Clinical and histopathologic features of acquired perforating collagenosis: A case report

@#A 51-year-old hypertensive and diabetic male patient, admitted due to acute kidney injury on top of chronic kidney disease, was referred to the dermatology service. He presented with a 3-month history of multiple discrete pruritic papules with keratotic plugs over the extensor aspects of the bilateral upper and lower extremities, initially managed as a case of scabies infestation but medications given provided no relief. Histopathologic analysis of a skin biopsy revealed findings of acquired perforating collagenosis. Resolution of lesions and pruritus were noted after starting on a topical corticosteroid ointment on the lesions, as well as hemodialysis to address the renal failure. Subsequent consults showed no recurrences and only a minor sequela of post-inflammatory hyperpigmentation.

Acquired reactive perforating collagenosis, a rare entity at uncommon site

Acquired reactive perforating collagenosis (ARPC), rare disorder characterized by transepidermal elimination (TEE) of collagen fibers, is seen in adult diabetics. Genetic predisposition, familial aggregation, trauma, bites and scratching are implicated. Diabetics develop microvascular diseases leading to intense pruritus causing repeated micro trauma leading to necrosis of connective tissue of dermis, causing TEE. Isolated papules, plaques and nodules with central keratotic plugs, are mostly seen on extensor surfaces of limbs but trunk and face may be involved. Histopathology shows extrusion of abnormal collagen fibers through epidermis. Multiple treatment modalities show variable response. A 52 year old diabetic female had multiple, itchy, well defined, erythematous papules and plaques with central adherent crusting on lower back since 1 month. Histopathology showed cup shaped epidermal depression filled with plug of altered collagen, acanthotic epidermis with hyperkeratosis and parakeratosis. Underlying epidermis was thin with fine slits through which vertically oriented basophilic collagen fibers were extruded.

Analysis of 74 Open Globe Injuries Requiring Vitreo-Retinal Intervention and Its Correlation with Ocular Trauma Score

Aim: Retrospective study of 74 eyes with open globe injuries requiring V-R Intervention & its correlation with ocular trauma score.Results: Commonest cause of injury: Hammer-chisel/stone in 32.43% (24) & Thorn/wooden stick 27% (20). Average age-30.5yrs. Average interval between trauma & intervention was -10.04days (4hrs – 52days).Discussion: Delay of presentation to ophthalmologist has lot of significance,high incidence of endophthalmitis & retinal detachment compared to other studies. Surgical outcome shows lower incidence of NO Light Perception & Significant reduction in number of cases with </=HM. Patients had better prognosis & visual outcome, higher incidence of 1/200- 20/50; 35.14% cases with >20/200. 60% of our cases had traumatic cataract, visual acuity may be underestimated in traumatic cataract. Faulty Projection of rays probably would be better criteria than RAPD. Extension of wound beyond pars plana, and aniridia (6.7%) are important risk factor.Conclusion: Modification of raw points is recommended in OTS criteria in Indian scenario.

Analysis of clinical and pathological features of 29 cases of perforating pilomatricoma / 中华皮肤科杂志

