Superficial Skin Wounds Research Articles

CHYLURIA AFTER RADICAL NEPHRECTOMY TREATED WITH N-BUTYL-2-CYANOACRYLATE

Chyluria is usually due to parasitic infection with Wuchereria bancrofti. Nonparasitic chyluria can be due to trauma, tuberculosis, surgery, for example aortoiliac bypass grafting, tumor or congenital lymphatic anomalies. We report a case of chyluria due to a lymphatic ureteral fistula after radical nephrectomy and lymphadenectomy. The fistula was treated successfully with ureteral occlusion using N-butyl-2-cyanoacrylate tissue adhesive. CASE REPORT A 42-year-old woman presented with severe left loin pain radiating to the iliac fossa. She had had 2 episodes of painless hematuria during the previous 4 months and was apyrexial with a large ballotable mass in the left loin. Erythrocyte sedimentation rate, serum albumin and creatinine were normal. Ultrasound and computerized tomography showed an 8 cm. heterogeneous solid lesion in the lower pole of the left kidney and suspiciously enlarged para-aortic nodes. Left radical nephrectomy was performed with the ureter ligated and transected at its mid third. The left para-aortic lymph nodes were 1 cm. in diameter and the entire lymphatic chain from the celiac axis to the pelvic brim was excised in continuity. Histology demonstrated Fuhrman grade II clear cell carcinoma without capsular invasion and reactive changes only in the lymph nodes. The patient noticed milky urine 3 weeks postoperatively. Urinalysis revealed 2.0 mmol./l. triglyceride concentration and 15.36 gm./l. proteinuria consistent with chyluria. There was post-prandial worsening of the chyluria and voiding was difficult due to obstruction from fibrin clots. Cystoscopy showed no chylous efflux. Retrograde assessment of the ureteral stump confirmed a fine communication with a lymphatic collection in the para-aortic space (fig. 1). There were multiple chyle clots in the bladder. Dilute povidone-iodine (0.2%, 15 ml.) was injected into the ureteral stump to sclerose the fistula.1 However, chyluria recurred 48 hours after the injection and persisted 2 months postoperatively, causing hypoproteinemia (albumin 27 gm./l.), ankle swelling, weight loss, lethargy and malaise. Under fluoroscopic guidance a catheter and long vascular sheath primed with 5% dextrose were advanced over a guide wire into the left ureteral stump. A mixture of 1 ml. N-butyl2-cyanoacrylate and 1 ml. iodized oil was injected into the upper half of the ureteral stump with immediate solidification (fig. 2). The chyluria resolved immediately and serial abdominal ultrasonography showed no evidence of intraabdominal lymphatic collection. At 1-year followup the patient was well with no recurrence of chyluria. DISCUSSION N-butyl-2-cyanoacrylate has been used to close minor superficial skin wounds as an alternative to sutures for many years. It has also been used by interventional radiologists for a wide variety of purposes, including embolization of intracranial arteriovenous malformations, spinal dural arteriovenous fistulas, uterine arteriovenous malformation, massive obstetric hemorrhage and high flow prapism due to blunt perineal trauma.2 In the urinary tract interventional radiologists have performed antegrade transrenal ureteral occlusion as palliative treatment of lower urinary tract fistulas, mainly in the presence of extensive pelvic malignancy or following radiotherapy. Gianturco coils with tissue adhesive and detachable balloons with or without tissue adhesive have also been used.3

Gross, Histological and Immunohistochemical Features of Mucormycosis in the Platypus

Nine male and five female adult free-living platypuses, obtained in a prospective capture-release study from northern Tasmania, exhibited gross features of cutaneous mycosis caused by Mucor amphibiorum. The lesions were present on the hind limbs (six cases), front limbs (four), tail (five), dorsal trunk (three) and ventral trunk (one). They varied in size, and ranged from raised red nodules or plaques, which sometimes exuded purulent material, to ulcerated lesions with central cavitation, red exuding centres and raised epidermal margins. Older lesions were covered either partly or fully by thickened and irregular epidermis. Histological examination of skin biopsies revealed discrete, poorly encapsulated granulomas, or more commonly a diffuse granulomatous or pyogranulomatous inflammation. Inflammatory cells consisted of neutrophils or eosinophils, sparse plasma cells and lymphocytes, many macrophages and occasional multinucleated giant cells. Fibrovascular tissue was diffusely and irregularly scattered in the granulomatous regions. Sphaerules characteristic of M. amphibiorum infection were observed in all lesions. The cutaneous distribution of the lesions and the natural history of the platypus indicated that entry of M. amphibiorum may have been via superficial skin wounds. T cells were the predominant infiltrating lymphoid cells in the diffuse lesions, indicating the importance of the cell-mediated response to infection.

