title: Intractable wounds caused by arteriosclerosis obliterans with end-stage renal disease treated by aggressive debridement and epidermal grafting.
abstract: BACKGROUND
  Patients receiving hemodialysis (HD) need to avoid skin laceration; amputation is common because of intractability of wounds and complications with other diseases, including diabetes mellitus. We have reported the usefulness of aggressive debridement deep enough to expose bone marrow cells, occlusive dressing, and epidermal grafting for diabetic foot ulcers and wounds from rheumatic diseases.
  
  
  OBJECTIVE
  To test whether this experimental protocol is effective to treat intractable wounds in a patient receiving HD accompanied with arteriosclerosis obliterans (ASO).
  
  
  RESULTS
  A 78-year-old patient with chronic renal failure and arteriosclerosis obliterans suffered a wound with exposed bone on the left great toe. Aggressive combination therapy was effective despite methicillin-resistant Staphylococcus aureus infection, and the wound healed in 13 weeks.
  
  
  CONCLUSIONS
  This study, reporting a single case, limits the interpretation of results.
  
  
  CONCLUSIONS
  Aggressive debridement exposing bone marrow cells is useful in preparing a healthy wound bed and epidermal sheet grafting may be accepted more advantageously in an ischemic environment and adopt a site-specific phenotype via mesenchymal-epithelial interactions.
authors.affiliation: Department of Dermatology, Osaka University Graduate School of Medicine, Suita-shi, Japan. takafussa0710@yahoo.co.jp
authors.forename: Takaaki
authors.initials: T
authors.lastname: Hanafusa
authors.forename: Yuji
authors.initials: Y
authors.lastname: Yamaguchi
authors.forename: Ichiro
authors.initials: I
authors.lastname: Katayama
mesh_terms: D000368:Aged; D001162:Arteriosclerosis Obliterans / Q000150:complications* / Q000209:etiology; D003646:Debridement; D004817:Epidermis / Q000637:transplantation*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D016106:Methicillin Resistance; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D006435:Renal Dialysis; D012720:Severity of Illness Index; D012775:Shoes / Q000009:adverse effects; D012883:Skin Ulcer / Q000150:complications* / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D013211:Staphylococcus aureus / Q000302:isolation & purification / Q000502:physiology; D013492:Suppuration / Q000382:microbiology; D013997:Time Factors; D014034:Toes; D014945:Wound Healing