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Dermatofibrosarcoma protuberans (DFSP) is a rare, slow-growing soft tissue sarcoma, typically presenting as a cutaneous lesion. However, its occurrence in chronic wounds is infrequently documented, posing diagnostic and therapeutic challenges. This report details the case of a 59-year-old female with no significant medical history, presenting with a chronic, non-healing wound on the left shoulder, persisting for three years. Initially a small nodule, it progressed into an ulcerating lesion. Physical examination revealed a contracted scar with restricted shoulder mobility. After obtaining informed consent, a surgical excision of the lesion was performed by an electrocautery. Histopathology confirmed DFSP, characterized by spindle fibrous cells, with skin ulceration and deep dermal infiltration. A split-thickness skin graft achieved successful closure. This case underscores the importance of considering DFSP in chronic, non-healing wounds. Timely intervention and appropriate surgical management are crucial for favorable outcomes.

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A 98-year-old female, with a past medical history of trigeminal neuralgia (TN) and non-melanoma skin cancer, presented with a crescent-shaped ulcer on her right nasal ala that had been present for months. On exam, the patient was aware of her issue, readily admitted to manipulation of the area, and had a past medical history significant for TN. The patient's history and clinical presentation led to a diagnosis of trigeminal trophic syndrome (TTS). TTS is an extremely rare, ulcerative condition that can arise in patients suffering from TN. While TN itself is well-documented, treatment is often challenging and usually focused on achieving symptomatic relief; for this patient, she did not achieve adequate management of her neuropathic symptoms, and her condition progressed to TTS. Thus, given the patient's ongoing multi-modal TN treatment, she was encouraged not to pick or manipulate the area to the best of her ability to curb the extent of ulceration. Given that TTS is so infrequently seen, we are hopeful that, by identifying the specifics of the underlying neuronal aberrancies in the future, we may be able to better grasp TTS's pathophysiology, ulcer development, and potential future treatment options.

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Background: Nonhealing leg ulcers are challenging to manage and cause significant patient morbidity. To promote healing, newer techniques focus on delivering/enhancing dermal matrix components. Aim: The aim of this study was to compare the therapeutic efficacy of autologous platelet-rich plasma (PRP), autologous platelet-rich fibrin matrix (PRFM), recombinant human epidermal growth factor (rhEGF), and collagen particles in treating nonhealing leg ulcers. Materials and Methods: Open, randomized prospective study was conducted in a single tertiary center over 2 years where after fulfilling the criteria, randomization was done into four groups. Group A: Autologous PRP (double spin, manual method, weekly); Group B: Autologous PRFM (weekly); Group C: rhEGF (daily application); and Group D: Collagen particles (weekly) along with cleansing, debris removal, and wound dressing. Treatment endpoints were complete healing/6 months of treatment, whichever was earlier. Follow-up was done two weekly by clinical assessment, photographs, and measurement of the ulcer area. Epi info 7 software was used for statistical analysis. Results: A total of 48 patients completed the study, 12 in each group, with mean age: 42.37 ± 4.56 years and male-to-female ratio 2.6:1. Underlying etiology was varicosities (43.75%), traumatic (25%), diabetes (22.91%), and leprosy (8.34%). At baseline, all groups were comparable in terms of patient and ulcer characteristics. Complete healing was seen in 79.17% at the end of 12 weeks: 91.67% of patients from Groups A and B each, and 66.67% from Groups C and D each. The mean time to complete healing was 6.9 ± 2.5 weeks, the least in Group B (4.73 ± 2.3 weeks). Differences between excellent (≥75%) ulcer healing across all groups were statistically significant at the end of 8 weeks where Group B showed maximum improvement. No major adverse events were seen. Conclusion: PRFM resulted in relatively faster ulcer healing compared with other modalities.