Evaluating the effects of topically applied products on superficial skin wounds

Evaluating the effects of topically applied products on superficial skin wounds

Fibrinolytic action on fresh human clots of whole body extracts and two semipurified fractions from Lonomia achelous caterpillar.

The severe bleeding diathesis produced by intoxication with the venom of Lonomia achelous caterpillars is characterized by prolonged bleeding from superficial skin wounds as well as massive hemorrhage into body cavities. The aim of the present study was to evaluate the effect of the crude venom and its fibrinolytic fractions on in vitro lysis of whole blood clots. Venom fractions with fibrinolytic activity were obtained by gel filtration chromatography on Sephadex G75 using imidazole buffer, pH 7.4, at a flow rate of 24 ml/h. Four peaks with fibrinolytic activity were obtained by this method. The highest activity was found in the first two peaks (both peaks were used for the experiments). The results show that the caterpillar venom degraded the preformed clots at a slower rate than plasmin. In addition, plasma protease inhibitors of the fibrinolytic system (alpha 2-antiplasmin, alpha 2-macroglobulin, PAI, etc.) only weakly inhibited the lytic effect of the caterpillar venom. These characteristics, as well as the pattern of fibrinogen degradation products, the delay period on fibrin plate lysis and amidolytic activity on chromogenic substrate, reported previously, indicate that the caterpillar enzymes are different from plasmin and trypsin.

Increased Antibiotic Resistance Among Skin Isolates

Excessive use of antibiotics has led to increasing resistance among many bacteria. This retrospective study from Miami evaluated the antimicrobial susceptibility of Staphylococcus aureus and Pseudomonas aeruginosa isolates obtained from superficial skin wounds and leg ulcers at the time of hospital admission in patients hospitalized in 1995 to 1996, and compared the results with a …

Carbon Dioxide Injury of `Empire' Apples

Occasional occurrence of a superficial skin injury associated with CA storage can cause severe commercial loss in the `Empire' cultivar in the northeast. To develop industry strategies to prevent losses due to the disorder, we have examined a number of factors related to its occurrence. 1) Fruit from six orchards were stored with 2% or 5% CO2 (with 2% O2) at 0.5 or 3°C for 6 or 9 months. Orchard variation in susceptibility was high. Preharvest factors such as maturity or mineral levels in the fruit did not account for these differences. Incidence of the disorder was much higher at 5% than at 2% CO2. However, temperature did not affect the extent of injury. 2) Exposure of fruit stored at 2% CO2/2% O2 to 5% CO2 at 4-week intervals from harvest until 20 weeks indicated that fruit were most susceptible to injury between 0 and 8 weeks. 3) A postharvest treatment with diphenylamine (DPA) prevented occurrence of the disorder, ethanol reduced it, but ascorbic acid had little effect. 4) Fruit were held at storage temperatures for up to 10 days before exposure to either 2% or 5% CO2. Injury was highest in fruit exposed one day after harvest and negligible when exposed after 10 days. Collectively the results indicate that rapid CA can aggravate the disorder if care is not taken to maintain low CO2 concentrations in the storage atmosphere but that use of DPA for control of superficial scald will prevent its occurrence.

External genitalia gunshot wounds: a ten-year experience with fifty-six cases.

To determine the appropriate methods for the diagnosis and management of gunshot injuries to the external genitalia. Retrospective analysis. Fifty-six patients with gunshot wounds (GSWs) to the external genitalia were seen over the last 10 years. All patients underwent physical examination, radiographic staging, and surgical exploration, according to protocol. There were 25 testicular, 19 scrotal soft tissue, 14 penile, 4 epididymal, 4 urethral, 4 vasal, and 3 superficial scrotal skin injuries. When possible, all injuries, except for the vasal and 1 urethral injury, were primarily repaired with excellent long-term results. Orchiectomy was required in half of testes struck by gunshots. Associated injuries with single GSWs were mostly to the proximity soft tissue and were amenable to conservative management. Major associated injuries were present in patients with multiple GSWs. In the absence of a suspected major associated injury, genital GSWs required only two diagnostic studies, a retrograde urethrogram for suspected urethral injury and a routine abdominal radiograph. Gunshot injuries to the penis or perineum, blood at the penile meatus, or gross hematuria were highly suggestive of urethral injury. Successful management of genital GSWs is dependent upon prompt surgical exploration, conservative debridement, and primary repair.

