# Cutting Through Complexity: Surgical Management of Severe Palmoplantar Keratoderma

## TL;DR

This paper discusses a rare skin condition called Olmsted syndrome and presents a successful surgical treatment approach that allowed a patient to regain normal daily activities.

## Contribution

The paper introduces a novel surgical approach for managing Olmsted syndrome with a long-term follow-up of 16 years.

## Key findings

- Initial debridement down to the deep dermis resulted in recurrence after three months.
- Extensive excision combined with a bilayer wound matrix dressing and negative pressure wound therapy led to full resolution.
- The patient, now a college student, has maintained normal daily activities for 16 years.

## Abstract

Olmsted syndrome is a rare genetic disorder characterized by severe thickening of the palms and soles, often resistant to conventional treatments. We present the case of a patient with Olmsted syndrome with a 16-year follow-up. The patient presented at five years of age with treatment-resistant palmoplantar keratoderma despite three years of dermatological management, leading to complications. Surgical interventions included initial debridement down to the deep dermis, which resulted in recurrence after three months. This was followed by a decision for extensive excision down to the subcutaneous tissue, use of a bilayer wound matrix dressing followed by negative pressure wound therapy, and a thin split-thickness graft, resulting in full resolution. The patient, now a college student, has regained normal daily activities. This case underscores the challenges and highlights a novel surgical approach for managing Olmsted syndrome, demonstrating a 16-year follow-up and aiming to improve patient outcomes in these complex cases.