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A non-healing diabetic foot ulcer (DFU) is a debilitating clinical problem amounting to socioeconomic and psychosocial burdens. DFUs increase morbidity due to prolonged treatment and mortality in the case of non-treatable ulcers resulting in gangrene and septicemia. The overall amputation rate of the lower extremity with DFU ranges from 3.34% to 42.83%. Wound debridement, antibiotics, applying growth factors, negative pressure wound therapy, hyperbaric oxygen therapy, topical oxygen, and skin grafts are common therapies for DFU. However, recurrence and nonhealing ulcers are still major issues. Chronicity of inflammation, hypoxic environment, poor angiogenesis, and decreased formation of the extracellular matrix (ECM) are common impediments leading to nonhealing patterns of DFUs. Angiogenesis is crucial for wound healing since proper vessel formation facilitates nutrients, oxygen, and immune cells to the ulcer tissue to help in clearing out debris and facilitate healing. However, poor angiogenesis due to decreased expression of angiogenic mediators and matrix formation results in nonhealing and ultimately amputation. Multiple proangiogenic mediators and vascular endothelial growth factor (VEGF) therapy exist to enhance angiogenesis, but the results are not satisfactory. Thus, there is a need to investigate novel pro-angiogenic mediators that can either alone or in combination enhance the angiogenesis and healing of DFUs. In this article, we critically reviewed the existing pro-angiogenic mediators followed by potentially novel factors that might play a regulatory role in promoting angiogenesis and wound healing in DFUs.

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Prevalence of nonhealing ulcers of lower extremities has increased over years causing heavy health, social, and economic burdens. Chronic ulcers are difficult to treat since they require tailored multistep treatment and patient compliance. To treat chronic wounds successfully, clinicians must keep in mind the ulcer etiology as well as the underlying diseases. Several factors may be involved in the pathogenesis of chronic skin ulcers. Leukocytoclastic vasculitis belongs to the group of immune vascular diseases and may be an extrahepatic manifestation of hepatitis C virus (HCV) infection. We describe the case of a patient with a nonhealing vasculitic leg ulcer and chronic HCV infection successfully treated with the combination of advanced dermal substitute and direct-acting antiviral therapy. An 81-year-old female presented to our unit with a 6-month history of a leg ulcer that developed from an exudating skin nodule. At presentation, the lesion was large,caused a severe pain and was unresponsive to analgesics. Skin biopsy showed leukocytoclastic vasculitis. She had a history of old untreated HCV infection, hypertension, type 2 diabetes mellitus, chronic venous insufficiency and tibial arteriopathy. The application of porcine-derived dermal substitute achieved only initial improvement. Therefore, direct-acting antiviral therapy was started, and when HCV RNA became undetectable in blood, pain disappeared and skin ulcer improved up to healing. In conclusion vasculitic leg ulcers can be caused by HCV infection. In such cases, even the use of innovative skin therapy, may obtain only initial and partial improvement, and eradication of HCV viremiais essential to obtain wound healing.

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Pyoderma gangrenosum is an uncommon ulcerative auto-inflammatory dermatosis. Numerous studies suggest cutaneous side effects of the COVID-19 vaccine. Pyoderma gangrenosum has been reported as one of the rare side effects of the COVID-19 vaccine. In this report, a 36-year-old male was admitted to a hospital due to a progression of pyoderma gangrenosum on the lateral aspect of his upper arm which had developed eight months ago, following the first dose of Sinopharm BBIBP COVID-19 vaccine. The reported symptoms included headache, blurred vision, palpitation, fatigue on exertion, documented fever, chills and productive cough with yellow sputum, possibly due to the inflammatory effect of pyoderma gangrenosum. In the past, the patient's face had several abnormal skin lesions similar to the newly developed lesion. In addition, the newly developed lesion did not regress despite using medication. COVID-19 vaccinations could potentially trigger pyoderma gangrenosum, especially in patients with a past medical history of similar lesions in different body parts. Therefore, we recommend inquiring about the past medical history of pyoderma gangrenosum or abnormal skin lesions prior to vaccination.

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Pyoderma gangrenosum (PG) is a rare inflammatory skin disease of unknown origin. As with other vaccines, COVID-19 vaccines have been associated with many cutaneous reactions. Although COVID-19 vaccination is crucial, it is important for dermatologists and other physicians to be aware of the possible cutaneous reactions that can occur following COVID-19 vaccination. In this report, we describe a 73-year-old woman with a personal history of PG who experienced a recurrence after receiving her second dose of the tozinameran vaccine. Although extremely rare, flares of other inflammatory dermatoses, including lichen planus, have been reported following COVID-19 vaccination. Here we discuss the overlap in pathogenesis of PG and COVID-19, proposing possible mechanisms behind this rare phenomenon.

