An innovative and less invasive management of recurrent pyogenic granuloma in the esthetic zone: A case report with 18-month follow-up.
J Indian Soc Periodontol. 2017 May-Jun;21(3):241-244
Authors: Tiwari S, Neelakanti A, Sathyanarayana S
Pyogenic granuloma (PG) is a nonneoplastic, tumor-like growth commonly seen in the oral mucosa or skin. Although nonpathological, its existence might lead to complications such as secondary infections or diastema formation. Hence, surgical removal of the growth seems mandatory. Histopathologic and radiographic evaluation is essential for accurate diagnosis and to rule out malignancy. A 28-year-old systemically healthy female patient reported with a swelling which involved the interdental space of maxillary left central and lateral incisors. The lesion initially developed as a "pimple-like" swelling and gradually increased in size over 2 years. It was managed in a novel method by reflecting a papilla preservation flap, excising the lesion from inside the flap till healthy tissue was visible, and then exposing to diode laser to prevent recurrence. Subsequent histopathologic examination confirmed the diagnosis of PG. This novel, less invasive esthetic procedure employed a papilla preservation flap and laser irradiation technique. This simple modification not only helped in healing by primary intention and producing a good esthetic outcome but also showed no recurrence till date.
PMID: 29440794 [PubMed]
Wool-derived keratin dressings versus usual care dressings for treatment of slow-healing venous leg ulceration: study protocol for a randomised controlled trial (Keratin4VLU).
BMJ Open. 2018 02 13;8(2):e020319
Authors: Jull A, Wadham A, Bullen C, Parag V, Waters J
INTRODUCTION: Keratins, filament-forming proteins found in vertebrate epithelium, are downregulated in slow-healing venous leg ulcers (VLU) compared with normal-healing VLU. Laboratory and animal model research has suggested exogenous keratins increase expression of endogenous keratins. A non-randomised controlled trial of an exogenous keratin dressing reported increased healing in slow-healing VLU. To date, no randomised controlled trial has been done to verify these promising findings.
METHODS AND ANALYSIS: The Keratin4VLU trial is a single-blind, pragmatic, parallel group, randomised controlled trial of keratin dressings compared with usual care non-medicated dressings in patients with VLU where either (1) the ulcer area is greater than 5 cm2, (2) the ulcer has been present for more than 26 weeks or (3) both. All patients will receive compression therapy. The primary outcome is the proportion of patients with healed VLU at 24 weeks after randomisation as adjudicated by blinded review of an ulcer photograph. Secondary outcomes are time to healing, estimated change in ulcer area, change in health-related quality of life, agreement between blinded and unblinded assessors and adverse events. The analysis will be intention-to-treat on the primary and secondary outcomes (excepting health-related quality of life).
ETHICS AND DISSEMINATION: The Keratin4VLU trial received ethical approval from the Northern A Health and Disability Ethics Committee. We plan to publish the results within 1 year of trial completion and will include the results on the trial registration page.
TRIAL REGISTRATION NUMBER: NCT02896725; Pre-results.
PMID: 29440219 [PubMed - in process]
Ulcerated Basal Cell Carcinomas Masquerading as Venous Leg Ulcers.
Adv Skin Wound Care. 2018 Mar;31(3):130-134
Authors: Tchanque-Fossuo CN, Millsop JW, Johnson MA, Dahle SE, Isseroff RR
BACKGROUND: Nonmelanoma skin cancers rarely arise from venous leg ulcers (VLUs). Although basal cell carcinoma (BCC) is the most common nonmelanoma skin cancer, its association with lower-extremity ulcers is not as frequently reported as other malignancies.
OBJECTIVE: To report a case series of biopsy-proven BCC from lower-extremity ulcers of patients who presented at a multispecialty wound clinic.
METHODS: Four male patients (mean age, 82.75 years) with 4 chronic VLUs (duration ranging from 2 months to 10 years) underwent a biopsy of their ulcerative lesions.
RESULTS: Histologic examination of the specimens revealed 4 cases of BCC. All of the lesions were surgically excised, followed by split-thickness skin graft (n = 2) or healing by secondary intention (n = 2). All of the patients remained healed at follow-up ranging from 15 to 27 months, except for 1 patient who opted for conservative management and had not completely healed at 14 months' follow-up.
