Difference In Cosmetic Outcome Research Articles

Total Cranial Vault Remodelling Versus Minimally Invasive Suturectomy With Postoperative Helmet Therapy in Sagittal Craniosynostosis

Different surgical techniques have been explored over time to treat children with scaphocephaly. The objective of this study is to compare morbidity and cosmetic outcomes in total cranial vault remodelling (TCVR) and minimally invasive suturectomy with postoperative helmet therapy (MISPH) in patients with scaphocephaly. The authors performed a retrospective comparative cohort study, including 43 patients with isolated sagittal craniosynostosis who underwent TCVR (n=17) or MISPH (n=26) at the Antwerp University Hospital between April 2008 and December 2022. MISPH was associated with significantly shorter procedure duration (TCVR 199 ± 48 min, MISPH 69 ± 12 min, P<0.001), decreased blood loss (TCVR 610 ± 298 mL, MISPH 85 ± 73 mL, P<0.001) and lower transfusion rate (TCVR 100%, MISPH 54%, P<0.001). Mean length of stay at the intensive care unit and the hospital were significantly shorter after MISPH (TCVR 6 ± 1 d, MISPH 3 ± 0.5 d). The change in CI after TCVR was significantly larger than after MISPH during the first postoperative year. However, the CI in the MISPH group was significantly higher during the first year compared with the TCVR group. Mean CI of the MISPH group reached normal limits during the first year, while in the TCVR group, mean CI reached normal values 5 years after surgery. The authors could not find a statistically significant difference in cosmetic outcome between the 2 groups. The authors conclude that MISPH is associated with decreased morbidity and comparable cosmetic results when compared with TCVR in the treatment of scaphocephaly.

Cyanoacrylate vs. sutures in clean and clean-contaminated surgical wounds - a randomised control study.

Various techniques of closure of surgical incisions have been described ranging from various suture materials, staples and tapes to adhesive compounds. Cyanoacrylate is an adhesive compound available for surgical incision closure. Although sutures have been the preferred universal choice for surgical incision closure, glue is gaining popularity in specific places like pediatric injuries, facial injuries, laparoscopic incision closure, etc. This study aimed to compare the results between the application of cyanoacrylate and conventional suturing. In this randomized control study, patients were divided into two groups of 100 each. The surgical incisions were closed using cyanoacrylate glue in Group A patients and polyamide (EthilonTM 2-0) in Group B patients. Post-operative pain was assessed using Visual Analogue Scale on the first, third, and seventh day. The wounds were evaluated for complications on post-op days 1, 3, 7, and 30 using the ASEPSIS score. Cosmetic outcome was assessed at the end of first month using the Modified Hollander Cosmesis Scale. Post-operative pain was significantly less in the glue group on days 1, 3, and 7. Wound infection with dehiscence occurred in 4 cases (4 %) in Group A and one patient (1 %) in Group B, which was statistically insignificant. There was no significant difference in cosmetic outcomes in either Group. Cyanoacrylate is a good alternative to sutures in skin closure of clean and clean-contaminated surgical wounds.

Quality of Life Following Robotic Transaxillary Versus Conventional Hemithyroidectomy: A Comparative Analysis.

Background: Robotic technology has proven safe and effective for thyroidectomy procedures. Few studies have addressed the quality-of-life outcomes of robotic thyroidectomy compared with conventional thyroidectomy. Materials and Methods: The database of a tertiary medical center was retrospectively reviewed for all patients with thyroid disease who had undergone robotic hemithyroidectomy in 2012-2020. All patients treated by transaxillary robotic surgery and a similar number of randomly selected patients treated by conventional cervical surgery completed a standardized self-administered thyroid disease-specific quality-of-life (QOL) questionnaire (ThyPRO). Clinical data were derived from the medical files. The results were compared using mean comparison tests and multivariate logistic regression models. Results: The cohort consisted of 131 patients: 63 after robotic thyroidectomy and 68 after conventional thyroidectomy. The mean age was 38.87 ± 14.11 and 58.85 ± 14.1 years, respectively (P < .0001). The robotic hemithyroidectomy group reported better QOL outcomes in physical and mental health parameters, including decreased anxiety, depression, lower sex life impairment, and cognitive impairment scores (P < .0001). Furthermore, after adjusting for age, gender, malignancy status, and surgical approach, we found that patients undergoing robotic hemithyroidectomy had a lower probability of experiencing depressive symptoms than the conventional hemithyroidectomy group (odds ratio = 0.31; 95% confidence interval, 0.11-0.88). Of interest, no significant difference in cosmetic outcomes was found. Conclusions: Patients who underwent robotic thyroidectomy report better postoperative QOL after surgery than patients operated by the conventional approach in terms of anxiety, depression, cognitive and sex-life scores.

