Dorsum Of Left Foot Research Articles

Bullous Tinea Pedis

A woman in her 70s presented with a skin eruption on the left dorsal foot that had developed spontaneously 2 weeks before. The rash initially appeared with pruritic papules that evolved to fluid-filled blisters and persisted despite self-treatment with topical hydrocortisone 1% cream and antibiotic ointment. Examination revealed an erythematous plaque with tense and denuded bullae (Figure 1). She received oral cephalexin for presumed bullous impetigo. Bacterial culture and herpes simplex virus and varicella zoster virus polymerase chain reaction (PCR) swab results were negative.

Skin infection by Mycobacterium farcinogenes–senegalense group in an immunocompetent patient: a case report

BackgroundMycobacterium farcinogenes–senegalense group mostly cause bovine farcy, which rarely infect human beings. We reported one case of cutaneous Mycobacterium farcinogenes–senegalense group infection in an immunocompetent victim.Case presentationA 66-year-old Taiwanese woman with hypertension developed tender nodules on her left dorsal foot for 2 months. Tissue culture identified Mycobacterium farcinogenes–senegalense group. The lesion was treated successfully with clarithromycin and sulfamethoxazole/trimethoprim, followed by surgical excision.ConclusionsMycobacterium farcinogenes–senegalense group infection should be considered as a potential pathogen of skin infection in immunocompetent patients.

Harvester’s palsy – bilateral common peroneal nerve palsy: A descriptive case report

Peroneal neuropathy is the common mononeuropathy of the lower extremities in adults. The documented etiologies for peroneal nerve injury include trauma, traction, and external compression. Fibular neck is the most common site of common peroneal nerve (CPN) injury as the nerve lies superficial and vulnerable for injury. A 50-year-old male presented with foot drop in his left leg after working in squatting position for prolonged hours along with sensory disturbance in dorsum of left foot. Clinical examination showed poor dorsiflexion in both side ankle with preserved plantar flexion. Electrophysiological findings locate the site of lesion to be CPN at the level of fibular neck. We conclude that CPN is injured due to knee flexion in farmers repeatedly squatting for long hours. Superficial peroneal nerve may be spared due to their interfascicular arrangement at the level of fibular neck placing deep peroneal nerve near the fibula making them more susceptible to compression type of injury. Peroneal nerve may be damaged at multiple sites including ankle. The condition can be reversed with conservative treatment, primarily by avoiding the precipitating position.

New proposal for skin grafts on tendon-exposed wounds.

Performing a skin graft is not feasible for tendon-exposed defect reconstruction because tendons are fibrous connective tissues with relatively poor blood supply. This study proposes a method to effectively perform skin graft surgery in tendon-exposed wounds. A 48-year-old male patient with diabetes mellitus had a very large left dorsal foot defect (8×8 cm). The wound bed had healthy granular tissue, with tendon exposure. The tendons were turned over so that the posterior side would behave as the anterior side. The edge of the paratenon was then fixed together to the surrounding granulation tissue or dense remnant fascia using absorbable sutures, and the close granulation tissue was approximated and buried. A split-thickness skin graft was performed after 1 week. The graft site was stably taken on postoperative day 3. A small disruption was then observed at the graft site within 1 week postoperatively, but conservative treatment was continued for 1 month, after which the defect site was completely restored. This technique can increase the success rate of skin grafts for defects with tendon exposure.