Objective:To analyze clinical and pathological features of childhood perforating pilomatricoma, and to explore its pathogenesis.Methods:A retrospective analysis was conducted on clinical and histopathological data from 29 children with perforating pilomatricoma in Department of Dermatology, Beijing Children′s Hospital from 2014 to 2020.Results:Among the 29 patients, 11 were males, and 18 were females, with a male-to-female ratio of 1∶1.64. Their age at onset ranged from 3 months to 14 years and 10 months, and the median age at onset was 4.58 years. The disease duration ranged from 2 months to 2 years, with an average of 8.72 months. The perforation occurred 2 days to 1 year and 6 months after the onset of pilomatricoma, with an average of 1.85 months. Ulceration occurred in 1 patient after the treatment with ichthammol, as well as in 3 patients after local scratching or bumping, and spontaneous ulceration without definite precipitating factors occurred in the remaining 25 patients. The average duration from the onset of disease to tumor perforation was 6.87 months. Skin lesions occurred on the face in 15 cases, on the lateral neck in 8, on the upper limb in 4, as well as on the scalp in 2. Perforating pilomatricoma clinically manifested as indurated subcutaneous nodules with crusts or ulcers, and was classified into 3 subtypes: ulcerative type (19 cases) , horny type (8 cases) , and crusted type (2 cases) . The tumor diameter ranged from 0.3 to 2.5 cm, with an average of 1.2 cm. Histopathological examination showed that the tumor was located in the superficial to middle dermis, and mainly consisted of basophils and ghost cells; in 19 cases, the tumor mass was extruded onto the skin surface through a perforated epidermal channel, and the epidermis around the perforation site was hyperplastic and invaginated into the dermis, forming epithelial tunnels surrounding the tumor; in 4 cases, the skin on the tumor surface was thinned and ruptured; in 6 cases, the perforation site could not be observed due to surgical separation of the epidermis and tumor. All lesions were resected, and no infection or recurrence was observed during the postoperative follow-up.Conclusions:Childhood perforating pilomatricoma mostly occurs on the face and neck, usually with rapid progress, and can be classified into ulcerative type, horny type and crusted type. Histological findings suggest that transepithelial elimination is an important mechanism underlying the occurrence of perforation in pilomatricoma.

Clinical application of the mixed reality technique to assist the location and anatomy of perforator vessels of the anterolateral femoral flap / 口腔疾病防治

Objective@#To explore the clinical application value of mixed reality technology in locating perforator vessels and assisting perforator vessel dissection to harvest anterolateral thigh flaps.@*Methods@#Six patients who needed anterolateral thigh flap repair after resection of oral and maxillofacial tumors were recruited from the Department of Oral and Maxillofacial Surgery of Nanchong Central Hospital from January 2020 to January 2021. Before surgery, the CT angiography data of the lower limbs of the patients carrying the calibration points were imported into the data workstation to perform 3D reconstruction of the perforator vessels and surrounding tissues of the thigh, and the reconstruction results were imported into Microsoft HoloLens 2 glasses. During the operation, calibration was performed at the calibration point of the operative area so that the preoperative reconstruction results were superimposed on the operative area through Microsoft HoloLens 2 glasses. The clinical application value of mixed reality technology assisted perforator vessel location and anatomy of anterolateral femoral perforator flap was discussed from six aspects: whether the perforator vessel was reconstructed preoperatively, intraoperative calibration time, whether the actual position of the perforating vessels passing through the fascia lata fulcrum deviated from the preoperative reconstruction result within 1 cm, time required to harvest the flap, and whether the actual route of the perforator vessel was consistent with the reconstruction result, and whether the postoperative flap survived.@*Results @# The position and course of perforating vessels were successfully reconstructed in 6 cases before the operation. The actual course of perforating vessels during the operation was consistent with the reconstruction results. The deviation between the actual position of the perforating points and the preoperative reconstruction results was within 1 cm, which met the requirements of the actual asisting of the anterolateral thigh flap. The average time of flap harvest was (70.50 ± 7.20) min. The average calibration time was (13.33 ± 5.50) min. All flaps survived.@* Conclusions @# Mixed reality technology projects the reconstruction results of anterolateral femoral perforator vessels directly into the operative area, which provides a new method for asisting localization and anatomy of anterolateral femoral flap perforator vessels and reduces the possibility of injury to perforator vessels.

Dermatosis Perforante Adquirida (Enfermedad de Kyrle) / Acquired perforating dermatosis (Kyrle disease)

RESUMEN La enfermedad de Kyrle se define como una enfermedad cutánea perforante, de etiología aún no conocida, infrecuente, con tendencia a la cronicidad, caracterizada por un trastorno de la queratinización con eliminación transepidérmicade componentes de la matriz extracelular, se la asocia con enfermedades sistémicas principalmente la diabetes mellitus y la insuficiencia renal crónica en hemodiálisis entre otras, aunque también se puede manifestar en personas sin antecedentes patológicos previos. Presentamos el caso de una paciente de 42años condiagnóstico de enfermedad de Kyrle,sin otra patología asociada hasta el momento de la evaluación, realizamos además, una revisión bibliográfica sobre el tema.

