The surgeon is, at times, confronted with the problems of covering large defects of the soft tissue of the groin area, which result from trauma, ablative surgical treatment or prosthetic graft infection. Coverage is a challenging problem particularly when the wound is complicated by radiation. Defects of the soft tissue, however extensive, that do not have any vital structures exposed could be easily handled with skin grafting, provided there is a healthy vascular bed after surgical debridement and frequent dressing changes. The complicated wounds should be covered as expeditiously as possible to avoid desiccation and weakening of the vessel wall and, in the presence of vascular prosthesis, to avoid contamination and graft thrombosis. Exposure of the femoral vessels or prosthetic grafts requires urgent coverage with well vascularized muscle and muculocutaneous flaps based on well-defined vascular pedicle. Reonstruction with well-vascularized tensor fascia lata flap has enabled us to maintain the patency of native femoral artery and a viable distal lower extremity in a male patient, who had a sudden ruptured femoral artery after radiation therapy on burned groin.
Bandages ; Blood Vessel Prosthesis ; Burns ; Debridement ; Desiccation ; Fascia Lata ; Fascia ; Femoral Artery ; Groin ; Humans ; Lower Extremity ; Male ; Skin Transplantation ; Thrombosis ; Transplants ; Wounds and Injuries

PURPOSE: Exaggerated pro-inflammatory reactions during the acute phase of Kawasaki disease (KD) suggest the role of immune dysregulation in the pathogenesis of KD. We investigated the profiles of T regulatory cells and their correlation with the clinical course of KD. METHODS: Peripheral blood mononuclear cells were collected from 17 KD patients during acute febrile and subacute afebrile phases. T cells expressing CD4, CD25, and Foxp3 were analyzed using flow cytometry, and the results were correlated with the clinical course of KD. RESULTS: The percentage of circulating CD4+CD25highFoxp3+ T cells among CD4+ T cells was significantly higher during the subacute afebrile phase than during the acute febrile phase (1.10%+/-1.22% vs. 0.55%+/-0.53%, P=0.049). Although levels of CD4+CD25lowFoxp3+ T cells and CD4+CD25-Foxp3+ T cells were only slightly altered, the percentage of CD4+CD25+Foxp3- T cells among CD4+ T cells was significantly lower during the subacute afebrile phase than during the acute febrile phase (2.96%+/-1.95% vs. 5.64%+/-5.69%, P=0.036). Consequently, the ratio of CD25highFoxp3+ T cells to CD25+Foxp3- T cells was higher during the subacute afebrile phase than during the acute febrile phase (0.45%+/-0.57% vs. 0.13%+/-0.13%, P=0.038). CONCLUSION: Decreased CD4+CD25highFoxp3+ T cells and/or an imbalanced ratio of CD4+CD25highFoxp3+ T cells to CD4+CD25+Foxp3- T cells might play a role in KD development. Considering that all KD patients were treated with intravenous immunoglobulin (IVIG), recovery of CD4+CD25highFoxp3+ T cells during the subacute afebrile phase could be a mechanism of IVIG.
Flow Cytometry ; Humans ; Immunoglobulins ; Immunoglobulins, Intravenous ; Mucocutaneous Lymph Node Syndrome ; T-Lymphocytes