Rare Lower Extremity Fibrosarcomatous Variant of Dermatofibrosarcoma With Myxoid Features Treated With Transtibial Amputation

Dermatofibrosarcoma protuberans (DFSP) is an uncommon soft tissue tumor originating from the dermis, with high rates of local recurrence and invasive growth but low likelihood of distant metastasis. Fibrosarcomatous transformation (FS-DFSP) of DFSP accounts for approximately 5-15% of DFSP tumors, is a higher-grade tumor, with higher chances of metastasis and poorer prognosis. We present a case of a 66-year-old female presented with a large fungating mass on the left dorsal foot. Ultrasound-guided core needle biopsy with immunohistochemistry suggested a spindle cell neoplasm, favoring myxofibrosarcoma with intermediate grade. The patient elected for below-knee amputation over limb salvage with wide resection and free flap reconstruction. Based on clinical presentation, radiologic, histologic features and fluorescence in situ hybridization (FISH) studies confirmed the diagnosis of fibrosarcomatous variant of dermatofibrosarcoma protuberans with myxoid change. FS-DFSP with myxoid change is a rare soft tissue tumor that requires aggressive treatment due to its high rates of recurrence. This case presents a rare tumor in a unique location that was successfully treated with limb amputation, which is not documented in current literature.

Surgical Treatment of Complete Foot Drop: Partial Tibial Nerve Transfer to the Motor Branch of the Tibialis Anterior: 2-Dimensional Operative Video.

This video will be demonstrating the surgical treatment of complete foot drop with partial tibial nerve transfer to the motor branch of the tibialis anterior. Foot drop occurs when there is injury to the deep peroneal nerve that results in the paralysis of the tibialis anterior muscle and subsequent loss of ankle dorsiflexion.1-5 The patient who is the subject of this video is a 27-yr-old female with a 6-mo history of foot drop. She presented with complete loss of ankle dorsiflexion and great toe extension due to traumatic fall on her left knee while running. Upon physical examination, she had all the features of complete foot drop with loss of ankle dorsiflexion and ankle eversion. She also had decreased sensation to light touch over left dorsal foot, left great toe, and left lateral lower leg. The patient has consented to this procedure. The partial tibial nerve transfer to the motor branch of tibialis anterior muscle is the preferred treatment option for foot drop as it restores ankle dorsiflexion with minimal donor site complications. At 12 mo postsurgery, she has regained 4/5 for ankle dorsiflexion on motor testing compared to the 0/5 she had preoperatively.

Thermal Manikin of Infant

Compared to an adult, an infant requires more consideration regarding the thermal environment so it is necessary to evaluate the thermal environment as it affects infants. However, experiments on infant subjects regarding their thermal environment based on the different heat balance of their body cannot ethically be conducted. We could instead consider using a thermal model for the human body, but thermal manikins based on heat transfer per unit area are rare. Therefore, this study aims to develop a thermal manikin to model the heat transfer per unit area and the body form of an infant in order to evaluate the infant’s thermal environment. When evaluating the thermal environment or heat balance of the body in the outside environment, it is essential to consider the asymmetry and unevenness of the temperature of the skin, as an element of the human body, and not just the unevenness and asymmetry of physical factors in the environment. Moreover, when receiving short wavelength direct solar radiation, light and shaded areas have significant differences in skin temperature. The following 20 body parts were investigated in the study: anterior head, posterior head, ventral trunk, dorsal trunk (including buttocks), right medial arm, right lateral arm, left medial arm, left lateral arm, right dorsal hand, right palmar hand, left dorsal hand, left palmar hand, right anterior leg, right posterior leg, left anterior leg, left posterior leg, right dorsal foot, right plantar foot, left dorsal foot, and left plantar foot. This paper measured the body surface area for each part of an infant’s body in order to establish the form of an infant model from the view of the heat transfer area, and verified the validity of the model.

New-Onset Vasculitis in a Patient With Recurrent Henoch–Schonlein Purpura

ABSTRACT An 81-year-old outdoorsman from northern New York with a history Henoch–Schonlein purpura presented with 2 weeks of worsening shortness of breath, oliguria, and a bilateral lower-extremity purpuric and petechial rash with circinate lesions on his left dorsal foot. The symptoms and rash did not improve after broad-spectrum antibiotics for presumed pneumonia and systemic corticosteroid administration for a presumed vasculitis flare. A skin biopsy showed a leukocytoclastic vasculitis with negative IgA immunofluorescence. A chest computed tomography showed bilateral cavitary lung nodules. Further blood testing was performed to confirm the diagnosis.

