Repair effects of varying degrees of iatrogenic penis skin necrosis / 中华医学美学美容杂志

Objective:To investigate the repair method and curative effect of iatrogenic penis skin necrosis of varying degrees.Methods:From June 2016 to December 2018, a total of 20 patients with varying degrees of iatrogenic penis skin necrosis were treated in our center. According to the area of the necrotic skin of penis, different treatment methods were selected: 2 patients with change dressing; 9 patients with relaxation suture; 7 patients with scrotal skin flap based on one side anterior scrotal artery; 2 patients with penile embedded in scrotum and secondary repair.Results:All patients were cured, there was no infection and flap necrosis. All of the patients were satisfied with the appearance of the penis, the flaps of anterior scrotal artery flap and scrotal pedicle embedding the penis survived well and the penis erectile function was not affected during the follow-up for 6 to 12 months.Conclusions:For patients of varying degrees of iatrogenic penis skin necrosis, individualized treatment should be adopted, which can effectively repair the penile defects and achieve satisfactory effect.

Repair experience of skin necrosis after penile thickening with acellular dermal matrix patch / 中华泌尿外科杂志

A serious complication of penile girth enhancement with acellular dermal matrix(ADM) patch is large area penile skin necrosis. Since the penile skin has characteristics such as thin, elasticity, pliability, and durability to withstand erection and friction, the repair surgery is often difficult to achieve good results. Furthermore, the implantation of ADM patch increases the difficulty of surgery. From March 2014 to August 2019, a total of 13 patients with skin necrosis after penile girth enhancement with ADM patch were treated in our center.The debridement and change dressing, according to the condition of the necrotic skin of penis, were performed in all patients. 7 patients used the repairing method of scrotal skin flap via one side scrotal artery, 6 patients used the repairing method of full thickness skin graft. The penile function was not affected with 6 to 12 months′ follow-up after surgery and the curative effect was satisfactory.

Simple external skin expansion technique in treatment of skin necrosis defect after the surgery for Pilon fracture / 天津医药

Objective To evaluate the clinical effects of simple external skin expansion technique in treatment of skin necrosis defect after the surgery for Pilon fracture.Methods Data of 12 patients with skin necrosis defect after the surgery for Pilon fracture treated with simple external skin expansion technique in our hospital from May 2015 to January 2017 were retrospectively analyzed.There were 10 males and 2 females in the 12 patients with age 32-58 years old(average 45.30± 8.91 years old).There were 4 cases with open fractures and 8 cases with closed fractures.The defect area was about 9.1 cm long and 3.9 cm wide.There were 3 cases with skin necrosis of open fractures and 9 cases with postoperative skin necrosis of incision site. After completely debridement and removing infection from the skin necrosis areas, kirschner needle wired intermittented through the skin,the kirschner wire was around a sterile silicone rubber tube at both ends and the kirschner wire was connected to the both ends of the Kirschner on the opposite side.After giving moderate tensile force,which showed that the skin on both sides was still bleeding,no obvious pale color on skin,two ends of rubber tube were fixed with forceps. Using the ductility of skin and the tensile force of sterile silicone rubber tube to gradually extend the skin and to gradually narrow and close the suturing wound.All patients were followed up for 3-6 months to observe the effect of surgery.Results All of the 12 cases were healed in 2-4 weeks,average(2.50±0.59)weeks.The patients were sutured directly after simple external skin expansion,and 4 patients were sutured with the surface of the external plate or tendon,and parts of wound were delayed healed after the re-suture.The skin color,lustre,hair growth and elasticity were normal,no bloated,and tenderness was normal after simple external skin expansion.Conclusion The simple external skin expansion technique in treatment of skin necrosis defect after the surgery for Pilon fracture is a simple,effective and economic method,which is worthy of clinical promotion.

Calcifilaxis / Calciphylaxis

La calcifilaxis es una vasculopatía caracterizada por isquemia y necrosis cutánea dolorosa debida a calcificación, fibroplastia de la íntima y trombosis de las arteriolas paniculares. Compromete más frecuentemente a pacientes con insuficiencia renal crónica terminal y tiene muy elevada mortalidad. La biopsia de las lesiones cutáneas se utiliza como método diagnóstico. No se han registrado hallazgos específicos de laboratorio. Las lesiones cutáneas generalmente comienzan en las extremidades a modo de moteado violáceo doloroso similar al livedo reticularis. La evolución natural es hacia úlceras y escaras. La primera línea de tratamiento consiste en el cuidado de las lesiones cutáneas y antibioticoterapia. El tiosulfato sódico se utiliza como tratamiento debido a su actividad como antioxidante y quelante. Se presentan dos casos clínicos.

