Role of Classical Panchakarma on Dushta Vrana (Chronic Non-healing Wound) - A Case Study

A non-healing wound generally described as a wound that will not heal within four weeks. If wound does not heal within this usual time period, the cause is usually found in underlying condition that has either gone unnoticed or untreated. As the science has advanced, newer remedies are tried out for speedy recovery, but the oldest remedies still lead the race. A female patient of age 22yrs, non-obese, non-smoker with chronic history of non-healing wound on left gluteal region. Any therapeutic scheme was unsuccessful and patient came for Ayurved treatments. Significant relief found after Panchakarma which includes classical Virechana Karma and Jaluvakavachrana

Contact dermatitis presenting as non-healing wound: case report

Topical antiseptics are commonly used in the management of minor wounds, burns, and infected skin. These agents are widely used by health professionals and are often self-prescribed by patients as they are easily available over-the-counter. This case illustrates a 73 year old man who presented with a non-healing wound on his right forearm for 4 weeks. The wound started from an insect bite and progressively enlarged with increasing pruritus and burning sensation. Clinically an ill-defined ulcer with surrounding erythema and erosion was noted. There was a yellow crust overlying the center of the ulcer and the periphery was scaly. Further inquiry revealed history of self treatment with a yellow solution to clean his wound for 3 weeks. Patient was provisionally diagnosed to have allergic contact dermatitis secondary to acriflavine. Topical acriflavine was stopped and the ulcer resolved after treatment with non-occlusive saline dressing. Skin patch test which is the gold standard for detection and confirmation of contact dermatitis showed a positive reaction (2+) to acriflavine. Acriflavine is widely used as a topical antiseptic agent in this part of the world. Hence, primary care physicians managing a large variety of poorly healing wounds should consider the possibility of contact allergy in recalcitrant cases, not responding to conventional treatment. Patient education is an important aspect of management as this would help curb the incidence of future contact allergies

Morphea (Localized Scleroderma) Presenting With Recurrent Skin and Soft Tissue Infections: A Diagnostic Dilemma.

Morphea or localized scleroderma is reported to be triggered through diverse stimuli. We present a case of morphea that presented as a non-healing wound with superimposed methicillin-sensitive Staphylococcus aureus (MSSA) infection. In our case, morphea was thought to have been potentially triggered by a post-surgical infection. We discuss the potential infectious triggers and common infections that may confound the diagnosis

EFFICACY OF VRUNO-HEAL OIL IN THE MANAGEMENT OF DUSHTA VRUNA (NON HEALING WOUND)

Vruna is the commonest problem we face in practice. The wound in and out itself is the biggest challenge to medical practitioners, even more, when it's a non-healing type. In practice, Dushta vrana is that the most typically encountered problem faced by a health professional. Wound healing is a major problem in surgical practice also. Acharya Sushruta, has explained Vrana very well in “Sushruta Samhita” as a concourse of wound healing procedures described by Sushruta still holds its place today. Sushruta has described Shashti Upakrama (60 measures) for the great management of Vruna (wound). Here is a case report- of 57 Years male presented with complaints of an ulcer/ non healing wound on medial aspect and on lateral malleolus of right foot with pain, discharge, foul smell, edema, discoloration, and pus discharge. The case was treated with Vruno-heal oil as local application, and with few internal medications. Among these 60 Upakramas - Parisheka, Lekhana, Kashaya, Mrudukarma, Bandha modalities were used to treat the wound

The use of vacuum-assisted wound closure to enhance skin graft acceptance in a horse

A 16-year-old horse was admitted to the clinic of the Department of Surgery and Anesthesiology of Domestic Animals of the Faculty of Veterinary Medicine (Ghent University) for the treatment of a very large, non-healing wound extending over the dorsomedial and dorsolateral aspects of the left metatarsus. Surgical debridement of exuberant granulation tissue and new bone was performed under general anesthesia, followed by standard wound care under a bandage. Once a new bed of healthy granulation had formed, skin grafting was performed using the punch graft method. Due to the presence of a significant amount of wound exudate, cast immobilization was considered to be contraindicated. Instead, vacuum-assisted closure (VAC) therapy was used as a method of securing the skin grafts to the wound bed during the first days post-operatively. After five days of VAC therapy, the wound dressing was removed and an acceptance of nearly 100% of the punch grafts was observed. Complete epithelialization of the wound was evident 42 days after skin grafting. As far as the authors know, this is the first report describing the use of VAC therapy as a method of wound management in combination with punch grafting on the distal limb of a horse

