穿支蒂足背外侧皮神经浅静脉营养血管皮瓣的解剖基础

目的为穿支蒂足背外侧皮神经浅静脉营养血管皮瓣修复前足软组织缺损提供解剖基础。方法在30侧动脉内灌注红色乳胶的成人足标本上解剖观测:1足背外侧皮神经/足外侧缘静脉的走行与分布;2足底外侧动脉足背穿支与足背外侧皮神经浅静脉营养血管间吻合关系。另在1侧新鲜标本上进行摹拟手术设计。结果 1足背外侧皮神经外侧支为主干的延续,伴足外侧缘静脉恒定的沿足外侧缘径直前行,分布于足背外侧缘及第5趾外侧缘皮肤;2足背外侧皮神经/足外侧缘静脉营养血管为多节段、多源性,其中足底外侧动脉在第5跖骨与小趾外侧群肌之间浅出的足背穿支位置相对恒定,并分出众多的细小血管与足外侧缘静脉旁血管链的分支密切吻合。结论可形成以足底外侧动脉足背穿支蒂足背外侧皮神经浅静脉营养血管皮瓣转位修复前足软组织缺损。     

Morphology of the keratin filament network in palm and sole skin: Evidence for site-dependent features based on stereological analysis

Ridged or glabrous skin of palms and soles has a specialized function and can be preferentially involved volved in various disorders of keratinization. To better define the morphological features of ridged skin, we carried out a qualitative and quantitative (stereological) analysis of normal epidermis from the palm and sole of four subjects. Skin from the upper arm was examined for control purposes. The study focused on the appearance and arrangement of the keratin filament network in relation to epidermal differentiation. Whereas palm and sole epidermis was essentially similar both qualitatively and quantitatively, it differed markedly from the epidermis from the arm. The volume density of keratin filaments was significantly higher (P<0.03) in all subcorneal layers of the palm and sole compared with the arm. The volume density of the keratin filaments increased markedly from the basal to the upper spinous layer of ridged skin and they formed denser aggregates in the upper spinous and granular layers, providing an extensive matrix for the deposition of keratohyalin. The presence of dense keratin aggregates appeared to be a distinct ultrastructural feature of human ridged skin. Such keratin aggregates have not been described in normal skin from other sites, but showed some resemblance to the keratin clumps seen in non-ridged skin of patients with the Dowling-Meara form of epidermolysis bullosa simples.     

Serum levels of tissue inhibitor of metalloproteinase-1 and 2 in patients with eosinophilic fasciitis

BACKGROUND: Serum levels of tissue inhibitor of metalloproteinases (TIMPs) have been reported to be elevated in patients with various connective tissue diseases. However, there has been no report that evaluates TIMPs in patients with eosinophilic fasciitis (EF). OBJECTIVES: To determine serum TIMP-1 and TIMP-2 levels in patients with EF and to investigate their clinical significance. METHODS: Immunohistochemical stainings were performed in normal and EF skin samples. Serum TIMP-1 and TIMP-2 levels of 11 patients with EF and 12 healthy individuals were also measured with specific enzyme-linked immunosorbent assays. RESULTS: The fascia of EF patients was stained only by TIMP-1. Serum TIMP-1 levels (mean +/- SD) were significantly higher in EF patients than in healthy individuals (206.3 +/- 65.4 vs. 145.2 +/- 36.2 ng mL(-1), P < 0.01). Serum TIMP-1 levels in EF patients were significantly correlated with serum gamma-globulin and IgG levels (r = 0.86, P < 0.05; r = 0.83, P < 0.005, respectively). CONCLUSIONS: These results suggest that TIMP-1 is involved in the pathogenesis of EF, and that TIMP-1 may be a useful marker for the disease activity as well as serum gamma-globulin or IgG levels.     