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INTRODUCTION: A persistent inflammation is perpetuated by infiltrating immune cells and cytokines secreted from these immune cells. Additionally, apoptotic keratinocytes and adipocytes in diabetes causes diabetic foot ulcer (DFU) to arrest in an inflammatory phase without progressing to the resolution phase. This leads to a nonhealing DFU and, despite advanced treatments consisting of wound debridement, off-loading the ulcer of necrotic tissue, wound dressings to keep it moist and control exudate, medication, and preventing infection, DFUs remain a clinical problem. Nonhealing DFUs pose not only an economic burden but also increased morbidity and mortality in the form of psychological stress with and increased chance of amputation, and even death. Thus, investigating the complicated underlying molecular mechanism responsible for nonhealing patterns and designing better therapeutics is warranted. This review article focuses on the role of IL-8-mediated persistent inflammation and phenotypic change of fibroblasts due to this inflammatory cascade. We have discussed various sources of interleukin (IL)-8 secretion and the possible association of IL8-fibroblast plasticity as a cause of nonhealing DFUs. MATERIAL AND METHODS: A literature search on PubMed, Google Scholar, and PMC was done including the terms diabetic foot ulcer, diabetes, diabetic ulcer, chronic inflammation, interleukin 8, diabetic wound, and nonhealing diabetic foot ulcers. The articles in the English language and published in last 10 years were selected. From the pool of these, the articles describing the relationship between IL-8 and nonhealing diabetic foot ulcer and diabetic ulcer were used sorted out and used for this review article following PRISMA guidelines. CONCLUSION: Increased infiltration of inflammatory immune cells, secretion of pro-inflammatory cytokines, altered keratinocyte-fibroblast function, and phenotypic changes of fibroblasts in DFUs seem to be critical to the nonhealing of DFUs. Thus, inhibiting IL-8 secretion and downstream signaling seems to be a goal of potential therapeutics.

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Nonhealing leg ulcers are a major health problem worldwide with a high economic burden since they require human and material resources. Moreover, nonhealing ulcers are a major nontraumatic cause of lower limb amputations. Dermal substitutes have emerged as an effective therapeutic option for treatment of skin lesions, but data on leg ulcers are scarce. We evaluated safety and efficacy of a porcine-derived dermal substitute in the treatment of chronic vascular leg ulcers. Records of patients with nonhealing ulcers seen at our unit from 2018 to 2019 were retrospectively reviewed. Wound etiology, wound area, and complications were evaluated. Each patient received one application of porcine-derived dermal substitute and was followed-up. Six patients (5 females and 1 male) with a mean age of 61.3 (52-81) years presented with nonhealing leg ulcers. After surgical debridement and wound bed preparation, porcine-derived dermal substitute was applied onto the ulcer. Granulation was satisfactory within 10 days. All wounds healed after an average time of 14 weeks. Graft take was good, and no graft loss, rejection, or associated infection were observed. In conclusion, the data presented indicate that dermal substitutes are safe and effective for treatment of chronic nonhealing vascular leg ulcers.

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The aim of this study was to evaluate the impact of 2 lockdown periods during coronavirus disease 2019 (COVID-19) on the course and management of nonhealing vascular ulcers of lower limbs. A total of 41 patients were included in the study. Before the pandemic began they had been seen at our unit at weekly intervals. During lockdown from March 9, 2020, to May 18, 2020 subjects were not allowed to enter the hospital unless they needed urgency or emergency surgery, or oncological management. During the second lockdown, from October 19, 2020, to December 11, 2020 patients could be followed up at distance by direct outreach including telephoning contacts. Data obtained early after each lockdown were compared with those obtained prior to the pandemic. Data for the first lockdown show that pain intensified and there was an increase in the recurrence rate of wounds, of their severity, and of superimposed infections as compared with the prelockdown period. The risk of lower-limb amputation was also considerably greater. During the second and less restrictive lockdown, patients were followed up by telemedicine and data indicate that skin lesions had not worsened any further. The management of vascular wounds was impacted by the pandemic unfavorably with health care failures in the hospital as well as in the primary care settings. In conclusion, the treatment of vascular leg ulcers is challenged by the COVID-19 pandemic as this spreads worldwide. This seems to be in keeping with what happens for other diseases. The data we obtained indicate that the pandemic-related lockdown has a deleterious effect on vascular skin wounds, with an increase of severity and mortality risk. The impact appears to be proportional to the number and the degree of limitations imposed on people.