Calciphylaxis is vasculopathy characterized by ischemia and painful skin necrosis due to calcification and intimal fibroplasia of thrombosis of the panicular arterioles. It most frequently compromises patients with terminal chronic renal failure and has a high mortality rate. Biopsy of skin lesions is used as a diagnostic method. No specific laboratory findings have been recorded. Skin lesions usually begin in the extremities like a painful purplish mottling similar to "livedo reticularis". The natural evolution is to ulcers and bedsores. The first line of treatment involves the care of skin lesions and antibiotic therapy. Sodium thiosulfate is used as treatment due to its antioxidant activity and as a chelating. Two clinical cases are here reported.

Anticoagulants in dermatology.

Anticoagulants are the cornerstone of treatment of venous thromboembolism associated with various medical conditions and surgical procedures. They act on different steps of the coagulation pathway and are broadly categorized into heparins, vitamin K antagonists, and inhibitors of thrombin and factor Xa. The classification is evolving as newer and better oral and parenteral anticoagulants are being added. Anticoagulants in dermatology are important not only for their therapeutic application in cutaneous thrombotic dermatoses such as livedoid vasculitis, purpura fulminans, superficial and deep venous thrombosis and others but also for their use in non‑thrombotic dermatoses such as lichen planus, recurrent oral aphthosis, chronic urticaria and several others. Further, the use of anticoagulants for any indication is associated with various adverse effects with dermatologic manifestations including specific reactions such as warfarin‑induced skin necrosis, heparin‑induced thrombocytopenia and anticoagulant‑associated cholesterol embolization syndrome.

Warfarin skin necrosis mimicking calciphylaxis in a patient with secondary hyperparathyroidism undergoing peritoneal dialysis

Warfarin skin necrosis (WSN) is an infrequent complication of warfarin treatment and is characterized by painful ulcerative skin lesions that appear a few days after the start of warfarin treatment. Calciphylaxis also appears as painful skin lesions caused by tissue injury resulting from localized ischemia caused by calcification of small- to medium-sized vessels in patients with end-stage renal disease. We report on a patient who presented with painful skin ulcers on the lower extremities after the administration of warfarin after a valve operation. Calciphylaxis was considered first because of the host factors; eventually, the skin lesions were diagnosed as WSN by biopsy. The skin lesions improved after warfarin discontinuation and short-term steroid therapy. Most patients with end-stage renal disease have some form of cardiovascular disease and some require temporary or continual warfarin treatment. It is important to differentiate between WSN and calciphylaxis in patients with painful skin lesions.

A case study:the therapeutic experience for skin necrosis caused by improper arginine infusion / 药学实践杂志

Objective To discuss the measures to prevent adverse events caused by misused hyperosmolar drugs. Methods Clinical pharmacists were involved in the treatment of one case of skin necrosis caused by hyperosmolar arginine infu-sion,analyzing the cause of the adverse events and proposing solutions and preventative measures.Results Treatment includs external application of Epson salt,debridements,infection prevention and so on were implemented.All bruises were absorbed with good wound healing.Conclusion Clinical pharmacist should play a role in examining prescriptions and ensuring drug safe-ty for patients.

Two Cases of Skin Necrosis after Canaliculodacryocystorhinostomy in Young Women

PURPOSE: To report 2 cases of skin necrosis over the medial canthus following canaliculodacryocystorhinostomy in young women diagnosed with canalicular obstruction. CASE SUMMARY: (Case 1) A 31-year-old female presented to our clinic with epiphora in the right eye that had developed 2 years prior. On examination, a right upper and lower canalicular obstruction was noted and the patient underwent canaliculodacryocystorhinostomy with silicone tube intubation. Topical 0.04% mitomycin-C eyedrops were applied twice a day from postoperative day 1 for 7 days. The patient revisited our emergency center with swelling, redness, and tenderness in the medial canthal region that developed 3 days after the initial surgery. Furthermore, a skin ulceration had developed followed by an exudative oozing with crust. (Case 2) A 23-years-old female visited our clinic with epiphora in the right eye that had developed 3 months prior. Ophthalmic examinations revealed a common canalicular obstruction in the right eye and canaliculodacryocystorhinostomy with silicone tube intubation was performed. Seven days postoperatively, the patient developed mild pain and tenderness over the right lacrimal sac and medial canthal erythema with purulent discharge was noted. Furthermore, a localized skin necrosis had developed. CONCLUSIONS: Localized skin necrosis may rarely develop after canaliculodacryocystorhinostomy in young women. If localized skin symptoms develop postoperatively, the patient should be closely monitored.

