ABSTRACT
Four patients with pyoderma gangrenosum were treated with hyperbaric oxygen to prepare the wounds for skin grafting. Each wound responded to a course of daily hyperbaric oxygen with reduction of infection and increased capillary angiogenesis. During follow-up periods of 12 to 30 months, all wounds remained healed. Although the exact etiology of pyoderma gangrenosum is unknown, vasculitis with wound ischemia and infection are prominent components. Inspired oxygen partial pressures of 1100 to 1300 mmHg elevate wound oxygen tension despite relative ischemia. The impaired intracellular bacterial killing of hypoxic leukocytes is corrected during each day's 2-hour bolus of hyperbaric oxygen. Daily wound oxygenation increases collagen production by fibroblasts to support capillary angiogenesis.
Subject(s)
Hyperbaric Oxygenation , Pyoderma/surgery , Skin Transplantation , Skin Ulcer/surgery , Surgery, Plastic/methods , Adolescent , Adult , Female , Follow-Up Studies , Graft Survival , Humans , Male , Middle Aged , Wound HealingABSTRACT
Anal incontinence, as a result of traumatic lesions upon the anal sphincter, is a devastating problem. Direct approximation by appropriate repair may not produce the appropriate animation of the anal sphincter and return of function. The transfer of the gracilis muscle for anal sphincteroplasty, which was initially described for neurogenic dysfunction, is recommended for repair and reconstruction of traumatic and dysfunction. The use of this technique in two patients with anal incontinence following trauma proved to be helpful in alleviating the problems of the patients. A diverting colostomy is used prior to the repair of the anal sphincter. Physical therapy regimens of the reconstructed anal sphincter by the muscle transfer is done prior to closing of the colonic stoma and restoring normal continuity and function of the lower part of the alimentary tract.
Subject(s)
Anal Canal/surgery , Muscles/surgery , Anal Canal/injuries , Fecal Incontinence/etiology , Fecal Incontinence/surgery , Humans , MethodsABSTRACT
Once the inadvertent infiltration of Adriamycin occurs, it is recommended to immediately treat the problem. This has been accomplished by wide excision and meshed split thickness skin grafting for resurfacing of the defect. Obtaining a healed wound alleviates the stiffness from lack of motion or ruptured tendons. Pain from the open ulcer, which is prone to infection in the immunosuppressed patient, is lessened. An analogy between pit viper envenomization and Adriamycin infiltration is discussed.