A double-blind comparison of adhesive bandages with the use of uniform suction blister wounds

<h3>• Background and Design.—</h3> The assessment of cutaneous wound healing in humans has been hampered by the inability to evaluate multiple wounds with identical origins, treatment histories, and sizes. There have been no double-blind wound healing studies in humans that compared one wound dressing with another. The purpose of this study was to determine if identical suction blister wounds could serve as a model to evaluate and compare wound healing and overall cosmetic appearance of wounds treated with commercially available adhesive bandages. In a double-blind study, we compared superficial skin wounds of identical depth and diameter, created on the forearms of five human subjects by means of a suction blister device. The wounds were covered by two common, commercially available adhesive bandages or a copolymer of polyurethane membrane type of wound dressing. We compared the degree of reepithelialization, erythema, skin depression, and overall cosmetic appearance of wounds with respect to the specific adhesive bandages used. <h3>Results.—</h3> The wounds covered with the copolymer of polyurethane membrane were judged to have better overall appearance and advanced reepithelialization compared with identical wounds covered by the other wound dressings. With the use of ×5 magnification for viewing the wounds on the final day of evaluation (between days 18 and 22), the wounds treated with the copolymer of polyurethane membrane were judged to be the least depressed wounds in fields of identical wounds in the three subjects studied. Concordance between the evaluators' "blinded" assessments was uniform, and no discrepancy between the evaluators' assessments occurred at any of the time points. <h3>Conclusion.—</h3> Identical wounds created with a suction blistering device can be used reliably to detect differences between the performances of wound dressings in healing superficial wounds. Superficial cutaneous wounds covered with a copolymer of polyurethane dressing demonstrated a superior rate of reepithelialization, less depression, and a better overall cosmetic appearance than wounds covered with two commercially available adhesive bandages. (<i>Arch Dermatol.</i>1992;128:1354-1357)

A Double-blind Comparison of Adhesive Bandages With the Use of Uniform Suction Blister Wounds

The assessment of cutaneous wound healing in humans has been hampered by the inability to evaluate multiple wounds with identical origins, treatment histories, and sizes. There have been no double-blind wound healing studies in humans that compared one wound dressing with another. The purpose of this study was to determine if identical suction blister wounds could serve as a model to evaluate and compare wound healing and overall cosmetic appearance of wounds treated with commercially available adhesive bandages. In a double-blind study, we compared superficial skin wounds of identical depth and diameter, created on the forearms of five human subjects by means of a suction blister device. The wounds were covered by two common, commercially available adhesive bandages or a copolymer of polyurethane membrane type of wound dressing. We compared the degree of reepithelialization, erythema, skin depression, and overall cosmetic appearance of wounds with respect to the specific adhesive bandages used. The wounds covered with the copolymer of polyurethane membrane were judged to have better overall appearance and advanced reepithelialization compared with identical wounds covered by the other wound dressings. With the use of x5 magnification for viewing the wounds on the final day of evaluation (between days 18 and 22), the wounds treated with the copolymer of polyurethane membrane were judged to be the least depressed wounds in fields of identical wounds in the three subjects studied. Concordance between the evaluators' "blinded" assessments was uniform, and no discrepancy between the evaluators' assessments occurred at any of the time points. Identical wounds created with a suction blistering device can be used reliably to detect differences between the performances of wound dressings in healing superficial wounds. Superficial cutaneous wounds covered with a copolymer of polyurethane dressing demonstrated a superior rate of reepithelialization, less depression, and a better overall cosmetic appearance than wounds covered with two commercially available adhesive bandages.

Restoration of the epidermal phenotype by follicular outer root sheath cells in recombinant culture with dermal fibroblasts

In order to better understand how outer root sheath (ORS) cells are able to reepithelialize superficial skin wounds, the level of epidermal differentiation achieved by isolated ORS cells in vitro was determined. Using postmitotic human dermal fibroblasts (HDF) as efficient feeder cells, large numbers of ORS cells from individual follicles were generated. Passaged ORS cells were grown exposed to air on HDF-populated collagen gels in the CRD device (Noser and Limat, In vitro 23, 541–545, 1987) which allows histiotypic tissue organization. In such recombinant organotypic cultures, ORS cells developed distinct epidermal strata comparable to interfollicular keratinocytes (NEK). Ultrastructurally, desmosomes and intermediate filaments increased in number toward the epithelial surface and small keratohyalin (KH) granules (but no large irregular KH granules as in NEK) were abundant, adjacent to an electrondense stratum corneum. Also, synthesis of epidermal suprabasal keratins (K1 and 10; 2D gels) was lower in ORS cultures, but clearly visible suprabasally by immunofluorescence along with other epidermal markers (involucrin, filaggrin, surface glycoprotein gp80, pemphigus vulgaris antigen). Basement membrane components (laminin, type IV collagen, bullous pemphigoid antigen) were detectable in both ORS and NEK in these assays. Thus, phenotypic expression was largely comparable, but, whereas terminal differentiation (keratinization) was progressing in NEK cultures limiting their lifespan, this seemed to be better controlled in ORS cultures and viable cell layers persisted resulting in longer survival time.

