Abstract: Chronic limb ischemia (CLI) presents a therapeutic challenge. A collaborative multidisciplinary model utilizes the collective skills of the vascular surgeon, podiatrist, and plastic surgeon to achieve optimal outcomes. As treatment paradigms continue to evolve toward minimally invasive approaches, a thoughtful comparison of the available options is essential for wound care specialists. Minimally invasive, catheter-based options offer less morbidity with reduced patency compared to traditional, open bypass. Individualized selection of the most appropriate revascularization option should be made after careful consideration of the wound severity, anatomic location of occlusive disease and patient comorbidities.

Abstract: Over a 7-month period (October 2008–April 2009), 150 patients were seen at a North Carolina wound care center, two of whom presented with unusual fungal infections—Rhodotorula and Chromblastomycosis. Both patients responded to topical antifungal therapy, and in one case, a unique combination of silver and miconazole. The authors were unable to locate a reference to this treatment combination in the literature. Fungal infections, particularly in combination with bacteria, may prove to be an emerging problem, and should encourage wound care center specialists to check for fungal infections in cases of refractory ulcers.

Abstract: Advanced skin cancers sometimes develop complex wounds with associated pain, infection, malodor, massive discharge, and bleeding, which distresses patients and decreases his or her quality of life (QoL). The following cases presented large fungating skin ulcers that were treated with palliative abrasion along with wound resurfacing using free skin grafting. Palliative surgery allowed the patients to lead a more comfortable daily life at home with family.

Abstract: Systemic vasculitis is a group of heterogeneous diseases characterized by inflammation and blood vessel walls necrosis. Usually the skin is one of the first organs involved, especially with damage of small to medium size vessels. The cutaneous patterns may help clinicians to diagnose these diseases at the beginning of their course, preventing complications due to internal organ involvement. The following case presents a patient with a microscopic polyangiitis that started with several skin ulcerations localized on the inferior limbs.

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Abstract: Following standard care, nonhealing lower extremity (LE) ulcers were managed with a bacterial cellulose (BC) wound dressing, Dermafill™, (AMD/Ritmed, Tonawanda, NY), derived from Acetobacter xylinum. The time to 75% reduction in wound size was compared in 11 chronic wounds before and after the application of BC. The mean period of observation before the application of BC was 315 days; (95% CI: 239–392 days). With the application of BC to these chronic wounds, the mean time to 75% epithelization was reduced to 81 days (95% CI: 50–111 days) with a median of 79 days. The ra

Abstract: Paget’s disease of the breast is a rare malignancy of the nipple-areola complex and accounts for 1%–4% of all breast cancers. The disease is frequently associated with an underlying in-situ or invasive carcinoma in the breast tissue that extends to the nipple and areola. Paget’s disease is characterized clinically by eczema-like inflammatory skin changes and histologically by malignant cell infiltration in the dermis (Paget’s cells). Although Paget’s presents less commonly than a palpable mass or mammography abnormality, it is an important consideration in the differ

Abstract: Vascular disease is a known risk factor for pressure ulcer development, but the underlying mechanisms of this association are less established. The authors evaluated the relationship between endothelial function (EF) and history of pressure ulcers in a nested case-control study of community-dwelling elderly, 60 years and older. Endothelial function was measured using peripheral arterial tonometry, and persons with a history of pressure ulcers in the past 5 years (n = 7) were matched 2:1 by age and gender to controls with no history of pressure ulcers (n = 14). Overall endothel

I n recent years, there has been growing evidence that the experience of living with a chronic wound has a significant impact on a patient’s quality of life.^1,2 A consistent finding, particularly in the qualitative work that has been completed, is that pain is a symptom patients find particularly distressing.^3–5
A recent Canadian study⁶ suggests that the prevalence of pain in patients with pure or mixed venous ulcers is approximately 50%, with over 50% of these using analgesia as part of their treatment. Similar figures have been reported in other studie

Acknowledgment: This study was funded in part by HSR&D, Nursing Research Initiative, Department of Veteran’s Affairs (NRI 1-005-01), Washington, DC, and National Institutes of Health, National Institute of Nursing Research (NINR RO1 NR07721), Bethesda, Md.

I t is commonly asserted that diabetes causes diminished inflammatory responses,¹ although this assertion has never been empirically verified. The purpose of this study was to examine the impact of diabetes on localized inflammatory responses among individuals with infected chronic wounds. The specific aim was to desc

Chronic sacral ulcers, which develop as pressure ulcers and radiation ulcers, are a well-known clinical problem and usually require surgical treatment with gluteal fasciocutaneous (FC) flaps for closure.^1,2 Recently, the superiority of gluteal perforator-based flaps in the reconstruction of sacral pressure sores has been recognized. Gluteal FC rotation flaps can still be used, especially for older patients who cannot tolerate lengthy surgeries. A distressing problem with gluteal FC rotation flaps is that a large dog-ear (Burow’s triangle) may develop on the buttock (Figure