Pyoderma gangrenosum: skin grafting and hyperbaric oxygen as adjuvants in the treatment of a deep and extensive ulcer

Araújo, Fernanda Mendes; Kondo, Rogério Nabor; Minelli, Lorivaldo

doi:10.1590/abd1806-4841.20132680

Cited by 18 publications

(11 citation statements)

References 9 publications

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“…Cheng et al, [ 12 ] for example, reported that HBOT reduced the expression of cyclooxygenase-2 and provided brain protection following ischemia. Other typical uses for HBOT include the treatment of extensive ulcers, [ 39 ] including diabetic foot ulcers, [ 40 ] flap [ 41 ] and other organ ischemia, and reperfusion injuries. [ 42 – 44 ] Hyperbaric oxygen is used because it helps to increase the availability oxygen.…”

Section: Discussionmentioning

confidence: 99%

Hyperbaric oxygen therapy can ameliorate the EMT phenomenon in keloid tissue

et al. 2018

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Background:Hyperbaric oxygen therapy (HBOT) has been widely used in the clinical setting. In this study, HBOT therapy was evaluated for its ability to ameliorate the epithelial-to-mesenchymal transition (EMT) phenomenon in keloid tissue.Methods:Keloid patients were randomly divided into two groups: keloid patients (K group, 9 patients) and keloid patients receiving HBOT (O group, 9 patients). A third group with normal skin (S group, 9 patients) was established for control. Before HBOT and surgery, a laser Doppler flowmeter was used to measure the keloid blood supply of patients in the O group. Hematoxylin and eosin (H&E) staining was used to observe morphology. E-cadherin, ZO-1, vimentin, fibronectin, vascular endothelial growth factor (VEGF), and hypoxia inducible factor (HIF)-1α were measured by immunofluorescence staining and Western blot analysis. Real-time quantitative polymerase chain reaction (RT-qPCR) was used to evaluate the mRNA expression level of these factors as well.Results:In the O group, keloid blood perfusion was significantly reduced after patients received HBOT. Compared with the K group, lower expression levels of vimentin, vibronectin, VEGF, and HIF-1α were observed in the O group, whereas the expression of E-cadherin and ZO-1 was significantly higher. The mRNA expression of E-cadherin and ZO-1 was also increased after HBOT.Conclusions:The expression levels of factors related to the EMT phenomenon were significantly reversed in keloid patients after they received HBOT, indicating that HBOT may be an effective therapy against the EMT phenomenon in keloid patients.

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Section: Discussionmentioning

confidence: 99%

Hyperbaric oxygen therapy can ameliorate the EMT phenomenon in keloid tissue

et al. 2018

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“…The use of bioengineered skin and dermal substitutes 160 could represent a good alternative option even if specific wide trials are necessary to support their use and cost-effectiveness. The potential benefit of negative pressure wound therapy 161-163 and hyperbaric oxygen therapy 164-166 as adjunctive treatments are also mentioned in small case reports.…”

Section: Methodsmentioning

confidence: 99%

Pyoderma Gangrenosum: A Current Problem as Much as an Unknown One

Vallini

Andreini

Bonadio

2017

The International Journal of Lower Extremity Wounds

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Pyoderma gangrenosum (PG) is a rare neutrophilic inflammatory skin disease, characterized by recurrent skin ulcers, which in almost 50% of cases are associated with systemic autoimmune disorders, including rheumatoid arthritis, chronic hepatitis, inflammatory bowel disease, paraproteinemias and hematological malignancies. A systematic search of literature for PG was carried out using the PubMed, Embase, and Google Scholar databases for the purpose of this review and 2780 articles were retrieved up to February 2017. Inflammation represents the predominant aspect of the disease, but its pathophysiological mechanisms are not completely clear yet, since there are many studies showing only one or more isolated findings of the disease. The goal of PG treatment is to reduce inflammation in order to promote ulcer healing by minimizing side effects of therapy. Several systemic and local treatments are available, but the lack of large randomized double-blind studies results in an absence of a uniform therapeutic standard: thus, more clinical studies are required in order to make head-to-head comparisons between combination and single-drug therapies and to identify specific combination therapies for distinctive clinical patterns of PG.

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“…However, after the inflammatory process is controlled, large, hard‐to‐heal wounds usually persist, requiring the use of adjuvant therapies, such as skin grafts. The fear of pathergy at the donor site is probably the main reason for the low advocacy of autologous skin grafting in patients with PG …”

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confidence: 99%

“…Split‐thickness skin grafts (STSGs) may also be performed; however, as it is a procedure comprising a deeper cleavage, the concern of pathergy at the donor site may be greater in comparison with ESGs. More recently, some experience suggested that if the STSG is carried out accompanied by adequate immunosuppression this will lead to improved healing of ulcers with PG . Pichler et al .…”

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confidence: 99%