Pheohyphomycotic cyst.

Sir, Pheohyphomycosis is an affection characterized by dematiaceous yeast-like cells, hyphae and pseudo-hyphae in the affected tissue.[1] It can occur in any climatic region, but it is more frequent in the tropics. The involvement of skin and subcutaneous tissue is known as subcutaneous pheohyphomycosis.[12] The term “phaeohyphomycosis” was coined by Ajello et al. in 1974.[3] These fungi often infect patients who are not overtly immunocompromised and therefore may be encountered in a wide variety of cases. A 60-year-old housewife presented to dermatology outpatient department of a tertiary care hospital with a smooth painless swelling on the dorsal aspect of left foot of two years duration. The patient gave a history of minor trauma to the involved foot with a wooden splinter while doing household chores two months prior to occurrence of lesions. There was no history of discharge from the swelling. Her medical history revealed that she was hypertensive and was suffering from degenerative joint disease limited to both the knees. Her general and systemic examination was remarkably normal. Complete haemogram, routine biochemistry, urinalysis, chest roentgenogram and cardiac evaluation were normal. The tuberculin skin test was negative. Cutaneous examination revealed a well-defined smooth swelling on the dorsum of left foot with intact overlying skin with a groove in between clinically looking like a loculated cystic swelling [Figure 1]. Radiological examination including ultrasound suggested a subcutaneous swelling without bony involvement. There was no evidence of lymphangitic spread or regional lymphadenopathy. Histopathological examination of biopsy from left foot swelling showed a cystic structure lined by a granulomatous inflammatory infiltrate. Culture from the tissue sample showed no growth on Sabourauds dextrose agar. Gomori Methenamine Silver (GMS) staining of biopsy tissue revealed multiple black staining hyphae with irregular branching [Figure 2]. Masson-Fontana staining showed multiple hyphae containing melanin, consistent with the diagnosis of pheohyphomycotic cyst. Species identification could not be done due to lack of resources at our end.Figure 1: A smooth lobulated swelling on the dorsum of left footFigure 2: Gomori Methenamine Silver stained section showing black staining hyphae with irregular branching along the cyst wall (×20)With a working diagnosis of pheohyphomycosis, the patient was started on oral saturated solution of potassium iodide in the concentration of 1 gm/ml along with itraconazole 200 mg twice daily along with monitoring of liver enzymes. The patient was lost to follow-up after three months of therapy due to personal difficulties. Phaeohyphomycosis is a rare infection caused by dematiaceous fungi, of which most commonly incriminated are Exophiala, Alternaria, Bipolaris, Wangiella, and Curvularia.[4] The clinical manifestations of pheohyphomycosis can be divided into four categories: (i) superficial form, including “black piedra” and “tinea nigra” representing infection of superficial layers of skin; (ii) cutaneous and corneal form, which includes dermatomycosis. onychomycosis and mycotic keratitis; (iii) subcutaneous form comprising of cystic lesions which usually follow after a traumatic event; (iv) systemic or invasive form, in which there is dissemination to other organs; this form occurs in immunocompromised patients and organs commonly involved include lungs, brain, paranasal sinuses and rarely, the skin.[5] Subcutaneous infection is caused by traumatic inoculation of the organisms and is usually observed in exposed areas of skin surface. Although diagnosis relies on culture of the organism or demonstration of pigmented hyphae in tissue biopsy, in some cases, cystic lesions are caused by nonpigmented hyphae and the condition is then termed as hyalohyphomycotic cyst.[2] In our patient, histopathology showed a cystic structure in the deep dermis and the wall of the cyst lined by a suppurative granulomatous infiltrate with multiple pigmented hyphae along the cyst wall. Hyphal elements could be clearly visualized on GMS staining. To differentiate from hyalohyphomycosis (nonpigmented hyphae), Masson-Fontana stain can be utilized to demonstrate pigment melanin in the fungus.[67] In our case both GMS stain and Masson-Fontana stain confirmed the diagnosis of phaeohyphomycosis. Subcutaneous disease can be managed by surgical excision which is the chief modality of treatment with or without antifungal therapy.[3] Nevertheless; itraconazole at a dose of 200 mg twice daily provided some respite from surgical management in an individual who was unwilling to tolerate extensive debulking surgery.[8]