The use of honey in healing a recalcitrant wound following surgical treatment of hidradenitis suppurativa

Ancient civilizations used honey to heal wounds. Despite the rediscovery of honey by modern physicians1 its use in conventional medicine, unlike in complementary medicine, remains limited. Much anecdotal evidence, some clinical observations, some animal models and some randomised controlled trials support the efficacy of honey in managing wounds2,3 , but few detailed descriptions of the use of honey in healing difficult surgical wounds have previously been published

Neoplasia in Three Aye-Ayes (Daubentonia madagascariensis)

Tumours diagnosed in three aged captive aye-ayes (Daubentonia madagascariensis), held in two different institutions, are described. A cerebral glioblastoma was diagnosed based on histological and immunohistochemical findings in one of the animals following initial presentation with bilateral mydriasis, absent pupillary reflex, head tilt and ataxia. A second animal was humanely destroyed due to impaired locomotion associated with spondylosis and a post-mortem diagnosis of cholangiocarcinoma was made based on histology with further confirmation with immunohistochemical labelling for cytokeratin 7. A third aye-aye suffering from dental disease was diagnosed with an oral squamous cell carcinoma following an excisional biopsy from a non-healing wound in the lip. Due to progression of the neoplasia the animal was humanely destroyed and post-mortem examination revealed the presence on an additional unilateral phaeochromocytoma

Primary angiosarcoma of the oral cavity in a young adult

Angiosarcoma is a rare neoplasm, constituting only 2% of all the soft tissue tumors and most frequently involves the skin of the head and neck region in elderly males. They are extremely aggressive tumors with high rates of metastasis and poor outcomes. We report a unique case of angiosarcoma involving an unusual site – upper alveolus and maxilla in a young patient highlighting the diagnostic challenges in such a scenario. A 29 years old female presented with a non-healing wound of the oral cavity, which had progressed to the current maximum size of 6.4 cm within one month. Magnetic resonance imaging (MRI) scan revealed the involvement of maxilla up to the floor of the orbit and adjacent soft tissue. However, no distant metastasis was detected on Positron Emission Tomography (PET) scan. Biopsy of the lesion showed an irregular, highly pleomorphic, and mitotically active epithelioid soft tissue tumor conclusively diagnosed as angiosarcoma

Expression of hepatocyte growth factor-like protein in human wound tissue and its biological functionality in human keratinocytes

Hepatocyte growth factor-like protein (HGFl) and its receptor, Recepteur d'Origine Nantais (RON), have been implicated in the development of wound chronicity. HGFl and RON expression was detected in acute wound tissue, chronic wound tissue and in normal skin using quantitative polymerase chain reaction (Q-PCR). HGFl and RON expression was also assessed in chronic healing and chronic non-healing wound tissues using Q-PCR and immunohistochemical staining. Expression was similarly detected in the HaCaT immortalized human keratinocyte cell line using reverse transcription polymerase chain reaction (RT-PCR). rhHGFl was used to assess the impact of this molecule on HaCaT cell functionality using in vitro growth assays and electric cell-substrate impendence sensing (ECIS) migration assays. HGFl and RON transcript expression were significantly increased in acute wound tissue compared to chronic wound tissue and were also elevated, though non-significantly, in comparison to normal skin. Minimal expression was seen in both healing and non-healing chronic wounds. Treatment of HaCaT cells with rhHGFl had no effect on growth rates but did enhance cell migration. This effect was abolished by the addition of a phospholipase C gamma (PLCγ) small molecule inhibitor. The increased expression of HGFl and RON in acute, healing wounds and the pro-migratory effect of HGFl in an in vitro human keratinocyte model, may indicate a role for HGFl in active wound healing

Locally Advanced Spiroadenocarcinoma in the Regional Axilla of a Breast Cancer Patient: Hallmarks of Definitive Diagnosis and Management.

Eccrine spiroadenocarcinoma is an extremely rare malignant eccrine gland tumor which may masquerade as other more common malignancies such as poorly differentiated squamous carcinoma or metastatic breast cancer. We report a case of an ulcerated axillary skin lesion with bulky adenopathy in a 77 year-old female with a prior history of ipsilateral triple negative breast carcinoma. The clear transition of benign spiradenoma to malignant carcinoma was essential to establishing a definitive diagnosis and treatment plan