Limb Skin Research Articles

Toward Novel Wearable Pyroelectric Temperature Sensor for Medical Applications

Knowledge of an amputees’ residual limb skin temperature is considered to be of particular importance as an indicator of tissue health. Temperature within the prosthetic socket typically varies over the range 25 °C to 35 °C and this warm, confined environment causes sweating which creates favourable conditions for both the growth of bacteria and an increased risk of tissue breakdown. With this in mind a wearable sensor for the real-time measurement of temperature variations at the prosthetic socket/liner interface is under development and a proof of concept prototype is presented. The sensor exploits the large pyroelectric effect present in ferroelectric lead zirconate titanate PbZr x (Ti(1– x ))O3 (PZT) and has several inherent advantages over other methods of temperature sensing. The sensing element is a low cost commercially available thick-film PZT device. Mathematical models are developed to describe the sensor immitance and response to temperature change, and both the clamped and unclamped capacitances are investigated over the range 20 °C to 40 °C. Sensor characteristics were found to be dominated by the clamped dielectric constant and operation under short-circuit conditions is found to offer a constant sensor gain over the temperature range of interest.

Standardized Approach to Quantitatively Measure Residual Limb Skin Health in Individuals with Lower Limb Amputation.

Objective: (1) Develop a standardized approach to quantitatively measure residual limb skin health. (2) Report reference residual limb skin health values in people with transtibial and transfemoral amputation. Approach: Residual limb health outcomes in individuals with transtibial (n = 5) and transfemoral (n = 5) amputation were compared to able-limb controls (n = 4) using noninvasive imaging (hyperspectral imaging and laser speckle flowmetry) and probe-based approaches (laser doppler flowmetry, transcutaneous oxygen, transepidermal water loss, surface electrical capacitance). Results: A standardized methodology that employs noninvasive imaging and probe-based approaches to measure residual limb skin health are described. Compared to able-limb controls, individuals with transtibial and transfemoral amputation have significantly lower transcutaneous oxygen tension, higher transepidermal water loss, and higher surface electrical capacitance in the residual limb. Innovation: Residual limb health as a critical component of prosthesis rehabilitation for individuals with lower limb amputation is understudied in part due to a lack of clinical measures. Here, we present a standardized approach to measure residual limb health in people with transtibial and transfemoral amputation. Conclusion: Technology advances in noninvasive imaging and probe-based measures are leveraged to develop a standardized approach to quantitatively measure residual limb health in individuals with lower limb loss. Compared to able-limb controls, resting residual limb physiology in people that have had transfemoral or transtibial amputation is characterized by lower transcutaneous oxygen tension and poorer skin barrier function.

Effect of a professional soccer match in skin temperature of the lower limbs: a case study

The purpose of this study is to analyze the relationship between lower limbs skin temperature (Tsk) recorded by infrared thermography and creatine kinase (CK) response following an official soccer game. A professional soccer player, from the first division Brazilian League, defender, 27 years and 183 cm of height was analyzed. Measures of Tsk with a thermal camera and blood CK concentrations were obtained 24 hr before (24H-PRE), 24 (24H-POST) and 48 hr (48H-POST) after an official match. The results showed that CK values were 193 U/L 24 hr before, rising to 1,083 U/L 24 hr after the game and 414 U/L 48 hr after the game. Anterior thigh Tsk was 31.5°C, 33.8°C, and 31.8°C in the moments 24H-PRE, 24H-POST, and 48H-POST, respectively. Similarly, anterior leg presented temperature of 31.2°C, 33.3°C, and 31.5°C at the same moments. Qualitative analysis of the thermograms showed that whole lower limbs are much warmer 24 hr after the match and certain areas as the right anterior thigh, the left anterior leg, both anterior ankles, and both posterior thighs have not fully recovered their initial Tsk 48 hr after the match. The results of this study indicate that participation in a professional soccer match can lead to significant increases in Tsk values measured by IRT 24 hr after the match. Considering this variable as an indicator of muscular damage, it could help in the process of training control, being part of an injury prevention program in professional soccer clubs.

