Aesthetic outcome of running subcuticular suture versus running horizontal mattress suture in closure of linear wounds of the trunk and extremities: a randomized evaluator-blinded split-wound comparative effectiveness trial.

BACKGROUND: Both running horizontal mattress (HM) and running subcuticular (SQ) suturing techniques have been suggested to be superior to other running cuticular suturing techniques . These two techniques have not been directly compared. OBJECTIVE: To compare cosmetic outcomes between a running HM and a running SQ technique in a split scar model following linear closure of trunk and extremity defects. METHODS: Fifty patients were enrolled in a randomized, evaluator-blinded, split-scar study. One side of the surgical wound was randomized to receive one intervention (HM vs SQ) with the other side receiving the alternate intervention. The primary outcome was the POSAS score at a minimum of 3 months post-operatively. RESULTS: Observer POSAS sum of components was 19.49 and 17.76 for HM and SQ, respectively (p=0.14). The mean score for patient overall opinion was 4.71 for HM and 3.50 for the SQ technique (p=0.02). Overall opinion scores of evaluators were 3.87 and 3.29 for HM and SQ, respectively (p=0.03). LIMITATIONS: Single-center study of a relatively homogenous population. CONCLUSION: Although there was no significant difference in the sum of POSAS components between HM and SQ (p=0.14), both patients and evaluators had a superior overall opinion of the SQ-treated side (patient p=0.02, evaluator p=0.03).

Aesthetic outcome of intermediate closure versus intermediate closure followed by 2-octyl cyanoacrylate: A randomized evaluator-blinded split-wound comparative effectiveness trial.

BACKGROUND: Dermatologic surgeons are increasingly using surgical adhesives in their practice. Studies comparing sutured wounds to those that utilize a combination of suturing and skin adhesive have not been previously conducted. OBJECTIVE: To compare the cosmetic outcome and patient wound care satisfaction of an intermediate suture closure with an intermediate suture closure followed by the application of 2-octyl cyanoacrylate (2-OCA). METHODS: Fifty patients were enrolled in a randomized, evaluator-blinded, split-scar study. Following intermediate sutured closure of a surgical defect, one side of the wound was randomized to receive an additional application of 2-OCA. After 3 months, the scar was assessed using the POSAS tool and patients reported wound care preferences. RESULTS: As the primary outcome measure, the mean sum of observer POSAS was 12.80 for sutured closure alone versus 12.40 for sutured closures followed by 2-OCA (P = .49). LIMITATIONS: Single-center study of a relatively homogenous population. CONCLUSION: Although there were no significant differences in scar cosmesis, both patients and observers tended to prefer the side with an additional application of 2-OCA in most POSAS components, in overall opinion, and in patient wound care satisfaction. Dermatologic surgeons may add this to their practice without sacrificing scar outcomes or patient satisfaction.

An unusual case of multiple grouped non-familial trichoepitheliomas.

Trichoepitheliomas (TEs) are benign and rare adnexal hamartomas of the pilosebaceous units. Trichoepitheliomas could occur in the setting of an underlying genetic disorder with multiple TEs or as solitary non-hereditary TEs. We report a healthy 32-year-old woman with sporadic multiple clustered and non-segmental TEs without positive family history. There have been two other cases reported in the literature that had non-familial multiple TEs, one was facially disfiguring and the other was in a segmental pattern. Our case has been the only one reported in the English literature which has sporadic, multiple TEs clustered unilaterally and non-segmentally on the trunk.

Comparative analysis of open and robotic transversus abdominis release for ventral hernia repair.

BACKGROUND: Transversus abdominis release (TAR) is a safe, effective strategy to repair complex ventral incisional hernia (VIH); however, open TAR (o-TAR) often necessitates prolonged hospitalization. Robot-assisted TAR (r-TAR) may benefit short-term outcomes and shorten convalescence. This study compares 90-day outcomes of o-TAR and r-TAR for VIH repair. METHODS: A single-center, retrospective review of patients who underwent o-TAR or r-TAR for VIH from 2015 to 2016 was conducted. Patient and hernia characteristics, operative data, and 90-day outcomes were compared. The primary outcome was hospital length of stay, and secondary metrics were morbidity, surgical site events, and readmission. RESULTS: Overall, 102 patients were identified (76 o-TAR and 26 r-TAR). Patients were comparable regarding age, gender, body mass index, and the presence of co-morbidities. Diabetes was more common in the open group (22.3 vs. 0%, P = 0.01). Most VIH defects were midline (89.5 vs. 83%, P = 0.47) and recurrent (52.6 vs. 58.3%, P = 0.65). Hernia characteristics were similar regarding mean defect size (260 ± 209 vs. 235 ± 107 cm2, P = 0.55), mesh removal, and type/size mesh implanted. Average operative time was longer in the r-TAR cohort (287 ± 121 vs. 365 ± 78 min, P < 0.01) despite most receiving mesh fixation with fibrin sealant alone (18.4 vs. 91.7%, P < 0.01). r-TAR trended toward lower morbidity (39.2 vs. 19.2%, P = 0.09), less severe complications, and similar rates of surgical site events and readmission (6.6 vs. 7.7%, P = 1.00). In addition, r-TAR resulted in a significantly shorter median hospital length of stay compared to o-TAR (6 days, 95% CI 5.9-8.3 vs. 3 days, 95% CI 3.2-4.3). CONCLUSIONS: In select patients, the robotic surgical platform facilitates a safe, minimally invasive approach to complex abdominal wall reconstruction, specifically TAR. Robot-assisted TAR for VIH offers the short-term benefits of low morbidity and decreased hospital length of stay compared to open TAR.

Addressing Noncommunicable Disease on Short-Term Medical Trips: A Longitudinal Study of Hypertension Treatment in Santo Domingo.

BACKGROUND: Noncommunicable diseases (NCDs) are the leading cause of mortality worldwide and pose complex challenges in developing nations. Short-term medical trips, which often operate independently of government and pharmaceutical companies, are in a unique position to address NCDs in developing nations. In 2010, the Dominican Aid Society of Virginia shifted the focus of their semiannual clinic to addressing NCDs in Paraíso, Santo Domingo. OBJECTIVE: This study analyzes the longitudinal impact of a short-term medical trip on the control of hypertension in their patient population. METHODS: Returning patients were identified through a review of medical records from 2014 and 2016. A sample of patients who only visited in either 2014 or 2016 were matched on sex and age and served as an internal comparison group. A generalized linear mixed model was applied to assess changes in blood pressure, the proportion of patients receiving blood pressure treatment, and the intensity of blood pressure treatment within and between returning and new patients over the study period. FINDINGS: There was a significant decrease in diastolic blood pressure within returning patients. Change in systolic blood pressure was significantly different between returning and new patients, with improvement in returning patients. There was a significant increase in the proportion of new patients receiving blood pressure treatment and a higher intensity of blood pressure treatment over time. The change in the proportion of patients receiving blood pressure treatment in the new patient group was significantly higher than that of the returning patient group. CONCLUSIONS: Short-term medical trips with a recurrent presence in a community may improve control of hypertension and other NCDs in developing nations. Further research into the impact that short-term medical trips may have on NCDs is needed.