Porokeratosis is an uncommon autosomally dominant inher ted disorder. Clinically, it is characterized by nonhealing plaques that develop most comnorly on the limbs. We report a case of disseminated superficial porokeratosis in immunosuppre sed kidney transplant recipient. An abrupt and extensive eruption of porokeratosis was observed in a 46-year-old man 7 months after renal transplantation, while being treated with cyclosporin A and prednisone. The histological features were essentially the same as the typical cornoid lamella. Immunosuppression may exacerbate or initiate the developm nt of porokeratosis in patients predisposed to alterations of cutaneous growth dynamics.
Cyclosporine ; Extremities ; Humans ; Immunosuppression ; Kidney Transplantation ; Kidney* ; Middle Aged ; Porokeratosis* ; Prednisone ; Transplantation*

OBJECTIVETo investigate the effects of unified surgical scheme for wounds on the outcome of patients with extensive deep partial-thickness to full-thickness (briefly referred to as deep) burn.

METHODSOne hundred and thirty-seven patients with extensive deep burn hospitalized from July 2007 to November 2012 underwent unified surgery according to area of deep wound (unified scheme group, US). Among them, 57 patients with deep wound area less than 51% TBSA received escharectomy or tangential excision by stages followed by autologous mesh skin grafting; 52 patients with deep wound area from 51% to 80% TBSA underwent escharectomy or tangential excision by stages followed by autologous mesh skin grafting and/or small skin grafting, or escharectomy or tangential excision followed by large sheet of allogeneic skin covering plus autologous mesh skin grafting and/or small skin grafting after the removal of allogeneic skin; 28 patients with deep wound area larger than 80% TBSA received escharectomy or tangential excision by stages followed by autologous microskin grafting plus coverage of large sheet of allogeneic skin, or escharectomy or tangential excision followed by small autologous skin grafting and/or intermingled grafting with small autologous and/or allogeneic skin. Another 120 patients with extensive deep burn hospitalized from January 2002 to June 2007 who did not receive unified surgical scheme were included as control group (C). Except for the surgical methods in group US, in 53 patients with deep wound area less than 51% TBSA in group C escharectomy or tangential excision was performed followed by autologous small skin grafting; in 40 patients with deep wound area from 51% to 80% TBSA in group C escharectomy or tangential excision was performed followed by autologous microskin grafting plus large sheet of allogeneic skin covering, or escharectomy or tangential excision followed by large sheet of allogeneic skin embedded with stamp-like autologous skin; in 27 patients with deep wound area larger than 80% TBSA in group C escharectomy or tangential excision was performed followed by covering with large sheet of allogeneic skin embedded with stamp-like autologous skin without intermingled grafting with small autologous and allogeneic skin in group US. In group US, escharectomy of full-thickness wound in extremities was performed with the use of tourniquet in every patient; saline containing adrenaline was subcutaneously injected when performing escharectomy or tangential excision over the trunk and skin excision; normal skin and healed superficial-thickness wound were used as donor sites for several times of skin excision. The baseline condition of patients and their treatment in the aspects of fluid resuscitation, nutrition support, anti-inflammation, and organ function support were similar between the two groups. The mortality and incidence of complications of all patients and wound healing time and times of surgery of healed patients were compared between the two groups. Data were processed with independent sample t test, Mann-Whitney U test, and Fisher's exact test.

RESULTS(1) Both the mortality and the incidence of complications of patients with deep wound area less than 51% TBSA in group US were 0, which were close to those of group C (with P values above 0.05). The number of times of surgery of healed patients with deep wound area less than 51% TBSA in group US was 2.4 ± 0.9, which was obviously fewer than that of group C (3.5 ± 1.8, U=-5.085, P<0.001), but with wound healing time close to that of group C (U=-1.480, P>0.05). (2) Both the mortality and the incidence of complications of patients with deep wound area from 51% to 80% TBSA in group US were 0, which were significantly lower than those of group C [both as 20.0% (8/40), with P values below 0.01]. The number of times of surgery and wound healing time of healed patients with deep wound area from 51% to 80% TBSA in group US were respectively 3.0 ± 1.0 and (43 ± 13) d, which were obviously fewer or shorter than those in group C [4.2 ± 2.3 and (61 ± 34) d, with U values respectively -2.491 and -2.186, P values below 0.05]. (3) Both the mortality and the incidence of complications of patients with deep wound area larger than 80% TBSA in group US were 25.0% (7/28), which were close to those of group C [both as 25.9% (7/27), with P values above 0.05]. The number of times of surgery and wound healing time of healed patients with deep wound area larger than 80% TBSA in group US were close to those of group C (with U values respectively -0.276 and -0.369, P values above 0.05).

