Surgery for Pyodermia fistulans sinifica to circumvent heart transplantation (Case Report) *
|
|
- Godfrey Atkins
- 5 years ago
- Views:
Transcription
1 Journal of Plastic, Reconstructive & Aesthetic Surgery (2011) 64, e12ee16 CASE REPORT Surgery for Pyodermia fistulans sinifica to circumvent heart transplantation (Case Report) * V. Penna*, S. Dowlatshahi, N. Torio Padron, G.B. Stark, H. Bannasch Department of Plastic and Hand Surgery, University Medical Centre Freiburg (UMCF), Hugstetter Strasse 55, Freiburg, Germany Received 2 June 2010; accepted 20 July 2010 KEYWORDS Hidradenitis suppurativa; Pyodermia fistulans sinifica; Acne inversa; Heart Transplantation; Plastic Surgery Summary Introduction: Pyoderma fistulans sinifica (PFS) is a rare chronic cutaneous and subcutaneous infectious disease and is associated with major physical and psychological morbidity. In this article, we present the case of a young patient affected by severe PFS, who concomitantly suffered severe left-sided cardiac insufficiency and was considered for cardiac transplantation. By radical debridement and skin grafting of all areas affected by PFS, the patient s overall condition rapidly improvedandwascorrelatedwithasignificant and measurable improvement of cardiac function. Case report: Plastic surgery was consulted on a 32-year-old male by the cardiac intensive care unit with a 2-year history of recurrent pyogenic skin infections of the inguinal and axillary regions. He presented with a dilated cardiomyopathy with an ejection fraction (EF) of 15%, first-degree pulmonary insufficiency and second-degree mitral insufficiency and an overlying myocarditis leading to the picture of severe cardiac insufficiency, making him eligible for heart transplantation. The intention was to eradicate the chronic infective wounds as a preparative prior to cardiac transplantation. Radical debridement of the involved areas and coverage with split-thickness skin grafts took place and led to a significant improvement of the patient s condition. Echocardiography revealed a % improvement of the EF to 40%. Cardiac transplantation became unwarranted. At 1.5 years postoperatively, the patient is free of disease and has a normal cardiac function. Discussion: PFS is characterised in its early stages by local inflammation with beginning ulceration and can be managed conservatively. In advanced stages, as illustrated in this report, PFS must be considered as the potential source of systemic inflammatory process with significant alterations in multiple-organ systems and must be treated aggressively. ª 2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. * Dr. Penna and Dr. Dowlatshahi both equally contributed to the work and therefore are both first authors. * Corresponding Author. Tel.: þ ; fax: þ address: vincenzo.penna@uniklinik-freiburg.de (V. Penna). URL: /$ - seefrontmatterª 2010 BritishAssociationofPlastic, ReconstructiveandAesthetic Surgeons. Publishedby Elsevier Ltd. Allrightsreserved. doi: /j.bjps
2 Surgery for Pyodermia fistulans sinifica The exact aetiology of Pyoderma fistulans sinifica (PFS) is not well defined. It was first described as a distinct entity in 1839 by Velpeau (1795e1867). 1 Velpeau considered the inflammatory process to originate from the sweat glands and gave it its primary name Hidradenitis suppurativa (HS). It has been ascertained that PFS actually results from follicular plugging with follicular and perifollicular inflammation and subsequent bacterial superinfection. HS is therefore a misnomer and actually represents an acneiform disorder that is based on follicular occlusion rather than an infection of sweat glands. Fox den disease is also a synonym for this pathology. 2 The term acne inversa has been suggested to designate this condition more precisely, as its pathogenesis is acneiform and its manifestation characteristic in localisations inverse to acne. Estimated at a prevalence of 0.3e4% in industrialised countries, 3 PFS is characterised by a chronic cutaneous and subcutaneous infection with a subcutaneous fistulous system. Its predominant location is the lower body including the anogenital and thigh region, but the axillae and the mammary regions can also be affected. PFS may initially present as superficial skin infection but superinfection, abscesses and sinus tracts generally ensue. These fistulous systems are either epithelialised or non-epithelialised and can extend deep into the epifascial fat. PFS can be regarded as a systemic inflammatory condition: its possible association with arthritis of the large joints, ranging from asymmetric pauciarticular arthritis to a symmetric polyarthritis and/or polyarthralgia syndrome and may be part of HLA-B27enegative spondyloarthropathies. 4 Arthropathy worsens during flares of PFS, and often improves after PFS resolves. A case with local infection by PFS leading to flagrant cardiac insufficiency by haematogenic spreading of the infectious process is presented and discussed. Case report Plastic surgery was consulted on a 32-year-old male with a 2-year history of recurrent pyogenic skin infections of the inguinal and axillary regions by the cardiac service that had been following the patient for a dilated cardiomyopathy with an ejection fraction (EF) of 15%, firstdegree pulmonary insufficiency and second-degree mitral insufficiency with an overlying myocarditis leading to the picture of full-fledged cardiac insufficiency requiring heart transplantation. We were consulted to assess the extent of soft tissue involvement in the infectious process and, if possible, to help clear the infection prior to cardiac transplantation. The patient reported that the skin infections started after having shaved his axillae and genital region. He had been treated with isotretinoin for 1.5 years without success. Abscess incision and drainage occurred twice, accompanied by the administration of brief courses of systemic antibiotics. Despite these efforts, disease progression could not be stopped. Haematogenic bacterial spread led to acute myocarditis, further reducing cardiac function and making cardiac transplantation necessary. Upon presentation, the patient was in the cardiac intensive care unit and was being monitored very closely. He was febrile, with otherwise normal and stable vital signs. Examination showed multiple subcutaneous and cutaneous fluctuant lesions in axillary, inguinal and anogenital regions with sinuses draining with purulent and foul-smelling fluid (Figure 1(a)e(c)). The advanced and chronic disease process had led to scarring in these areas. Chest X-rays demonstrated cardiomegaly, without signs of pulmonary congestion (Figure 2(a)), cardiac catheterisation revealed a cardiac minute volume of 5.49 and a cardiac index of Pulmonary venous resistance was estimated at dyn (i.e., 1.8 Wood), blood cultures were negative. Laboratory testing revealed probnp values beyond 7000 pg ml 1 (reference below 125 pg ml 1 ) and a leucocyte count of ml 1. Wound cultures showed significant growth of Gram-positive skin flora sensitive to cefuroxime. The patient was continued on intravenous cefuroxime and radical debridement of the involved areas (groin, axillae and anogenital region) with vacuum-assisted closure was performed (Figure 3(a)and (b)). In order to allow for adequate wound management, a temporary ileostomy was placed. Definitive coverage occurred 10 days postoperatively by means of split-thickness skin grafts. The postoperative course was complicated by a small bowel obstruction due to adhesions, which was treated emergently by adhesiolysis. The remaining postoperative course was characterised by excellent graft take and a significant improvement of the patient s overall condition: 1 week postoperatively, the patient was afebrile, and the leucocyte count returned to normal. Upon discharge to an inpatient rehabilitation facility 1 month postoperatively, the patient was afebrile, blood cultures were negative. Interestingly, a repeat chest X-ray revealed the absence of signs of cardiomegaly observed 1 month prior (Fig. 2(b)). Echocardiography findings were consistent with our observation, revealing a % improvement of the EF to 40%. Cardiac transplantation became unwarranted. At 1.5 years postoperatively, the integument in the grafted areas remains intact, and the patient is free of disease (Figure 4(a) and (b)). Discussion e13 The first description of PFS published in 1962 by Krauspe and Stelzner 5 was followed by a second publication in 1984, 2 where Stelzner reconsidered PFS and placed it under the category of retention dermatopathies. Wittmann et al. 6 follow Stelzners hypothesis and define PFS as a distinct chronic infectious disease different from HS (Table 1). They state that PFS always does have epithelialised tracts lying deep epifascial, while HS comes along with superficial tracts and only sometimes epithelialisation. Another described characteristic is that PFS does not have a relation to skin structures ( The skin may be involved only as the point of origin ) while HS always has a relation. Histological crosscuts of affected skin of the presented patient where scrutinised considering
3 e14 V. Penna et al. Figure 1 Upon presentation, the patient demonstrated clear signs of soft tissue infection in the axillary a), inguinal, genital and gluteal (b) regions consistent with Hidradenitis suppurativa. Wittmann s article together with a skin pathologist of our Pathological Department. We interestingly found both, very superficial non-epithelialised tracts together with deep epithelialised tracts. These findings, together with current literature, sustain that HS and PFS are synonyms for the same cutaneous manifestation, PFS being the most severe manifestation. 7e9 The exact nomenclature of the described cutaneous disease is still an object of debate in literature; further discussion is far beyond the scope of this article. 6 PFS is a physically and psychologically most debilitating condition characterised by chronic and recurrent pyogenic infections of the skin and subcutaneous tissues. Medical treatment alone is only recommended in early stages and in mild disease. Various modalities have been described such as topical clindamycin, systemic tetracycline, minocycline, erythromycin, antiandrogens, finasteride, oral retinoids, dapsone, immunosuppressive treatment using intralesional or systemic steroids, cyclosporine, etanercept, adalimumab and infliximab. 10 Figure 2 Posteroanterior chest x-rays of the patient. a) Upon presentation, b) One month after excision and skin grafting of the involved areas.
4 Surgery for Pyodermia fistulans sinifica e15 Figure 3 Intraoperative pictures of the anogenital (a) and axillar region (b) after radical debridement and vacuum assisted therapy prior to split-thickness skin grafting. Figure 4 a) genital region, b) axilla at 18 months postoperatively. Notwithstanding the promising results achieved with biologics, the potential severe side effects must be carefully considered. Surgery remains the mainstay of treatment and should be performed as early as possible once complications such as abscess, scarring and fistulation are evident. 10 The goal is to remove the diseased tissues such as draining abscesses and sinuses, along with the scar tissue. 7,8 Incision and drainage of individual lesions are not definitive. The more aggressive the local surgical treatment, the lower is the local recurrence rate. 7 The use of defect coverage by means of various flaps (fasciocutaneous flaps, musculocutaneous flaps or skin grafts) seems to represent a durable and curative treatment modality. 8 At our institution, the preferred method of treatment is wide excision and skin grafting. Cardiac insufficiency can have various reasons. In general, a reduced contractional force of the heart muscle due to, for example, myocardial infarction or myocarditis is the underlying pathological mechanism. The presented patient suffered of a haematogenically induced myocarditis, which was histologically classified as a borderline myocarditis with macrophage infiltration, but without myocardial necrosis. Immunohistochemistry and PCR did not reveal microbiological agents. Thus, the proof of a causative link between PFS and myocarditis cannot be ultimately provided. However, considering that no other plausible conditions for the development of cardiac insufficiency are given and postoperative recovery was impressive, PFS as the sole cause of cardiac insufficiency is likely. The purpose of this article is to demonstrate how PFS can have drastic systemic implications and assume lifethreatening dimensions. Its adequate treatment in a timely fashion, as demonstrated in our case, can represent a lifesaving measure in the context of a systemic inflammatory process. Table 1 Distinguishing characteristics of HS and PFS following Wittmann 6 Disease Relation to skin structures Epithelialized tracts Deep epifascial tracts Predominant location PFS No Always Yes Lower body HS Yes Sometimes No Axillae