Radiation Induced Hand Necrosis of an Orthopaedic Surgeon Who Had Treated a Patient with Fluoroscopy-Guided Spine Injection / 대한정형외과학회잡지

As the frequency of radiation exposure by fluoroscopy continues to increase in orthopaedic fields, the level of hazard for the orthopaedic surgeon increases at the same time. Exposure of the clinician's hand is highest during performance of surgery or procedures within the actual clinics. Studies on radiation exposure on thyroid, eye or whole body, or reports on radiation treatment of cancer or for dermal lesions occurring from therapeutic intervention on the body such as heart and liver, and studies on radioactive damage to hands derived from radioactive material handlers have been reported; however, no studies on radioactive damage to a clinician's hand have been reported. Therefore, we report on a case of chronic radiation dermatitis and necrosis of an orthopaedic surgeon's hand as well as its soft tissue defect.

Complications from Cosmetic Procedures Performed by Non-Professionals: A Case Analysis and Review of Treatments / 대한피부과학회지

BACKGROUND: As the desire to maintain a youthful appearance escalates nationwide, the numbers of patients presenting with complications subsequent to cosmetic treatments performed by non-professionals are increasing. OBJECTIVE: The purpose of this study was to overview complications from cosmetic therapeutic attempts by non-professionals, and to discuss their management from a dermatologist's point of view. METHODS: During the period January 1st, 2011 to December 31st, 2013, a total of 24 patients who visited the Severance Hospital at Yonsei University for complications that developed after cosmetic treatments by oriental doctors, non-medical personnel, and general practitioners were enrolled in this study. Patient clinical characteristics, past history, diagnosis, biopsy results, and treatment information were collected. RESULTS: The most common complication was a granulomatous foreign body reaction (n=15, 62.5%), followed by skin necrosis (n=8, 33.3%), and misdiagnosis and malpractice by non-professionals (n=5, 20.8%). Three patients had more than 2 complications combined. Patients with granulomatous foreign body reactions were usually managed with conservative treatments or excisions, while those with skin necrosis were managed with debridement and secondary intention healing. CONCLUSION: As the number of cosmetic therapeutic attempts made by non-professionals increases, dermatologists need to understand the potential complications that can arise following these procedures, and should take an active role in managing the patients.

Cutaneous Complications of Terlipressin.

Three cases of skin changes in cirrhotic patients treated with the vasoconstrictor agent terlipressin. We identified three patients who developed skin necrosis and determined any factors, which put them at an increased risk of doing so.Two patients developed extensive skin necrosis over the abdomen & chest wall and lower limbs. The third patient had developed extensive necrosis of both lower limbs and digital gangrene.With increasing clinical use of terlipressin and an increasing incidence of obesity and non-alcoholic fatty liver disease-related cirrhosis, the incidence of these serious complications is likely to rise. Earlier recognition and treatment may lead to improved outcome.

Modified technique of radical inguinal lymphadenectomy to reduce the complication of skin necrosis for penile carcinoma / 中华泌尿外科杂志

Objective To report a modified radical inguinal lymphadenectomy the aim of which is to reduce the incidence of the complication of skin necrosis.Methods One hundred and twenty-six modified radical inguinal dissections were performed in 63 patients with penile carcinoma from June 2002 to June 2010.A modified radical inguinal dissection characterized by an S-shaped incision and precisely separating layers using an anatomical mark was performed.The boundaries of dissection were the same as classic radical inguinal lymphadenectomy.The incidences of complications of skin flap necrosis were retrospectively analyzed.Results The follow-up time ranged from 12 to 93 months.A total of 37 complications occurred,including 7 minimal skin necroses (5.6％),3 wound infections (2.4％),19 lymphedemas (15.1％),2 seroma formations (1.6％),5 lymphocele (4.0％),and 1 deep venous thrombosis (0.8％).There were no complications in 106 dissections (84.1％ ),and 20 dissections had one or two minor complications ( 15.9％ ).Conclusions The complication of skin necrosis related to groin dissection in patients with penile carcinoma could be reduced by using this modified inguinal dissection technique,which characterized by an S-shaped incision and precisely separating layers with using an anatomical landmark.