CONCLUSIONSUnified surgical scheme can indirectly decrease the mortality and the incidence of complications of burn patients with deep wound area from 51% to 80% TBSA; it can reduce times of surgery of healed patients of this type and shorten their wound healing time.

Burns ; surgery ; Debridement ; methods ; Extremities ; Humans ; Severity of Illness Index ; Skin ; pathology ; Skin Transplantation ; Transplantation, Autologous ; Treatment Outcome ; Wound Healing

We report a case of successful heart transplantation after 67 days of support with venoarterial extracorporeal membrane oxygenation (ECMO) in a patient who underwent surgery for type A aortic dissection and myocardial infarction complicated by irreversible myocardial damage and a deep sternal wound infection. During ECMO support, left heart vent and distal limb perfusion were performed. Mediastinitis was treated with mediastinal washout and irrigation. Multiple complications from peripheral ECMO were successfully managed.
Cardiomyopathies ; Extracorporeal Membrane Oxygenation* ; Extremities ; Heart Transplantation* ; Heart* ; Humans ; Mediastinitis* ; Myocardial Infarction ; Perfusion ; Shock ; Transplantation ; Wound Infection

To study the characteristics of acute rejection after limb allotransplantation, 29 male Sprague-Dawley rats were randomly divided into 2 groups, with 15 rats in control group and 14 rats in experimental group. Each rat in control group underwent limb replantation. Each rat in experimental group received limb transplantation from Wistar rat. No immunosuppressive drugs were used after operation. The circulation of the transplanted limb, time and signs of rejection, histopathological changes in the tissues of the limb graft when rejected and survival time of limb grafts were evaluated. In the control group, no signs of rejection were observed, the circulation of each replanted limb was normal, it could survive for a longer time. The experimental group showed clinical signs of rejection (sub dermal edema and erythema) after a mean time of 3.36+/-1.15 days, and the mean survival time of the allografts was only 7+/-0.78 days. Histopathological examination showed most violent rejection reaction in skin. It is concluded that with Wistar-to-SD limb transplantation without use of immunosuppression, rejection of the grafts would occur after a mean time of 3.36+/-1.15 days; the earliest signs of rejection were edema and erythema of the skin, skin being the most representative component of limb graft rejection.
Acute Disease ; Extremities/*transplantation ; *Graft Rejection ; Graft Survival ; Random Allocation ; Rats, Sprague-Dawley ; Rats, Wistar ; Skin/immunology ; Transplantation, Homologous

We report a case of successful heart transplantation after 67 days of support with venoarterial extracorporeal membrane oxygenation (ECMO) in a patient who underwent surgery for type A aortic dissection and myocardial infarction complicated by irreversible myocardial damage and a deep sternal wound infection. During ECMO support, left heart vent and distal limb perfusion were performed. Mediastinitis was treated with mediastinal washout and irrigation. Multiple complications from peripheral ECMO were successfully managed.
Cardiomyopathies ; Extracorporeal Membrane Oxygenation ; Extremities ; Heart Transplantation ; Heart ; Humans ; Mediastinitis ; Myocardial Infarction ; Perfusion ; Shock ; Transplantation ; Wound Infection

transplantation surgery and pathology, so that maxillofacial reconstructive surgeons may occasionally be faced with the challenge of diagnosing skin refection of a composite tissue allograft. Facial allotransplantation (FAT) is a new surgical technique that could be considered as a new paradigm in facial reconstruction. Since the first human FAT had been achieved in 2005, 17 cases have been reported in the world up to date. However, many problems such as life-long immunosuppression, immune rejection, ethical problems and psychological problems are remained, so facial CTA is new reconstructive option with no general acceptance. The authors reviewed the indications, the results of 17 cases and their complications, and additional consideration factors in this article, and intended to raise the awareness of oral and maxillofacial surgeons in this type of facial transplantation.]]>
Animals ; Extremities ; Facial Transplantation ; Hand ; Humans ; Immunosuppression ; Joints ; Larynx ; Rats ; Rejection (Psychology) ; Skin ; Trachea ; Transplantation, Homologous ; Transplants

OBJECTIVETo investigate the application of tourniquet in burn patients during tangential excision on the extremities.

