Vacuum assisted closure device improves the take of mesh grafts in chronic leg ulcer patients.

BACKGROUND: Vacuum assisted closure (VAC) is established in the management of acute and chronic wounds. In recent years, few data have been published concerning VAC therapy after skin graft transplantation. OBJECTIVES: The aim of this study was to determine whether postoperative VAC helps assist closure of mesh grafts in chronic leg ulcer patients. PATIENTS/METHODS: We report a consecutive case series of 54 patients with chronic leg ulcers who received a total of 74 mesh grafts. A postoperative VAC therapy was performed in 28 mesh grafts, and 46 mesh grafts were treated with standard gauze therapy. RESULTS: In the VAC group, 92.9% of grafts showed complete healing, compared to 67.4% in the control group without postoperative VAC therapy. Differential analysis revealed a negative correlation of the take rate in patients over 70 years of age or in patients suffering from diabetes mellitus or dermatoliposclerosis. Particularly patients with diabetes mellitus and of greater age exhibited improved take rates, both 100%, in the VAC group compared to 50 and 62%, respectively. CONCLUSION: The results of our retrospective study demonstrate for the first time the significant benefit of VAC therapy after skin grafting in chronic leg ulcer patients as evaluated in a clinical trial.

Successful treatment of stasis dermatitis with topical tacrolimus.

Stasis dermatitis is a common dermatologic disorder as a consequence of impaired venous drainage and often accompanied by chronic leg ulcers. Until today the standard in acute therapy represents the topical administration of highly potent corticosteroids and if possible a consequent long-term compression therapy. The macrolide tacrolimus represents a new selective inflammatory cytokine release inhibitor by binding to macrophilin-12 and inhibiting calcineurin. Beside the resulting anti-inflammation and immunosuppression an antipruritic effect have been discussed as further clinical benefits of tacrolimus. Here we report for the first time about a 81-year old patient suffering from an ulcus cruris mixtum and stasis dermatitis treated with topical 0.1% tacrolimus ointment twice daily for 5 days. Until now tacrolimus is available for topical treatment as a fatty ointment only. Although we would have preferred a more hydrophilic base for treatment of acute stasis dermatitis we achieved complete healing. As this is only a case report about one single patient further clinical investigations are needed to confirm this observation in more individuals with stasis dermatitis.

The Van der Woude syndrome: a case report and review of the literature.

The Van der Woude syndrome is a rare autosomal dominant developmental malformation usually associated with bilateral lower lip pits. These congenital lip pits appear clinically as a malformation in the vermilion border of the lip, with or without excretion. As a genetic defect has been identified as a microdeletion of chromosome bands 1q32-q41, genetic counselling of patients may be considered. A nonsense mutation in the interferon regulatory factor-6 (IRF-6) is discussed as a pathogenic relevant factor. Therapeutic intervention is generally not necessary, although surgical excision is especially indicated in patients with recurrent inflammation. Physicians should be aware of the Van der Woude syndrome because it has been reported to be associated with a variety of malformations or other congenital disorders.

Comparison of 18FDG-PET with 131iodine and 99mTc-sestamibi scintigraphy in differentiated thyroid cancer.

18Fluorine-fluorodeoxyglucose (FDG) positron-emission tomography (PET) has emerged as a useful method in various fields of oncology. The aim of the present study was to evaluate the clinical significance of this technique in differentiated thyroid carcinoma and to compare the results with other imaging modalities, particularly with whole-body 131iodine scintigraphy (WBS) and hexakis (2-methoxyisobutylisonitrile) (99m)technetium (I) scintigraphy (MIBI). Whole-body PET imaging using FDG was performed in 54 patients. There were 39 patients with papillary tumors and 15 patients with follicular tumors (including 3 Hürthle-cell carcinomas). Primary tumor stage (pT) was pT1 in 5 cases, pT2 in 19 cases, pT3 in 2 cases, pT4 in 24 cases, and unknown in 4 cases, respectively. Finally, for each case an overall clinical evaluation was done including histology, cytology, thyroglobulin level, sonography, computed tomography, magnetic resonance imaging, and subsequent clinical course, to allow a comparison with functional imaging results. Compared with WBS, FDG-PET gave different results in the majority of cases with recurrence/metastases (11 FDG-true-positive/WBS-negative tumor sites and 8 WBS-true-positive/FDG-negative tumor sites). In 7 patients with recurrence/metastases, FDG-PET and WBS gave corresponding results (10 sites). In 28 patients, FDG-PET and WBS were normal (including 2 false-negative cases). MIBI was performed in 44 cases. FDG-PET was better correlated to MIBI (congruent positive results in 13 tumor sites) than to WBS. Compared with MIBI, FDG-PET was superior in 5 cases (including 3 patients with distant metastases). Two FDG-negative/MIBI-positive tumors were observed. Different tracer uptake mechanisms have to be considered regarding "nonspecific" tumor imaging with FDG-PET or MIBI. Nevertheless, since spatial resolution with respect to tomographic imaging is inferior with single photon emission computer tomography (SPECT) using MIBI, the observed higher sensitivity of PET might be due to the higher spatial resolution of this method. As far as grading could be obtained, FDG-PET seemed to be more sensitive than WBS in high-grade tumors, whereas WBS was positive predominantly in low-grade carcinomas, although statistical significance could not be reached. The results prove the clinical usefulness of FDG-PET and MIBI for detection of 131iodine-negative tumor tissue in differentiated thyroid cancer.