Medical follow-up of the exposed victim two years after " 5.7" radiation accident in Nanjing

Objective To investigate the late effects induced by ionizing radiation and the rehabilitation treatment of local radiation injury by medical follow-up of the patient exposed to192Ir at 5.7 accident in Nanjing, and to provide more experience for the treatments in the medical emergency of nuclear or radiological accident. Methods According to the history inquiry and physical examination of the patient in detail and the record of clinical symptoms and signs, the changes of the blood system, immune system, reproductive system, eyes, nervous system were systematically evaluated. The effects of rehabilitation treatment for the patient with lower limb dysfunction were also assessed. Results After the medical treatments of the patient, the hematopoietic immune system was restored, but the bone marrow aspiration still showed low bone marrow hyperplasia in right ilium. Meanwhile, the level of sex hormones was within the normal range, but semen examination showed sperm motility was 0. The radiation damage also occurred in the eye lens, retina and fundus. However, the psychological evaluation showed that the patient was stable and the right lower limb skin wound healing was well except for dysfunction and pain in some extent, which was relieved after the rehabilitation treatment. Conclusions The physiological function of the exposed victim with mild bone marrow type acute radiation sickness could be completely or partially restored after the clinical treatment in the early stage. Key words: Radiation accident; Bone marrow form of acute radiation sickness; 192Ir; Late effects; Medical follow-up

Canine leishmaniosis caused by Leishmania major and Leishmania tropica: comparative findings and serology

BackgroundInfection and clinical disease associated with Leishmania major and Leishmania tropica, two common agents of human cutaneous leishmaniosis, have rarely been reported in dogs. This study describes dogs infected with these Leishmania spp. prevalent in the Middle East and North Africa, and compares the serological response of dogs infected with Leishmania infantum, L. major or L. tropica to whole promastigote antigen enzyme-linked immunosorbent assay (ELISA) of each species and to rK39 dipstick.ResultsLeishmania major infection in a 5-month-old male dog was associated with alopecic and ulcerative periocular and limb skin lesions which responded to allopurinol treatment. Infection was detected by skin and blood polymerase chain reaction (PCR) and confirmed by DNA sequencing but the dog was seronegative. Leishmania tropica infection was detected in a 3-month-old female dog co-infected with Babesia vogeli and Anaplasma platys and with no skin lesions. PCR and DNA sequencing of the blood and parasite culture were positive for L. tropica. Sera from 11 dogs infected with L. infantum, L. major or L. tropica were reactive with all three Leishmania spp. antigens except for sera from a dog with L. major infection. No significant differences were found between reactivity of dog sera to the antigen of the infecting species, or to the other Leishmania spp. antigens. Sera from dogs infected with L. infantum and L. tropica were positive with the rK39 antigen kit, while dogs with L. major infection were seronegative.ConclusionsSkin lesions in L. major infected dogs from this study and previous reports (n = 2) were ulcerative and located on the muzzle, feet and foot pads and not associated with generalized lymphadenomegaly and splenomegaly. In previous L. tropica infections, skin lesions were proliferative mucocutaneous in young dogs (n = 2), or associated with widespread dermatitis, lymphadenomegaly and splenomegaly in older dogs with similarity to L. infantum infection (n = 2). This study suggests that ELISA serology with whole promastigote antigen is not distinctive between L. infantum, L. major and L. tropica canine infections and that some L. major infections are not seropositive. PCR with DNA sequencing should be used to discriminate between canine infections with these three species.

MiR‑199a‑3p is involved in the pathogenesis and progression of diabetic neuropathy through downregulation of SerpinE2.

