[History of healing; wound suturing]. / Geschiedenis van het genezen; de wondhechting.

The history of wound suturing reflects that of surgery itself. In wound treatment, which encloses the technique of suturing as well as suturing materials, wound suturing plays a prominent role. In ancient India, Egypt and the Greek and Roman societies wound treatments as well as suturing techniques and instruments were developed that strongly resemble those in our days. Catgut and silk are known since antiquity. Hardly any progress is noted up to the nineteenth century. The debate on closed or open wound treatment has never stopped. The improvement of catgut by Lister started in 1860. In the 19th century prototypes of mechanical suturing instruments (staplers) were developed. They were introduced into clinical practice in the early decades of the 20th century. The greatest progress in wound suturing started after World War II with the introduction of advanced semiautomatic stapler machinery and with the manufacture of synthetic non-resorbable and resorbable fibres. They have revolutionized surgery and were instrumental in developing new fields (microsurgery).

[Surgery in the last 40 years: looking back in wonder]. / De heelkunde in de laatste 40 jaar: omzien in verwondering.

Much has changed in surgery in the last 40 years: From the fifties, new findings were introduced, such as antibiotics, anticoagulants, cytostatics, cardiac and pulmonary surgery, artificial respiration, osteosynthesis, arteriography, synthetic fibres and image intensifying in the clinic. The average hospital stay in the surgical ward used to be 21 days, mortality 6-7%. Owing to the long hospital stays, nurses, physicians and interns grew familiar with the pre- and postoperative courses. In the sixties, reconstructive vascular surgery became possible, where earlier limbs had to be amputated. The first pacemakers were inserted. There was widespread lung surgery because of tuberculosis, and owing to the great poliomyelitis epidemic of 1953, there was ample expertise of artificial respiration. Surgical treatment of fractures took off, and the first hip prostheses were introduced. The average hospital stay shrunk to about 14 days and the mortality to less than 2%. A turning point in surgical management came in 1961. In that year, the free Saturday was introduced, marking a transition from austerity to luxury. The medical successes were overtaken by the patients' needs, expectations and claims. Physicians started to work fixed hours, rather than when required. The seventies saw the beginning of intensive care and great progress in paediatric surgery; organ transplantation came in the eighties. The recent years were marked by formalization and protocolling of treatment and information. The growing influence of the government and of bureaucracy, and the encroachment upon the surgeon's social position and income interfere with his work with the patients.

The use of Marlex mesh in patients with generalized peritonitis and multiple organ system failure.

Patients with generalized peritonitis form a rather threatened group, with a high mortality and risk of complications which increases when multiple organ failure develops. In 20 patients with this condition, the laparotomy wound was closed without tension using a Marlex mesh prosthesis, after surgical treatment of the underlying illness and drainage of the abdominal cavity. The mortality was lower than expected, according to data from the literature; also, pulmonary complications, residual abscesses and wound dehiscence occurred less frequently. This method seems to be a valuable contribution to the complex treatment of these patients.

The Bishop-Koop anastomosis-a find in pediatric surgery.

A technique of intestinal anastomosis, developed for the treatment of meconium ileus, was used by the authors in the treatment of neonates suffering from various other intestinal anomalies such as atresia, volvulus and apple-peel syndrome. This technique was used in 6 neonates to make a safe intestinal reconstruction.

Penile cancer.

A retrospective study was made of the case histories of 91 patients with a penile tumor. The tumor histology of 56 patients could be re-evaluated, confirming the diagnosis: epidermoid cancer. Fifty three of these 56 patients were treated more than five years before the retrospective evaluation. Penile carcinoma has not increased in frequency during the last few decades. No correlation could be found between venereal diseases and penile carcinoma, nor between the duration of symptoms before treatment and the development of metastases. Amputation is the treatment of choice. Lymph node dissection must be performed when metastatic disease is suspected. When patients die of tumor, this is caused by metastatic disease, but in about 50 percent of cases the patients can be saved by dissection of positive nodes, preventing a further extension. More than 70 percent of 53 patients have survived for at least five years without evidence of recurrence or metastatic disease including six (out of 11) patients in whom the dissected inguinal lymph nodes showed involvement. In this series of patients cytostatic therapy was not used. Bleomycin is known to have a definite action on these tumors, but only the far future can show if better results are to be expected with a combination of the described therapy with cytostatic drugs.