Turi George K, Donovan Virginia, DiGregorio Julie, Criscitelli Theresa M, Kashan Benjamin, Barrientos Stephan, Balingcongan Jose Ramon, Gorenstein Scott, Brem Harold
George 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.
Adv Skin Wound Care. 2016 Aug;29(8):376-82. doi: 10.1097/01.ASW.0000484665.45022.b3.
To clarify the histopathology of acute osteomyelitis, chronic osteomyelitis, primary vasculitis, and secondary-type vasculitis.
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.
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.
A tertiary care hospital.
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.
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.
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.
阐明急性骨髓炎、慢性骨髓炎、原发性血管炎和继发性血管炎的组织病理学。
本继续教育活动面向对皮肤和伤口护理感兴趣的医生和护士。
目标/结果：参加本教育活动后，参与者应能更好地：1. 描述本研究的参数和意义。2. 识别慢性伤口的诊断和治疗方法。3. 区分骨髓炎和血管炎的组织病理学。
慢性伤口的存在可导致显著的发病率/死亡率。了解对标准伤口治疗无效的伤口组织的病理改变对于有效的伤口管理和愈合至关重要。作者描述了4种伤口病因，具体为急性骨髓炎、慢性骨髓炎、原发性血管炎和继发性血管炎。
一家三级护理医院。
对一家三级护理医院在24个月期间进行的1392例伤口手术进行回顾性研究。所审查的组织标本包括下肢、骶骨、髋部/骨盆、躯干、会阴和臀部的软组织感染。
急性骨髓炎定义为以多形核白细胞为主的骨组织，有破骨细胞骨吸收伴皮质骨边缘扇贝样改变及骨碎屑的证据。慢性骨髓炎定义为围绕失活组织有大量纤维化且淋巴细胞和浆细胞大量浸润的骨组织。原发性血管炎主要定义为血管壁的炎症和坏死。在显微镜下多血管炎的皮肤病变中，乳头真皮可见有大量炎性肉芽肿的溃疡。继发性血管炎定义为炎症细胞浸润血管壁及小血管壁的纤维蛋白样坏死。
这4种类型伤口的病理情况可使设计用于诊断和治疗的标准算法复杂化，通过组织病理学分析进行准确诊断有助于制定针对性治疗方案。