ABSTRACT Kyrle's disease is defined as a perforating skin disease, of an unknown etiology, infrequent, with a tendency to chronicity, characterized by a disorder of transepidermal keratinization, and elimination of components of the extracellular matrix, it is associated with mainly systemic diseases decompensated diabetes mellitus and chronic renal failure on hemodialysis among others, although it can also manifest itself in those without any previous pathology. We present the case of a 42-year-old female patient diagnosed with Kyrle's disease and without any associated pathology.

Research progress of acquired reactive perforating collagenosis / 中国医师杂志

Reactive perforating collagenosis is a rare skin disease characterized by the expulsion of denatured collagen fibers through the epidermis. The specific pathogenesis of the disease is not clear, and according to the etiology it can be divided into hereditary and acquired. Hereditary is relatively rare, usually seen in infants, and acquired is usually seen in adults, often associated with other systemic diseases, such as diabetes, chronic renal failure, cirrhosis, pulmonary fibrosis, tuberculosis, pulmonary aspergillosis, thyroid disease, scabies, hepatitis, acquired immunodeficiency syndrome (AIDS), malignant tumors and so on. There is no standard treatment for the disease.

Transcranial lateral perforating gunshot injury through skull base presenting without residual damage: A fortunate survivor / 中华创伤杂志(英文版)

We reported a case of a 32 years old male presenting with a perforating gunshot injury in craniocerebral region 3 h after the assault. The bullet entered above the right zygomatic arch, travelling through the coronal plane, and exited from the left zygomatic arch. The patient was fully conscious at presentation and developed facial nerve palsy during his hospital stay. Non-contrast CT scan of the head revealed fractures of the right orbit, bilateral maxilla, bilateral pterygoid plates, ethmoid air cells, vomer and left zygoma, and without any cerebral damage. He was treated conservatively and the facial palsy was resolved. The patient survived without any complications. Such case has not been described in the available literature till date.

Dermatosis Perforante Adquirida / Acquired perforating dermatosis

RESUMEN Los trastornos perforantes constituyen un grupo de enfermedades caracterizadas por la extrusión transepidérmica de material dérmico. La etiopatogenia es desconocida, sin embargo, la forma adquirida generalmente se presenta asociada a enfermedades sistémicas como insuficiencia renal y diabetes mellitus, entre otras. El prurito es el síntoma cardinal de esta patología, y clínicamente presenta pápulo-nódulos centrados por costras queratósicas. En cuanto al tratamiento, la dermatosis perforante adquirida (DPA) es de difícil control, con tendencia a la cronicidad. Presentamos el caso de una paciente de género femenino de 57 años de edad, con antecedente de diabetes,hipertensión arterial (HTA), hipotiroidismo e insuficiencia renal, con prurito generalizado de varios meses de evolución.

ABSTRACT Perforating disorders are a group of diseases characterized by transepidermal extrusion of dermal material, it includes reactive perforating collagenosis, perforating folliculitis, elastosis perforansserpiginosa and Kyrle's disease, and in recent years the term acquired perforating dermatosis (APD) has been used to refer to the perforating dermatoses that occur in adult patients associated with systemic disorder (kidney failure, diabetes mellitus, hypothyroidism, among others). The etiopathogenesis is still controversial and it is believed that several factors participate in the process, such as traumatism produced by chronic pruritus in predisposed patients, diabetic microangiopathy may contribute to collagen damage and to the microdeposition of substances that are no removed by dialysis, causing local inflamatory reaction. The itching constitudes the main symptom of this pathology, and clinically presents a papulo-nodules centered by keratosis crusts. Differential diagnoses include: nodular prurigo, multiple keratoacanthomas, sarcoid, and other perforating dermatosis. Treatment is difficult, with great tendency to chronicity. We report the case of a 57 year-old female patient, with history of type 2 diabetes, hypothyroidism and renal failure, with itching of several months of evolution.

