ABSTRACT
Wounds closed under tension have a tendency to stretch. To assess whether this stretching can be limited by inserting absorbable subcuticular sutures, 28 wounds, which involved elliptical excisions, were closed with PGA and PDS sutures in opposite halves of the same wound. PGA scars were found to be significantly wider than their PDS counterparts and were associated with greater hypertrophy at 6 months.
Subject(s)
Cicatrix/pathology , Polyesters , Polyglycolic Acid , Skin/pathology , Sutures , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Polydioxanone , Wound HealingABSTRACT
A single-staged transverse forked flap in columella reconstruction is described. This can be either unilateral or bilateral and an example of each is presented.
Subject(s)
Carcinoma, Basal Cell/surgery , Nasal Septum/surgery , Nose Neoplasms/surgery , Surgical Flaps , Aged , Female , Humans , Male , MethodsABSTRACT
PIP: Routine vasectomy was performed on a 29-year old man for whom rheumatoid arthritis had been diagnosed 4 years previously and treated with nonsteroidal anti-inflammatory drugs. The man experienced a flare-up of arthralgia in the wrists 2 weeks prior to the vasectomy. He was treated with a single course of parenteral methyl prednisolone and was in remission at the time of the surgery. On the day following the vasectomy, the patient noticed some erythema around the wound and felt unwell but did not seek medical advice until 4 days later. He was clinically toxic when he presented and experiencing painful gangrene of the scrotum. Treatment was begun immediately with parenteral benzyl penicillin, tobramycin and metronidazole plus aggressive debridement; 30 ml of pus drained and beta hemolytic streptococci Group A, sensitive to penicillin, were cultured. Within a few hours, further spread of gangrene along the penile shaft was noted. He was given hyperbaric oxygen treatment for 3 days followed by secondary debridement. No further spread of the gangrene occurred. 1 week later there was a good tranulating bed over the anterior scrotum. Meshed split skin graft was applied with tie-over dressings. An almost 100% take was achieved 4 weeks later. If hyperbaric oxygen had been employed immediately after surgery, spread of the gangrene might have been avoided. The use of hyperbaric oxygen should be considered as a firstline treatment.^ieng
