1/124. Developing venous gangrene in deep vein thrombosis: intraarterial low-dose burst therapy with urokinase--case reports.Two patients with developing venous gangrene of the lower extremity and contraindications to systemic thrombolytic therapy are presented. Low-dose intraarterial burst therapy with urokinase provided rapid amelioration of symptoms and avoided amputation without any serious bleeding complications in both patients.- - - - - - - - - - ranking = 1keywords = lower (Clic here for more details about this article) |
2/124. Leg ulcers: a common problem with sometimes uncommon etiologies.In the U.S., leg ulcers present a significant clinical problem, occurring at a rate of approximately 600,000 new cases per year. In most cases, the cause of ulceration is venous or arterial in nature. One uncommon but significant cause of leg ulcers is sqaumous cell carcinoma (SCC). Although the incidence of SCC is higher in white than black populations, blacks with SCC typically exhibit involvement of areas of the skin that are not chronically sun-exposed, especially the lower extremeties. Predisposing factors include burn scars, chronic infection or ulceration, and chronic discoid lupus erythematosus. Leg ulcers of atypical presentation or those that fail to heal should alert the clinician to consider uncommon etiologies.- - - - - - - - - - ranking = 1keywords = lower (Clic here for more details about this article) |
3/124. hidradenitis suppurativa occurring on the leg.The case of a patient with a recurrent, painful ulceration on the lower leg, clinically and histologically resembling hidradenitis suppurativa, is presented. The fact that this site is devoid of apocrine glands supports the concept that apocrine involvement in hidradenitis suppurativa is coincidental and that these glands are involved secondarily. It is suggested that in this patient the pathogenesis of the disease is follicular occlusion rather than selective apocrine poral closure.- - - - - - - - - - ranking = 1keywords = lower (Clic here for more details about this article) |
4/124. Maggot therapy for the treatment of intractable wounds.BACKGROUND: Fly maggots have been known for centuries to help debride and heal wounds. Maggot therapy was first introduced in the USA in 1931 and was routinely used there until the mid-1940s in over 300 hospitals. With the advent of antimicrobiols, maggot therapy became rare until the early 1990s, when it was re-introduced in the USA, UK, and israel. The objective of this study was to assess the efficacy of maggot therapy for the treatment of intractable, chronic wounds and ulcers in long-term hospitalized patients in israel. methods: Twenty-five patients, suffering mostly from chronic leg ulcers and pressure sores in the lower sacral area, were treated in an open study using maggots of the green bottle fly, Phaenicia sericata. The wounds had been present for 1-90 months before maggot therapy was applied. Thirty-five wounds were located on the foot or calf of the patients, one on the thumb, while the pressure sores were on the lower back. Sterile maggots (50-1000) were administered to the wound two to five times weekly and replaced every 1-2 days. Hospitalized patients were treated in five departments of the Hadassah Hospital, two geriatric hospitals, and one outpatient clinic in Jerusalem. The underlying diseases or the causes of the development of wounds were venous stasis (12), paraplegia (5), hemiplegia (2), Birger's disease (1), lymphostasis (1), thalassemia (1), polycythemia (1), dementia (1), and basal cell carcinoma (1). Subjects were examined daily or every second day until complete debridement of the wound was noted. RESULTS: Complete debridement was achieved in 38 wounds (88.4%); in three wounds (7%), the debridement was significant, in one (2.3%) partial, and one wound (2.3%) remained unchanged. In five patients who were referred for amputation of the leg, the extremities was salvaged after maggot therapy. CONCLUSIONS: Maggot therapy is a relatively rapid and effective treatment, particularly in large necrotic wounds requiring debridement and resistant to conventional treatment and conservative surgical intervention.- - - - - - - - - - ranking = 2keywords = lower (Clic here for more details about this article) |
5/124. The reversal sural artery neurocutaneous island flap in composite lower extremity wound reconstruction.Reconstruction of the lower third of the leg and the forefoot remains a challenge due to a lack of regional muscle units and minimal subcutaneous tissues. Reverse island flaps have been applied to similar reconstructive problems in the upper extremity. Recently, the reverse sural artery neurocutaneous island flap has been utilized to reconstruct complex wounds of the lower extremity and forefoot in young and middle-aged individuals. We present our use of the flap in a patient cohort 65 years of age or older. Unique among this group was the high prevalence of diabetes and peripheral vascular disease. Nonetheless, the reverse sural artery neurocutaneous island flap proved a safe and reliable means of achieving wound closure.- - - - - - - - - - ranking = 6keywords = lower (Clic here for more details about this article) |