5 e16 Conflict of interest None. Funding None. References 1. Velpeau ALA. Aisselle, phlegmons, abces. Dictionnaire de Medecine ou repertoire general des sciences medicales 1833; vol. 2. p Stelzner F. Causes of pilonidal sinus and pyoderma fistulans sinifica. Langenbecks Arch Chir 1984;362:105e Brown TJ, Rosen T, Orengo IF. Hidradenitis suppurativa. South Med J 1998;91:1107e14. V. Penna et al. 4. Alba D, Torres E, Ripoll MM. Reactive arthritis and hidradenitis suppurativa. An Med Interna 1995;12:464e5. 5. Krauspe C, Stelzner F. Pyodermia fistulans sinifica. On the clinical and histopathological changes in fistulous dermatitis with remarks on the relation to so-called hidradenitis suppurativa and acne conglobata. Chirurg 1962;33:534e8. 6. Wittmann DH, Schein M, Seoane D. Pyoderma fistulans sinifica (fox den disease): a distinctive soft-tissue infection. Clin Infect Dis 1995;21:162e Slade DE, Powell BW, Mortimer PS. Hidradenitis suppurativa: pathogenesis and management. Br J Plast Surg 2003;56: 451e Buimer MG, Wobbes T, Klinkenbijl JH. Hidradenitis suppurativa. Br J Surg 2009;96:350e Alikhan A, Lynch PJ, Eisen DB. Hidradenitis suppurativa: a comprehensive review. J Am Acad Dermatol 2009;60: 539e61. quiz 562e Revuz J. Medical treatments of hidradenitis suppurativa: a new paradigm. Dermatology 2007;215:95e6.
Chapter 19 Hidradenitis Suppurativa
1 Chapter 19 Hidradenitis Suppurativa Peter Nthumba Hidradenitis suppurativa is a chronic, recurrent, painful inflammatory skin disease, first described in 1833 by a French surgeon. Verneuil, another French
More informationHIDRADENITIS SUPPURATIVA
Print Close Window Note: Large images and tables on this page may necessitate printing in landscape mode. Copyright 2004-2005 The McGraw-Hill Companies. All rights reserved. Fitzpatrick Color Atlas, 5e
More informationEtanercept for Treatment of Hidradenitis
Home Search Browse Resources Help What's New About Purpose Etanercept for Treatment of Hidradenitis This study is currently recruiting patients. Sponsors and Collaborators: University of Pennsylvania Amgen
More informationA Chinese man with chronic recalcitrant hidradenitis suppurativa successfully treated with infliximab
Hong Kong J. Dermatol. Venereol. (2008) 16, 206-210 Case Report A Chinese man with chronic recalcitrant hidradenitis suppurativa successfully treated with infliximab CK Kwan and LY Chong A 31-year-old
More informationClinical Role of Modified Seton Procedure and Coring Out for Treatment of Complex Anal Fistulas Associated With Hidradenitis Suppurativa
Int Surg 2015;100:974 978 DOI: 10.9738/INTSURG-D-14-00237.1 Clinical Role of Modified Seton Procedure and Coring Out for Treatment of Complex Anal Fistulas Associated With Hidradenitis Suppurativa Yukihiko
More informationAbscess. A abscess is a localized collection of pus in the skin and may occur on any skin surface and be formed in any part of body.
Abscess A abscess is a localized collection of pus in the skin and may occur on any skin surface and be formed in any part of body. Ethyology Bacteria causing cutaneous abscesses are typically indigenous
More informationHidradenitis Suppurativa. Young-San, Jeon. Department of Surgery Thyroid and breast center, Goo Hospital
Hidradenitis Suppurativa Young-San, Jeon Department of Surgery Thyroid and breast center, Goo Hospital Definition Hidradenitis suppurativa/acne inversa (HS) is a chronic, inflammatory, recurrent, debilitating
More informationClinical Policy Title: Surgery for hidradenitis suppurativa
Clinical Policy Title: Surgery for hidradenitis suppurativa Clinical Policy Number: 17.02.04 Effective Date: July 1, 2016 Initial Review Date: April 27, 2016 Most Recent Review Date: April 19, 2017 Next
More informationThe Practical Use of LIGASANO white in Plastic Surgery
Practical experience 3 The Practical Use of LIGASANO white in Plastic Surgery Emergency Hospital of Mureş County, Romania Reports of practical experience from the burn center and plastic surgery department
More informationDRAFT FOR PUBLIC CONSULTATION. Clinical Commissioning Policy Proposition: Infliximab for the treatment of hidradenitis suppurativa
Clinical Commissioning Policy Proposition: Infliximab for the treatment of hidradenitis suppurativa Information Reader Box (IRB) to be inserted on inside front cover for documents of 6 pages and over,
More informationSingle Technology Appraisal (STA) Adalimumab for treating moderate to severe hidradenitis suppurativa
Single Technology Appraisal (STA) Adalimumab for treating moderate to severe Comment 1: the draft remit Response to consultee and commentator comments on the draft remit and draft scope (pre-referral)
More informationHidradenitis suppurativa
Hidradenitis suppurativa Key points Hidradenitis suppurativa is a chronic relapsing inflammatory condition affecting the skin and subcutaneous tissue It manifests as painful deep nodules, abscesses, sinus
More informationSquamous cell carcinoma complicating hidradenitis suppurativa
British Journal of Dermatology (1990) 123, 527-531. Squamous cell carcinoma complicating hidradenitis suppurativa A.V.ANSTEY, J.D.WILKINSON AND P.LORD* Departments of Dermatology and "Surgery, Wycombc
More informationSpartan Medical Research Journal
Spartan Medical Research Journal Research at Michigan State University College of Osteopathic Medicine Volume 3 Number 2 Fall, 2018 Pages 92-99 Title: A Novel Treatment of Acne Fulminans with Adalimumab:
More informationHidradenitis suppurativa
PEER REVIEWED FEATURE 2 CPD POINTS Hidradenitis suppurativa Debilitating and challenging to treat VICTORIA HARRIS MB BS, LLB ANDREW LEE MB BS, MMed SHIVAM KAPILA MB BS, BSc(Med), MS ALAN COOPER OAM, BSc,
More informationHidradenitis suppurativa: a disease of follicular epithelium^ rather than apocrine glands
British Journal of Dermatology (1990) 122, 763-769. Hidradenitis suppurativa: a disease of follicular epithelium^ rather than apocrine glands CARMEN C.-W.YU AND M.G.COOK, Departmem of Hisiopathology, St.