粘液型脂肪肉腫の1例

症例は29歳，男性。8ヵ月前から生じた右大腿内側の粘液型脂肪肉腫に対して，手術目的に当科に入院した。術前に施行したCTでは薄筋に接して内部の均一な，楕円形の腫瘤を認めた。MRIではT1強調画像で均一な低信号，T2強調像で均一な高信号を認めた。エコーでは境界明瞭で全域に血流の豊富な腫瘤を認め，内部は大小の隔壁で区切られていた。エラストグラフィでは辺縁部で硬く，内部で柔らかい像を認めた。腫瘍細胞は多数の隔壁で区切られており，周囲との境界は明瞭であった。病理所見では大量の粘液基質や，印環細胞様の細胞を認め，chicken－wire様の分枝を伴う毛細血管が多数認められた。好塩基性の沈着物を認める領域ではアルシアンブルー染色が濃染した。自験例は臨床的，病理学的にも典型的な粘液型脂肪肉腫と考えられた。

Erratum to: PMMA embolization to the left dorsal foot artery during percutaneous vertebroplasty for spinal metastases

Erratum to: PMMA embolization to the left dorsal foot artery during percutaneous vertebroplasty for spinal metastases

PMMA embolization to the left dorsal foot artery during percutaneous vertebroplasty for spinal metastases

Distal arterial embolization to the foot with PMMA during vertebral augmentation has not been previously reported. We report a rare case of distal PMMA embolization to the dorsal foot artery during ipsilateral percutaneous lumbar vertebral augmentation in a patient with spinal osteolytic metastases. A 68-year-old woman was admitted because of severe disabling low back pain. Plain roentgenograms, MRI and CT-scan revealed osteolysis in the L4 and L5 vertebral bodies with prevertebral soft tissue involvement. Percutaneous vertebroplasty with PMMA was performed in L2 to L5 vertebrae under general anesthesia. Intraoperatively, leakage into the segmental vessels L3 and L5 was observed. Four hours after the procedure the clinical diagnosis of acute ischemia and drop foot on the left was made. CT-angiography justified linear cement leakage in the course of the left third lumbar vein and fifth lumbar artery, and to the ipsilateral common iliac artery. The patient was treated with low molecular heparin and the ischemia resolved without further sequelae 1 week postoperatively. PMMA leakage is a complication associated with vertebroplasty and kyphoplasty. Although the outcome of the PMMA embolization to the vessels resolved without sequelae, in our case spine surgeons and interventional radiologists should be aware on this rare complication in patients with osteolytic vertebral metastases even when contemporary cement containment techniques are used.

Case Report and Review of Articles: Rheumatoid Vasculitis

We describe here a case of a 70 yr old man with long-standing rheumatoid arthritis who presented with low grade fever, fatigue, loss of appetite and weight, bluish discoloration of the fingers and patches of gangrenous skin on the fingers. There was intense pain in the fingers which prevented him from sleep. Along with these symptoms he developed loss of sensation in the dorsum of left foot, then left foot drop. We give below full account of the case and review of the causes of vasculitis. We want to emphasize on the importance of identifying vasculitis as one of the complications of rheumatoid arthritis and intensive treatment of this complication, as it is a life-threatening complication.

