The global prevalence and incidence of autoimmune diseases are increasing year by year, and the autoimmune diseases have become a major threat to public health. In the progression of the diseases, persistent and complex abnormal immune responses often lead to long-term unhealed skin ulcers, which not only affect the life quality of patients, but also lead to the aggravation of primary diseases. Therefore, doctors in burn surgery and other wound repair surgeries should pay attention to the understanding of autoimmune diseases. In the treatment of autoimmune disease-related ulcers, it is recommended to formulate a unified treatment plan according to the law of occurrence and development of the diseases, and multidisciplinary cooperation is needed to accelerate wound healing and improve the quality of wound healing.
Autoimmune Diseases/therapy* ; Humans ; Quality of Life ; Skin Ulcer/therapy* ; Ulcer ; Wound Healing

Based on the characteristics of clinical symptoms of chronic skin ulcers in traditional Chinese and Western medicine, the current animal models of skin ulcers are summarized. This article analyzes the advantages and disadvantages of animal models according to the etiology and pathogenesis of chronic skin ulcers, traditional Chinese and Western medicine diagnostic criteria and observation indicators, and eva-luates the agreement between the existing animal models and the characteristics of clinical syndromes of traditional Chinese and Western medicine for chronic skin ulcers. Through analysis and comparison, it is found that most of the existing modeling methods are single-factor animal models, and there are certain gaps in the physiological and pathological characteristics of chronic skin ulcers caused by clinical multi-factors and interactions. Most of the modeling methods are guided by Western medicine. The lack of pathogenic factors of traditional Chinese medicine(TCM) in the process of modeling. Therefore, this article proposes to establish a reasonable quantification standard for chronic skin ulcer animal models, and to establish a combination model of chronic skin ulcer disease with traditional Chinese and Western medicine as the focus of future animal model research.
Animals ; China ; Drugs, Chinese Herbal ; Medicine ; Medicine, Chinese Traditional ; Skin Ulcer/drug therapy* ; Syndrome

It is difficult to differentiate acute skin failure (ASF) from pressure ulcer (PU). ASF is defined as unavoidable injury resulting from hypoperfusion caused by severe dysfunction of another organ system. We describe a case of ASF mistaken as PU that resulted in a legal dispute. A 74-year-old male patient was admitted to our intensive care unit with sepsis due to bacterial pneumonia. Despite the use of air cushions and regular position changes, skin ulcerations occurred over his occiput, back, buttock, elbow, and ankle. After improvement in his general condition, he was transferred to the department of plastic and reconstructive surgery. Debridement was performed immediately, followed by conservative treatment (including a vacuum-assisted closure device) for 6 weeks. The buttock and occiput wounds were treated surgically. Despite complete healing, his caregivers sued the hospital for failing to prevent PU formation. ASF is a pressure-related injury resulting from hemodynamic instability due to organ system failure. Unlike PU, ASF may occur despite the implementation of all appropriate preventive measures. Furthermore, misdiagnosis of ASF as PU can lead to litigation. Therefore, it is critical for the proper diagnosis to be made quickly, and for physicians to explain that ASF occurs despite proper preventative treatment.
Aged ; Ankle ; Buttocks ; Caregivers ; Debridement ; Diagnosis ; Diagnostic Errors ; Dissent and Disputes ; Elbow ; Hemodynamics ; Humans ; Intensive Care Units ; Jurisprudence ; Male ; Necrosis ; Negative-Pressure Wound Therapy ; Plastics ; Pneumonia, Bacterial ; Pressure Ulcer ; Sepsis ; Skin Ulcer ; Skin ; Wounds and Injuries

Postburn scar contracture for ankle is commonly treated with contracture release procedure and skin graft but contracture recurrence rate is high. Contracture in grafted skin is inversely related to the graft thickness but full-thickness skin graft is limited in large defect coverage. Using ADM for ankle joint defect which was following ankle postburn scar contracture release procedure with grafting split-thickness skin may be an alternative reconstructive option. We present a 63-year-old man with postburn scar contracture and Marjolin ulcer on his left ankle. He originally had limited ankle movement function but surgical resection of skin malignancy and surrounding scar tissue released the ankle. Coverage using ADM and STSG was performed and NPWT was used for graft fixation. Ankle range of motion was satisfactory at postoperative follow-up. The ADM and STSG with NPWT could be considered an alternative reconstruction option after contracture release for ankle.
Acellular Dermis* ; Ankle ; Ankle Joint ; Cicatrix* ; Contracture* ; Follow-Up Studies ; Humans ; Middle Aged ; Negative-Pressure Wound Therapy* ; Range of Motion, Articular ; Recurrence ; Skin Transplantation ; Skin* ; Transplants* ; Ulcer

