June, 2006

Dear Readers,

The first article in this issue of the journal describes the uncommon disease, hidradenitis suppurativa (HS), which involves the chronic infection of apocrine glands. The sites affected can include the axilla, buttocks, groin, perineum, and perianal areas. Di Saia (Medial thigh lift used to reconstruct perineal hidradenitis suppurativa defect: a case report) describes a case in which the HS patient had undergone 2 surgical excisions of the affected areas. While the diseased tissue was cleared, there were post-operative deformities that can occur following this surgery. The author describes the approach used to correct the deformities and the long-term results.

Liu et al (The effects of graduated compression stockings on cutaneous surface pressure along the path of main superficial veins of lower limbs) have applied an engineering approach to investigate the effects of graduated compression stockings (GCSs) along the main saphenous veins of 6 healthy, female subjects. They report their findings related to tested locations, body postures, and types of GCSs. As pressures were seen to be influenced by various body postures, “…the authors suggest that proper lower-extremity exercises, such as ankle and knee flexions, are still necessary even if the subject is wearing a GCS. This not only will help avoid sustained high pressure exerted at the local regions but also will assist the skeletal muscle pump in preventing the backflow of blood.”

In a brief communication, Al-Muhairi and Phillips (Surgical pearl: a wound dressing tip for venous ulcers) discuss a method for preventing the skin indentation, painful erosions, and new ulcers that may result from multilayer compression dressing usage. The authors have had success in preventing the development of these complications in venous ulcer patients by tapering the edges of a foam dressing prior to applying the compression bandage. The authors conclude that the commercial development of a foam with tapered edges would be advantageous in the treatment of venous ulcers.

Ogino et al (Tie-over dressing technique using rubber bands for skin graft) report on a variation of the conventional tie-over dressing technique commonly used with skin grafts. The authors staple sterile, 5-mm wide rubber bands around the wound at 3 cm to 5 cm intervals, dress the grafts with nonadherent gauze and a cotton/foam bolus, and secure the rubber bands to establish a pressure dressing. The authors find this technique to be particularly useful in dressing grafts on highly mobile areas, such as the buttock, hip joint, or shoulder joint.

A case series by Humburg et al (Negative pressure wound therapy in post-cesarean superficial wound disruption: a report of 3 cases) illustrates the use of negative pressure wound therapy (NPWT) in patients who have experienced wound complications post-cesarean section. The authors discuss NPWT as an alternative to healing by secondary intention in this group of patients. The patients in this series found the course of treatment and aesthetic results acceptable.

In Diagnostic Dilemmas, Etufugh et al describe the case of a patient presenting with hemorrhagic bullae and multiple erosions on the trunk, axilla, back, groin, legs, hands, and volar aspect of the wrists, arms, and feet. Along with the clinical presentation, histopathology and direct immunofluorescence analysis confirmed the diagnosis of bullous pemphigoid. The treatment options and those chosen for this patient along with the outcome are discussed.