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Diabetic foot ulcers (DFUs) represent a tremendous burden to health care systems. Offloading is one of the key tenants to healing DFU and knee-high irremovable offloading devices are considered the gold standard for offloading DFU. However, the gold standard is rarely utilized in clinical practice. Patients' limited tolerance for such devices is one of a number of reasons that have been attributed to the lack of use of these devices. The practice of evidence-based medicine relies on shared decision making by pairing patients' values and preferences with the best available evidence. The present case report reviews the process of a patient-centered approach to identify the best offloading option for a patient with DFU. In consultation with the patient, a series of modalities were evaluated for offloading 2 unilateral forefoot DFUs. It is suggested that optimizing DFU offloading outcomes at the population level will require concerted efforts to employ the best offloading solution at the individual patient level. Offloading modalities are necessitated to mitigate the physical stress imparted on DFU during the weightbearing activity that patients engage in. Success is likely to be maximized by maintaining a mind-set of treating individual patients with DFUs as opposed to simply treating DFUs.Levels of Evidence: Level V: Case report.

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BACKGROUND: Microorganisms are known to be involved in the formation of biofilm. These biofilms are often seen in chronic wound infections, surgical site infections, implants etc., These are capable of causing recalcitrant infections and most of them are also known to possess high antibiotic resistance. OBJECTIVES: This study was conducted to detect the biofilm formation in bacterial isolates from chronic wound infections. MATERIALS AND METHODS: In the present study, ninety two isolates from chronic wound infections were identified by MALDI-TOF-MS (bioMerieux) and VITEK-2-MS (bioMerieux). These isolates were further screened for biofilm formation by three methods i. e., Tissue Culture Plate method (TCP), Tube Method (TM) and Congo Red Agar (CRA) method. Impact of biofilm production was correlated with the antibiotic resistant pattern. STATISTICAL ANALYSIS: Statistical analysis was done for all three methods considering TCP as Gold Standard and parameters like senitivity and specificity of TM i.e. 47.2 and 100% respectively. RESULTS: Out of 92 isolates, biofilm formation was seen in 72 isolates (78.2%) by TCP method. 64 isolates were strong biofilm producers, 8 isolates were moderate biofilm producers and 20 isolates were nonbiofilm producing. High prevalence of biofilm formation was seen in nonhealing ulcers infected with Staphylococcus aureus followed by Klebsiella pneumoniae. CONCLUSION: Among three screening methods used for detection of biofilm production, TCP method is considered to be a standard and most reliable for screening of biofilm formation in comparison to TM and CRA.

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PURPOSE: To evaluate the clinical course and outcome of canine SCCEDs treated with a combination of cotton-tip debridement (CTD), scalpel blade debridement (SBD), and superficial grid keratotomy (SGK). METHODS: Medical records of dogs diagnosed with SCCED and treated by the same diplomate (FJO) from 2011 to 2019 were reviewed. Age, breed, sex, affected eye, time of onset before treatment, previous procedures performed, time to healing, need for a second treatment, and complications were reported. RESULTS: A total of 308 eyes (291 dogs) met the inclusion criteria and were included in the study. All dogs received the same treatment (CTD + SBD + SGK) and the same topical medication (tobramycin 0.3% solution and sodium chloride 5% ointment). All eyes healed. Mean age at presentation was 9 years and 6 months (114.4 ± SD 28.0 months), and Boxer was the most common breed (93/308; 30.2%). Mean corneal healing time was 11.5 days (±SD 6.6). Complications occurred in 15/308 (4.9%) eyes. The three main complications observed were infected epithelial ulcer, infected stromal ulcer, and melting corneal ulcer, and 7/15 (46.7%) of the complications were diagnosed in Boston Terrier. Healing occurred after one treatment in 299/308 (97.1%) eyes, and the remaining cases needed a second treatment. CONCLUSIONS: CTD + SBD + SGK is an inexpensive and efficient treatment for SCCED in dogs. Boston Terrier may be at higher risk of developing complications following this procedure.