Warfarin Induced Skin Necrosis

Warfarin is widely used for the prevention of cerebral infarction, especially in patients with atrial fibrillation or artificial valve. Although hemorrhagic problems are well known, skin necrosis is a rare complication. Failures of early diagnosis or management may lead to serious results. We report a case of skin necrosis induced by warfarin therapy.

A Case of Advanced Papillary Thyroid Cancer Associated with Skin Necrosis / 대한내분비외과학회지

Although the majority of differentiated thyroid cancers show an indolent course, about 15% of the cancers invade via extra-thyroidal extension (ETE). ETE usually occurs through direct spreading to the strap muscles, the sternocleidomastoid muscle, the recurrent laryngeal nerve, the trachea, the larynx, the esophagus, the pharynx, and/or the major vessels. Direct invasion to the subcutaneous tissue and overlying skin is possible but a rare scenario. We report a 66-year-old patient with locally aggressive papillary thyroid cancer accompanied by skin necrosis. The tumor was resected completely without removal of the overlying skin.

A Case of Churg-Strauss Syndrome Showing Severe Skin Necrosis / 대한피부과학회지

Churg-Strauss syndrome is a disorder characterized by asthma, fever, systemic vasculitis, extravascular granulomas and hypereosinophilia. A 70-year-old woman with a 2-year history of bronchial asthma was admitted to hospital, due to extensive hemorrhagic bullae embedded in necrotic tissue on both extremities, the buttocks and trunk. The patient showed abnormal laboratory findings including significant peripheral blood eosinophilia and p-ANCA (+), and histopathologically leukocytoclastic vasculitits with marked eosinophlilic infiltration. Based on the clinical course, laboratory data and pathologic findings, the diagnosis of Churg-Strauss syndrome was made. Treatment with oral prednisolone was started, and the clinical findings improved.

Small incision and Absorbable suture for closed Achilles tendon rupture / 中国矫形外科杂志

[Objective]To investigate new methods of the management of closed rupture of Achilles tendon surgery to reduce postoperative skin necrosis.[Method]Small incisions and Absorbable sutures were used to manage 39 cases of closed Achilles tendon rupture,with proximal stump a Bunnell-type suture and remote stump percutaneous repair.[Result]In the 39 cases,three developed slight skin necrosis,of which two healed by changing dressings,the other one healed by debriding and sutureing.Follow-up of 10 months to 36 months was available for 35 cases.According to Arner-Lindholm efficacy evaluation standard,29 cases (82.9%) had excellent result,4(11.4%) had good result,with the good to excellent result of 94.3%.[Conclusion]Small incisions and Absorbable sutures used to manage the closed Achilles tendon rupture,with proximal stump a Bunnell-type suture and remote stump percutaneous repair is an effective and reliable methord for closed Achilles tendon repture,with small invasion,less impact on the skin blood supply,less skin necrosis,less re-rupture reinfection,and faster recovery.

Vasopressin-induced Skin Necrosis / 대한피부과학회지

Intravenous vasopressin is a commonly used modality for the control of bleeding of the esophageal varices. The ischemic cutaneous necrosis by vassopressin can be occurred at extravasated sites, or proximal to an intravenous catheter site, or at isolated pressure points. We report a case of cutaneous necrosis which occurred at intravenous catheter sites and at distant sites from direct intravenous flow during vasopressin therapy.

A case report of facial skin necrosis by traumatic hematoma

Interferon-beta Induced Skin Necrosis

Local cutaneous reactions have been reported at injection sites of interferon therapy, but these are usually erythema or rarely induration. Skin necrosis at the injection site is rare. We describe here a patient with multiple sclerosis who presented with cutaneous necrosis at the injection sites of interferon-β. Biopsy of the necrotic lesion showed dermal vessel thrombosis and complete ischemic coagulative necrosis of epidermis and dermis.

A Case of Coumarin-Induced Skin Necrosis / 대한피부과학회지

Coumarin-induced skin necrosis is a rare complication of oral administration of coumarin derivatives. Clinically, the lesions begin with well-defined purpuric patches and progress to bullae and necrosis on the trunk, buttock or female breast. Histopathologic findings show a fibrinoid degeneration or thrombus formation in the dermal blood vessels with occasional vessel rupture and hemorrhage. We report a 77-year-old man who suffered from a typical necrotic patch on his right buttock developing during the course of coumarin therapy. Our case was diagnosed as coumarin-induced skin necrosis, based on the characteristic clinical course and histopathologic findings.