Giant variant of acquired perforating dermatosis, clinically masquerading as a sarcoma: A report of a rare case

Acquired perforating dermatosis is a group of disease characterized by transepidermal elimination of altered dermal constituents of unknown pathogenesis. The giant variant was first described in 2006, as an emerging entity with seven reported cases to date. Here is an 83-year-old male presented with a 4-year history of gradually enlarging soft tisssue mass with ulcerartions at the left knee joint. Imaging revealed an extra-articular, single, heterogeneous, multinodular mass, suspicious for a soft tissue sarcoma. Wide local excision of the mass showed fleshy, hemorrhagic nodules communicating with epidermal ulcers. Microscopy showed cystic spaces straddling dermis and subcutis, containing eosinophilic, amorphous, granular material extruding through epidermal craters, surrounded by exuberant myofibroblastic proliferation. Trichrome and van-Gieson stains confirmed that the extruded material is collagen and the histology was compatible with the giant variant of acquired perforating collagenosis. Awareness of histological appearance prevents misdiagnosis and overtreatment of this entity, masquerading as a sarcoma clinically.

Granuloma anular perforante: patologia inusual / Perforating Granuloma Annulare: unusual pathology

Resumen El Granuloma Anular (GA) es una dermatosis inflamatoria crónica, benigna, auto limitada, de etiología desconocida. Existen numerosas variantes clínicas dentro de las cuales se encuentra la perforante, de presentación inusual. La histopatología más característica de GA, cuenta con la presencia de histiocitos epitelioides en empalizada alrededor de áreas de degeneración focal de fibras de colágeno con depósitos de mucina. La variedad perforante evidencia eliminación transepidérmica de fibras de colágeno. Se presenta un paciente de 72 años de edad, diabético, dislipémico, con lesiones pruriginosas en dorso de ambas manos, con el diagnóstico de granuloma anular perforante. Realizó tratamiento con clobetasol tópico, más antihistamínicos por vía oral, quedando una cicatriz atrófica.

Abstract Granuloma annulare is a chronic, benign, self-limiting, inflammatory dermatosis of unknown etiology. There are numerous clinical variants within which is the perforating, unusual presentation. The most histopathology characteristic of GA is the presence of palisading epithelioid histiocytes around areas of focal degeneration of collagen with mucin deposits. The perforating variety evidences transepidermal elimination of collagen tissue. A 72 years-old, diabetes, dyslipidemic patient is presented with pruritic lessions on the dorsum of both hands, with the diagnosis of perforating granuloma annulare. I perform medical treatment with topical clobetasol, leaving an atrophic scar.

Clinical and histopathologic features of acquired perforating collagenosis: A case report

@#A 51-year-old hypertensive and diabetic male patient, admitted due to acute kidney injury on top of chronic kidney disease, was referred to the dermatology service. He presented with a 3-month history of multiple discrete pruritic papules with keratotic plugs over the extensor aspects of the bilateral upper and lower extremities, initially managed as a case of scabies infestation but medications given provided no relief. Histopathologic analysis of a skin biopsy revealed findings of acquired perforating collagenosis. Resolution of lesions and pruritus were noted after starting on a topical corticosteroid ointment on the lesions, as well as hemodialysis to address the renal failure. Subsequent consults showed no recurrences and only a minor sequela of post-inflammatory hyperpigmentation.

