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Difficult wounds: an update.

Richard F Edlich1, Kathryne L Winters, L D Britt

  • 1Distinguished Professor Emeritus of Plastic Surgery and Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia, USA. richardedlichmd@gmail.com

Journal of Long-Term Effects of Medical Implants
|July 19, 2005
PubMed
Summary
This summary is machine-generated.

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This review highlights advances in treating Gardner's syndrome, pseudofolliculitis barbae, nasal septal perforation, factitious wounds, and hidradenitis suppurativa. New surgical and laser techniques offer improved outcomes for these challenging dermatological conditions.

Area of Science:

  • Dermatology
  • Surgical Innovation
  • Medical Review

Background:

  • Gardner's syndrome (GS) presents with extracolonic manifestations like epidermal cysts.
  • Pseudofolliculitis barbae commonly affects individuals who shave, leading to ingrown hairs and keloids.
  • Nasal septal perforations arise from surgery, trauma, or substance abuse.
  • Factitious wounds result from self-harm, requiring psychiatric intervention.
  • Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition affecting apocrine gland areas.

Purpose of the Study:

  • To review revolutionary advances in the treatment of five distinct dermatological conditions: Gardner's syndrome, pseudofolliculitis barbae, nasal septal perforation, factitious wounds, and hidradenitis suppurativa.
  • To describe novel surgical and therapeutic approaches for these conditions.

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  • To emphasize the importance of multidisciplinary care for complex cases.

    • Main Methods:

    • Review of current literature and clinical practices for the specified conditions.
    • Description of surgical techniques, including rhytidectomy incisions for GS cysts, skin grafting for pseudofolliculitis barbae, external approach for nasal septal repair, and surgical management of HS.
    • Discussion of adjunctive therapies such as laser treatment for pseudofolliculitis barbae and HS, and psychotherapy for factitious wounds.

    Main Results:

    • Benign epidermal cysts in Gardner's syndrome are excised using cosmetic incisions.
    • Laser therapy has revolutionized pseudofolliculitis barbae treatment, offering a potential cure.
    • The external approach has improved the reliability of nasal septal perforation repair, with radial forearm free flaps used for large defects.
    • Factitious wounds necessitate immediate psychiatric evaluation followed by wound repair.
    • Carbon dioxide laser treatment is an effective, rapid, and economical option for chronic hidradenitis suppurativa.

    Conclusions:

    • Significant advancements have been made in managing Gardner's syndrome, pseudofolliculitis barbae, nasal septal perforation, factitious wounds, and hidradenitis suppurativa.
    • Innovative surgical techniques and emerging therapies like laser treatment are improving patient outcomes.
    • A comprehensive approach, including psychiatric care when necessary, is crucial for optimal management.