Skin Side Research Articles

Cutaneous adverse reactions to herbal medicines

The use of medicinal plants is as old as human history. The adoption of plants in the prevention and treatment of diseases has maintained its position in various societies and cultures. Many people believe using medicinal herbs is not detrimental if there is no benefit. In recent years, due to the trend of people and the increase in the consumption of medicinal plants, extensive research is being done in the field of pharmaceuticals and the use of medicinal plants and their properties for the treatment of diseases. Skin diseases are among the most common diseases in the world. Some of the most common skin disease symptoms are skin rashes, itchy skin, prominent bumps, peeling, blisters or sores, discoloration, etc. Since the skin plays a vital role as the first defense barrier of the body, skin diseases can cause dangerous problems for all age groups, from infants to the elderly. Therefore, investigating the possible adverse effects of medicinal plants on the structure and function of the skin is of particular importance. Plants can cause side effects or reduce other pharmaceutical medication effects when improperly used. According to studies, adverse skin responses to herbal medications can be caused by dermal contact or prolonged exposure to medicinal herbs. These reactions are also linked to several risk factors, such as adverse effects, dose, health state, and interactions. This article reviews the findings and data available in articles published between 1953 and October 2022 on the skin side effects of medicinal plants in various databases, including Google Scholar, PubMed, and Scientific Information Database.

INNV-22. A CASE REPORT OF MULTIPLE LESIONS DISAPPEARING AFTER TMZ+TTFIELDS+ DARAFENIB AND TRAMETINIB IN A PATIENT WITH GBM

Abstract A 44-year-old female patient developed the disease with left visual field defect in both eyes. Brain MRI on September 13, 2021, showed irregular masses in the right basal ganglia, thalamus, and hippocampus of temporal lobe, with the lesion extending to the right midbrain and right optic tract. On September 28, 2021, intraoperative total resection of lesions in right gyrus, hippocampus, thalamus and cingulate herniawas performed under nuclear magnetic navigation and electrophysiological detection. The pathological integration diagnosis result was glioblastoma, IDH wild type with TERT C228T mutation, chromosome 7 amplification and BRAF V600E mutation, WHO grade 4, MGMT non-methylation, postoperative visual acuity same as before. Based on the protocols and data of the clinical trials that have been conducted, and the safety of simultaneous use of TTFields during radiotherapy is controllable and patients can benefit, we started the follow-up treatment: standard TMZ (75mg/m2/d), combined with TTFields and retaining the transducer arrays placed on the shaved scalp. The dose of 60/54Gy, 30 times was selected. The application time of TTFields was relatively long throughout the radiotherapy period, and patient compliance was good, with treatment duration of about 20 hours per day. One month after conventional radiotherapy, reexamination indicated that local T1 enhanced hypersignal and PWI showed hyperperfusion. The methionine PET suggested that tumor activity might still exist. We found that the BRAF V600E mutation may provide therapeutic benefit, so this patient was treated with TMZ (standard 5/28 regimen) +TTFields+ Darafenib and Trametinib. Nearly two months after the follow-up treatment, a re-examination found a remarkable phenomenon, the multiple lesions disappeared. At present, the patient continues to be treated with TTFields for a relatively long time, and the skin side effects are only grade ONE. The combination of TTFields with targeted agents and chemotherapy brought clinical benefit to the patient with manageable adverse reactions.

The effect of recombinant human epidermal growth factor on radiation dermatitis in rectal and anal cancer patients: a self-controlled study

BackgroundOur previous study reported that recombinant human epidermal growth factor (rhEGF)-triggered EGFR internalization promoted radioresistance. Here, we aimed to evaluate the effect of rhEGF on the skin protection of rectal and anal cancer patients receiving radiotherapy.MethodsOne hundred and ninety-three rectal and anal cancer patients who received radiotherapy were prospectively enrolled from January 2019 to December 2020. To perform self-controlled study, the left and right pelvic skin area (separated by midline) were randomly assigned to the rhEGF and control side. The association between radiation dermatitis and factors including rhEGF, the dose of radiotherapy and tumor distance from anal edge were analyzed.ResultsAmong 193 enrolled patients, 41 patients (21.2%) did not develop radiation dermatitis, and 152 patients (78.8%) suffered radiation dermatitis on at least one side of pelvic skin at the end of radiotherapy. For the effect on radiation dermatitis grade, rhEGF had improved effect on 6 (4.0%) patients, detrimental effect on 2 (1.3%) patients, and no effect on 144 (94.7%) patients. Whereas for the effect on radiation dermatitis area, rhEGF showed improved effect on the radiation dermatitis area of 46 (30.2%) patients, detrimental effect on 15 (9.9%) patients, and no effect on 91 (59.9%) patients. The radiation dermatitis area of rhEGF side was significantly smaller than that of control side (P = 0.0007).ConclusionsrhEGF is a skin protective reagent for rectal and anal cancer patients receiving radiotherapy.Trial registrationChinese Clinical Trial Registry identifier: ChiCTR1900020842; Date of registration: 20/01/2019.