Nitroimidazole derivative-induced fixed drug eruptions: Not so uncommon

Sir, Adverse reactions to medications are common and often manifest as a cutaneous eruptions. The term fixed drug eruptions (FDE) describes the development of one or more annular or oval erythematous patches as a result of systemic exposure to a drug recurring at the same site with repeated exposure to the same drug or others of similar group, with or without residual hyperpigmentation. Most studies report FDEs to be the second or third most common skin manifestations.[1] The actual frequency may be higher than current estimates, owing to the availability of a variety of nutritional supplements that are also known to elicit FDEs. In this case series, out of ten cutaneous ADR cases, eight patients were suffering from FDEs of which five were due to nitroimidazole derivatives which were documented within a short span of one and half months, that is 12 OPD days. The suspected offending nitroimidazole derivatives were metronidazole (three cases), tinidazole (one case), and ornidazole (one case). Most of them (three cases out of 5 i.e., 60%) developed FDEs within an average of 2 days. Oral mucosal ulceration along with lip involvement was the most (three cases, i.e., 60%) common manifestation, but in two (40%) occasions blisters over the dorsum of foot [Figure 1] and glans penis were also evident along with oral lesions. The patients were treated by the dermatologists with withdrawal of the suspected agent, with or without systematic antibiotic, oral antihistaminic agents and antiseptic mouth wash in relevant cases. Most of the lesions (three cases i.e., 60%) healed with residual pigmentation (in two of the cases there was no residual pigmentation). Only two patients gave history of the occurrence of similar lesion previously following exposure to drug (probably metronidazole). Unfortunately, no supporting documentation was found. The patients were counselled regarding avoidance of the suspected drug. These were clearly mentioned in the OPD case sheets for future reference. Figure 1 FDE over dorsum of left foot healed with residual pigmentation after withdrawal of the drug Causality assessment as per Naranjo's algorithm[2] showed probable ADR score within 5 to 8, whereas severity assessment as per Modified Hartwig and Siegel Scale[3] showed all the cases to be of “moderate severity” (level 3). Although nitroimidazole derivatives are known to cause FDEs,[4,5] according to standard western literature nitroimidazole derivatives, commonly used as antiprotozoal and antibacterial rarely causes FDEs. They are not routinely included in the list of causal drugs of FDEs.[6] This may not hold true in a setting, as for example in India, where use of nitroimidazole derivatives is widespread both as self-medication and as prescription drugs.

First reported case of African viper bite treated with Indian polyvalent anti snake venom