CONCLUSIONS: Biopsies are warranted for any VLU with documented stalled healing following 3 months of standard of care. One biopsy is performed at the periphery of the ulcer and another at the base in order to rule out the presence of malignant transformation because of BCC, squamous cell carcinoma, sarcoma, melanoma, lymphoma, or metastases.
PMID: 29438147 [PubMed - in process]
Loteprednol etabonate for inflammatory conditions of the anterior segment of the eye: Twenty years of clinical experience with a retrometabolically designed corticosteroid.
Expert Opin Pharmacother. 2018 Feb 10;:
Authors: Comstock TL, Sheppard JD
INTRODUCTION: Topical corticosteroids are an important pharmacotherapy for the management of various inflammatory conditions affecting the anterior segment of the eye. However, medications in this class are associated with well-known risks including increased intraocular pressure (IOP) and development of cataracts. The topical corticosteroid loteprednol etabonate (LE) was developed with the specific intention of minimizing these side effects. Areas Covered: The focus of this review is to examine published efficacy and safety data for LE, a drug engineered to undergo rapid metabolism to inactive metabolites with the goal of improved safety. Two decades of clinical research focused on LE formulations are reviewed, including the use of LE in combination with tobramycin. The cumulative body of experience affirms the concept that the molecular design of LE confers certain safety benefits without compromising the desired anti-inflammatory efficacy of a topical corticosteroid. Expert opinion: Loteprednol etabonate is a mainstay for topical therapy of a wide variety of commonplace and niche conditions of the ocular surface and the anterior segment, including in the healing post-operative patient. Its versatility and safety allow eye care providers to recommend both acute induction as well as chronic maintenance therapy with appropriate follow-up.
PMID: 29430976 [PubMed - as supplied by publisher]
Dystrophic calcinosis cutis within burns, successfully treated with excision and secondary intention wound healing.
Clin Exp Dermatol. 2018 Feb 12;:
Authors: Lockwood KA, Oliphant T
PMID: 29430689 [PubMed - as supplied by publisher]
Definitive Wound Closure Techniques in Fournier's Gangrene.
Am Surg. 2018 Jan 01;84(1):86-92
Authors: Lauerman M, Kolesnik O, Park H, Buchanan LS, Chiu W, Tesoriero RB, Stein D, Scalea T, Henry S
Necrotizing soft tissue infection of the perineum, or Fournier's gangrene (FG), is a morbid and mortal diagnosis. Despite the severity of FG, the optimal definitive wound closure strategy is unknown, as are long-term wound outcomes. A retrospective review was performed over a 3-year period at a single trauma center. Patients were managed according to our institutional approach focusing on primary wound closure and secondary intention healing in residual wounds. Overall 168 patients were included. Complete primary wound closure was accomplished in 39.9 per cent of patients. Patients undergoing primary wound closure were primarily male (89.6 vs 64.4%, P < 0.001), had lower mean sequential organ failure assessment (SOFA) scores (1.70 ± 2.30 vs 2.98 ± 3.36, P = 0.004), more often had perineum-limited FG (67.2 vs 42.6%, P = 0.003), and required fewer debridements (2.40 vs 2.79, P = 0.02). On logistic regression, predictors of primary closure included gender (odds ratio 4.643, 95% confidence interval 1.885-11.437, P = 0.001) and SOFA score (odds ratio 0.834, 95% confidence interval 0.727-0.957, P = 0.01). Wound healing rates increased over time, to an 82.1 per cent wound healing rate without further intervention at greater than six months of follow-up. Wounds healed with secondary intention ranged from 70 to 9520 cm3 and primary closure ranged from 126 to 6912 cm3, whereas wounds requiring skin grafts ranged from 405 to 16,170 cm3. Complete primary wound closure is often achievable in FG patients. Using this standardized approach to FG wound management, even large wounds and wounds undergoing secondary intention healing will often close with long-term wound care and do not require flap creation or early skin grafting.
PMID: 29428033 [PubMed - in process]