The present study aimed to investigate the expression status of miRNA-199a-3p in patients with diabetic neuropathy (DN) and the mechanism by which this miRNA is involved in the genesis of DN. The expression of miRNA-199a-3p in plasma of peripheral blood was compared between patients with diabetes and a family history of diabetes and control volunteers by reverse transcription-quantitative polymerase chain reaction (RT-qPCR); in 60 diabetes patients, 45 (75%) demosntrated upregulated miR-199a-3p expression compared with control volunteer plasma. RT-qPCR was also used to detect miRNA-199a-3p expression in paired lower limb skin tissues from 30 patients with DN and 20 control volunteers; miR-199a-3p expression in patients with DN was significantly higher than in the control group. Next miR-199a-3p expression levels were evaluated with respect to the clinic-pathological parameters of diabetes; increased expression of miR-199a-3p was significantly associated with increased disease duration (P=0.041), glycated hemoglobin (HbA1C) levels (P=0.033), and fibrinogen levels (P=0.003). Finally, the effects on downstream mRNA expression levels were investigated as a result of manipulating miR-199a-3p levels. miR-199a-3p overexpression inhibited the expression of the extracellular serine protease inhibitor E2 (SerpinE2). Therefore, it may be hypothesized that miR-199a-3p can induce DN via promoting coagulation in skin peripheral circulation, through the downregulation of SerpinE2. The present findings suggested that miR-199a-3p may have potential as a novel therapeutic target for the treatment of patients with DN.

The Value of Using a SkinFibroMeter for Diagnosis and Assessment of Secondary Lymphedema and Associated Fibrosis of Lower Limb Skin.

Skin fibrosis is a clinically serious pathological process of secondary lymphedema (SLE). The detection of latent or incipient skin fibrosis, including early tissue changes, using sensitive diagnostic equipment is essential. The SkinFibroMeter has been used in skin care; however, its ability to assess skin fibrosis in patients with SLE of the lower limb has not been explored. In this study, 45 female patients with secondary unilateral lower limb LE and 15 healthy female volunteers were enrolled. The skin stiffness values of affected and healthy limbs were measured by using the SkinFibroMeter, and skin samples were assayed by Masson staining. The circumference and interstitial fluid of limbs were also measured and analyzed. Increasing skin stiffness with increasing severity of SLE of the lower limb and skin stiffness significantly positively correlated with stage of lower limb SLE. Our results demonstrate that the SkinFibroMeter is very sensitive and accurate for detecting skin fibrosis of edematous limb. Therefore, this new instrument is a promising prospect for diagnosis and assessment of skin fibrosis in patients with lower limb SLE.

Erratum to: Effects of Kinesio taping compared to arterio-venous Impulse System™ on limb swelling and skin temperature after total knee arthroplasty.

It is an established fact that post-operative (p.o.) soft-tissue swelling and lymphoedema after total knee arthroplasty (TKA) have a major influence on the p.o. early functional outcome. Kinesio taping has a proven clinical effect in increasing lymph drainage. Despite the decades of experience gained and the assumed positive effects, hardly any investigations have been conducted to date on the influence of Kinesio taping on the p.o. healing process after TKA. The objective of the present study was to test the hypothesis that Kinesio taping used as a lymph application leads to a reduction of p.o. soft-tissue swelling. As a secondary objective, it was to be tested whether there is an effect on skin temperature as a surrogate parameter for dermal micro-circulation. In this prospective study with a historical control (A-V Impulse System™ group), 42 subjects were included and treated with Kinesio taping after implantation of a TKA. The patients of the study group were treated immediately p.o. with Kinesio® Tex Gold™ fan cut tape as a lymph application with a common base. A thermographic temperature determination of the knee joint operated on was performed on each patient in the supine position every day from the first to the seventh p.o. day. The leg circumference was documented daily at eight specified measuring points on both lower limbs. As a statistical analytical approach, the so-called principal component analysis was used. An analysis of variance was performed. The significance level was set at p < 0.001. The course of soft-tissue swelling of the study group did not differ from that of the control group at any point in time. For the temperature course of the medial wound aspect, no difference was seen between the Kinesio taping study group and the A-V Impulse System™ group. In contrast, the temperature course of the lateral wound aspect showed a reproducibly higher temperature in the Kinesio tape group than in the control group (0.6 °C (0.5–0.8), p < 0.001). The hypothesis of the study that Kinesio taping as a lymph application induces a reduction of soft-tissue swelling after TKA must be rejected on the basis of the present data. Solely the temperature of the lateral wound aspect was higher in the Kinesio taping group than in the control group, so that an increased blood circulation can be assumed here. Considering that the actively working A-V Impulse System™ used in the control group also increases local blood circulation, the effect of the passive Kinesio tape is surprising. However, this was not reflected in a quicker wound healing, as the day of last wound secretion was the same in both groups. Kinesio taping as a lymph application represents an equivalent alternative to the A-V Impulse System™ for therapy after total knee arthroplasty with regard to soft-tissue swelling and wound healing.

