A Novel Foil Flip-Over System as the Final Layer in Wound Closure: Excellent Cosmetic Results and Patient Comfort

BACKGROUND Wound closure after excision is commonly done with sutures or staples. A new sutureless innovative wound closure system is available for sutureless skin closure. OBJECTIVE To evaluate wound healing, patient comfort, and cosmetic results of a foil flip-over system for excision of small skin lesion. MATERIALS AND METHODS Patients presenting to the department of Dermatology of Erasmus University Medical Center, Rotterdam, The Netherlands for skin surgery during a 1.5-year period were prospectively studied. Key outcome measures were wound healing, patient comfort, and cosmetic results. Three independent physicians scored photographs of the scars. Evaluation tools used were comfort and body image questionnaires and visual analogue scales. RESULTS Ninety-six patients with 103 lesions were included in our study. The surgeon scored wound healing as excellent or good in 96%. No wound infections occurred. Ninety-two percent of patients scored removal of the system as comfortable. Median patient grade of scar after 1 month was 8 out of 10 points (interquartile range [IQR] 79). Median independent physician grade of photographs of the scars was 7.7 (IQR 7.18.0). CONCLUSION Sutureless foil flip-over is promising, with excellent patient comfort characteristics and good to excellent cosmetic results

Blood transfusions and local tumor recurrence in colorectal cancer. Evidence of a noncausal relationship

OBJECTIVE. The authors analyzed the effect of blood transfusions on the pattern of colorectal cancer recurrence. BACKGROUND. Retrospective studies suggest that blood transfusions are associated with a poor prognosis in patients who undergo operations for colorectal malignancies. In a previously published, randomized trial, it was investigated whether autologous blood transfusions could overcome this putative detrimental effect. However, this did not appear to be the case. METHODS. In the current study, the authors analyzed the patterns of recurrence in 420 patients who underwent curative operations for colorectal cancer. RESULTS. Patients who did not require transfusions (N = 143) had significantly better disease-free survival than those who did need transfusions (N = 277); percentages at 4 years were 73% and 59%, respectively (p = 0.001). No difference was found between both groups in comparing cumulative percentages of patients having metastases; percentages at 4 years were 25% in the group that did not undergo transfusion and 27% in the transfused group. The percentage of cases having local recurrence, however, was significantly increased (p = 0.0006) in the transfused group as compared with the group that did not undergo transfusion; percentages at 4 years were 20% and 3%, respectively. The groups of patients receiving only allogeneic, only autologous, or both types of transfusions all had a significantly higher incidence of local recurrence than the patients who did not receive transfusions, but no differences were found between these three groups. CONCLUSIONS. These findings suggest that the association between blood transfusions and prognosis in colorectal cancer is a result of the circumstances that necessitate transfusions, leading to the development of local recurrences, but not of distant metastases

Indications for incisional hernia repair: An international questionnaire among hernia surgeons

Background: Incisional hernia repair can be a significant challenge for both surgeon and patient. Despite the growing amount of literature describing various methods of surgical techniques, little has been published regarding the natural course of incisional hernia and the opinions about indications for incisional hernia repair. Methods: A questionnaire was sent to a group of surgeons internationally renowned in incisional hernia surgery and research. Results: Pain and limitations of daily activities were considered the most important indications for repair. Cosmetic complaints were seen as least important. About 23% of patients were asymptomatic. More than 20% did not receive surgical treatment. Conclusions: A large proportion of patients with incisional hernia is not operated. Despite this large group of patients, valid data describing the natural course are absent. A prospective trial monitoring incisional untreated hernias as well as comparing conservative treatment with repair should be performed