Flame-retardant and thermal-protective polyimide-hydroxyapatite aerogel fiber-based composite textile for firefighting clothing

Firefighting protective clothing is an essential equipment for firefighters that can provide protection from all kinds of thermal hazards and prevent burn injuries. However, it is still a challenge to develop lightweight firefighting clothing without compromising their excellent fire-resistant and thermal-protective performance. In this study, we report a novel polyimide aerogel fiber-based double-layer smart textile comprising of flame-retardant outer layer (ambient-side) with excellent fire resistance and phase-changeable inner layer (next to skin side) with thermal-regulating function, achieving comprehensive flame-retardant and thermal-protective function. The polyimide-hydroxyapatite-reduced graphene oxide (PI-HAP-rGO) aerogel fabric (outer layer) acquires 54.7% and 70.0% reduction of peak heat release rate compared with that of pure PI aerogel fabric and commercial aramid fabric, respectively, exhibiting excellent fire resistance. The phase-changeable polyimide-hydroxyapatite/eicosane (PI-HAP/C20) fabric (inner layer) with high melting enthalpy of 193.2 J g−1 can delay the temperature rise by thermal buffering effects during the phase change process, endowing cool somatosensory temperature for firefighters. Consequently, the double-layer smart textile can extend the time (280.0 s) to pain threshold of human skin, much longer than that of the commercial aramid fabric (101.0 s) and glass fiber fabric (56.5 s), which exhibits huge potential for next-generation firefighting clothing.

Importance of education on infection control and on the hand skin health of dental personnel.

Hand hygiene plays a significant role in infection control, yet it is performed correctly only 40% of the time. The daily use of soap, disinfectants and gloves can also affect hand skin health. Periodical educational interventions regarding hand hygiene can improve infection control. The current study aimed to identify the existing hand hygiene practices applied by dental personnel, to evaluate knowledge about infection control, to determine the adverse effects of hand hygiene on the skin, and to assess the effectiveness of the educational interventions concerning these topics. This study was carried out at the Vilnius University Hospital Žalgiris Clinic, Lithuania. At the 1st stage, data was collected by using a self-administered questionnaire. At the 2nd stage, dental personnel underwent an educational intervention and the surveys were redistributed to determine any changes in the level of knowledge. In most cases, dental workers performed hand hygiene when it was needed. The proper method was selected by 53.4% on average. The main mistakes were the excessive use of soap and only occasional use of a disinfectant. The reported hand skin side effects included dryness (68.8%) and fissures (37.5%). Only half (50.5%) of the staff regularly used emollients. After the educational intervention, there was a 24.9% improvement in hand hygiene compliance. The correct procedure for hand hygiene was reported by half of the participants. Washing hands with soap was the preferable choice, while alcohol-based hand rub (ABHR) was avoided. Skin problems were reported by more than 70% of the respondents. Training had a positive impact on the hand hygiene knowledge of the dental personnel.

Discovery of potent and selective HER2 PROTAC degrader based Tucatinib with improved efficacy against HER2 positive cancers

HER2 is a validated therapeutic target for HER2 positive breast cancer and gastric cancer. TKIs have significantly improved the prognosis of patients with HER2 positive cancer. However, the pan-HER TKIs always caused gastrointestinal and skin side effects, and acquired drug resistance inevitable compromised their therapeutic efficacy. Herein, we describe the discovery of the first potent and selective HER2 PROTAC degrader based Tucatinib with improved antitumor activity in vitro and in vivo. The preferred selective HER2 PROTAC, CH7C4, efficiently degraded HER2 with DC50 of 69 nM and Dmax of 96%, and inhibited the proliferation of BT-474 cells with IC50 of 0.047 ± 0.006 nM via long lasting HER2 degradation and strong repression of downstream pathway. Moreover, CH7C4 had acceptable pharmacokinetic profiles with a half-life of 5.31 h, and significantly inhibited the growth of BT-474 xenografts in vivo with TGI of 73%. As the first selective HER2 PROTAC degrader with better activity in vitro and in vivo than Tucatinib, CH7C4 provides new insights into the development of new therapeutic strategy for HER2 positive cancer.

