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Major Histopathologic Diagnoses of Chronic Wounds
George K Turi1, Virginia Donovan, Julie DiGregorio
1George K. Turi, MD • Assistant Director of Pathology • Winthrop University Hospital • Mineola, New York • Assistant Professor of Pathology • Stony Brook University School of Medicine • Stony Brook, New YorkVirginia Donovan, MD • Chair and Program Director • Department of Pathology • Winthrop University Hospital • Mineola, New York • Stony Brook University School of Medicine • Stony Brook, New YorkJulie DiGregorio, CCRP • Supervisor • Research & Clinical Trials • Winthrop University Hospital • Mineola, New YorkTheresa M. Criscitelli, EdD, RN, CNOR • Assistant Vice President • Administration • Perioperative/Procedural Department • Winthrop University Hospital • Mineola, New YorkBenjamin Kashan, MD • General Surgery Resident • Nassau University Medical Center • Oceanside, New YorkStephan Barrientos, MD • Chief General Surgery Resident • Vidant Medical Center/Brody School of Medicine • Greenville, North CarolinaJose Ramon Balingcongan, PA-C • Physician Assistant • Division of Wound Healing and Regenerative Medicine, Department of Surgery • Winthrop University Hospital • Mineola, New YorkScott Gorenstein, MD, FACEP • Clinical Director and Clinical Assistant Professor • Department of Surgery • Winthrop University Hospital • Mineola, New YorkHarold Brem, MD, FACS • Professor • Department of Surgery • Stony Brook University School of Medicine • Chief • Division of Wound Healing & Regenerative Medicine • Winthrop University Hospital • Mineola, New York.
Purpose:
To clarify the histopathology of acute osteomyelitis, chronic osteomyelitis, primary vasculitis, and secondary-type vasculitis.
Target Audience:
This continuing education activity is intended for physicians and nurses with an interest in skin and wound care.
Objectives/Outcomes:
After participating in this educational activity, the participant should be better able to:1. Describe the parameters and significance of this study.2. Identify chronic wound diagnosis and treatment.3. Differentiate the histopathology of osteomyelitis and vasculitis.
Objective:
The presence of a chronic wound can result in significant morbidity/mortality. Understanding the pathological alterations of wound tissue that are refractory to standard wound therapy is essential for effective wound management and healing. The authors describe 4 wound etiologies, specifically, acute osteomyelitis, chronic osteomyelitis, primary vasculitis, and secondary-type vasculitis.
Setting:
A tertiary care hospital.
Design:
A retrospective review of 1392 wound operations performed during a 24-month period at a tertiary care hospital was conducted. Tissue specimens reviewed included soft tissue infections of the lower extremity, sacrum, hip/pelvis, trunk, perineum, and buttocks.
Main Results:
Acute osteomyelitis is defined as bone tissue with a predominance of polymorphonuclear leukocytes, evidence of osteoclast bone resorption with scalloping of the cortical bone edges, and bone detritus. Chronic osteomyelitis is defined as bone tissue with a significant amount of fibrosis surrounding devitalized tissue and heavy infiltration of lymphocytes and plasma cells. Primary-type vasculitis is defined primarily as inflammation and necrosis of blood vessel walls. In cutaneous lesions of granulomatosis with polyangiitis, ulceration with numerous inflammatory granulomas is seen in the papillary dermis. Secondary vasculitis is defined by vessel wall infiltration by inflammatory cells and fibrinoid necrosis of the small vessel wall.
Conclusions:
Pathologies of these 4 types of wounds can complicate standard algorithms designed for diagnosis and treatment, and accurate diagnosis through histopathologic analysis can help tailor targeted treatment.
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