The one-stage surgical treatment of multilocated pressure sores using various myocutaneous island flaps.

Report on 32 patients suffering from chronical pressure sores (n = 18 solitary, n = 14 multilocated), Campbell stages IV-VI, overlaying sacral bone, ischial tuberosity and tuber femoris, which were treated by using various combinations of myocutaneous island flaps (uni- or bilaterally glutaeus maximus and/or biceps femoris flaps). Indications, operative procedures, perioperative management and follow-up results are presented. Superficial skin lesions (n = 2) and wound dehiscence (n = 1) appeared as temporary wound complications in the 14 patients with multilocated pressure sores. In all cases stable and durable coverage was achieved without any recurrence. The value of adequate rehabilitation in avoiding relapses is pointed out.

Keratins of the human hair follicle: “Hyperproliferative” keratins consistently expressed in outer root sheath cells in vivo and in vitro

Abstract Keratins produced by morphologically distinct compartments of the human hair folicle (hHF) were analysed and compared to those produced by cultured hHF and interfollicular keratinocytes. Five of the major keratins, the basic keratins nos. 5 and 6 (apparent mol. mass 60 and 58 kDa) and the acidic keratins nos. 14, 16, and 17 (51, 49 and 48 kDa), could be labelled in intact hHF and were found in all fractions of the outer root sheath (ORS). The other major keratins, which were not labelled under these conditions (basic-neutral hHbI and -II; 60–62 kDa and acidic hHaI and -II; 40–42 kDa) were associated with hair shaft (hHS) both in the follicle and, virtually unchanged, in the distal part of the hair. Another, previously undescribed, group of proteins with keratin-like properties exhibiting a broad pI-spectrum (basic to slightly acidic: hIC-I, -II, -III, 64–67 kDa; distinctly acidic: hIC-IV, about 54 kDa) was detected in isolated inner root sheath (IRS), in the cuticular material shed from denuded hHS, and also in nail plates. In our experiments only ORS cells grew readily in culture irrespective of their origin from peripheral (mesenchyme-adjacent) or more central ORS-cell layers. In contrast to keratinocytes from interfollicular epidermis (IFE) the cultured ORS cells expressed a keratin set virtually identical to that expressed in vivo. This set also closely resembled that expressed by IFE keratinocyte cultures. The identity of the respective keratins (nos. 5, 6, 14, 16, and 17) present in all these cells in vivo and in vitro was confirmed by tryptic peptide mapping. The data indicated that the microenvironment (in situ) directs the differentiation of ORS cells in a manner comparable to the way it is directed by conventional culture conditions, with consistent expression of the “basal'” and “hyperproliferative” set of keratins. This, however, does not exclude the possibility that other types of environmentally induced response may occur, as seen for example during the reepithelialization of superficial skin wounds by ORS cells.

Reinnervation of Experimental Superficial Wounds in Rats

Sensory reinnervation of a superficial skin wound in the rat was studied by labeling sensory axons with anterogradely transported wheat germ agglutinin-horseradish peroxidase. Reinnervation starts after 3 days from the edge of the wound as well as from beneath the wound. About 2 weeks after the production of the wound, some hyperinnervation appears to be present, but after a few additional weeks, the innervation pattern is essentially normal. The results indicate that structural recovery of sensory axons is rapid and probably complete when skin wounds heal with no or minimal scar formation.

Sensory reinnervation and sensibility after superficial skin wounds in human patients

In humans the innervation and sensibility after a superficial skin wound, the donor site for medium split thickness skin grafts, was investigated using sensibility tests and indirect immunohistochemistry with antibodies to neurofilament. After one to two weeks extensive sprouting of neurofilament immunoreactive nerve fibers was observed. Four weeks after the operation the wound had healed and the sensibility and distribution of neurofilament-positive nerve fibers resembled that of normal unoperated skin. These findings are discussed in view of recent studies indicating a role of sensory neurons in inflammation and wound healing.