More informationClinical Policy Title: Hidradenitis suppurativa surgery
Clinical Policy Title: Hidradenitis suppurativa surgery Clinical Policy Number: 17.02.04 Effective Date: July 1, 2016 Initial Review Date: April 27, 2016 Most Recent Review Date: March 6, 2018 Next Review
More informationAesthetic reconstruction of the nasal tip using a folded composite graft from the ear
The British Association of Plastic Surgeons (2004) 57, 238 244 Aesthetic reconstruction of the nasal tip using a folded composite graft from the ear Yong Oock Kim*, Beyoung Yun Park, Won Jae Lee Institute
More informationUsing the sac membrane to close the flap donor site in large meningomyeloceles
The British Association of Plastic Surgeons (2004) 57, 273 277 Using the sac membrane to close the flap donor site in large meningomyeloceles Cengiz Bozkurt a, Selçuk Akın a, *,Şeref Doğan b, Erkut Özdamar
More informationBreast debridement and closure cpt
Breast debridement and closure cpt Close Breast debridement cpt code Medicare Billing Guidelines, Medicare payment and reimbursment, Medicare codes. Here is a list of CPT codes and Diagnoses that are.
More informationSystemic diseases. Dra. Raquel Rivera
Systemic diseases Dra. Raquel Rivera Hidradenitis Suppurativa Wednesday, 12th September 2018 International Society Meeting: EHSF - European Hidradenitis Suppurativa Foundation 13:30-17:30 Place: Room 252AB
More informationReconstruction of axillary scar contractures retrospective study of 124 cases over 25 years
British Journal of Plastic Surgery (2003), 56, 100 105 q 2003 The British Association of Plastic Surgeons. Published by Elsevier Science Ltd. All rights reserved. doi:10.1016/s0007-1226(03)00035-3 Reconstruction
More informationInteresting Case Series. A Case of Fournier s Gangrene
Interesting Case Series A Case of Fournier s Gangrene Anthony Maurice Kordahi, MD, and Ahmed S. Suliman, MD Division of Plastic Surgery, University of California San Diego Correspondence: kordahi.amk@gmail.com
More informationSuperficial Granulomatous Pyoderma of the Face: A Case Report and Review of the Literature
Superficial Granulomatous Pyoderma of the Face: A Case Report and Review of the Literature Sarah M. Persing, MPH, a and Donald Laub Jr, MD, FACS a,b a University of Vermont College of Medicine, Burlington;
More informationCASE REPORT An Innovative Solution to Complex Inguinal Defect: Deepithelialized SIEA Flap With Mini Abdominoplasty
CASE REPORT An Innovative Solution to Complex Inguinal Defect: Deepithelialized SIEA Flap With Mini Abdominoplasty Augustine Reid Wilson, MS, Justin Daggett, MD, Michael Harrington, MD, MPH, and Deniz
More informationClinical teaching/experi ence. Lectures/semina rs/conferences Self-directed. learning. Clinical teaching/experi ence
Regional Medical Center (The MED) Plastic Surgery PGY-3 By the end of the Plastic Surgery at the MED, the PGY-3 residents are expected to expand and cultivate knowledge and skills developed during previous
More informationNkanyezi Ferguson, MD, FAAD University of Iowa Hospital and Clinics Iowa City, IA
Nkanyezi Ferguson, MD, FAAD University of Iowa Hospital and Clinics Iowa City, IA U030 - Hair Care Practices and Hair Disorders in Skin of Color DISCLOSURES No relevant relationships with industry To discuss
More informationManagement of recurrent phyllodes with full thickness chest wall resection
ORIGINAL ARTICLES Management of recurrent phyllodes with full thickness chest wall resection R Awwal a, SA Shashi b, MS Khondokar c, SH Khundkar d Abstract: Phyllodes tumours are biphasic fibroepithelial
More informationEndoscopic assisted harvest of the pedicled pectoralis major muscle flap
British Journal of Plastic Surgery (2005) 58, 170 174 Endoscopic assisted harvest of the pedicled pectoralis major muscle flap Arif Turkmen*, A. Graeme B. Perks Plastic Surgery Department, Nottingham City
More informationNanogen Aktiv. Naz Wahab MD, FAAFP, FAPWCA Nexderma
