in management of cutaneous radiation injuries including early diagnosis, lesion assessment, and treatment prognosis. Radiation combined injuries are special and important issues in severe nuclear accidents, which often accompanied by serious skin traumas. Mass victims of RCI would be the focus of public health concern. Three‐dimensional (3D) bioprinting, as a versatile and favourable technique, offers effective approaches to fabricate biomimetic architectures with bioactivity, which provides potentials for resolve the challenges in treating radiation‐associated skin injuries. Combining with the cutting‐edge advances in 3D skin bioprinting, the authors analyse the damage characteristics of skin wounds in both cutaneous radiation injury and RCI and look forward to the potential value of 3D skin bioprinting for the treatments of radiation‐associated skin injuries. [ABSTRACT FROM AUTHOR]

Lipedema is a progressive connective tissue disease with enlargement of adipose tissue, fibrosis, fluid collection, and dermal thickening. Herein, we present a case of lipedema associated with skin hypoperfusion and ulceration in which soft tissue debulking with liposuction improved patients' symptoms. A 39-year-old female presented with asymmetric progressive initially unilateral lower limb swelling with severe pain with subsequent skin ulceration. Conservative management failed to improve her condition. After excluding other causes and detailed radiologic investigation, lipedema was diagnosed with an associated impaired skin perfusion. Trial of local wound care and compression therapy failed to improve the condition. Subsequent soft tissue debulking with circumferential liposuction and ulcer debridement and immediate compression showed dramatic improvement of the symptoms and skin perfusion. The unique nature of this case sheds light on lipedema as a loose connective tissue disease. Inflammation and microangiopathies explain the associated pain with hypoperfusion and ulceration being quite atypical and in part might be related to the large buildups of matrix proteins and sodium contents leading to fragility in microvessels with frequent petechiae and hematoma and subsequent tissue ischemia. Conservative measures like compression therapy plays a significant role in disease course. Surgical debulking with liposuction was shown to be efficacious in reducing the soft tissue load with improvement in limb pain, edema, circumference, and skin perfusion that was seen in our patient. Lipedema is a frequently misdiagnosed condition with disabling features. Skin involvement in lipedema with potential hypoperfusion was shown and it requires further investigation. [ABSTRACT FROM AUTHOR]