Treatment of leg ulcers with cultured epithelial autografts: clinical study and case reports.

Leg ulcers are a significant medical problem in the United States. The number of affected patients at any given time is staggering. Treatment modalities have widely varied and are often unsuccessful. We evaluated the effectiveness of cultured epithelial autografts in the treatment of leg ulcers due to various etiologies that had failed other standard therapy. Eighty-six ulcers in 36 patients were treated with cultured epithelial autografts after full evaluation of their ulcers. The ulcers were grouped by etiology and healing was assessed by time to healing, number of ulcers healed and mean number of graft applications. The results achieved in the past five years have shown that cultured epithelial autografts are highly effective in treating chronic leg ulcers. Eighty percent of venous insufficiency ulcers healed in 5.7 weeks. Similar results were seen with ulcers of other etiologies including arterial insufficiency, pyoderma gangrenosum, scleroderma, and vasculitis. Positive results were seen in cases where other treatment methods had failed and seems independent of systemic corticosteroids.

Treatment of pyoderma gangrenosum with cultured keratinocyte autografts.

BACKGROUND: Pyoderma gangrenosum is an uncommon chronic skin disease characterized by rapidly enlarging cutaneous ulcers. Immunosuppressive agents, such as corticosteroids, are the mainstay of therapy. OBJECTIVE: We describe a patient with pyoderma gangrenosum treated with cultured keratinocyte autografts for a full-thickness ulcer located on the dorsal and lateral aspects of the foot. METHODS: After stabilizing the ulcer with intralesional and systemic corticosteroids, the ulcer was debrided and cultured keratinocyte autografts were secured with nylon mesh. An outer dressing of gauze and elastic bandage was used. RESULTS: The patient had > 95% "take" of the grafts and the ulcer was fully healed in less than 1 month. The grafted area preserved the clinical phenotype of the palmar skin from which the original biopsy was taken. CONCLUSION: Cultured keratinocyte autografts can provide permanent wound coverage for patients on high doses of immunosuppressive medications.

Congenital absence of dermatoglyphs.

Congenital absence or unusual patterns of human dermatoglyphs (fingerprints) occur in several syndromes that are rare and poorly understood. The abnormalities of dermatoglyphs fall into four categories: complete absence, ridge hypoplasia, ridge dissociation, and ridges-off-the-end. Complete congenital absence of ridges is an exceedingly rare syndrome that consists of neonatal blisters and milia, adult traumatic blistering and fissuring, absence of sweating, contracture of digits, and absence of dermatoglyphs on the hands and feet. The syndrome is inherited in an autosomal dominant pattern, and only two kindreds have been described in the literature. We describe a newly identified patient and kindred with findings similar to the previously reported cases and review the clinical and histopathologic findings of this syndrome.

Chronic verrucous varicella-zoster virus infection in patients with the acquired immunodeficiency syndrome (AIDS). Histologic and molecular biologic findings.

Verrucous skin lesions have been attributed to various herpes viruses in immunosuppressed patients, including those with human immunodeficiency virus infection (HIV). We examined such lesions from six HIV-infected patients to determine the range of microscopic findings present and to establish which herpesviruses were present. Verrucous epidermal hyperplasia, pseudocarcinomatous hyperplasia, and massive hyperkeratosis correlate with the warty clinical appearance of the lesions. Herpetic cytopathic changes, including multinucleated epidermal giant cells, steel-gray nuclei, necrotic acantholytic keratinocytes, and Cowdry type A nuclear inclusions were seen most prominently in the dells between papillations and in adnexal epithelium. In two cases, increased numbers of spindled cells were seen in the dermis. Immunoperoxidase staining with anti-type IV collagen antibodies demonstrated that these findings were not those of Kaposi's sarcoma, but represent a fibrotic reaction to the infection. Viral cultures of four of the cases demonstrated the presence of varicella-zoster virus, whose presence was detected by the polymerase chain reaction in paraffin-embedded lesional tissue from all six cases. Polymerase chain reaction did not show the presence of cytomegalovirus, herpes simplex, Epstein-Barr, or human papillomavirus. We conclude that these unusual verrucous lesions are a chronic manifestation of herpes zoster infection and that the reported presence of other agents in such lesions is probably coincidental.

Synthetic membranes and cultured keratinocyte grafts.

Significant progress has been made in skin replacement options in the past several decades. Although initially various materials have been used mainly for burn coverage, their application to dermatologic practice has increased significantly. We review the research, progress, and other aspects of wound coverage with synthetic membranes and cultured epithelial sheets in both burn and nonburn wound management.