Skin graft or skin flap. Skin grafts or skin flaps are done after the scar tissue is removed. Skin grafts involve replacing or attaching skin to a part of the body that is missing skin. Skin grafts are performed by taking a piece of healthy skin from another area of the body (called the donor site) and attaching it to the needed area. Skin flaps are similar to skin grafts, where a part of the skin is taken from another area, but with the skin flaps, the skin that is retrieved has its own blood supply. The section of skin used includes the underlying blood vessels, fat, and muscles. Flaps may be used when the area that is missing the skin does not have a good supply of blood because of the location or because of damage to the vessels.
Pulse therapy involves taking high doses of glucocorticoids over a short period of time. This approach is typically used to treat acute flares, as well as a “bridge” therapy until DMARD treatment reaches full effect. Typically, pulse therapy is given as a high-dose IV infusion, for instance IV methylprednisolone 1000 mg daily for 3 consecutive days once per month. Lower doses may also be used. Although, IV infusion is the preferred route of administration for pulse therapy, steroids may also be given orally or by intramuscular injection. Patients who receive steroid pulse therapy alone may have a response that lasts 6 to 8 weeks. If given in combination with DMARD treatment, responses can last much longer. 1