Early Diagnosis and Surgical Treatment for Necrotizing Fasciitis: A Multicenter Study.

Necrotizing fasciitis (NF) is a group of relatively rare infections, usually caused by two or more pathogens. It affects the skin and subcutaneous tissues of lower and upper limbs, perineal area (Fournier's gangrene), and the abdominal wall. Early diagnosis and aggressive surgical management are of high significance for the management of this potentially lethal disease. We conducted a retrospective study in patients who presented, during the last decade, at four University Surgical Departments in the area of Athens, Greece, with an admission diagnosis of NF. Demographic, clinical, and laboratory data were gathered, and the preoperative and surgical treatment, as well as the postoperative treatment was analyzed for these patients. A total of 62 patients were included in the study. The mean age of patients was 63.7 (47 male patients). Advanced age (over 65 years) (P < 0.01) and female sex (P = 0.04) correlated significantly with mortality. Perineum was the mostly infected site (46.8%), followed by the lower limbs (35.5%), the upper limbs, and the axillary region (8.1%). Diabetes mellitus was the most common coexisting disease (40.3%), followed by hypertension (25.8%) and obesity (17.7%). The most common symptom was local pain and tenderness (90.3%). Septic shock occurred in eight patients (12.9%) and strongly correlated with mortality (P < 0.01). Laboratory data were used to calculate the LRINEC score of every patient retrospectively; 26 patients (41.9%) had LRINEC score under 6, 20 patients (32.3%) had LRINEC score 6-8, and 16 patients (25.8%) had LRINEC score >9. Surgical debridement was performed in all patients (mean number of repeated debridement 4.8), and in 16 cases (25.8%) the infected limb was amputated. The mean length of hospital stay was 19.7 days, and the overall mortality rate of our series was 17.7%. Diagnosis of NF requires high suspect among clinicians, as its clinical image is non-specific. Laboratory tests can depict the severity of the disease; therefore, they must be carefully evaluated. Urgent surgical debridement is the mainstay of treatment in all patients; the need of repetitive surgical debridement is undisputed.

Facial skin blood flow responses during exposures to emotionally charged movies.

The changes in regional facial skin blood flow and vascular conductance have been assessed for the first time with noninvasive two-dimensional laser speckle flowmetry during audiovisually elicited emotional challenges for 2min (comedy, landscape, and horror movie) in 12 subjects. Limb skin blood flow and vascular conductance and systemic cardiovascular variables were simultaneously measured. The extents of pleasantness and consciousness for each emotional stimulus were estimated by the subjective rating from -5 (the most unpleasant; the most unconscious) to +5 (the most pleasant; the most conscious). Facial skin blood flow and vascular conductance, especially in the lips, decreased during viewing of comedy and horror movies, whereas they did not change during viewing of a landscape movie. The decreases in facial skin blood flow and vascular conductance were the greatest with the comedy movie. The changes in lip, cheek, and chin skin blood flow negatively correlated (P<0.05) with the subjective ratings of pleasantness and consciousness. The changes in lip skin vascular conductance negatively correlated (P<0.05) with the subjective rating of pleasantness, while the changes in infraorbital, subnasal, and chin skin vascular conductance negatively correlated (P<0.05) with the subjective rating of consciousness. However, none of the changes in limb skin blood flow and vascular conductance and systemic hemodynamics correlated with the subjective ratings. The mental arithmetic task did not alter facial and limb skin blood flows, although the task influenced systemic cardiovascular variables. These findings suggest that the more emotional status becomes pleasant or conscious, the more neurally mediated vasoconstriction may occur in facial skin blood vessels.