Raynaud syndrome is a medical condition that causes pain, numbness, and changes in skin color at the distal extremities. Raynaud syndrome can be subdivided into primary Raynaud's and secondary Raynaud's. The former is diagnosed when the cause is unknown and the latter is caused by an underlying condition, such as connective tissue diseases, injury, smoking, or certain medications. Both cancer chemotherapy and β-blockers are relatively common causes of Raynaud syndrome but there are no reports of its association with methimazole administration. The authors encountered a 43-year old woman with hyperthyroidism who developed digital ulcers associated with Raynaud syndrome after a methimazole treatment. Her digital ulcers and Raynaud syndrome were improved after methimazole was replaced with propylthiouracil and conventional therapy. This paper reports this case along with a review of the relevant literature.
Connective Tissue Diseases ; Drug Therapy ; Extremities ; Female ; Humans ; Hyperthyroidism ; Hypesthesia ; Methimazole* ; Propylthiouracil ; Skin Pigmentation ; Smoke ; Smoking ; Ulcer

Ozone was discovered in the mid-nineteenth century and is proven to have many therapeutic effects, including its common application as a disinfectant to kill microorganisms in various conditions. Ozone therapies have been utilized for various purposes ever since it was discovered. Extensive studies over a century have verified its therapeutic effects, consistency, and safety with minimal and preventable side effects in medical care. Emerging evidence revealed that ozone also plays important roles in the management and prevention of various skin disorders including infectious skin diseases, skin related allergic diseases, erythema scaly diseases, wound healing and ulcer recovery. Herein, the author now summarizes the recent clinical applications of ozone therapy in dermatology and provide commentary on what we have learned in our practice. Our focuses are the efficacy and safety of ozone therapies as well as the application prospects of ozone on various skin disorders. In addition, the author discusses the potential mechanisms involved in ozone therapy and the efforts we should make for.
Humans ; Ozone ; therapeutic use ; Skin Diseases ; therapy ; Skin Ulcer ; therapy ; Wound Healing

To achieve early detection of HIV infection, physicians must be aware of symptoms related to HIV infection. Dermatologists, in particular, can play an important role, because more than 90% of patients infected with HIV will develop at least one type of dermatologic disorder, which may be the first indicator of the existence of infection. A 26-year-old male presented with a one-year history of intractable pruritus associated with multiple excoriations and small ulcers. Initially, his condition clinically resembled adult atopic dermatitis. However, no improvement was observed despite treatment including narrowband ultraviolet B (UVB), antihistamine, and topical and systemic corticosteroid. After a week, the patient developed seizures and was diagnosed with diffuse large B-cell lymphoma of the brain. HIV testing was performed, and the patient was revealed to be HIV-positive. He began highly active antiretroviral therapy (HAART), and the pruritus and skin condition improved dramatically. Herein, we report a case of HIV infection for which the presenting sign was intractable pruritus.
Adult ; Antiretroviral Therapy, Highly Active ; Brain ; Dermatitis, Atopic ; HIV Infections* ; HIV* ; Humans ; Lymphoma, B-Cell ; Male ; Pruritus* ; Seizures ; Skin ; Ulcer

PURPOSE: Negative pressure wound therapy (NPWT) is an adjunct therapy using negative pressure to remove fluid from open wounds through a sealed dressing and a specialized tubing that is connected to a collection container. NPWT is suitable for acute and chronic wound condition because it was designed to accelerate granulation formation on deep wound. Therefore, we performed this study to assess the effectiveness of NPWT for various wound condition in burn center. METHODS: We enrolled 17 patients who were treated with NPWT from January 2014 to April 2016. We analyzed the characteristics and outcomes of the patients through retrospectively. RESULTS: Among 17 patients, there were 13 patients for contact burn, 2 patients for electrical injury, 1 patient for diabetic foot ulcer and 1 patient for Flame burn. Most of the contact burn victims were injured by the exposure of relatively low temperature for a long time and some of them were injured under the condition of sensory deterioration including spinal cord injury, diabetes or sedatives. Wound coverage was accomplished by split thickness skin graft (STSG) in 12 patients. Local flap was done in 1 patient. STSG with local flap was done in 3 patients. And there were 1 patient who got a conservative management. The duration of NPWT application was from 8 days to 101 days (average 36.2 days). CONCLUSION: NPWT showed good clinical outcomes under various wound condition. Therefore, we think that it can be a new treatment paradigm for difficult wound management in burn center.
Bandages ; Burn Units* ; Burns* ; Diabetic Foot ; Humans ; Hypnotics and Sedatives ; Negative-Pressure Wound Therapy* ; Retrospective Studies ; Skin ; Spinal Cord Injuries ; Transplants ; Ulcer ; Wound Healing ; Wounds and Injuries

OBJECTIVETo discuss the efficacy of the myogenic elephant skin cream combining with VSD for treating severe bedsores.