Dear Editor, The compositional differences between venoms among different geographic regions may be due to evolutionary environmental pressure acting on isolated populations. The polyvalent variety of anti snake venom (ASV) with local specificity remains the mainstay of therapy in most countries. ASV against the venom of one species occasionally may have partial cross neutralizing activity against other venoms, usually from closely related species, known as paraspecific activity. We managed a case of an African viper bite successfully using Indian polyvalent ASV as the specific African variety was not available to us. A 25 year old serving soldier of a foreign army contingent in UN mission in the Democratic Republic of Congo, was brought on 29 Sep 07 at 0025 hours, with a history of a mildly painful snake bite of about two hours duration on the left foot. There was no history suggestive of neurological involvement. Clinical examination revealed normal vital parameters and a normal general examination. Local exam revealed swelling and tenderness of left foot extending beyond the ankle to the distal leg. Two fang marks 1.5 cm apart were visible on dorsum of left foot along with a small patch of ecchymosis (Fig. 1). Fig. 1 Fang marks with swelling of foot. A bed side whole blood clotting time revealed no clotting at 30 minutes, with a clotting time of 35 minutes by capillary method. Bleeding time was in normal range. Since specific ASV for the regional area was not available, a decision to give Indian polyvalent ASV (which was available) was taken as an emergency life saving measure. A total of 150 ml of reconstituted ASV (15 vials of polyvalent Indian variety) was administered as per standard protocol over next nine hours in view of progressively increasing swelling in the leg and deranged clotting time in range of 15 to 21 minutes. The progression of the swelling of the limb halted and clotting parameters started improving (Fig. 2). Antibiotics and other supportive therapy were given. The patient had a haemoglobin drop from 16.3 to 13.6 gm per dl and mild thrombocytopenia in range of 1,20,000 to 1,40,000/mm2 during the initial few days which subsequently recovered. He also developed an uncomplicated resolving small abdominal wall hematoma (confirmed by ultrasound). He was discharged at three weeks with a complete and uneventful recovery. Fig. 2 Reduction of swelling of the limb by day three. The mortality after untreated viper bites like Crotalus durissus terrificus is said to have been up to 70 %, but this has been reduced to less than 12% by ASV treatment and in African varieties like Atractaspis and bush vipers (like those found in the Congo basin) the mortality ranges from 8-43% [1, 2]. “Specific” antivenom, implies that the antivenom has been raised against the venom of a particular snake that has bitten the patient (Monovalent or monospecific antivenom). Polyvalent antivenom neutralises the venoms of several different species of snakes. FAV AFRICA is the polyvalent equine ASV recommended for Sub-Saharan African snakes. The Indian ASV contains sera against the saw scaled viper, Russel's viper. Indian Cobra (Naja naja) and the banded krait. Analysis of Indian cobra (Naja naja) venom samples from eastern, western and southern India revealed differences in composition, biochemical, and pharmacological properties emphasizing regional variation: continents will logically be different [3]. There are only a handful of documented cases of snake bites managed with ASV pertaining to different geographical locations. Use of Tiger Snake ASV in Stephen's Banded Snake envenomation in Australia, pit viper envenomation (South American) treated with nonspecific ASV and two North American coral snake venoms treated with Mexican ASV have been described [4, 5, 6]. A study was performed to assess the ability of polyvalent anti snake venom VACSERA (produced by Egypt), to neutralize venoms of snakes not only from Egypt but also African and Middle Eastern habitats showed encouraging results [7]. There is a description of a severe systemic envenomation of a African bush viper managed successfully with Near Middle East ASV [8]. Ours is possibly the first reported case of an African viper bite successfully managed with Indian polyvalent ASV given in the backdrop of unavailability of specific antisera. We recommend that more studies be carried out on this paraspecific activity of the Indian ASV.

A case discussion on eczema

Eczema is a form of dermatitis where inflammation of epidermis occurs. The exact cause of eczema is not known. Although it is activated by the immune system and is related to allergic reactions, it is not the same as other allergic reactions. In Ayurveda, the disease is described by the name “Vicharchika.” Virechana is the best line of management for skin disorders. Controlling eczema more effectively can make a radical improvement to the patient's quality of life. A case report of 45-year-old male, who presented with complaints of rashes over dorsum of both foot associated with intense itching and burning sensation, oozing wound posterior to lateral malleolus and dorsum of left foot has been presented here.

Langerhans Cell Histiocytosis Presenting as Brown Lichenoid Patches

Langerhans cell histiocytosis (LCH) is related diseases characterized by proliferation of Langerhans cell with involvement of bone, skin, lung and other organs. LCH usually occurs in childhood and are presented as multiple small papules or eczematoid lesion mostly. We report a 50-year-old man with 3 brown lichenoid patches on left dorsal foot. He was diagnosed pulmonary LCH 5 years ago. Typical LC cells on skin lesion and CD1 complex positive staining confirm the diagnosis of LCH. We consider brown lichenoid patches may be a previously unreported cutaneous presentation in cutaneous or multisystem LCH.