6/124. Healing of diabetes and vascular ulcers on switching from peritoneal dialysis to hemodialysis.Vascular complications are the main problem in diabetic patients and can be worsened by continuous ambulatorial peritoneal dialysis (CAPD). A 46-year old woman with a family history of diabetes progressively developed hyperglycemia and subsequently lower limb ulcers after beginning CAPD. Hypertonic bags were required to control fluid balance. On account of the severe and painful ulcers, the patient was changed to hemodialysis. Within a few weeks her diabetes improved and the vascular ulcers healed completely.- - - - - - - - - - ranking = 1keywords = lower (Clic here for more details about this article) |
7/124. Martorell's hypertensive leg ulcer: case report and concise review of the literature.Hypertensive leg ulcers (Martorell's ulcers) are a unique form of lower extremity ischaemic leg ulcer. First described by Martorell, and Hines and Farber in the 1940s, these ulcers are defined by pain disproportionate to the size of the ulcer, specific location on the lower extremity, female-to-male predominance, association with long-standing, often poorly, controlled hypertension, and healing response to specific antihypertensive agents. We present a case of Martorell's hypertensive ischaemic leg ulcer and a concise review of the 104 previous cases in the world's English literature. Hypertensive ischaemic leg ulcers will be more commonly recognised with a renewed appreciation of the existence of this clinical entity.- - - - - - - - - - ranking = 2keywords = lower (Clic here for more details about this article) |
8/124. Unexpected healing of cutaneous ulcers in a short child.A boy aged 10 years was referred to the Paediatric Department of Milan University Hospital, Milan, italy, with a long history of pain in the lower limbs, alleviated only by exposure to cold. His legs were swollen, with multiple cutaneous ulcers. He had severe painful crises, and was totally incapacitated. After the diagnosis of erythermalgia was made, numerous treatments were tried, but none were successful. After finding growth hormone (GH) deficiency, we started treatment with recombinant GH. He had immediate relief of pain and complete healing of ulcers. We postulate that the healing of the ulcers can be attributed to the GH-promoting effect on dermal connective tissue.- - - - - - - - - - ranking = 1keywords = lower (Clic here for more details about this article) |
9/124. Aggressive, extensive, vasculitic leg ulceration associated with hydroxyurea therapy and a fatal outcome.The association of lower leg ulcer development and hydroxyurea therapy in patients with myeloproliferative disorders has been reported previously. In most of these cases the ulcers healed with cessation of the hydroxyurea together with meticulous attention to wound care. We report a patient who developed painful vasculitic ulcers secondary to hydroxyurea on both lower legs whilst on long-term hydroxyurea therapy for idiopathic thrombocytosis. The ulcers extended relentlessly despite stopping hydroxyurea, maximizing topical therapies and starting intensive systemic treatment. We discuss the association of hydroxyurea therapy with the development of painful ulceration.- - - - - - - - - - ranking = 2keywords = lower (Clic here for more details about this article) |
10/124. Healing of skin necrosis and regression of anticardiolipin antibodies achieved by parathyroidectomy in a dialyzed woman with calcific uremic arteriolopathy.AIM: To present the impact of parathyroidectomy on the spontaneous healing of necrotic lesions of the skin of the lower leg and on anticardiolipin antibodies regression in a 68-year-old female dialyzed patient with hyperparathyroidism and calcific-uremic arteriolopathy (CUA). methods: After the occurrence of initial lesions of the lower leg skin, the intact parathyroid (iPTH) level, calcium (Ca) and phosphorus (P) product were measured, and on two occasions at 6-week intervals, the titer of anticardiolipin antibodies was determined, followed by a clinical monitoring of the progress of necrotic skin lesions. Two months after the occurrence of the skin lesions, the patient's right leg was amputated below the knee due to gangrene, and a histopathological analysis of the skin tissue sample of the amputated lower leg was made. After parathyroidectomy, iPTH, Ca x P product were measured, and on two occasions at 6 weeks' intervals, anticardiolipin antibodies titer was determined, followed by a clinical monitoring of lesions of the left lower leg skin. RESULTS: Before parathyroidectomy, iPTH level and Ca x P product were increased, as well as IgG anticardiolipin antibody titer measured on two occasions 6 weeks apart. The histopathological analysis of the skin tissue sample of the amputated right lower leg showed mural calcification of artery walls and thrombotic occlusions of small arteries, arterioles, and dermal capillaries, in addition to epidermolysis. A week after parathyroidectomy, iPTH level and Ca x P product were within normal range. Two measurements 6 weeks apart revealed no anticardiolipin antibodies. Eight weeks after parathyroidectomy, spontaneous healing of necrotic skin lesions of the left lower leg was observed. CONCLUSION: Regression of anticardiolipin antibodies, normalization of Ca x P product, and healing of the skin lesions after parathyroidectomy all pointed to the elevated PTH level as a crucial factor in the pathogenesis of CUA.- - - - - - - - - - ranking = 6keywords = lower (Clic here for more details about this article) |
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