El trauma ocular en la infancia / Ocular trauma in childhood

RESUMEN Objetivo: Determinar los resultados de la aplicación del ocular trauma score como herramienta de pronóstico visual en traumatismos. Métodos: Se realizó un estudio descriptivo longitudinal retrospectivo en el Servicio de Oftalmología del Hospital Pediátrico Provincial Docente "Eduardo Agramonte Piña", desde enero del año 2011 a enero de 2016. El universo estuvo conformado por 438 pacientes quienes recibieron ingreso hospitalario, y la muestra quedó conformada por 357 ojos de 356 pacientes con el diagnóstico de trauma ocular. Se analizaron las siguientes variables: etiología al ingreso, edad, sexo, topografía y tipo de lesión, evento traumático, agente causal, agudeza visual inicial según tipo de lesión y el pronóstico visual según el ocular trauma score. Resultados: El 81,3 por ciento de los pacientes ingresados presentaron etiología traumática; 64,6 por ciento fueron varones, con predominio del grupo de edad entre 5 y 9 años. Hubo una preponderancia de los traumas cerrados. Los accidentes recreativos fueron los más predominantes; los palos y las piedras resultaron el agente causal más frecuente y la agudeza visual final fue superior a la inicial. Conclusiones: La etiología traumática constituye la primera causa de ingreso en el Servicio de Oftalmología, donde se observa predominio de los pacientes entre 5 y 9 años, fundamentalmente del sexo masculino. Los traumas del globo ocular cerrado predominan sobre los del globo ocular abierto. Estos últimos presentan mayor afectación de la agudeza visual. El accidente recreativo y doméstico es más frecuente, así como los palos y las piedras como agentes causales. La mejoría de la agudeza visual fue significativa en este estudio, lo que se correspondió con la predicción sugerida por el ocular trauma score(AU)

ABSTRACT Objective: To determine the results of the application of the ocular trauma score as a tool for visual prognosis in traumatisms. Methods: Descriptive, longitudinal and retrospective study was carried out. The universe consisted of 438 patients who received hospital admission and the sample consisted of 357 eyes of 356 patients with the diagnosis of ocular trauma at admission. Different variables were analyzed: etiology at admission, age, sex, topography and type of injury, traumatic event, causal agent, initial visual acuity according to type of injury and visual prognosis according to ocular trauma score. Results: 81,3 percent of the patients admitted had traumatic etiology, 64.6 percent were males with predominance of the group aged between 5 and 9 years. There was a preponderance of closed traumas. The sticks and stones were the most frequent causal agent and the final visual acuity was superior to the initial one. Conclusions: The traumatic etiology is the first cause of admission in the Ophthalmology Service, where predominance is observed between 5 to 9 years, mainly of the male sex. The traumas to closed ocular globe predominate over those of open ocular globe presenting these last greater affectation of the visual acuity. The recreational and domestic accident is more frequent, as well as the sticks and stones as causal agents. The improvement in visual acuity is significant, corresponding with the prediction suggested by ocular trauma score(AU)

Perforating Ocular Injuries- A Retrospective Study From Tertiary Care Hospital Of North India.

Background: Ocular trauma is one of the main cause of corneal blindness which affects 12% of world’s population & is amenable to treatment. The leading cause of non-congenital unilateral blindness in children is ocular trauma. Children suffer a higher percentage of open globe injuries than adults which yield worse visual outcomes in ocular trauma. Aims: The objective of the study was to analyse epidemiological pattern of perforating ocular injuries. Materials & Methods: The present 5 years retrospective study involves all the patients who had been reported as a case of perforating/penetrating ocular injury in the tertiary care hospital. The records of all patients with perforating ocular injury seen during this period were reviewed & data such as demographic details, presenting visual acuity, all ocular findings, examinations etc were collected. Results: Total of 365 perforating/penetrating ocular injury patients were seen during study period. Maximum incidence of perforating injuries was noticed ≤10 years of age i.e. 36.2%. Males (79.5%) outnumbered females in the present study. Regarding structural involvement, cornea constitute (65.5%) perforating injuries followed by corneoscleral i.e. 19.7%. Conclusion: From present study, we may conclude that maximum incidence of perforating injury was noticed in children with more preponderance in males. Corneal perforation is more common as it is the most exposed part of eye.