Применение метода дозированного тканевого растяжения при дефектах кожи и тканей в области верхней конечности

Применение метода дозированного тканевого растяжения при дефектах кожи и тканей в области верхней конечности

National strategy for the integration of pharmacovigilance in the Moroccan TB Control Program.

The objective of this work is to demonstrate the interest of integration of pharmacovigilance in Moroccan Tuberculosis Control Program (MTCP). The integration of pharmacovigilance in MTCP was conducted in October 2012with the Global Fund support. We compared the reports notified before and after this integration (period 1: January 2010–October2012; period 2: October 2012–December 2013). The detection of signals was based on the Information Component available inVigiMine. We used the SPSS version 10.0 and Med Calc version 7.3 for data analysis. The average number of spontaneous reports increased from 3.6 to 37.4 cases/month (P< 10-3). The average age was 40.7 ± 17.5 years; the sex ratio was 0.8. Hepatic reactions (32.7%) predominated during the first period, while skin reactions (24.1%) were in the second period (P = 10-4), and40.9% of cases in the first period were serious against 15.8% in second period (P = 0.003). Nine signals were generated (hepaticenzyme increase, cholestasis, jaundice, arthralgia, acne, lower limb edema, pruritus, skin rashes, and vomiting). The integration of pharmacovigilance in Moroccan Tuberculosis Control Program improved the management of ADRs and detected new signals of antituberculosis drugs.

Outcomes of Surgical Treatment of Skin Cancer at Surgical Oncology Unit of Donka, Conakry University Hospital

Aim: The main aim of this study was to evaluate outcomes after surgical treatment of skin cancer. Methods: This retrospective cohort study concerned 46 patients who presented 43 skin cancers lesions surgically treated at surgical oncology unit, Conakry University Hospital. There were 29 (61.7%) squamous cell carcinoma, 12 (25.5%) melanoma, 4 (8.5%) sarcomas and 1 (2.1%) porocarcinoma. Surgical indications and prognosis factors were analyzed. Results: Surgical treatment included simple excision in 2 cases (3.8%), wide excision in 38 cases (71.7%) and amputation/disarticulation in 13 cases (24.5%). Inguinal lymph node dissection was performed in 16 patients (34.3%). Postoperative complications were wound suppuration (5 cases), lower limb lymphedema (4 cases), seroma (2 cases) and skin flap necrosis (1 case). Surgical margins were free in 28 (60.9%) patients, infiltrated in 3 patients (6.5%) and unspecified in 15 patients (32.6%). The median follow-up after surgery was 29 months. During the follow-up, 13 patients (28.3%) had a relapse. The relapse was influenced by surgical margins (p = 0.012) and iterative resection (p = 0.04). Overall survival was 65.2%. Factors related to survival in univariate analysis were: iterative resection (p = 0.008), fungated tumor (p = 0.037), the status of surgical margins (p = 0.002) and the occurrence of relapse (p = 0.0000). In multivariate analysis, the status of surgical margins was the only independent prognostic factor. Conclusion: The prognosis after surgical treatment of cutaneous cancers depends on the resection margins.

Thermal Assessment for Prostheses: State-of-the-Art Review

Hundreds of young people have had limbs amputated after being wounded by civil wars, explosions or gunshots. Heat and perspiration within a prosthetic socket are the most common side effects of reduced quality life for prosthesis. Besides, the environment between liner and skin is an ideal host of residual limb skin problems such as contact dermatitis and bacterial infections. It is important to minimize the limiting heat transfer to improve amputee safety and comfort. Usually, when there is a skin problem, the treatment requires the amputee not to wear his/her prosthesis for an extended period of time. This functional loss can adversely affect the amputee’s physical, mental and emotional well-being. This work aims to highlight a number of important issues concerning the effect of thermal conditions on prosthetics to shed light on new design methods for prosthetics.

