Humans ; Ulcer/pathology* ; Herpesvirus 4, Human ; Epstein-Barr Virus Infections ; Skin Diseases

Humans ; Ulcer/pathology* ; Herpesvirus 4, Human ; Epstein-Barr Virus Infections ; Skin Diseases

Hepatocyte growth factor (HGF) is a multifunctional cytokine that is related to many diseases. HGF mainly contributes to cell migration,proliferation,and survival and regulates vascular angiogenesis,matrix deposition,and degradation of wound healing. HGF also promotes wound reepithelialization and reduces scar formation. This review article summarizes the role of HGF in wound repair and the relationship between HGF and other growth factors,especially when applied for the clinical treatment of chronic skin ulcers.
Cell Movement ; Cell Proliferation ; Hepatocyte Growth Factor ; physiology ; Humans ; Skin Ulcer ; pathology ; Wound Healing

OBJECTIVETo analyze the etiology and clinical characteristics of Marjolin's ulcer, and to explore its prevention and treatment.

METHODSMedical records of 187 patients with Marjolin's ulcers admitted to the Department of Burns and Reconstructive Surgery of Xiangya Hospital of Central South University from January 1998 to May 2015 were retrospectively analyzed, including gender, age of onset of initial injury or primary disease, age of onset of Marjolin's ulcer, initial injury or primary disease, length of latency, lengths of pre- and post-ulceration periods, lesion site, lesion type, lesion area, local scar tension, histopathological type, degree of carcinoma cell differentiation, bone invasion and lymphadenopathy, treatment, and prognosis. The relationships between the age of onset of initial injury or primary disease and the length of latency, and the length of pre-ulceration period and the length of post-ulceration period were assessed by Spearman correlation analysis. The recurrence rates were processed with Fisher's exact test.

RESULTS(1) Among the patients, the ratio of male to female was nearly 1.6:1.0. The age of onset of initial injury or primary disease was 0.17-78.00 (17±18) years, and the age of onset of Marjolin's ulcers was 18-84 (49±14) years. (2) The most common initial injury among the patients was flame burn. The length of latency was 0.25-74.00 (32±16) years, and the lengths of pre- and post-ulceration periods were 0-73.00 (26±19) years and 0.08-59.00 (6±11) years respectively. The common lesion sites were the lower limbs and head and face. The rodent ulcer was the most common lesion type, and the lesion area was 1-625 (69±110) cm(2). There were obviously negative correlations between the age of onset of initial injury or primary disease and the length of latency, as well as the length of pre-ulceration period and the length of post-ulceration period (with r values respectively -0.71 and -0.50, P values below 0.01). The pathological scars of strong tension around lesions were seen in 176 cases. (3) The major histopathological type was squamous cell carcinoma, with high cell differentiation in most cases. (4) Bone invasion of carcinoma cells was observed in 59 cases. Lymph node enlargement was observed in 100 cases, and lymph node metastasis was observed in 18 cases. (5) Twenty patients did not receive any surgery, while 167 patients were treated by surgery with lesion extended resection as the main method. According to the condition of wound after the lesion extended resection, the wounds were mainly repaired by skin grafting and transplantation of local skin flap. The majority of wounds in 139 patients who underwent lesion extended resection were repaired in one surgery. Twenty-eight patients out of 104 followed-up cases had recurrence after surgery, mainly seen on head and face, upper limb, lower limb, and buttock, and there was no significant difference among them (P>0.05). The recurrence time of most patients was longer than 6 months after cure.

CONCLUSIONSPatients with Marjolin's ulcers in younger age of onset of initial injury or primary disease tend to have longer latency, during which the shorter the pre-ulceration period is, the longer the post-ulceration period will be. Marjolin's ulcers are prone to occur in scar sites with large tension. Early treatment of high tension scar and scar ulcer is important in prevention, and surgery is the optimal treatment for Marjolin's ulcers. Regular follow-up should be carried out owning to recurrence rate in certain degree after surgery.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Burns ; pathology ; Carcinoma, Squamous Cell ; pathology ; surgery ; Child ; Child, Preschool ; Cicatrix ; pathology ; Face ; pathology ; Female ; Humans ; Infant ; Lower Extremity ; pathology ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Skin Neoplasms ; pathology ; surgery ; Skin Transplantation ; Skin Ulcer ; pathology ; surgery ; Surgical Flaps ; Young Adult