Evaluation of Nutrient Foramina of the Dry Adult Human Femur Bone of North Indian Population

Introduction: The Femur bone is a highly vascular structure with unique features in its blood supply via numerous foramina located over its different segments, being named as vascular foramina . Among vascular foramina, nutrient foramen is an important one which gives way to the nutrient artery. Aim: To evaluate the nutrient foramina of the dry adult human femur bone of north Indian population. Subjects and Methods: The present study was undertaken using 50 dry adult human Femur bones of North Indian population. The samples were collected from the Anatomy department of the institute. Results: In the present study, among foramina of 50 dry adult human Femora, 31 Femora had single nutrient foramen, 18 had two nutrient foramina and 1 had three nutrient foramina. The medial lip of lineaaspera of Femur depicted the presence of nutrient foramina in majority of bones suggesting the entry zone for nourishment of shaft by perforating arteries. Size of nutrient foramina were ranging from size ≥ 0.55 mm to size ≥ 1.27 mm. Direction of nutrient foramina of all the Femora were directed upwards. Conclusion: This study may help orthopaedic surgeons in planning the surgical treatment of fracture of Femur with a possible reduction in post-operative complications. Combined periosteal and medullary blood supply to the bone cortex helps to explain the success of intramedullary reaming of long bone fractures particularly in the weight bearing Femur.

Long-term follow-up result for the foam sclerotherapy in the treatment of lower extremity incompetent perforating veins / 中华普通外科杂志

Objective To evaluate the long-term follow-up results of foam sclerosing agent in the treatment ofincompetent perforating vein.Methods 153 cases (316 incompetent perforating veins)received the treatment of foam sclerotherapy.The closure of perforating branches was followed up by ultrasound.Results 12 cases (27 incompetent perforating veins) were lost to follow up.289 incompetent perforating veins got follow up,The median follow-up time was 17 months (11-36 months).Closure rate was 100％ in vessels less than 3 mm in diameter,while that was 76％ invessels with the diameter between 3-5 mm.Closure rate was 16％ in vessels larger than 5 mm in diameter.Conclusion The long-term efficacy of the foam sclerosing agent in the treatment of incompetent perforating vein depends on the diameter of the vein.

Acquired Reactive Perforating Collagenosis as a Preceding Manifestation of Hodgkin's Lymphoma / 대한피부과학회지

A 40-year-old man presented with pruritic, multiple, variable-sized, erythematous umbilicated papules on the trunk and both extremities for 4 months. He was diagnosed with Hodgkin's lymphoma (stage IIA) after histopathologic examination of a neck mass that developed a month ago. A punch biopsy was performed on his right lower leg. Histological examination showed transepidermal elimination of the degenerated collagen. Masson's trichrome staining was performed to distinguish collagen fibers from the muscular tissue; using Masson's stain, the collagen appeared as a bluish color crossing from the dermis to the epidermis. The diagnosis of acquired reactive perforating collagenosis was made. The skin lesions showed much improvement after 6 cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine chemotherapy. Acquired perforating disorders are a group of cutaneous disorders that occur in adults with chronic kidney disease or diabetes mellitus. Cases of acquired perforating disorders associated with Hodgkin's lymphoma have been rarely reported in the English literature. To our knowledge, this is the first case of acquired reactive perforating collagenosis in a Korean patient with Hodgkin's lymphoma.

Anatomy of the septal perforating arteries of the heart / 대한해부학회지

The septal perforating arteries of the heart usually branch off from the anterior and inferior interventricular arteries and supply the interventricular septum and the conduction system therein. Since the septal perforating arteries are not directly visible from the outside of the heart, their anatomy and variations might be overlooked. However, the septal perforating arteries have their unique anatomy that needs to be recognized to avoid the damage of the vessels especially during common cardiac procedures such as the coronary artery bypass graft, percutaneous coronary intervention, and aortic valve replacement. A better understanding of these important arteries will help physicians to enhance the overall cardiac care for their patients. Therefore, this article discusses the anatomy, the relationship to the conduction system of the heart and the clinical significance of the septal perforating arteries.