JunB regulates angiogenesis and neurovascular parallel alignment in mouse embryonic skin.

Blood vessels and nerve fibers are often closely arranged in parallel throughout the body. Therefore, neurovascular interactions have been suggested to be important for the development of vascular networks. However, the molecular mechanisms and genes regulating this process remain unclear. In the present study, we investigated the genes that are activated in endothelial cells (ECs) following interactions with neurons during vascular development. Microarray analyses of human primary microvascular ECs co-cultured with mouse primary dorsal root ganglion cells showed that JunB is strongly upregulated in ECs by neurovascular interactions. Furthermore, the forced expression of JunB in ECs stimulated a tip-like cell formation and angiogenesis in vitro and induced vascular endothelial growth factor A (VEGFA) and the pro-angiogenic integrin subunit ITGB3 expression. Moreover, in vivo knockdown of JunB in ECs from developing mouse limb skin considerably decreased the parallel alignments of blood vessels and nerve fibers. Taken together, the present data demonstrates for the first time that JunB plays an important role in the formation of embryonic vascular networks. These results contribute to the molecular understanding of neurovascular interactions during embryonic vascular development.

由孔氏创伤球菌引起糖尿病性足病感染的个案报道

背景：孔氏创伤球菌是兼性厌氧菌，最初被认为是一种人体下肢皮肤的正常菌群，因孔氏创伤球菌引起侵袭性感染的病例在国内外文献报道中极其罕见，现报道我院中医外科一例由此菌引起的糖尿病足的病历。病例：患者为67岁女性以糖尿病足收入我院中医外科，术中和术后取分泌物做细菌培养，两次结果均培养出孔氏创伤球菌，后经左氧氟沙星静脉滴注和我院自制中药联合用药后，病情明显好转后出院。讨论：本文报道的病例在国内是第一例由孔氏创伤球菌引起的糖尿病性足病感染的病例，现在随着大量抗生素的使用，原认为是人体正常菌群的孔氏创伤球菌，也会引起人体侵袭性感染，应引起广大临床工作者的高度重视。 Background: Helcococcus kunzii is a facultative anaerobic bacteria, which was originally consi-dered a normal flora of human lower limb skin. The cases of invasive infection caused by Helco-coccus kunzii are extremely rare in domestic and foreign literature. In this paper, the patient with diabetes mellitus caused by Helcococcus kunzii is reported. The patient was 67 year old female with diabetes foot in our hospital surgery. In and after operation, the secretions were taken for bacterial culture. Helcococcus kunzii has been cultured two times. After the intravenous drip of levofloxacin and the combination of Chinese herbal medicine in our hospital, the condition of the patient improved significantly and discharged. Discussion: What has reported in this article is the first case of invasive trauma caused by the pathogen of diabetic foot disease cases in the country. Now with the use of a large number of antibiotics, Helcococcus kunzii, which was originally considered the normal bacteria of body can also cause the body invasive infection. And clinical workers should attach great importance to Helcococcus kunzii.

Large Stereotypy Full-Thickness Skin Graft for the Repair of Simple Limb Skin Avulsion

Objective: To explore the methods for the repair of large-area limb skin avulsion wound. Method: Eleven patients with simple limb skin avulsion underwent large-area stereotypy full-thickness skin graft for wound repair. Results: Wounds were repaired very well as well as the late appearance and functions were satisfactory in all 11 patients. During follow-up, the hypertrophic scars were mild, the recovery of joint function was good, and no severe complications occurred. Conclusion: Appropriate timing and skin for the repair of wound was the key to reduce postoperative dysfunction after simple limb skin avulsion. Large-area stereotypy full-thickness skin graft in wound repair had the advantage of improved skin survival rate, good appearance and function of the limb.