Nanogen Aktiv Naz Wahab MD, FAAFP, FAPWCA Nexderma Patient BM 75 y.o female with a history of Type 2 Diabetes, HTN, Hypercholesterolemia, Renal insufficiency, Chronic back Pain, who had undergone a L3-L4
More informationACNE VULGARIS: DIAGNOSIS AND TREATMENT
ACNE VULGARIS: DIAGNOSIS AND TREATMENT Federal Bureau of Prisons Clinical Guidance DECEMBER 2017 Clinical guidance is made available to the public for informational purposes only. The Federal Bureau of
More informationYonekura, Akihiko; Tomita, Masato;
NAOSITE: Nagasaki University's Ac Title Author(s) Citation Fournier's gangrene a case report Miyamoto, Takashi; Fukushima, Tatsu Yonekura, Akihiko; Tomita, Masato; Acta medica Nagasakiensia, 61(1), p Issue
More informationInteresting Case Series. Fournier s Gangrene and the Reconstructive Challenges for the Plastic Surgeon
Interesting Case Series Fournier s Gangrene and the Reconstructive Challenges for the Plastic Surgeon David Izadi, MB, BChir, MA(Oxon), MA(Cantab), MRCS, James Coelho, BMBS, MSc, MRCS, Sameer Gurjal, MBBCh,
More informationPlastic Surgery: An International Journal
Plastic Surgery: An International Journal Vol. 2013 (2013), Article ID 874416, 29 minipages. DOI:10.5171/2013.874416 www.ibimapublishing.com Copyright 2013 Akira Saito, Noriko Saito, Emi Funayama and Hidehiko
More informationA case of rosacea fulminans in a pregnant woman
Hong Kong J. Dermatol. Venereol. (2018) 26, 122-126 Views and Practice A case of rosacea fulminans in a pregnant woman JE Seol, SH Park, JU Kim, GJ Cho, SH Moon, H Kim Introduction Rosacea fulminans (RF)
More informationSingle-Stage Full-Thickness Scalp Reconstruction Using Acellular Dermal Matrix and Skin Graft
Single-Stage Full-Thickness Scalp Reconstruction Using Acellular Dermal Matrix and Skin Graft Yoon S. Chun, MD, a and Kapil Verma, BA b a Division of Plastic and Reconstructive Surgery, Department of Surgery,
More informationVacuum-Assisted Closure of Perineal War Wound Related to Rectum
Vacuum-Assisted Closure of Perineal War Wound Related to Rectum Nazım Gümüş, MD Plastic and Reconstructive Surgery Department, Adana Numune Research and Training Hospital, Adana, Turkey Correspondence:
More informationBreast Infections. Epworth Benign Breast Disease Symposium Miss Melanie Walker MBBS(Hons) FRACS Epworth Breast Service
Breast Infections Epworth Miss Melanie Walker MBBS(Hons) FRACS Epworth Breast Service Parenchymal Breast Infection Infections associated with breast feeding Central or subareolar abscesses +/- mammary
More informationRole of free tissue transfer in management of chronic venous ulcer
Original Article Role of free tissue transfer in management of chronic venous ulcer K. Murali Mohan Reddy, D. Mukunda Reddy Department of Plastic Surgery, Nizams Institute of Medical Sciences, India. Address
More informationAlthough the precise aetiology of pilonidal sinus disease is debatable, two main schools of thought exist:
Pilonidal sinus wounds: the clinical approach Author: Dr. Dibyesh Bannerjee Journal of Community Nursing 1999 Pilonidal disease, or 'jeep disease', is a well-known complex surgical problem. It is an unglamorous
More informationCase 1. Debridement Cultures Keflex Silvadene
The Red Breast Beth McLellan, M.D. Assistant Professor Division of Dermatology Albert Einstein College of Medicine Montefiore Medical Center Jacobi Medical Center Case 1 48 year old radiation oncologist
More informationThe gluteal perforator-based flap in repair of pressure sores
The British Association of Plastic Surgeons (2004) 57, 342 347 CASE REPORTS The gluteal perforator-based flap in repair of pressure sores Çilingir Meltem*, Çelik Esra, Fındık Hasan, Duman Ali Department
More informationHidrarenitis Suppurativa (HS) was first. Back to basics: understanding hidradenitis suppurativa PRACTICE DEVELOPMENT
Back to basics: understanding hidradenitis suppurativa KEY WORDS Dermatology Fistulae Hidradenitis Suppurativa Scarring Sinus tracts Hidradenitis Suppurativa (HS) is a chronic recurrent debilitating skin
More informationOSTEOMYELITIS. If it occurs in adults, then the axial skeleton is the usual site.