3D-printed bolus ensures the precise postmastectomy chest wall radiation therapy for breast cancer.

PurposeTo investigate the values of a 3D-printed bolus ensuring the precise postmastectomy chest wall radiation therapy for breast cancer.Methods and materialsIn the preclinical study on the anthropomorphic phantom, the 3D-printed bolus was used for dosimetry and fitness evaluation. The dosimetric parameters of planning target volume (PTV) were assessed, including Dmin, Dmax, Dmean, D95%, homogeneity index (HI), conformity index (CI), and organs at risk (OARs). The absolute percentage differences (|%diff|) between the theory and fact skin dose were also estimated, and the follow-up was conducted for potential skin side effects.ResultsIn preclinical studies, a 3D-printed bolus can better ensure the radiation coverage of PTV (HI 0.05, CI 99.91%), the dose accuracy (|%diff| 0.99%), and skin fitness (mean air gap 1.01 mm). Of the 27 eligible patients, we evaluated the radiation dose parameter (median(min–max): Dmin 4967(4789–5099) cGy, Dmax 5447(5369–5589) cGy, Dmean 5236(5171–5323) cGy, D95% 5053(4936–5156) cGy, HI 0.07 (0.06–0.17), and CI 99.94% (97.41%–100%)) and assessed the dose of OARs (ipsilateral lung: Dmean 1341(1208–1385) cGy, V5 48.06%(39.75%–48.97%), V20 24.55%(21.58%–26.93%), V30 18.40%(15.96%–19.16%); heart: Dmean 339(138–640) cGy, V30 1.10%(0%–6.14%), V40 0.38%(0%–4.39%); spinal cord PRV: Dmax 639(389–898) cGy). The skin doses in vivo were Dtheory 208.85(203.16–212.53) cGy, Dfact 209.53(204.14–214.42) cGy, and |%diff| 1.77% (0.89–2.94%). Of the 360 patients enrolled in the skin side effect follow-up study (including the above 27 patients), grade 1 was the most common toxicity (321, 89.2%), some of which progressing to grade 2 or grade 3 (32, 8.9% or 7, 1.9%); the radiotherapy interruption rate was 1.1%.ConclusionA 3D-printed bolus can guarantee the precise radiation dose on skin surface, good fitness to skin, and controllable acute skin toxicity, which possesses a great clinical application value in postmastectomy chest call radiation therapy for breast cancer.

35341 The application of an emollient helps to reduce the skin side effects of anticancer treatments

Skin-related side effects of cancer treatment, a recurring complaint from patients, lead to further deterioration in patient’s quality of life (QOL). Patients also develop skin sores or cracks, causing discomfort or pain and increasing infection risks. The study objective was to assess skin acceptability in patients undergoing cancer treatment and receiving an emollient containing shea butter, Thermal Spring Water, niacinamide, microresyl and Aqua Posae Filiformis as actives. 47 patients were included, 42 were eligible for analysis.

35349 The use of photoprotection reduces skin side effects of patients undergoing anti-cancer treatments

The use of photoprotection reduces skin side effects of patients undergoing anti-cancer treatments. As some cancer treatments are photosensitizing, even indirect sunlight exposure requires protection. Using anti-UVB and anti-UVA sunscreens is an easily accessible way to prevent skin reactions. The study objective was to assess skin acceptability in patients undergoing cancer treatment who received a daily sun protector SPF100 UVA-PF36. 59 patients were included, 56 were eligible for analysis. Patients (mean age 60.2 years ± 12.8) were predominantly women (71%).

Pinnae and facial hypertrichosis induced by cetuximab.

