Treatment of Hypertrophic Granulation Tissue with Topical Steroids
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Journal Article Treatment of Hypertrophic Granulation Tissue with Topical Steroids Get access A. Shalom, MD, A. Shalom, MD 1Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel, Zerifin, Israel2University of Tennessee, Chattanooga, TN Search for other works by this author on: Oxford Academic Google Scholar L. Wong, MD, FACS L. Wong, MD, FACS 1Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel, Zerifin, Israel2University of Tennessee, Chattanooga, TN Search for other works by this author on: Oxford Academic Google Scholar The Journal of Burn Care & Rehabilitation, Volume 24, Issue suppl_2, March-April 2003, Page S113, https://doi.org/10.1097/00004630-200303002-00141 Published: 01 March 2003Keywords:
Granulation tissue
Granulation
Hidradenitis Suppurativa
Granulation tissue
Refractory (planetary science)
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This paper describes the association of two unusual side effects of treatment with isotretinoin for severe acne: paronychia and excess granulation tissue in the nails furrows. We report a case of male patient aged 19 years, who in the course of the 36th week of treatment with isotretinoin for acne grade III showed erythema, edema, excess granulation tissue and onychocryptosis in various nail beds of hands and feet, with no history of trauma associated. A literature review revealed few reports of these adverse events, and two clinical patterns of exuberant granulation tissue has been described: one in periungual location and other in lesions of previous acne. The rarity and lack of knowledge on the best treatment for granuloma-like reactions make this theme a considerable challenge.
Isotretinoin
Granulation tissue
Erythema
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Refractory (planetary science)
Airway obstruction
Granulation tissue
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Necrotizing fasciitis is a rapidly spreading infection of the soft tissue, which carries significant morbidity and mortality. This condition is treated with broad-spectrum antibiotics, irrigation and surgical debridement of the affected area, and hemodynamic support. Negative pressure wound therapy (NPWT) has been utilized after surgical debridement to promote wound healing, especially when significant debridement has occurred. Newer forms of NPWT such as negative pressure wound therapy with instillation and dwell time (NPWTi-d) have shown even greater promise by reducing the time to clear infections and promoting greater debridement with fewer procedures. This case report demonstrates the successful use of NPWTi-d on a 56-year-old man with a severe case of necrotizing fasciitis of the right lower extremity after extensive debridement. Despite the significant loss of soft tissue and the circumferential devitalization of the lower leg, this patient was able to accept a skin graft in approximately four weeks after admission to the hospital. Three months after initial presentation, his wounds were completely epithelialized and healing well. The advantages of using NPWTi-d include decreased dressing changes, increased wound granulation, and faster infection clearance. The disadvantages of such systems include increased cost, additional technical requirements, and required inpatient monitoring of the system. Despite these disadvantages, the authors believe that NPWTi-d is a reasonable choice for patients similar to the one presented in this case report.
Negative-pressure wound therapy
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Since the 1990's, negative pressure wound therapy (NPWT) has been used to treat soft tissue defects, burn wounds, and to achieve skin graft fixation. In the field of abdominal surgery, the application of NPWT is increasing in cases with an open abdominal wound requiring temporary wound closure and a second look operation. In the present study, the authors analyzed patients that underwent NPWT for postoperative wound dehiscence.The computerized records of patients that had undergone an abdominal operation from November 2009 to May 2012 were retrospectively analyzed.The number of total enrolled patients was 50, and 30 patients (60%) underwent an emergency operation. Diagnoses were as follows: panperitonitis or intra-abdominal abscess (24 cases, 48%), intestinal obstruction (10 cases, 20%), cancer (7 cases, 14%), mesentery ischemia (3 cases, 6%), and hemoperitoneum (1 case, 2%). NPWT was applied at a mean of 12.9 ± 8.2 days after surgery and mean NPWT duration was 17.9 days (2 to 96 days). The 11 patients (22%) with unsuccessful wound closure had a deeper and more complex wound than the other 39 patients (78%) (90.9% vs. 38.5%, P = 0.005). There were two complication cases (4%) due to delayed wound healing.Most patients recovered well due to granulation formation and suturing. NPWT was found to be convenient and safe, but a prospective comparative study is needed to confirm the usefulness of NPWT in patients whose wounds are dehisced.
Negative-pressure wound therapy
Wound dehiscence
Granulation tissue
Abdominal wound
Abdominal Compartment Syndrome
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Chronic wounds are a challenge to treatment. In this retrospective study, the effect of transdermal CO2 application on wound healing in chronic ulcers was investigated and compared to the effect of CO2 on acute surgical wounds. Eightysix patients (52 females and 34 males) with chronic wounds of different origin except arterial occlusive disease were included. In addition, 17 patients (5 females, 12 males) with wide excision wounds after surgical therapy of acne inversa were considered. The indication for CO2 application was a wound at risk for infection. Treatment was performed with a Carboflow® device once daily for 30 to 60minutes. Therewas clinical evidence of improvement of granulation and reductionof discharge and malodor within 1 week of treatment in both chronic and acute wounds. Only 9 patients, all diabetics, needed an additional systemic antibiosis. The treatment was well tolerated. No adverse effects have been noted. Transdermal CO2 application is a useful method to reduce the risk of infection and improve wound healing in both chronic and certain acute wounds. Systematic prospective trials are needed.
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Granulation tissue
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We have analyzed the clinical, analytical, radiologic, therapeutic an evolutive of cases of systemic mastocytosis (SM) skin lesions. The diagnostic of MS is difficult in the absence of skin lesions.
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