OSTEOMYELITIS Introduction Osteomyelitis is an acute or chronic inflammatory process of the bone and its structures secondary to infection with pyogenic organisms. Pathophysiology Osteomyelitis may be
More informationObjectives. Routine to Rare: Complex Wound and Skin Conditions 8/29/2017
Routine to Rare: Complex Wound and Skin Conditions Debbie Harrell RN, MSN Objectives Describe various pediatric complex wound and skin conditions. Identify the root causes of complex wound and skin conditions
More informationWhat you need to know about HS HIDRADENITIS SUPPURATIVA. Hidradenitis Suppurativa
What you need to know about HS HIDRADENITIS SUPPURATIVA HS Hidradenitis Suppurativa The Irish Skin Foundation is a national charity with a mission to improve quality of life for people with skin conditions,
More informationThe presence of chronic furuncular masses, usually
Hidradenitis Suppurativa: Successful Treatment Using Carbon Dioxide Laser Excision and Marsupialization PAUL G. HAZEN yz, MD, AND BRENT P. HAZEN yz,md BACKGROUND Hidradenitis suppurativa (HS) is a disease
More informationKoebner Phenomenon in Radiation Associated Angiosarcoma of the Breast: Linear Metastasis in Split Skin Graft Donor Site
ISPUB.COM The Internet Journal of Surgery Volume 9 Number 2 Koebner Phenomenon in Radiation Associated Angiosarcoma of the Breast: Linear Metastasis in Split Skin Graft Donor Site A Chhabra, A Goyal, R
More informationSurgical treatment of hidradenitis suppurativa: case series and review of the literature Shahzad Ather, David SY Chan, David J Leaper, Keith G Harding
REVIEW ARTICLE Surgical treatment of hidradenitis suppurativa: case series and review of the literature Shahzad Ather, David SY Chan, David J Leaper, Keith G Harding Ather S, Chan DSY, Leaper DJ, Harding
More informationHidradenitis suppurativa treated with combination of infliximab and dapsone
DOI: 10.4149/BLL_2012_074 Bratisl Lek Listy 2012; 113 (5) CASE REPORT Hidradenitis suppurativa treated with combination of infliximab and dapsone Kozub P, Simaljakova M Department of Dermatovenerology,
More informationManagement of Complex Avulsion Injuries of the Dorsum of the Foot and Ankle in Pediatric Patients by Using Local Delayed Flaps and Skin Grafts
Management of Complex Avulsion Injuries of the Dorsum of the Foot and Ankle in Pediatric Patients by Using Local Delayed Flaps and Skin Grafts Ahmed Elshahat, MD Plastic Surgery Department, Ain Shams University,
More informationInteresting Case Series. Reconstruction of Dorsal Wrist Defects
Interesting Case Series Reconstruction of Dorsal Wrist Defects Maelee Yang, BS, and Joseph Meyerson, MD The Ohio State University Wexner Medical Center, Columbus Correspondence: maelee.yang@osumc.edu Keywords:
More informationObjectives. 1. Recognizing benign skin lesions. 2.Know which patients will likely need surgical intervention.
The Joy of Pediatric Skin Dr. Claire Sanger University of Kentucky Plastic & Reconstructive Surgery Objectives 1. Recognizing benign skin lesions 2.Know which patients will likely need surgical intervention.
More informationWorld Journal of Colorectal Surgery
World Journal of Colorectal Surgery Volume 6, Issue 1 Article 4 Excision With Layered Primary Closure In The Surgical Treatment of Sacrococcygeal Pilonidal Cyst Disease Michael L. Lorentziadis Athens Medical,
More informationClinical Policy Title: Intralesional steroid injection for acne
Clinical Policy Title: Intralesional steroid injection for acne Clinical Policy Number: 16.02.07 Effective Date: June 1, 2017 Initial Review Date: April 19, 2017 Most Recent Review Date: May 19, 2017 Next
More informationAesthetic surgery techniques after excision of dermatofibrosarcoma protuberans: a case report
British Journal of Plastic Surgery (2005) 58, 556 560 CASE REPORT Aesthetic surgery techniques after excision of dermatofibrosarcoma protuberans: a case report G. Dagregorio a, *, V. Darsonval b a Department
More informationDermatopathology Cytokeratin expression in pilonidal sinus
British Journal of Dermatology 2002; 146: 409 413. Dermatopathology Cytokeratin expression in pilonidal sinus I.KUROKAWA, S.NISHIJIMA,* K.SUZUKI, K.KUSUMOTO, H.SENSAKI, N.SHIKATA AND A.TSUBURA Department
More informationVACUUM ASSISTED CLOSURE (V.A.C.) THERAPY: Mr. Ismazizi Zaharudin Jabatan pembedahan Am Hospital Kuala Lumpur
VACUUM ASSISTED CLOSURE (V.A.C.) THERAPY: Mr. Ismazizi Zaharudin Jabatan pembedahan Am Hospital Kuala Lumpur Learning Objectives Define Negative Pressure Wound Therapy (NPWT) Discuss guidelines for the
More informationDermatology Pearls and News Flash ACP Utah Chapter Scientific Meeting 2017
Dermatology Pearls and News Flash ACP Utah Chapter Scientific Meeting 2017 Christopher M Hull, MD University of Utah School of Medicine Christopher.hull@hsc.utah.edu Conflict of interest No conflicts to
More informationA Comparitive Study of Laying Open of Wound Vs Primary Closure In Fistula in Ano
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-853, p-issn: 2279-861.Volume 13, Issue 9 Ver. III (Sep. 214), PP 39-45 A Comparitive Study of Laying Open of Wound Vs Primary Closure
More informationPedicled Fillet of Leg Flap for Extensive Pressure Sore Coverage
Pedicled Fillet of Leg Flap for Extensive Pressure Sore Coverage Shareef Jandali, MD, and David W. Low, MD Division of Plastic Surgery, University of Pennsylvania Health System, Philadelphia Correspondence:
More informationInteresting Case Series. Skin Grafting in Pyoderma Gangrenosum
Interesting Case Series Skin Grafting in Pyoderma Gangrenosum Marco Romanelli, MD, PhD, Agata Janowska, MD, Teresa Oranges, MD, and Valentina Dini, MD, PhD Department of Dermatology, University of Pisa,
More informationOur experience of simple technique for successful primary closure after excision of pilonidal sinus disease
International Surgery Journal Kela M et al. Int Surg J. 2015 Nov;2(4):647-651 http://www.ijsurgery.com pissn 2349-3305 eissn 2349-2902 Research Article DOI: http://dx.doi.org/10.18203/2349-2902.isj20151095
More informationIleo-rectal anastomosis for Crohn's disease of
Ileo-rectal anastomosis for Crohn's disease of the colon W. N. W. BAKER From the Research Department, St Mark's Hospital, London Gut, 1971, 12, 427-431 SUMMARY Twenty-six cases of Crohn's disease of the
More informationJPRAS Open 3 (2015) 1e5. Contents lists available at ScienceDirect. JPRAS Open. journal homepage:
JPRAS Open 3 (2015) 1e5 Contents lists available at ScienceDirect JPRAS Open journal homepage: http://www.journals.elsevier.com/ jpras-open Case report The pedicled transverse partial latissimus dorsi
More informationSurgical Wounds & Incisions
Surgical Wounds & Incisions A Comprehensive Review Assessment & Management Alex Khan APRN ACNS-BC MSN CWCN CFCN WCN-C Advanced Practice Nurse / Adult Clinical Nurse Specialist www.woundcarenurses.org 1
More informationGastrocnemius Myocutaneous Flap: A Versatile Option to Cover the Defect of Upper and Middle Third Leg
Downloaded from wjps.ir at 22:25 +0330 on Sunday November 18th 28 314 Gastrocnemius flap for coverage of leg defects Original Article Gastrocnemius Myocutaneous Flap: A Versatile Option to Cover the Defect
More informationVersatility of Reverse Sural Artery Flap for Heel Reconstruction
ORIGINAL ARTICLE Introduction: The heel has two parts, weight bearing and non-weight bearing part. Soft tissue heel reconstruction has been a challenge due to its complex nature of anatomy, weight bearing
More informationCHAPTER 16 LOWER EXTREMITY. Amanda K Silva, MD and Warren Ellsworth, MD, FACS
CHAPTER 16 LOWER EXTREMITY Amanda K Silva, MD and Warren Ellsworth, MD, FACS The plastic and reconstructive surgeon is often called upon to treat many wound problems of the lower extremity. These include
More informationListing Form: Heart or Cardiovascular Impairments. Medical Provider:
Listing Form: Heart or Cardiovascular Impairments Medical Provider: Printed Name Signature Patient Name: Patient DOB: Patient SS#: Date: Dear Provider: Please indicate whether your patient s condition
More informationPUT YOUR BEST FOOT FORWARD
PUT YOUR BEST FOOT FORWARD Bala Ramanan, MBBS 1 st year vascular surgery fellow Introduction The epidemic of diabetes and ageing of our population ensures critical limb ischemia will continue to grow.
More informationFamilial hidradenitis suppurativa: evidence in favour of single gene transmission
Journal of Medical Genetics, 1984, 21, 281-285 Familial hidradenitis suppurativa: evidence in favour of single gene transmission J S FITZSIMMONS*, E M FITZSIMMONS*, AND G GILBERTt From the *Clinical Genetic
More informationHidradenitis Suppurativa
1 Hidradenitis Suppurativa Therapeutic Update Francisco A. Kerdel BSc, MBBS Director of Dermatology Inpatient Service Larkin Community Hospital, Miami, Fl Clinical Professor and Vice Chairman of Dermatology
More informationName of Policy: Reduction Mammaplasty
Name of Policy: Reduction Mammaplasty Policy #: 056 Latest Review Date: November 2013 Category: Surgery Policy Grade: D Background/Definitions: As a general rule, benefits are payable under Blue Cross
More informationSchematic of diagnosing surgical site infections
Schematic of diagnosing surgical site infections Infection occurred within 30 days after an operation if no implant is in place within one year if an implant is in place eg. hip replacement Do NOT report
More informationRochester Patient Safety C. difficile Prevention Collaborative: Long Term Care Antimicrobial Stewardship (funded by NYSDOH)
Rochester Patient Safety C. difficile Prevention Collaborative: Long Term Care Antimicrobial Stewardship (funded by NYSDOH) Clinical Practice Guideline* for the Diagnosis and Management of Acute Bacterial
More informationDr. James B. Lowe Plastic Surgery ORAL SOFT TISSUE SURGERY INFORMATION SHEET AND INFORMED CONSENT
Dr. James B. Lowe Plastic Surgery ORAL SOFT TISSUE SURGERY INFORMATION SHEET AND INFORMED CONSENT Instructions This is an informed consent document that has been prepared to assist your plastic surgeon
More informationTHYROID EYE DISEASE ORBITAL DECOMPRESSION SURGERY
THYROID EYE DISEASE ORBITAL DECOMPRESSION SURGERY What is thyroid eye disease (TED)? TED is an autoimmune condition where the body s own immune system attacks the tissues of the thyroid gland and the eye
More informationA new classification system of nasal contractures
Original Article J Cosmet Med 2017;1(2):106-111 https://doi.org/10.25056/jcm.2017.1.2.106 pissn 2508-8831, eissn 2586-0585 A new classification system of nasal contractures Geunuck Chang 1, Donghak Jung
More informationHead and neck cancer - patient information guide
Head and neck cancer - patient information guide The development of reconstructive surgical techniques in the last 20 years has led to major advances in the treatment of patients with head and neck cancer.
