5-0 Polypropylene versus 5-0 fast absorbing plain gut for cutaneous wound closure: a randomized evaluator blind trial.

Mixed opinions exist regarding cosmetic outcomes of 5-0 fast absorbing plain (FG) gut relative to nonabsorbable suture material, such as 5-0 polypropylene (PP). High quality randomized trials comparing these two suture materials are lacking. To determine whether the use of PP during layered repair of linear cutaneous surgery wounds improves scar cosmesis compared to wound closure with FG. A randomized, split wound, comparative effectiveness trial was undertaken. Patients were evaluated 3 months after the intervention by two blinded physicians using the validated patient observer scar assessment scale (POSAS). Patient assessments were also captured using the same instrument as well as scar width and complications. The mean sum of the six components of the POSAS was 10.26 vs 12.74 for PP and FG, respectively, significantly (p < 0.001) in favor of PP. Mean observer overall opinion similarly showed better outcomes for PP than for FG [1.88 vs 2.52, respectively (p < 0.006)]. The mean sum of the patient assessed components of the POSAS for PP and FG was 12.3 vs 14.34, respectively (p = 0.11). Patient overall opinion significantly favored PP (2.41 vs 3.14, p = 0.043). PP resulted in small but statistically significant better cosmetic outcomes than FG. Pain experienced during suture removal was minimal for most patients.

Microcystic adnexal carcinoma involving a large portion of the face: when is surgery not reasonable?

BACKGROUND: We report a case of microcystic adnexal carcinoma (MAC) involving a large portion of the face, one of the largest of any MAC reported thus far in this area, and review the literature regarding the nature of the tumor and available treatments. We also review all of the reported cases of metastases and the possible role of radiation in the etiopathogenesis of this tumor. OBJECTIVE: To review the literature about what is known about therapy for MAC and what options are available to patients who have this disease. MATERIALS AND METHODS: Case report and review of the literature. RESULTS: Of the 274 cases of MAC thus far reported, there are 6 cases of metastases, only 1 of which resulted in death. CONCLUSION: Mohs surgery should be the treatment of choice for this tumor; however, when extirpation entails sufficiently large morbidity, given the low rate of metastases and mortality, observation is a reasonable alternative.

Necrotizing fasciitis following a motor vehicle accident with Candida species as the sole organisms.

Necrotizing soft-tissue infections exclusively due to Candida species are rare and not usually considered in the differential diagnosis of this devastating condition. When documented previously, Candida species are generally proposed to be a saprophytic component of multibacterial synergistic infection often associated with streptococcal species. We report a case of a 51-year-old man who developed necrotizing fasciitis secondary to Candida infection following a motor vehicle accident. His clinical presentation was very similar to that of clostridial gas gangrene. The only organisms isolated from tissue culture were Candida albicans and Candida tropicalis. Histopathology confirmed yeast forms and pseudohyphae within the debrided tissue specimens. No bacteria were identified on any of the wound swabs or tissue specimens. Our report is the first that reveals Candida as the sole identifiable cause for necrotizing fasciitis following trauma. Candida should be considered in the differential diagnosis of causative organisms for necrotizing fasciitis and infective myonecrosis.

Il est rare que les infections nécrosantes affectant les tissus mous soient uniquement dues au genre Candida et l'on ne tient habituellement pas compte de ce dernier au moment d'établir le diagnostic différentiel de cette grave complication. Lorsqu'elle est déjà documentée, la présence du genre Candida est généralement présentée comme un élément saprophyte dans une infection multibactérienne souvent streptococcique. Nous faisons ici état d'un patient de 51 ans qui a développé une fasciite nécrosante secondaire à une infection à Candida après un accident de la route. Le tableau clinique ressemblait fort à celui d'une gangrène gazeuse à Clostridium. Or, les seuls agents pathogènes isolés dans les cultures tissulaires ont été Candida albicans et Candida tropicalis. L'histopathologie a confirmé la présence de levures et de filaments pseudomycéliens dans les spécimens de tissus débridés. Aucune bactérie n'a été identifiée dans les frottis de plaie et les spécimens tissulaires. Notre rapport est le premier à mentionner Candida comme seule cause identifiable de la fasciite nécrosante post-traumatique. Il faut désormais tenir compte de Candida dans le diagnostic différentiel des agents pathogènes incriminés dans la fasciite nécrosante et la myonécrose infectieuse.