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CONTEXT: Chronic nonhealing ulcer is a troublesome condition in patients especially with diabetes. Autologous PRP therapy can safely and effectively heal a chronic nonhealing ulcer in such patients. AIMS: To study the effectiveness of autologous PRP therapy in a chronic nonhealing ulcer. SETTINGS AND DESIGN: A retrospective descriptive study from previous case records of chronic nonhealing ulcer patients who were treated with autologous PRP therapy at a specialty orthopedic hospital from September 2017 to August 2019. METHODS AND MATERIALS: Data on patients who presented with chronic nonhealing ulcers of >4 weeks duration who were treated with autologous PRP therapy and followed up for 20 weeks. STATISTICAL ANALYSIS USED: Statistical Package for the Social Sciences (SPSS) version 20 was used to calculate mean. Microsoft Excel was used for preparing the chart. RESULTS: The mean age of patients treated with autologous PRP therapy was 61.24 years, and the follow-up period was 20 weeks. The mean duration of ulcer healing following PRP therapy was 11.25 weeks, 80% of the patient showed ulcer size reduction of >75% following therapy. CONCLUSIONS: In this retrospective descriptive study, it has demonstrated the effectiveness and safety of autologous PRP therapy in the healing of chronic nonhealing ulcers.

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This study describes a unique clinical presentation of trigeminal trophic syndrome (TTS), which is not well described within the otolaryngology literature. Trigeminal trophic syndrome classically presents with a triad of symptoms: trigeminal anesthesia, facial paresthesias, and crescent-shaped ulceration of the lateral nasal ala. The patient discussed in this report had a self-induced, waxing and waning ulceration of the frontal scalp for 7 years and was evaluated and treated ineffectively by multiple physicians, including otolaryngologists, before TTS was diagnosed and a targeted treatment was initiated. Although extranasal presentation is uncommon, this condition must be considered when ulcers are encountered in the trigeminal dermatome. This case highlights the variability in presentation and the importance of awareness of this rare syndrome. We aim to facilitate more prompt diagnosis and expedite the initiation of appropriate treatment for TTS in the field of otolaryngology.

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Platelet rich fibrin (PRF) gel is a new second generation platelet concentrate, which has been widely used in various dermatological conditions such as nonhealing diabetic foot ulcers, venous ulcers, and trophic ulcers in leprosy. In this case report, we present a patient with nonhealing ulcer secondary to ecthyma gangrenosum, who showed dramatic response with PRF gel. This case suggests a role of PRF gel in nonhealing ulcers of infectious etiology which has not been described in English language literature. Considering previous literature and our case, it may be concluded that PRF gel may be utilized as an effective alternative for nonhealing ulcers of nonneoplastic etiology.

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Genital tuberculosis (TB) is a rare, comprising <0.5% cases of extrapulmonary TB. Among cases of genitourinary TB, glandular TB is even rarer. Its a diagnosis of exclusion. Most patients present later in the course of disease due to the associated stigma in view of site of involvement and the hesitancy on the patients's part. We saw two such cases of nonhealing genital ulcers in immunocompetent males.

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Rhinosporidiosis is a chronic granulomatous disorder of infective etiology and it frequently affects the nasal cavity and nasopharynx. Involvement of skin in rhinosporidiosis is unusual and it may manifest itself in a diverse manner mimicking several common dermatological conditions. Three cases of cutaneous rhinosporidiosis with different presentations are reported here to highlight the manifold nature of the condition. Cutaneous rhinosporidiosis can mimic several common cutaneous disorders.

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The human immunodeficiency virus (HIV) is known to cause altered disease presentations. We present here, the case of a 14-year-old boy who came to us with a chronic, painful, nonhealing ulcer of 4 months duration over the dorsum of right hand. Before our observation, he was variably diagnosed and treated as atypical mycobacterial infection, deep fungal infection, squamous cell carcinoma, and pyoderma gangrenosum. On administration of systemic corticosteroids his condition worsened, after which he was tested for, and found to be HIV positive. He was put onto valacyclovir, responded slowly, with healing after 2 months of antiviral therapy. The case report highlights unusual presentation in an under-considered age group and a slow response to otherwise effective therapy.