1/9. Primary cutaneous nocardiosis in a husband and wife.A 62-year-old woman suffered from acute purulent skin disease with multiple subcutaneous abscesses. At the same time, her 65-year-old husband presented with multiple subcutaneous nodules along the lymphatic vessels of his right arm. Both had a history of a minor scratch by a thorn of a bush at the site of infection. nocardia was identified as causative bacterium from the woman's lesions. Therefore the rare phenomenon of 2 different forms of acute primary cutaneous nocardiosis after simultaneous infection, lymphocutaneous infection, and superficial skin infection was diagnosed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/9. Fascial feeder and perforator-based V-Y advancement flaps in the reconstruction of lower limb defects.The principle of the V-Y advancement flap has been used since its first description by Blasius (1848) for reconstruction of smaller defects. We wish to describe V-Y advancement flaps, the design of which includes distinct perforator or fascial feeder vessels, which may originate from periosteum, muscle, cutaneous nerve or from large tendon sheaths. These flaps are planned in an oblique manner when there is a defect over the anterior, antero-lateral or antero-medial aspect, and in a vertical manner when there is a defect over the posterior aspect of the leg. The main advantage of this design is the ability to close the secondary defect primarily, allowing adequate cover of the defect, particularly in the pre-tibial region, without the unsightly divot left by a split skin graft in this area. When the flap includes branches of the long saphenous nerve on the medial aspect, superficial peroneal nerve laterally or sural nerve posteriorly it results in a sensate flap, giving protection in this vulnerable area, which has previously not been possible. We describe 40 cases where perforator-based V-Y advancement flaps have been used to cover large defects of the lower leg following excision of malignant skin lesions and in selected trauma cases that do not involve degloving injuries. This technique allows adequate soft tissue cover in the pre-tibial area and around the ankle with excellent aesthetic results. The planning, operative technique and the results with case presentations have been described.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/9. Use of autologous spiral vein grafts for vascular reconstructions in contaminated fields.Vascular reconstructions in heavily contaminated fields can be particularly challenging. Prosthetic grafts are rarely suitable because of the risk of infection, but the saphenous vein is usually too small for isodiametric replacement of large arteries and veins. Although surgeons rarely consider the use of spiral vein grafts, they may occasionally be the ideal autogenous vascular replacement because they can be tailored to fit a vessel of any size. We report the use of spiral vein grafts in three patients requiring vascular reconstructions in the presence of heavy bacterial contamination.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/9. Wound zygomycosis (mucormycosis) in otherwise healthy adults.Two previously healthy men sustained trauma that caused extensive soft tissue damage together with soil contamination. Within three days, rapidly advancing necrosis was observed at the wound margins. Histologic examination revealed the presence of non-septate branching hyphae characteristic of mucorales within tissues and in the lumen of blood vessels. In one case, the disease was unrecognized until widespread dissemination had taken place, and the patient died; in the other, a cure resulted from aggressive medical and surgical management. Infections due to mucorales generally occur in immune-compromised hosts. In cases of extensive trauma, inoculation of devitalized tissues with soil may initiate infection by zygomycetes, even in persons whose immunologic status appears to be normal.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/9. Phialemonium obovatum infection in a burned child.Phialemonium obovatum is reported for the first time as an opportunistic fungal pathogen of man. The fungus was recovered from biopsy specimens consisting of cutaneous and subcutaneous tissue obtained from thermal burn wounds antemortem and from spleen tissue and three burn sites postmortem. The hyaline hypae of P. obovatum were seen invading viable tissue and blood vessels. The taxonomy of the genus Phialemonium and the criteria for determining fungal burn wound invasion are discussed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/9. Threatened carotid artery rupture: a complication of radical neck surgery.Carotid artery rupture is an infrequent but highly dangerous postoperative complication of radical head and neck surgery. The principal predisposing factors are radiation therapy, infection, tissue necrosis, vessel exposure, and pharyngeal fistula formation. Actual or threatened carotid artery rupture has been most commonly managed by ligation of the involved vessel. We present a patient who showed signs of impending carotid artery rupture after both irradiation and radical neck surgery. Balloon embolization was employed in preference to traditional carotid artery ligation. The patient's risk factors for carotid artery rupture are analyzed and the application of balloon embolization is discussed.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
7/9. zygomycosis caused by Apophysomyces elegans.A case of zygomycosis caused by Apophysomyces elegans in a diabetic, obese female is described. The fungus gained entry into the body through injury to the skin, penetrating the keratin, epidermis, and dermis. Hyphal angioinvasion was observed. Fungal elements invaded the subcutaneous fat, skeletal muscle fibers, nerves, and large blood vessels, resulting in the spread of the infection. The rapidity with which A. elegans invaded the blood vessels left no choice except amputation of the leg to stop the spread of the infection. This zygomycetous fungus closely resembles absidia corymbifera. It is distinguished by its prominent campanulate apophyses. In its gross colony characteristics and failure to sporulate on routinely used media it resembles Saksenaea vasiformis.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
8/9. Histopathology of marine vibrio wound infections.Although marine vibrio wound infections and septicemia are being reported with increasing frequency, description of the histopathologic changes has been scanty. The histologic alterations in three patients with primary marine vibrio wound infections are presented. The lesions are characterized by intense acute cellulitis of the subcutis with much tissue destruction and extension into the adjacent dermis. The superficial dermis is devitalized and lacks an inflammatory cellular infiltrate. Subepidermal noninflammatory bullae are formed. Many organisms are seen both within the areas of intense acute inflammation and in devitalized areas. Organisms and inflammation are especially oriented around vessels, with associated acute vasculitis. It is concluded that the morphologic picture in marine vibrio wound infections is nonspecific yet characteristic.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/9. purpura fulminans localising to a recent burn injury.The development of progressive, severe skin changes (purpura fulminans) is a serious complication of septicaemia, particularly meningococcal septicaemia. purpura fulminans almost invariably leads to some full thickness skin loss and may lead to limb amputation. The pathophysiology may involve microemboli, endotoxins and direct bacterial damage to the vessels. We describe a case of purpura fulminans, probably as a result of meningococcal septicaemia, localising to a recent, healed burn with complete resolution. We can find no other record of the skin manifestations of meningococcal septicaemia localising to a previous injury.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |