Plantar keratodermia treated by split-skin grafts

Wynn-Williams, D.

doi:10.1016/s0007-1226(53)80022-6

Cited by 19 publications

(4 citation statements)

References 2 publications

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“…In severe cases of various types of palmoplantar keratoderma, full‐thickness excision of the palmoplantar skin with skin grafting has been attempted in order to reduce pain and improve function. The outcomes of the surgical procedures were reported by Wynn‐Williams (2) and Dencer (3) in 1953, by Keir (4) in 1967, by Salamon et al (6) in 1969 and more recently by Atherton et al (5) in 1990. Only eight cases of palmoplantar keratoderma of Olmsted have been treated surgically with skin grafting including our two cases (4,5,7–12) (Table 1).…”

Section: Discussionmentioning

confidence: 93%

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Palmoplantar Keratoderma and Skin Grafting: Postsurgical Long‐term Follow‐up of Two Cases with Olmsted Syndrome

Bédard

Powell

Laberge

et al. 2008

Pediatric Dermatology

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Olmsted syndrome is a rare congenital mutilating palmoplantar keratoderma associated with periorificial keratotic plaques. Treatment options include topical keratolytics, systemic retinoids, and debulking procedures. Full-thickness excision of hyperkeratotic plaques followed by skin grafting has been reported in the medical literature, although long-term results have not been evaluated. We present two cases of Olmsted syndrome with severe palmoplantar keratoderma treated with excision and skin grafting, along with long-term clinical results 11 years (patient 1) and 6 years (patient 2) following the initial surgery.

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Section: Discussionmentioning

confidence: 93%

“…The genetics underlying this syndrome have not yet been elucidated (1). In order to alleviate the pain and the incapacity associated with thick palmoplantar hyperkeratosis, full‐thickness excision followed by skin grafting has been attempted (2–12). Long‐term results have not yet been described thoroughly.…”

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confidence: 99%

Palmoplantar Keratoderma and Skin Grafting: Postsurgical Long‐term Follow‐up of Two Cases with Olmsted Syndrome

Bédard

Powell

Laberge

et al. 2008

Pediatric Dermatology

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“…diameter, fo r the heaped up cornified margin is undermined all round by a gran ula tion -lined ca vi ty. 4 It is emphasized that this method does not obviate the need fo r proper fo otwear and orthopaedic procedures indicated in second deformities.…”

Section: Dmentioning

confidence: 99%

The Rapid Healing of Plantar Ulcers

Walkey¹,

Williams²

1965

Leprosy Review

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The problem of the plantar ulcer of leprosy has been the subject of a number of scientific papers in recent years. Price (t) has restricted the use of the title to ulcers occuring in the anaesthetic but mobile fo ot thus differentiating ulcers occurring in fe et with fixed deformities. It has been stressed that the second group demands surgery directed to the deformity as a prequisite to healing of the ulcer, and in the fo rmer group the provision of protective fo otwear fo llowing the healing of the ulcer. For the actual healing of the ulcer only one approach has been advo cated by the many writers on this subject, namely, complete rest to permit a natural healing by scar tis�ue. The practical detail varies fr om bed rest with normal local measures to clean the ulcer, to the use of plaster of paris casts or its more elaborate descendent, the Karagiri boot. Andersen (2) as basis fo r this method, quotes Trueta, who popularised the plaster cast immobilisation of osteomyelitis in contrast to the fr equent dressings current until 1935. Contemporary with Trueta, Gillies and the then, small group of plastic surgeons shewed that many indolent ulcers (such as varicose ulcers then commonly treated by local applications and support) could be healed quickly by excision, which included the hard fibrous bed of the ulcer, and the application of a split skin graft.The attention of one of us (H.W.W.) was drawn to the problems of leprosy that might be amenable to plastic surgery by Paul Brand in 1956. A visit to the nearest leprosarium gave the immediate impression of plantar ulcer as the commonest cause of disability amongst leprosy patients. This impression is confirmed by all subsequent experience and is quoted by Languillon (3 ) who observed that among 3,000 leprosy patients examined 403 patients had 1 ,049 perforating plantar ulcers. The immediate reaction of the plastic surgeon was to excise and graft. At this time it was generally held that split skin would not stand up to hard wear and was therefore unsuitable to palmar or plantar surfaces. One article however had appeared by Wynn Williams (4) in which a split skin graft applied to the plantar surface had not needed to be replaced by fu ll thickness skin. The first leprosy ulcer treated by this method was a large one of the heel. This graft took completely and was seen regularly fo r three years without evidence of breakdown ( 1 2 ) .A small series completed in 1 95 8 shewed that two thirds of ulcers treated in this way were healed in a fo rtnight.At this point it might have been claimed that a specialised technique was involved and there fo re the method unsuitable fo r wide application. A second series published in 1 963 shewed an improved percentage cure and this time the surgery had been shared with a junior registrar. The present series has been largely the work of a third general surgeon, but again the results are similar. I Complicated ulcers i.e. with underlying osteomyelitis or neuropathic joint must be dealt with on the usual lines. RESULTS Nu mber of ulcers2...

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“…Patients most frequently present in the third and fourth decades (Masson 1969) of adult life. Tachau (1939), Wynn-Williams (1953 and Pollock et al (1972) found the disease to be commoner in women, where the axillary lesion predominates. In men, there is a frequent association of perineal disease with the.…”

Section: Introductionmentioning

confidence: 99%