Anti-EGFR targeted anti-cancer treatment is associated with various skin adverse events. Cetuximab is often associated with acneiform papules and skin disorders. Hypertrichosis cited in face pinnae and eyelash trichomegaly are seldom described. A 72-year-old female cancer patient presented deteriorating facial-pinnae hypertrichosis and eyelash prolongation post cetuximab infusion. Consecutive cetuximab administration led to exaggerating hairy skin side effects, fully alleviated when the drug was discontinued. To the best of our knowledge, this is the first reported case of an anti-EGFR-associated diffuse pinnae hypertrichosis presentation in a female patient in literature. This distinct entity can be easily diagnosed and manipulated with early drug withdrawal. An extensive review of relevant basic molecular research is provided to increase physicians' awareness.

Two doses of the Pfizer-BioNTech vaccine, two different side effects: Skin and eye

A 47-year-old male patient presented to our clinic with the complaints of eye pain, reduced vision and redness in the right eye three days after administration of the second dose of the Pfizer-BioNTech vaccine. The patient was diagnosed with uveitis associated with the Pfizer-BioNTech vaccine and inflammatory glaucoma due to the uveitis. In addition, an erythematous, morbilliform rash had developed three days after the first dose of the vaccine. This is the first case report in the literature to show both skin and eye side effects after the Pfizer-BioNTech vaccine.

The Value of Transrectal Ultrasound in the Preoperative Diagnosis of Complex Anal Fistula (CAF): Based on a Retrospective Cohort Study.

The Value of Transrectal Ultrasound in the Preoperative Diagnosis of Complex Anal Fistula (CAF): Based on a Retrospective Cohort Study.

Gut Microbiota Imbalance in Metastatic Colorectal Patients Treated With EGFRI and Long-Term Antibiotic Therapy for Cutaneous Toxicity: A Pilot Study

Patients with metastatic colorectal cancer (mCRC) frequently experience epidermal growth factor inhibitors (EGFRI)-induced skin side effects. Antibiotic treatment with doxycycline is often required in order to manage the skin and mucosal toxicity. Since these patients already have significant gut dysbiosis, the long-term antibiotic treatment may destabilize their gut microbiome.ObjectivesThe assessment of intestinal dysbiosis in patients undergoing treatment with EGFRI, who require antibiotic treatment with doxycycline in order to manage adverse skin effects.MethodsWe conducted a prospective pilot study between 2020 and 2021 involving 10 patients with mCRC. These patients were undergoing treatment with EGFRI and required either short-term or long-term treatment with doxycycline in order to manage skin toxicity.ResultsThe patients with mCRC who were treated with doxycycline for 8 weeks showed overexpression of Escherichia coli, Candida, and Geotrichum species compared to the patients who only received doxycycline treatment for two weeks.ConclusionsThe elevated levels of Escherichia coli and Candida species in the patients who received doxycycline for eight weeks compared to the patients who received the treatment for two weeks could provide a starting point for the development of a standardized guideline regarding the use of pre-active or reactive antibiotic treatment. We also highlight the importance of analyzing the intestinal microbiome of these patients. The identification of overexpressed species, as well as the deficiency of certain protective species, could guide the administration of probiotics to cover and repair the affected intestinal flora.

Non-destructive damage localization in built-up composite aerospace structures by ultrasonic guided-wave multiple-output scanning

This paper focuses on defect localization in a composite skin-to-stringer stiffened panel representative of modern aircraft construction by an ultrasonic scanning system using multi-channel transfer function extraction. An especially made mini-impactor is utilized as the excitation to generate a broad wave frequency range. At each scanning position, multiple excitations are concatenated to extract the Guided-Wave Structural Transfer Function (GWSTF) between two points of the test structure. This extraction is performed using an averaged, normalized cross-power spectrum operation that minimizes the influence of the excitation and that of uncorrelated noise. The GWSTF extracted from different sensor pairs is then related to the presence of damage at different locations. The system is thus able to locate damage in the panel in 2D (along and across the stringer direction), in a substantial improvement over a 1D scanning system developed by the authors previously. The system is tested on damage in the form of added masses and real damage in the form of through-thickness stringer notches. The results show good detection and location of damage, suggesting the potential for a practical inspection system targeting internal damage in aircraft structures when probed from the outer skin side.