Gunshot wounds of the skull during peacetime

66 patients with gunshot wounds were treated at the Department of Neurosurgery of Hanover University up to May 1982. These included wounds inflicted by bolt guns of the type used in slaughter houses, and by bolt-setting or nail-setting tools used in building construction work. The total mortality was 50%. Seventeen patients died directly after admission or within the first 24 hours. Operation was not indicated in cases which appeared hopeless. In patients with mild neurological deficits, only the superficial skin wounds were treated to avoid additional damage to the brain. CT scans performed in approximately one-half of the patients yielded valuable information on the path of the bullet and on haematomas. Postoperatively, there were several complications, mainly pneumonia and cerebrospinal fluid fistulas; in fact, pneumonia was responsible for the death of some patients. The mortality is compared with the findings by other authors. No patients remained in need of care after rehabilitation.

Liquid covering for superficial skin wounds and its effect on wound closure in guinea pigs.

An irrigatable bandage has been developed to hold fluid over a wound. Starting with superficial skin wounds on the back of guinea pigs, the bandage has been used to hold saline or phosphate-buffered saline containing antibiotics over the wound for up to 48 hours. Animals tolerated the bandage well for this period and bacterial contamination and wound maceration were not complications. The extent of reepithelialization with time was measured histologically under three separate conditions: wound exposed to air, wound covered and kept moist, and wound covered with liquid. By 24 hours 2 +/- 1%, 16 +/- 4% and 60 +/- 8% of the wound surface interfollicular areas showed some reepithelialization, respectively. On the average, at the same time these areas showed 15 +/- 2%, 19 +/- 2% and 37 +/- 1% coverage by epithelium. By these measurements, the liquid cover enhanced the rate of wound closure significantly.

Nerve growth factor: stimulation of polymorphonuclear leukocyte chemotaxis in vitro.

Topical application of mouse nerve growth factor (NGF) to superficial skin wounds of mice has previously been shown to accelerate the rate of wound contraction. Results of the present study reveal that NGF in the presence of plasma is also chemotactic for human polymorphonuclear leukocytes in vitro, and the concentration of NGF required for this effect is similar to that which stimulates ganglionic neurite outgrowth. This property does not arise from liberation of the C5a fragment of complement, nor does it require the known enzymic activity of NGF. (NGF inactivated with diisopropyl fluorophosphate is equally active.) We conclude that NGF can display biological effects on cells of nonneural origin and function, and this feature might play a role in the early inflammatory response to injury.

Healing of hyaluronic acid-enriched wounds: Histological observations

The influence of an exogenous supply of Na hyaluronate (HA) on the healing of superficial skin wounds in healthy and alloxan-induced diabetic rats was histologically assessed. Rats were treated by topical application on the wound site of a 2% Na hyaluronate solution. A facilitating effect of the HA-enrichment on wound repair processes (particularly epithelial migration and differentiation) was markedly evident in wounded diabetic rats. This result is discussed in terms of a possible favorable influence of an HA-enriched wound environment on cell migratory processes occurring during wound healing.

The Healing of Superficial Skin Wounds Is Stimulated by External Electrical Current

We studied the effects of direct electric current supplied by an energized silver-coated electrode on dermal and epidermal wound healing. Keratome-induced wounds (0.3 mm deep) on the skin of young domestic pigs were treated with either an energized (50-300 microA) electrode (DC), an unenergized electrode (placebo), or left untreated. Wounds were excised on days 1-7 after wounding and the epidermis was separated from the dermis. The epidermal sheet was evaluated for reepithelialization and the dermis was assayed for collagen biosynthetic capacity. Dermal collagen production among treatments did not differ markedly on days 1-4 after wounding. However, a highly significant increase (p less than 0.001) in the collagen synthetic capacity was observed on days 5, 6, and 7 in wound treated with DC. There was no significant difference in collagen synthesis among treatments when collagen production was corrected for DNA content. The rate of wound epithelialization was also significantly accelerated (p less than 0.05) in DC-treated wounds. These results suggest that the proliferative and/or migratory capacity of epithelial and connective tissue cells involved in repair and regeneration can be affected by an electrical field.

Age-related differences in healing of superficial skin wounds in humans.

The healing response of human volunteers was measured by monitoring the reestablishment of skin surface markings in unroofed blisters induced by brief exposure to a 1:1 aqueous solution of ammonium hydroxide. At all stages of repair, older individuals (ages 65-75 years) as a group lagged behind young adults (ages 18-25 years). Although individuals differed appreciably, especially in the older cohort, there was a good correlation between the rate of repair at two protected sites, the inner upper arm and the volar forearm. This suggests that healing response may a reliable measure of the physiologic status of the skin.