A fatal case of craniofacial necrotizing fasciitis

A case of fatal craniofacial necrotizing fasciitis is described in a 72-year-old diabetic woman and management is discussed. Progressive infection of the eyelids occured with involvement of the right side of the face. Computed tomography revealed soft tissue swelling. Antibiotic treatment was started and debridement performed; histopathology showed acute inflammation and thrombosis of the epidermis and dermis. Despite treatment, scepticemia occurred, resulting in death less than 48 h after presentation. At this time extensive necrosis had developed in the superficial fascia with undermining and gangrene of surrounding tissues. Streptococcus and Staphylococcus were the pathogens involved. Poor prognosis in similar patients has been associated with extensive infection, involvement of the lower face and neck, delayed treatment, advanced age, diabetes and vascular disease. Received: 26 August 1998 / Accepted: 4 December 1998     

Periocular Necrotising Fasciitis—A Case Report

Purpose: To document the step-by-step reconstructive surgical rehabilitation, over a 12-month period, of a patient with severe periocular necrotising fasciitis. Methods: This is a retrospective interventional case note review of a 68-year-old man who developed necrotising fasciitis a few days after an insect bite. He had severe facial cellulitis with subsequent necrosis of all four eyelids despite broad spectrum antibiotics. Results: The initial management included performing a wide surgical debridement, with the removal of infected and necrotic tissue extending bilaterally from the forehead to the mouth. Split skin grafts were used to cover the extensive tissue defects. Subsequent horizontal eyelid shortening and full-thickness skin was required to correct severe cicatricial ectropions, eyelid displacement and improve lagophthalmos. Conclusions: Necrotising fasciitis is an acute fulminant infection of the subcutaneous fat and deep fascia. The initial appearance may look like cellulitis but necrosis quickly follows. Facial disease with extensive periocular involvement represents a significant management challenge.     

Fascitis necrosante periorbitaria secundaria a rascado

An 80 year-old woman with no relevant medical history, consulted for worsening of right palpebral itching and pain after an insect bite. Her eyelids had areas of laceration due to scratching, which rapidly progressed to fibrinoid necrosis over the first 24 hours. Lesions were cultivated, revealing Streptococcus pyogenes and Staphylococcus aureus. The patient was admitted to hospital with the diagnosis of periorbital necrotising fasciitis, in order to receive treatment with intravenous ceftriaxone, linezolid, and immediate surgical debridement. She remained in hospital for 17 days. Daily wound management consisted of debridement of necrotic remains, disinfection with chlorhexidine, and wound dressing with mupirocin, sulfadiazine, and miconazole ointments. The patient suffered streptococcal toxic shock syndrome, but she recovered over the first week. Palpebral reconstruction was performed on day 15, consisting of a preauricular total thickness skin graft for the superior eyelid, and lateral malar advancement to cover the lower eyelid. Adequate cosmetic and functional results were obtained.     

Non-tuberculous mycobacterium infection mimicking flesh-eating bacteria

Non-tuberculous mycobacterial infections in immunocompetent children are generally limited to cervical lymphadenitis. However, spreading cutaneous infections are another rare presentation of nontuberculous mycobacterial infection. Here, we present a previously healthy 14 year-old male with a rapidly desquamating and spreading cutaneous lesion encompassing the entire left face. A multi-disciplinary approach was necessary to diagnose a cutaneous atypical mycobacterial infection. The patient was treated with a combination of debridement, antibiotics, and local wound care. Pediatric otolaryngologists should be aware of this rare presentation of mycobacterial infection in order to facilitate prompt and accurate diagnosis and expedite treatment for these children.     

Eosinophilic Fasciitis with Hypereosinophilia as the Initial Clinical Manifestation of Peripheral T-Cell Lymphoma,Not Otherwise Specified

A 58-year-old man presented with painful edema of the extremities, and a diagnosis of eosinophilic fasciitis (EF) was confirmed. He also met the criteria for hypereosinophilic syndrome (HES), but there were no findings suggestive of malignancies or hematologic neoplasms despite a close examination. He was started on steroid therapy but subsequently developed severe liver dysfunction, hemophagocytic lymphohistiocytosis, hepatosplenomegaly, and renal involvement. The diagnosis of peripheral T-cell lymphoma, not otherwise specified was finally established by a bone marrow reexamination and liver biopsy. In cases of eosinophilia, EF, and/or HES, it is important to suspect an intrinsic abnormality, including potential T-cell lymphoma.