More informationA Keloid Edge Precut, Preradiotherapy Method in Large Keloid Skin Graft Treatment
A Keloid Edge Precut, Preradiotherapy Method in Large Keloid Skin Graft Treatment WENBO LI, MD, YOUBIN WANG, MD, XIAOJUN WANG, MD, AND ZHIFEI LIU, MD* BACKGROUND Keloids are scars that extend beyond the
More informationDO NOT DUPLICATE. Pilonidal disease is a common anorectal problem
FEATURE Using Negative Pressure Wound Therapy Following Surgery for Complex Pilonidal Disease: A Case Series Frank P. Bendewald, MD; Robert R. Cima, MD, FACS, FASCRS; Dan R. Metcalf, MD; and Imran Hassan,
More informationReconstruction of seventeen full-thickness defects of the eyelids with twenty-two Hübner tarsomarginal grafts *
British Journal of Plastic Surgery (2005) 58, 361 365 Reconstruction of seventeen full-thickness defects of the eyelids with twenty-two Hübner tarsomarginal grafts * G. Dagregorio a, *, V. Huguier b, V.
More informationSpermatogenesis after scrotal reconstruction
The British Association of Plastic Surgeons (2003) 56, 484 488 Spermatogenesis after scrotal reconstruction Dali Wang a, *, Hong Zheng b, Fei Deng b a Department of Plastic Surgery, The Affiliated Hospital
More informationStreptococcus milleri causing treatable infection in perineal hidradenitis suppurativa
British Journal of Dermatology (1980) 103, 375. Streptococcus milleri causing treatable infection in perineal hidradenitis suppurativa A.S.HIGHET, R.E.WARREN*, R.C.D.STAUGHTONf AND S.O.B.ROBERTS Departments
More informationCase 1 History. William Tremaine, M.D. CP
Extraintestinal Manifestations of IBD Case Studies William Tremaine, M.D. Case 1 History 18 year-old woman with Crohn s disease Onset at age 5: colonic & perianal Sulfasalazine, prednisone, mercaptopurine
More informationSurgical Management of wounds, flaps, grafts, and scars
Disclosures Surgical Management of wounds, flaps, grafts, and scars I have no financial disclosures Cherrie Heinrich, MD, FACS Department of Plastic Surgery Regions Hospital Assistant Professor University
More information-> Education -> Excellence
Quality Conference 5/2557 Extravasations: Event -> Education -> Excellence รศ.นพ. รว ศ เร องตระก ล สาขาว ชาก มารศ ลยศาสตร ภาควชาศลยศาสตร Extravasations: Event 1. Thrombophlebitis - superficial vein 2.
More informationPolicy No: FCHN.MP Page 1 of 6 Date Originated: Last Review Date Current Revision Date 7/10/07 06/2014 7/2/14
Page 1 of 6 Date Originated: Last Review Date Current Revision Date 7/10/07 06/2014 7/2/14 SUBJECT: Abdominoplasty, Panniculectomy and Ventral/Incisional Hernia RELATED POLICIES/RELATED DESKTOP PROCEDURES:
More informationRUOLO DEL RADIOLOGO NELL IDROSADENITE ROBERTO RIZZATI
RUOLO DEL RADIOLOGO NELL IDROSADENITE ROBERTO RIZZATI DEFINITION Hidradenitis suppurativa (HS/AI): - Chronic - Inflammatory - Recurrent (at least 6 months) - Debilitating skin disease - Starting from the
More informationTechnology appraisal guidance Published: 22 June 2016 nice.org.uk/guidance/ta392
Adalimumab for treating moderate to severe ere hidradenitis suppurativa Technology appraisal guidance Published: 22 June 2016 nice.org.uk/guidance/ta392 NICE 2018. All rights reserved. Subject to Notice
More informationChapter 22. Pulmonary Infections
Chapter 22 Pulmonary Infections Objectives State the incidence of pneumonia in the United States and its economic impact. Discuss the current classification scheme for pneumonia and be able to define hospital-acquired
More informationPrior Authorization Conditions for Approval of Humira (adalimumab) Website Form Submit request via: Fax
Prior Authorization Conditions for Approval of Humira (adalimumab) Website Form www.highmarkhealthoptions.com Submit request via: Fax - 1-855-476-4158 All requests for Humira (adalimumab) require a prior
More informationKuwabara, Kaoru; Nonaka, Takashi; H. Citation Journal of Clinical Urology, 7(5),
NAOSITE: Nagasaki University's Ac Title Author(s) Gluteal-fold adipofascial perforato fistula reconstruction Fujioka, Masaki; Hayashida, Kenji; Kuwabara, Kaoru; Nonaka, Takashi; H Citation Journal of Clinical
More informationMeleney s Ulcer; A Rare but Fatal Abdominal Wall Disease Complicating Laparatomy Waweru JM
Case Report Meleney s Ulcer; A Rare but Fatal Abdominal Wall Disease Complicating Laparatomy Waweru JM Nyeri Provincial General Hospital Correspondence to: Dr Waweru, P.O. Box 36153-00200, Nairobi. Email:
More informationWound coverage of plantar metatarsal ulcers in leprosy using a toe web flap
Free full text on www.ijps.org Original Article Wound coverage of plantar metatarsal ulcers in leprosy using a toe web flap J. Joshua, V. Chakraborthy Premananda Memorial Leprosy Hospital, The Leprosy
More informationPartial Closure Technique After Pilonidal Sinus Excision: A Quick Healing Technique
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 16, Issue 8 Ver. IV(Aug. 2017), PP 59-63 www.iosrjournals.org Partial Closure Technique After Pilonidal
More informationSurgical Management of IBD in the Age of Biologics
Surgical Management of IBD in the Age of Biologics Lisa S. Poritz, M.D Associate Professor of Surgery Division of Colon and Rectal Surgery Objectives Discuss surgical management of IBD When to operate
More information