Development of CAPTSureTM – a new index for the assessment of pediatric postthrombotic syndrome

Background Postthrombotic syndrome (PTS) is a complication of deep vein thrombosis defined by the presence of characteristic signs and symptoms. We developed a discriminative and evaluative index for the assessment of upper extremity (UE) and lower extremity (LE) pediatric PTS. Methods The items to be included in the index were voted for by 26 pediatric thrombosis experts invited to participate in a Delphi survey. Subsequent item weighting was based on item importance elicited by the use of multicriteria decision analysis (MCDA); 122 healthcare providers and patients/parents were invited to participate in item weighting. The implications of the overall scores were explored by comparison with PTS diagnosis (independently assessed by two clinical experts) and parental satisfaction/dissatisfaction with their child's current condition. Results Items voted for inclusion by at least 70% of the Delphi survey respondents (81% response rate) were pain, paresthesia, swelling, heaviness, endurance, collateral circulation and arm circumference difference for the UE, and pain, paresthesia, swelling, heaviness, tightness, tired limb, redness/purple or blotchy skin, endurance, ulcers and thigh/calf circumference difference for the LE. Items were then weighted by the use of MCDA (82% response rate). The index had excellent discrimination for patients with/without PTS. For every 10-point increase in index scores (with higher scores being indicative of worse PTS), the odds of parental dissatisfaction increased by 75% and 92% in the UE and LE, respectively. Conclusion We report the development of the CAPTSure™ (index for the Clinical Assessment of Postthrombotic Syndrome in children), which reflects collective judgement of the severity of pediatric PTS. We also provide information on the meaning of the scores.

Varicosities of the lower extremity, new approaches: cosmetic or therapeutic needs?

Varicose veins of the lower extremity (VVLE) are a frequently encountered vascular disorder in the general population. The general view that VVLE are a non-serious disease with primarily aesthetic impact is a common misconception, as the disease can have a significant negative impact on generic and disease-specific quality of life. Further, VVLE may be associated with potentially threatening clinical conditions, such as chronic venous ulceration, venous thromboembolism and haemorrhage from ruptured varicose veins. In the case of symptomatic varicose veins, in the presence of advanced lower limb skin changes or when venous complications occur, a referral for dedicated evaluation by the vascular medicine specialist is recommended. The initial diagnostic test of choice to detect the extent of the varicose disease and to plan treatment is duplex ultrasound. Traditionally, compression therapy, surgical high ligation and stripping of the truncal veins have been considered standard of care for VVLE. Driven by the aim to reduce surgical trauma and improve the long-term effectiveness, minimally invasive treatment options have been developed in the last two decades, namely endovascular vein ablation techniques (EVA). Endovenous laser ablation and radiofrequency ablation have been established as first-line treatments for varicose veins associated with axial reflux on the basis of the most recent international guidelines. For practical purposes and depending on the concrete clinical situation, the various EVA and surgical techniques are often combined, leading to multimodal varicose vein therapy management. Knowledge of the different techniques is of utmost importance for the vascular medicine specialist. The purpose of this article is to provide an overview of the new EVA techniques and to elucidate the different therapeutic strategies for VVLE.

Improving Health-Related Quality of Life in Wounded Warriors: The Promising Benefits of Laser Hair Removal to the Residual Limb-Prosthetic Interface.

Wounded warriors with lower limb amputations using prosthetics commonly develop dermatologic complaints at the residual limb-prosthetic interface, which impact their health-related quality of life (HRQOL). To optimize this interface, military dermatologists routinely treat the subset of issues related to the pilosebaceous unit with laser hair removal (LHR). To characterize the impact of residual limb skin conditions on HRQOL in wounded warriors using lower limb prosthetics before and after treatment with LHR. Twenty wounded warriors with lower limb amputations using prosthetics were administered a validated HRQOL survey, the Skindex-16, before and after an average of 3 treatments of LHR to their residual lower limbs. Responses were statistically analyzed within the symptoms, emotions, and functioning subscales of the survey and in aggregate. Statistically significant (p < .05) improvement in HRQOL was observed across the symptoms, emotions, and functioning subscales and in aggregate. Dermatologic complaints at the residual limb-prosthetic interface in patients with traumatic lower limb amputation are well-established in the literature. The authors present the first report subjectively quantifying this impact on HRQOL and the marked improvement observed with LHR to the residual limb.