METHODSSeventy - nine burn patients who were arranged to receive tangential excision and skin grafting on the extremities were randomly divided into A and B groups. The patients in A group (n = 41) underwent the operation with the tourniquet applied continuously throughout the operation, while those in B group (n = 38), only with tourniquet applied during tangential excision. The amounts of blood loss and blood transfusion, the operation time and the take rate of grafted skin and the incidence of complications were investigated and recorded.

RESULTSThe amounts of blood loss and blood transfusion during operation in A group were 42% and 50% less than those in B group, respectively (P < 0.001). Moreover, the operation time on the upper and lower extremities in A group was much shorter (for 41% and 37%, respectively) than those in B group (P < 0.001). In addition, there was no difference of the take rate of skin graft and the incidence of subcutaneous hematoma between the two groups (P > 0.05).

CONCLUSIONContinuous tourniquet application during tangential excision on the extremities in burn patients was proved to be effective in reducing operational blood loss, blood transfusion and in shortening operation time.

Adult ; Blood Loss, Surgical ; prevention & control ; Blood Transfusion ; Burns ; surgery ; Extremities ; surgery ; Humans ; Skin Transplantation ; Tourniquets

Bone Neoplasms ; pathology ; surgery ; Bone Transplantation ; Extremities ; Humans ; Limb Salvage ; Neoplasm Staging ; Reconstructive Surgical Procedures

Dermatofibrosarcoma protuberans is a slowly growing, locally invasive malignant tumor which originates in the dermis. Clinically, the initial appearance of the tumor is that of an indurated plaque which subsequently gives rise to multiple nodules. In the tumor's later stages, however, its growth rate accelerates, and it can ulcerate, bleed or become painful. but, metastasis is very rare. Dermatofibrosarcoma protuberans occurs most frequently on the trunk and proximal parts of the limbs, less commonly in the head and neck region, and only rarely in the extremities and external genitalia. A characteristic feature of dermatofibrosarcoma protuberans is the tendency to recur locally. This is apparently due to the infiltrative growth pattern between collagen bundles. Therefore, a wide excision is treatment of choice. Skin grafting is the usual reconstructive procedure, but flap reconstructions are used for cosmetic and functional concerns in many anatomic locations. We report the case of wide atrophic dermatofibrosarcoma protuberans and the clinical usefulness of the expanded cutaneous flap using tissue expander in reconstruction of the tissue deficit after wide and deep excision of dermatofibrosarcoma protuberans of the chest and anterior neck.
Collagen ; Dermatofibrosarcoma* ; Dermis ; Extremities ; Genitalia ; Head ; Neck ; Neoplasm Metastasis ; Skin Transplantation ; Thorax ; Tissue Expansion Devices* ; Ulcer

PURPOSE: Tie-over dressing is widely used to secure skin grafting on face, body, or extremities. It can be a rather complicated task and is not easy to make compressive dressing again if performed in a conventional method. So, we hereby introduce an easy reproducible tie over dressing method. METHODS: After completing the skin graft, Cut the silastic drainage longitudinally in half and spread to the grafted skin margin. Drainage is fixed by using the stapes or sutures. A fluffy gauze bolus dressing is placed over a furacin impregnated gauze and wrapped around. After suturing the distal margin of silastics with opposite side using the silk thread either 5-0 or 3-0, knot of suturing, which is pressed down against the dressing while the threads are tightened, is made into center of each sides. RESULTS: It can make dressing again after observing the grafted skin, and it can also make pressure on the grafted area evenly until the grafted skin is taken. CONCLUSION: This dressing method makes the surgeons and patients comfortable. To surgeons, it provides more rapid and easier way to do dressing, and to patients, it eliminates pain caused by redressing.
Bandages ; Dimethylpolysiloxanes ; Drainage ; Extremities ; Humans ; Nitrofurazone ; Silk ; Skin ; Skin Transplantation ; Stapes ; Sutures ; Transplants