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Intractable wounds caused by arteriosclerosis obliterans with end-stage renal disease treated by aggressive debridement and epidermal grafting.

Hanafusa T, Yamaguchi Y, Katayama I

Department of Dermatology, Osaka University Graduate School of Medicine, Suita-shi, Japan. takafussa0710@yahoo.co.jp

BACKGROUND: Patients receiving hemodialysis (HD) need to avoid skin laceration; amputation is common because of intractability of wounds and complications with other diseases, including diabetes mellitus. We have reported the usefulness of aggressive debridement deep enough to expose bone marrow cells, occlusive dressing, and epidermal grafting for diabetic foot ulcers and wounds from rheumatic diseases. OBJECTIVE: To test whether this experimental protocol is effective to treat intractable wounds in a patient receiving HD accompanied with arteriosclerosis obliterans (ASO). METHODS AND RESULTS: A 78-year-old patient with chronic renal failure and arteriosclerosis obliterans suffered a wound with exposed bone on the left great toe. Aggressive combination therapy was effective despite methicillin-resistant Staphylococcus aureus infection, and the wound healed in 13 weeks. LIMITATIONS: This study, reporting a single case, limits the interpretation of results. CONCLUSION: Aggressive debridement exposing bone marrow cells is useful in preparing a healthy wound bed and epidermal sheet grafting may be accepted more advantageously in an ischemic environment and adopt a site-specific phenotype via mesenchymal-epithelial interactions.

Published 19 July 2007 in J Am Acad Dermatol, 57(2): 322-6.
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