Comparison of alternative methods for thermal disbudding in calves

Calves are frequently disbudded to reduce the number of injuries due to horns to other animals and farm workers. The most commonly used method is thermal disbudding which is increasingly causing animal welfare concerns (Stafford and Mellor, 2011; Sutherland et al., 2013, Cozzi et al., 2015). The objective of our study was to evaluate alternative disbudding methods either by injection of clove oil or its synthetic analogue isoeugenol.Forty Simmental calves (26 male, 14 female) aged between 1 and 5 days were treated using 4 different methods (n = 10): injection of 1.5 mL clove oil, injection of 1.5 mL isoeugenol, injection of 1.5 mL isotonic NaCl solution (control group) and thermal disbudding. For thermal disbudding sedation and local anesthesia were legally required. Horn growth of all calves was repeatedly measured. Computer tomography (CT) of the horn bud region and histological examination of biopsy samples taken from the horn bud region were performed. Additionally, saliva cortisol concentrations were measured before and after intervention.Significant differences in horn growth were found between isoeugenol treatment and control group (P = 0.001), between clove oil treatment and control group (P = 0.001) and between thermal dehorning and control group (P < 0.001). After clove oil injection 10/10 calves showed signs of inflammation and swelling of the horn bud region including the upper eye lid area. CT images of animals after thermal disbudding showed complete destruction on the horn buds but also severe local damage to the frontal bone. CT images of animals after clove oil or isoeugenol injection showed complete or partial destruction of the horn bud. Histological examination was performed at 1 horn bud per animal of 5 per each group. Eight biopsy samples showed normal unchanged epidermis and dermis (3 isoeugenol, 5 control group), in 6 samples normal vital skin side by side with necrotic epidermis and/or dermis was found (2 isoeugenol, 2 clove oil, 3 thermal dehorning). In one sample (thermal dehorning) necrotic bone with osteomyelitis was detected. In 3 samples (thermal dehorning) dystrophic calcification was present. After clove oil treatment necrotic epidermis and dermis as well vital skin with a purulent crust was detected.The highest mean cortisol value was measured in calves treated with clove oil. Fifteen minutes after treatment the mean value of thermal dehorned calves showed the lowest values, however these calves were sedated for the treatment.Thermal disbudding tended to have the highest efficacy of disbudding. Horn growth was also substantially decreased in clove oil and in isoeugenol group. In cases in which the horn growth was not totally suppressed the horns remained very small. Based on our results, disbudding calves with isoeugenol causes less tissue damage than thermal disbudding. Since clove oil caused temporary swelling we consider it less suitable. Future research is required to evaluate the behavioral responses of calves experiencing these methods of disbudding; in addition, more research is needed to optimize the injection volume and technique in a larger group of animal.

Pityriasis Rosea After Pfizer-BioNTech Covid-19 Vaccine: A Case Report

After the pandemic started, vaccines against SARS-CoV-2 were developed and applied in a short time. Later, various side effects were reported during the use of these vaccines. Among the skin side effects, besides local skin reactions at the injection site, urticaria, maculopapular rash and pityriasis rosea-like reactions were observed. We presented a female case who developed pityriasis rosea after administering the 3rd dose of the Pfizer-BioNTech COVID-19 vaccine.

The Occurrence and Management of Adverse Skin Events due to Continuous Glucose Monitoring

The use of continuous glucose monitoring (CGM) for blood glucose control is increasing and is effective in changing treatment methods and improving lifestyle by identifying problems in blood sugar patterns. However, adverse skin events are increasing due to the insertion of invasive tools or attachment of sensors to the skin for 14 days for intermittent CGM. These adverse events can be the reason for the discontinuation of CGM. Therefore, this paper aims to determine methods to identify and manage skin irritation and side effects caused by CGM accessories.

Nanostructured lipid carrier-embedded polyacrylic acid transdermal patches for improved transdermal delivery of capsaicin

Capsaicin has been used as a topical treatment for skeletomuscular and neuropathic pain. However, it has some side effects when it is applied to the skin such as burning, erythema, and skin irritation resulting in poor patient compliance. These adverse effects are caused by the rapid penetration of capsaicin into the outer layer of the epidermis and low permeation to the dermis layer. This study aimed to develop nanostructured lipid carriers (NLCs) embedded transdermal patches for improved transdermal delivery of capsaicin. An optimum formulation of NLCs (0.3% capsaicin) with a particulate size smaller than 200 nm, narrow size distribution, and acceptable colloidal stability was used for preparing transdermal patches. Polyacrylic acid (7%) was employed as the polymer base of the transdermal patches as it provided high adhesive performance and a sustained release of capsaicin. Moreover, the patches containing capsaicin-loaded NLCs could offer a higher deposition of capsaicin in the deeper layer of the skin compared to the conventional capsaicin patches. In vivo skin irritation studies indicated that the conventional capsaicin patches can cause skin irritation and redness, whereas capsaicin NLCs-loaded patches exhibited lower skin side effects. Therefore, the capsaicin NLCs-loaded patches could be a potential delivery system of capsaicin through the skin with possibly reduced skin irritation.