A case of simultaneously occurring lichen sclerosus and segmental vitiligo: connecting the underlying autoimmune pathogenesis

A 41‐year‐old African‐American woman reported a 6‐month history of asymptomatic white macules and patches that started on her left foot, and then spread proximally up her leg to her thigh, and then to her buttocks. She also noted that several of her pubic hairs had turned white, but only on the left side of the midline. She also complained of concomitant severe burning and itching in the vaginal area and that her vaginal skin had turned whitish pink. The patient denied contact with industrial or hazardous chemicals, and her medical history included childhood iron deficiency anemia only. On examination, the patient had linear guttate hypo‐ and depigmented macules on the left dorsal foot, extending up the medial calf, the medial and posterior thigh, and coalescing into scalloped patches across her left medial buttock (Fig. 1). There was sharp midline demarcation in the suprapubic region. Her pubic hairs on the left side were predominantly depigmented. Examination of the genital area revealed areas of atrophy, together with slightly hyperkeratotic pink and hypopigmented plaques covering the entire perineal area, with a slightly irregular rim of gray–brown hyperpigmentation almost encircling the introitus. The lichen sclerosus of the labia minora extended directly into the perianal region (Fig. 2). The vulvar area was tender to the touch.Hypo‐ and depigmented macules and patches on the medial left calf, thigh, and pubic areaimageDepigmented pubic hair on the left side and pink–white sclerotic plaques in the perineal areaimage A punch biopsy specimen taken from the perineum adjacent to the introitus showed a lichenoid infiltrate and papillary dermal sclerosis that was compatible with lichen sclerosus (Fig. 3). A Fontana–Masson stain showed complete absence of melanin in the epidermis, but melanophages were found in the dermis and in the lichenoid inflammatory infiltrate (Fig. 4). Melanin was also absent from the follicular epithelium of a hair follicle, but was present in the hair shaft of that follicle. Based on the clinical presentation and histology, a diagnosis was made of segmental vitiligo of the left lower extremity with overlapping lichen sclerosus in the perineal region.Histology shows hyperkeratosis, epidermal atrophy, and a lichenoid infiltrate with papillary dermal sclerosis (hematoxylin and eosin stain, ×4)imageComplete absence of melanocytes demonstrated in the epidermis (Fontana–Masson stain, ×10)image On two follow‐up evaluations spanning 6 weeks after a treatment regimen of clobetasol ointment 0.05% twice daily to all affected areas had been initiated, some repigmentation of the left lower leg was observed. There was markedly less erythema and the symptoms in the genital area had resolved, although slight scale remained in the vulvar plaques.

Verrucous Carcinoma Originating from a Diabetic Foot Ulcer: A Case Report

Background: It has been well-documented that chronic pressure or friction in the area of sensory loss might cause verrucous skin lesions especially on the feet of diabetic neuropathy victims. However, malignant change of these skin lesions have not yet been frequently reported. We report here a rare case of verrucous carcinoma originating from a diabetic ulcer and review the literature. Case Presentation: A 49-year-old male is a victim of diabetes mellitus. Due to osteomyelitis, he had received left third toe amputation, left second metatarsal sequestrectomy, and fourth toe shortening at distal phalangeal shaft two years before admission. He noted a fungating ulceration on his left dorsal foot which was at the base of the second toe 8 months before his coming for help. Initial skin biopsy was done and preliminary pathology results revealed verruca vulgaris. However, the fungating mass enlarged even after several scalpel shavings with topical antibiotics ointment. A second skin biopsy was done 3 months later. Unfortunately, histology results showed verrucous carcinoma. Sectional margin-free wide excision was done and full thickness skin graft was used to cover the soft tissue defect. Conclusion: In treating chronic diabetic ulcers, the possibility of potentially malignant change of the wound must be taken into consideration once the lesions persist or aggravate without infection or other offending factors. Any violating infection should be controlled by aggressive antimicrobial therapy with surgical debridement. Further biopsy should be performed to clarify any suspected malignant changes.

Dorsal venous foot ulcer caused by an intermetatarsal perforating vein

SummaryThis case report describes a woman (age: 79 years) with a recurrent venous ulcer located on the left dorsal foot. Duplex investigation showed that this ulcer was caused by an intermetatarsal insufficient perforating vein (PV). Finally Duplex-guided sclerotherapy of the causing PV has been chosen as therapy and the ulcer was successfully healed.