PURPOSE: This study was done to develop an evidence-based incontinence care protocol through an adaptation process and to evaluate the effects of the protocol. METHODS: The protocol was developed according to the guideline of adaptation. A non-randomized controlled trial was used for testing the effects of the new Incontinence Care Protocol. A total of 120 patients having bowel incontinence with Bristol stool type 5, 6, and 7 and admitted to intensive care units were recruited to this study. The newly developed incontinence care protocol was used with patients in the experimental group and conventional skin care was given to patients in the control group. Outcome variables were incontinence-associated dermatitis (IAD) severity, pressure ulcer occurrence and severity. RESULTS: The experimental group had significantly less severe IAD (t=6.69, p<.001), lower occurrence of pressure ulcers (chi2=7.35, p=.007), and less severity of pressure ulcers (Mann-Whitney=86.00, p=.009) than the control group. CONCLUSION: Use of this incontinence care protocol has the effects of preventing pressure ulcers and inhibiting worsening of IAD and pressure ulcers. Therefore, this incontinence care protocol is expected to contribute to managing IAD and pressure ulcers.
Aged ; Aged, 80 and over ; Dermatitis/pathology ; Evidence-Based Nursing/*standards ; Fecal Incontinence/pathology/*prevention & control ; Female ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Pressure Ulcer/epidemiology/pathology ; Program Development ; *Program Evaluation ; Severity of Illness Index ; Skin Care ; Urinary Incontinence/pathology/*prevention & control

Marjolin's ulcer is a rare malignancy arising from various forms of scars, mainly an old scar resulted from burn. The second most common origin is malignant degeneration arising from tissue within osteomyelitis fistulae. Not uncommonly, the lesions may arise secondary to ulcers due to venous insufficiency or pressure sores. The pathology of the majority of Marjolin's ulcer is a well-differentiated squamous cell carcinoma. The exact reason for an ulcer which undergoes a malignant transformation is unknown. The pathologic diagnosis is the gold standard. Surgery remains the preferred treatment after diagnosis is reached. Wide surgical excision with margins up to 2-3 cm has been suggested. The necessity of whether lymphatic dissection should be executed, or radiotherapy and chemotherapy following surgery is still in dispute. This article deals with the etiology of Marjolin's ulcer and its pathological grading, diagnosis, treatment, prognosis, and prevention, with a hope to provide some useful clinical information.
Burns ; complications ; Carcinoma, Squamous Cell ; etiology ; pathology ; surgery ; Cicatrix ; Humans ; Lymphatic Vessels ; Pressure Ulcer ; pathology ; surgery ; Prognosis ; Skin Neoplasms ; etiology ; pathology ; surgery ; Skin Ulcer

OBJECTIVETo investigate the clinical manifestation, diagnosis, and treatment of patients with Marjolin's ulcers.

METHODSThe clinical materials of 21 patients with Marjolin's ulcers hospitalized from January 2007 to January 2013 were retrospectively analyzed, including age, gender, injury causes, duration time of primary disease in developing Marjolin's ulcer, duration of ulcer, lesion site, ulcer area, symptoms and signs of ulcer region, bacterial culture results before operation, histopathological type, grade of carcinoma cell differentiation, depth of invasion, treatment, and outcome.

RESULTS(1) The age of 21 patients at the time of diagnosis of Marjolin's ulcers was 19-74 (47 ± 13) years, and the ratio of male to female was nearly 0.9:1.0. (2) The main primary lesions were flame burns and high temperature liquid scald, respectively occurred in 12 cases (57.1%) and 7 cases (33.3%). The time for development of Marjolin's ulcers from primary injury was 10-56 (40 ± 14) years. (3) Ulceration on top of scar lasted for longer than one year in 12 patients (57.1%). (4) Lesion site was mainly located in the limbs in 13 patients (61.9%), and on head and face in 6 patients (28.6%), respectively. (5) Ulcer area ranged 0.25-74.25 (39 ± 25) cm(2). Foul excretion, bleeding, intensified pain, and gradual enlargement of ulceration were observed in the lesion of most patients. (6) Bacterial culture of wound excretion before operation showed positive results in 16 patients (76.2%).

RESULTSof bacterial culture of blood were negative in all patients. (7) Pathological examination revealed squamous cell carcinoma in 20 cases and basal cell carcinoma in 1 case, and mostly of high or medium differentiation. Cancer cells in nearly 40% patients had invaded the subcutaneous tissue or deeper area. (8) All patients were treated by surgery, among them autologous skin grafting was done after excision of lesion in 11 patients, and in 5 patients the defects were closed with skin flaps after excision of lesion, and in 5 patients limbs harboring the lesion were amputated. Twelve patients (57.1%) received postoperative rehabilitation treatment. Two patients with pulmonary metastasis received chemotherapy. (9) Most of the flaps and skin grafts survived well after surgery, and a few cases with failure of skin grafting or transplantation of flaps underwent skin grafts again. Patients were followed up for 6 months to 5 years, in 4 patients recurrence occurred after surgery, and 2 of them died. The other patients survived without recurrence.

CONCLUSIONSSquamous cell carcinoma was the most common pathological type of Marjolin's ulcer admitted to our unit. A recurrent ulcer with long course should be considered as Marjolin's ulcer, and it should be scrutinized pathologically. Currently, surgery remains the optimal treatment for Marjolin's ulcer. Regular follow-up should be carried out after resection of the lesion to detect carcinoma recurrence and metastasis.