Exploration of the Potential Mechanism of Qi Yin San Liang San Decoction in the Treatment of EGFRI-Related Adverse Skin Reactions Using Network Pharmacology and In Vitro Experiments.

BackgroundAdverse skin reactions are the most common side effects of epidermal growth factor receptor inhibitors (EGFRIs) in the treatment of cancer, significantly affecting the survival rate and quality of life of patients. Qi Yin San Liang San Decoction (QYSLS) comes from folk prescription and is currently used in the clinical treatment of adverse skin reactions caused by EGFRIs. However, its therapeutic mechanism remains unclear.ObjectivesTo explore the potential mechanism of QYSLS in the treatment of adverse skin reactions caused by EGFR inhibition using network pharmacology and experimental research.MethodsFirst, we verified the effectiveness of QYSLS in vivo using model mice. Second, the related targets of adverse skin reactions associated with EGFR inhibition were predicted by the Gene Expression Omnibus (GEO) database, and effective components and predictive targets of QYSLS were analyzed by Traditional Chinese Medicine Systems Pharmacology (TCMSP) and Batman-TCM databases. Gene ontology and Kyoto Encyclopedia of Genes and Genomes pathway analyses were performed via the Bioconductor (R) V3.8 bioinformatics software. Molecular docking studies verified the selected key ingredients and targets. Finally, the results of network pharmacology were verified by in vitro experiments.ResultsIn the in vivo mouse model, QYSLS effectively reduced the occurrence of skin side effects. Network pharmacological results showed that the active ingredient luteolin, quercetin, licochalcone a, and kaempferol and the effective targets prostaglandin-endoperoxide synthase 2 (PTGS2), matrix metallopeptidase 9 (MMP9), and C–C motif chemokine ligand 2 (CCL2) were related to the interleukin-17 (IL-17) and tumor necrosis factor (TNF) pathway. Subsequently, the related active compounds and targets were verified using HaCaT cells as an in vitro adverse reaction model. The results showed that luteolin and quercetin increased the expression of PTGS2 and MMP9 and reduced the expression of CCL2 in HaCaT cells treated with gefitinib.ConclusionsThe results revealed that QYSLS effectively treats EGFRI-related adverse skin reactions through multi-target and multi-pathway mechanisms. Luteolin and quercetin may be the core active ingredients of QYSLS in the treatment of EGFRI-related adverse skin reactions, and their therapeutic effects are potentially mediated through PTGS2, CCL2, and MMP9 in the IL-17 and TNF signaling pathway.

Primary closure using a perforator flap-based technique for the treatment of Dupuytren's contracture

We aim to present a perforator flap-based technique that is useful in the resection and reconstruction of the palmar fascia for the treatment of Dupuytren's contracture with primary closure. A curve incision through the palmar skin radial to the hypothenar area was made. The ulnar side of the palmar skin and the subcutaneous fat was raised to the ulnar side, exposing the palmar fascia. The ulnar palmar digital artery extending from the superficial palmar arch curves distally towards the little finger at a point perpendicular to the fourth interdigital space with parting branches into the subcutaneous fat radial of the flap was carefully identified and preserved, and the Dupuytren's cords were excised. Depending on contracture involvement, additional incision extending from the arc of the palmar incision to the proximal interphalangeal joint is made to raise the digital flap similar to that of the palmar incision. The perforator flap was raised along the hypothenar region in 53 hands of 48 patients, nine women and 39 men, and their age at the time of surgery averaged 56 years. Two patients complained of paresthesia in the ring and little fingers after surgery in 2015, and the symptom had disappeared without further intervention before the latest follow-up in 2017. There was no incidence of skin necrosis, delayed healing, and no recurrence within the follow-up period. This perforator flap-based technique is technically reliable and straightforward with better exposure and easier removal of all the diseased fascia, making it possible for primary healing without skin necrosis and acceptable for the treatment of patients at all stages of the disease.