Advanced Treatment Options of Pyoderma Gangrenosum Ulcers.

INTRODUCTION: Pyoderma gangrenosum (PG) is a neutrophilic dermatosis often associated with autoimmune disease that, despite published literature, still poses diagnostic and therapeutic challenges due to its lack of serological and histological markers and wide possibility of differential diagnosis. Although immunosuppressive therapy usually is the first-line treatment, it has a long-lasting, unpredictable treatment course, thus necessitating the need for new treatment options. This report highlights 2 cases of PG ulcers treated with different methods that show a potentially faster healing time, as well as a review of advanced treatment options for PG. CASE REPORTS: Two men (21 years old and 64 years old) presented with PG ulcers and underwent 2 different treatment courses. The 21-year-old man received negative pressure wound therapy (NPWT) with a nonadhesive, less-invasive, skin-contact interface layer on the polyurethane foam. Stimulated growth of granulation tissue accelerated healing and prepared the wound bed for further epithelization. The second patient, the 64-year-old man, underwent treatment with autologous platelet-rich fibrin, which supplied the ulcer with growth factors and accelerated epithelialization. CONCLUSIONS: The new possibilities offered by NPWT with nonadhesive foam and regenerative medicine are typically affordable, effective, safe, and painless for the patient. Both methods were noninvasive, did not accelerated the pathergy phenomenon, and showed a potential for faster healing of PG ulcers.

An Atypical Chronic Ulcer Caused by Acute Myeloid Leukemia.

INTRODUCTION: Atypical chronic wounds are challenging for clinicians because of their identification, diagnosis, and treatment. These wounds may reflect an underlying systemic or malignant disease; therefore, an accurate diagnosis and initiation of the appropriate treatment are necessary. CASE REPORT: A 68-year-old man presented with an atypical chronic ulcer on his left shin of 2 years' duration. The ulcer was associated with acute myeloid leukemia. Initially, the surgeon treated the chronic wound with wide debridement and biopsy for pathohistological investigation. Leukemia cutis with accumulation of blast cells in the area of the ulcer was recognized by histological examination. Further, an absorbent cellulose-based core dressing with activated carbon was used, which appeared to be useful in reducing wound pain, odor, and exudate. CONCLUSIONS: Leukemia cutis is a specific sign of systemic leukemia and the result of dissemination of leukemic cells to the skin. Treatment should be directed towards eradication of the systemic disease, which also improves local manifestation of the disease.

Fournier's Gangrene Does Not Spare Young Adults.

INTRODUCTION: Fournier's gangrene is a rare but severe form of necrotizing fasciitis, primarily affecting the perianal, genital, and perineal regions. It is a rapidly progressive disease and can be potentially fatal; therefore, it should be treated as an emergency. CASE REPORT: Presented herein is the case of a 30-year-old man, without significant medical history, who presented to general surgery with complaints of swelling and pain in the gluteal area. The patient underwent emergency surgery on the day of admission to the emergency department where excessive fasciectomy and necrectomy were performed; broad-spectrum parenteral antibiotic therapy also was administered. CONCLUSIONS: Fournier's gangrene is a surgical emergency, and the main cornerstones of treatment are patient resuscitation, broad-spectrum parenteral antibiotic therapy, and, most importantly, surgical debridement. Any delay in treatment can dramatically increase mortality.

REGENERATION OF CHRONIC WOUNDS WITH ALLOGENEIC PLATELET GEL VERSUS HYDROGEL TREATMENT: A PROSPECTIVE STUDY.

- The aim of the study was to evaluate the efficacy and safety of the new method of platelet-rich plasma activation in the form of platelet gel, used in the treatment of non-healing chronic lower leg ulcers. The study was prospectively randomized, double blind and placebo controlled. We treated 60 patients (42 males and 18 females, mean age 69.43 years, SD 14.74) with chronic lower leg ulcers of different etiologies. Thirty patients were treated with allogeneic platelet gel and 30 with hydrogel. Both groups were comparable for duration of ulcer and its size. Treatment was repeated once a week for three consecutive weeks and then the last examination was scheduled at 6 months of the first platelet gel application. The t-test was used to analyze independent samples. Healing of chronic wounds with platelet gel was statistically significantly more effective compared to the treatment with hydrogel (p<0.05). At 6 months of platelet gel application, the mean wound area in the experimental group decreased to 35.01% (SD 53.69) of the initial wound size. In the control group, the wound area decreased to 89.95% (SD 71.82) of the initial wound size (p=0.001). The circumference of the wounds diminished to 54.62% (SD 39.85) of the initial value in the experimental group, compared to 91.28% (SD 29.32) in the control group (p<0.001). Allogeneic platelet gel prepared by the new method used in this study was found to be a good treatment option for non-healing chronic wounds when other methods are ineffective.