Burns ; complications ; Carcinoma, Squamous Cell ; etiology ; pathology ; surgery ; Cicatrix ; Female ; Humans ; Male ; Retrospective Studies ; Skin Neoplasms ; etiology ; pathology ; surgery ; Skin Transplantation ; Skin Ulcer ; etiology ; pathology ; surgery ; Surgical Flaps ; Treatment Outcome

Normal wound healing is a well-orchestrated process of inflammatory response, cell proliferation, and tissue remodeling. However, this orderly and precise process is impaired in chronic wounds. A series of complicated pathogenic factors, including enhanced inflammatory response, poor cell proliferation, restrained angiogenesis, restricted collagen deposition, and infection, contribute to the failure of healing of chronic wound. The application of platelet-rich plasma (PRP) has been explored as a treatment for chronic wounds as it can balance wound microenvironment for promoting wound healing. PRP can modulate the inflammatory mediators, growth factors, and cytokines, etc. to correct abnormal biological events and disorderly molecular environment of cell migration and proliferation, and thus promote wound healing appropriately. Yet, the mechanism of PRP in promoting healing of chronic wound is still not elaborated, and the clinical application of PRP needs to be standardized as soon as possible.
Cell Movement ; Cell Proliferation ; Chronic Disease ; Collagen ; Humans ; Platelet-Rich Plasma ; Severity of Illness Index ; Skin Ulcer ; metabolism ; pathology ; therapy ; Wound Healing ; physiology

OBJECTIVETo study the effect of Shengji Huayu Recipe (SHR)on the expression of MMP-3 and TIMP-1 in the skin ulcer tissue of diabetic rats.

METHODSThe skin ulcer model was established in diabetic mice. Different compatibility proportions of SHR [the ratio of Shengji Recipe (SJR) to Huayu Recipe (HYR) = 2:1, 1:1, and 1:2, respectively] were used to intervene. The expression of MMP-3 protein in the skin ulcer of diabetic rats was detected by Western blot method,and TIMP-1 protein was detected by immunohistochemical assay.

RESULTSAt each time point, there was no statistical difference in the blood glucose level among groups (P > 0.05). But all of them increased significantly,when compared with those of the normal wound group (P < 0.01). As for the difference between after would area treatment and before would area treatment, better effect was obtained in the SHR No. 3 group and the normal ulcer group than in the diabetic ulcer model group (P < 0.05). Results of Western blot showed that the MMP-3 protein expression was higher in the SHR No. 2 group than in the SHR No.3 group (P < 0.05). Immunohistochemical results showed that TIMP-1 protein expression was lower in the SHR No. 2 group than in the SHR No. 3 group and the diabetic ulcer model group (P < 0.05). TIMP-1 protein expression was higherin the SHR No. 3 group than in the SHR No. 2 group (P < 0.01).

CONCLUSIONUsing SHR No.3 was conducive to the promotion of wound healing in early wound repair stage, and using SHR No. 2 might be conducive to inhibiting the formation of pathological scar.

Animals ; Diabetes Mellitus, Experimental ; metabolism ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Male ; Matrix Metalloproteinase 3 ; metabolism ; Phytotherapy ; Rats ; Rats, Sprague-Dawley ; Skin ; drug effects ; pathology ; Skin Ulcer ; drug therapy ; metabolism ; Tissue Inhibitor of Metalloproteinase-1 ; metabolism

OBJECTIVETo study the role and mechanism of the Yi medicine, Yi Bu A Jie () extract, in topical treatment of diabetic skin ulcers, with a view to finding a breakthrough natural drug for the prevention and treatment of diabetic skin ulcers.

METHODSA model of diabetic skin ulcers in Kunming mice was developed. Yi Bu A Jie was extracted in a Soxhlet extractor. Two different concentrations of the extract (0.005 mg/mL and 0.01 mg/mL) were applied to the wound of diabetic skin ulcers once every 3 days, and local skin appearance and histopathological changes were observed.

RESULTSThe shortest healing time was 25.25±2.06 day with a low concentration (P=0.0037 compared with the high concentration group, 33.14±2.21 day; P=0.0082 compared with control group, 28.21±2.14 days). The longest healing time was in the high concentration group (P=0.0025 compared with the control group). In both groups, a large number of inflammatory neutrophil cells were exuded during the experimental period. In the low concentration group, capillary-rich granulation tissue and actively growing fibroblasts appeared in the wound, while there was much necrotic tissue in the high concentration group.

CONCLUSIONYi Bu A Jie extract has an inhibitory effect on diabetic skin ulcers in mice, and the low concentration is more suitable.

Administration, Topical ; Animals ; Diabetes Complications ; drug therapy ; pathology ; Drugs, Chinese Herbal ; administration & dosage ; pharmacology ; therapeutic use ; Mice ; Pharmaceutical Preparations ; administration & dosage ; Skin Ulcer ; drug therapy ; pathology ; Time Factors ; Tissue Extracts ; administration & dosage ; pharmacology ; therapeutic use ; Wound Healing ; drug effects