Clinical effects of perforating branch flaps of medial vastus muscle in repairing secondary wounds in donor sites of free anterolateral femoral perforator flaps / 中华烧伤杂志

Objective@#To investigate the clinical effects of perforating branch flaps of medial vastus muscle in repairing secondary wounds in donor sites of free anterolateral femoral perforator flaps.@*Methods@#From August 2014 to December 2016, 12 patients (8 males and 4 females, aged 35-72 years) with skin and soft tissue defects of extremities associated with tendon and bone exposure were treated in Hanzhong Central Hospital. The sizes of the primary wounds after debridement were 10 cm×8 cm-22 cm×14 cm, and the wounds were repaired with 12 cm×10 cm-24 cm×16 cm free anterolateral femoral perforator flaps. The anterolateral femoral donor sites, which were 8.0 cm×4.0 cm-14.0 cm×7.5 cm in the secondary wounds after skin extensional suture, were repaired with perforating branch flaps of medial vastus muscle in the size of 9.0 cm×5.0 cm-15.0 cm×8.5 cm. The medial femoral donor sites were sutured directly.@*Results@#All the perforating branch flaps of medial vastus muscle and free anterolateral femoral perforator flaps survived in 12 patients. Following up for 6 to 12 months, the medial femoral perforator flaps had good local shape and texture. The flaps of 8 patients without cutaneous nerve transection were sensitive. The sensation of the flaps of the other 4 patients gradually recovered, and the functions of the ipsilateral knee joints were normal.@*Conclusions@#The medial femoral perforator flap has a stable anatomy and abundant blood supply, which can be used to repair the secondary wound in the donor site of the free anterolateral femoral perforator flap conveniently. It is safe and easy to be popularized. Moreover, it has a good shape and function after operation.

Study on the Effects of Ethanol Extract of Sanguis Draconis on the Survival of Perforating Flap Model in Rats and PI 3K/Akt/ eNOS Pathway / 中国药房

OBJECTIVE： To study the effects of ethanol extract of Sanguis Draconis on the survival of perforating flap model in rats and PI3K/Akt/eNOS pathway. METHODS： Perforating flap model was established by cutting off surrounding vessels and keeping one perforator. After modeling， the rats were divided into model group （external use， normal saline） and ethanol extract of Sanguis Draconis （EESD， the content of dracorhodin was 75.08 mg/g） group （external use， 0.21 g/cm2）， with 10 rats in each group. They were given relevant medicine for consecutive 7 days， once a day. The flap survival rate and flap microvessel density were determined after given relevant medicine 7 days. Human umbilical vein endothelial cells （HUVECs） were reoxygenated and glycoconjugated 16 h after hypoxia and hypoglycemia to establish oxygen-glucose deprivation/oxygen-glucose recovery model of HUVECs. After modeling， model cells were divided into normal group， model group， dracorhodin high-concentration， medium- concentration and high-concentration groups （2.5， 1.0， 0.5 μg/mL）. After reoxygenated and glycoconjugated for 24 h， cells morphology was observed by microscope； cell viability and the content of NO were detected by MTT assay and colorimetry. mRNA expression of Akt， PI3K and eNOS， PI3K protein expression， the phosphorylation of Akt and eNOS protein were determined by RT-PCR and Western blot assay. RESULTS： In rat experiment， compared with model group， flap survival rate and microvessel density of rats were increased significantly in EESD group （P＜0.01）. In cell experiment， compared with normal group， the survival rate of HUVEC， NO content， mRNA expression of PI3K， Akt， eNOS，PI3K protein expression， the phosphorylation of Akt and eNOS protein were decreased significantly （P＜0.05 or P＜0.01）. Compared with model group， dracorhodin high-concentration， medium-concentration and high-concentration groups survival rate of HUVEC cells， NO content， mRNA expression of PI3K， Akt and eNOS， PI3K protein expression， the phosphorylation of Akt and eNOS protein were increased significantly （P＜0.05 or P＜0.01）. CONCLUSIONS： The survival rate of perforating flap model in rat can be increased by treating with EESD， the mechanism of which may be associated with the activation of PI3K/Akt/eNOS pathway to protect endothelial cells.