METHODSTwenty-nine cases of III and IV degree bedsores were treated from June 2009 to June 2013. Among them, 15 cases were treated by myogenic elephant skin cream combined with VSD (VSD group) including 7 males and 8 females with an average age of (69.0±5.3) years old ranging from 17 to 96 years;other 14 cases were treated by the treatment of conventional dressing change (control group) including 6 males and 8 females with an average age of (71.0±4.2) years old ranging from 40 to 86 years. At 7, 14, 21, 28 d after treatments, specimens of wound two groups were respectively taken to examine immunohistochemical CD34 adopted SABC, the number of wild vascular cross were observed as capillary density value under high magnification microscope. It was used to assess the hyperplasia of granulation tissue of wound. The capillary density value and the visual wound observation were indicators for evaluation of clinical efficacy.

RESULTSSeventeen of 19 cases got complete data of specimens of wound at 7, 14, 21, 28 d,included 9 cases of VSD group,8 of control group. In the microscope view, the capillary density of VSD group was higher than that of control group significantly (P<0.05), it showed the application of VSD technology improved hyperplasia of granulation tissue much faster than conventional dressing change. In VSD group, 13 cases with 15 wounds healed, 2 cases with 3 wounds improved; in control group,3 cases with 3 wounds healed,7 cases with 9 wounds improved, 4 cases with 5 wounds were unhealed.

CONCLUSIONUsing the VSD technology with continuous high pressure suction to clean the drainage of wound and lacuna thoroughly can effectively control infection,promote the growth of granulation tissue, and then applying myogenic elephant skin cream to improve partial blood supply while prompting rapid growth of new granulation tissue and epithelial cell. The risk of this treatment is low,and the course of treatment is short, this provides a safe and effective method for treating bedsores.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Drainage ; methods ; Female ; Humans ; Male ; Middle Aged ; Pressure Ulcer ; therapy ; Skin Cream ; therapeutic use

OBJECTIVETo study the application of VSD in the treatment of severe necrotizing fasciitis in extremities of patients.

METHODSEight patients, suffering from severe necrotizing fasciitis, who had been traditionally treated with iodophor-soaked gauze for 21 to 365 days in other hospitals, were transferred to our institute because of the nonhealing wounds and systemic toxic symptoms induced by infection, from January 2011 to August 2013. After admission, surgical debridement was performed timely, and the necrotic tissue was collected during the operation for pathological observation after HE staining. After the operation, VSD was started with negative pressure ranging from -100 to -80 kPa, and the furacilin solution (0.2 g/L) and oxygen (2 L/min) were continuously infused into the wound during the treatment. Surgical debridement was performed repeatedly according to the wound condition followed by change of VSD dressings to continue VSD treatment. The wounds were closed by suturing or with autologous skin grafts after being covered by fresh granulation tissue. The times of surgical debridement, times of change of VSD materials, wound healing status, and length of stay in our institute were recorded. All patients were followed up for a long time. Results HE staining showed that there were diffuse necrotic adipose and fibrous connective tissues in the necrotic tissue, and the normal tissue structure disappeared accompanied by significant infiltration of inflammatory cells. The number of surgical debridement was 2 to 10 (3.9 +/- 2.8) times. The number of VSD materials change was 2 to 10 (4.0 +/- 2.9) times. Wounds were closed by suturing and healed in two patients; wounds in the other six patients were partially sutured, their residual wounds were healed by autologous skin grafting. The length of stay in our institute was 20 to 49 (33 +/- 10) days. All patients were discharged after recovery. Patients were followed up for 2 to 24 months, and their wounds were found to be in good condition without ulceration or recurrence.

CONCLUSIONSVSD can effectively remove the necrotic tissues and exudates from the fascial spaces and promote proliferation of granulation tissue. Therefore it serves as an effective approach to the treatment of severe necrotizing fasciitis in extremities.

Debridement ; Drainage ; Extremities ; surgery ; Fasciitis, Necrotizing ; surgery ; Granulation Tissue ; Humans ; Negative-Pressure Wound Therapy ; Oxygen ; Pressure ; Skin ; Skin Transplantation ; Ulcer ; Vacuum