Interrupted subcuticular suture spacing during linear wound closures and the effect on wound cosmesis: a randomized evaluator-blinded split-wound comparative effectiveness trial.

Surgical reconstructions following Mohs micrographic surgery and standard surgical excisions are often closed with two layers of sutures: a deep subcuticular layer and a superficial cuticular layer. Some surgeons feel the need to place many deep sutures in order to reduce tension on cuticular sutures, as they believe this may decrease incidence of track marks and dehiscence, and lead to better cosmetic outcomes. However, others feel that a higher number of subcuticular sutures increases the risk of a suture reaction, which leads to patient anxiety and poorer wound cosmesis. To our knowledge, there are no studies published on the effect of subcuticular suture spacing on wound cosmesis. To determine whether suturing with 1-cm interval subcuticular sutures results in better cosmetic outcomes than suturing with 2-cm interval subcuticular sutures. Fifty patients were enrolled in a randomized clinical trial using a split-wound model, where half of the wound was repaired with sutures spaced 2 cm apart and the other half was repaired with sutures spaced 1 cm apart (ClinicalTrials.gov identifier NCT03327922). Both the evaluators and patients were blinded as to which side received which treatment. The scar was evaluated 3 months post-surgery by two blinded observers and the patients themselves using the Patient and Observer Scar Assessment Scale (POSAS), a validated scar assessment instrument. The total mean POSAS score for observers for the sides that received 1-cm interval subcuticular sutures and the sides that received 2-cm interval subcuticular sutures did not differ significantly at 3 months (P = 0·34). There was also no significant difference in the patient assessment scale score between the two sides at 3 months (P = 0·084). We found that 1-cm suture spacing was not significantly associated with improved overall cosmetic outcome compared with 2-cm suture spacing when evaluated by blinded observers or the patients themselves. Our results support the use of either interval. What is already known about this topic? Surgeons have differing opinions on the ideal frequency of subcuticular sutures for optimizing cosmetic outcomes and minimizing suture reactions. The effect of subcuticular suture spacing on wound cosmesis has not been previously explored in the literature. What does this study add? There was no significant difference in cosmetic outcome between 1-cm suture spacing and 2-cm suture spacing when evaluated by blinded observers and patients. Dermatology surgeons can use 2-cm suture spacing for increased efficiency, without significantly different cosmetic outcomes, detected by blinded observers and patients.

EVALUATION OF FUNCTIONAL OUTCOME OF SUPRACONDYLAR FRACTURES TREATED WITH CRISSCROSS VS LATERAL PINNING

Introduction : Supracondylar humerus fractures are the most common elbow fractures seen in children. The peak age is 5 to 6 years .Gartland classified these fractures in to extension and flexion type with former being most common. Extension injuries are further divided in to un displaced (type 1),partially displaced with intact posterior cortex(type 2),completely displaced (type 3).Type 2 and type 3 fractures requires intervention (closed reduction and pinning). In this scenario, our study is designed to know the functional outcome of Criss cross pinning versus lateral pinning in supracondylar humerus fractures Aim : 1. To restore the anatomy of the distal end of the humerus with percutaneous Kirschner's wire fixation. 2. To evaluate the functional and cosmetic outcome of displaced supracondylar fractures of the humerus in children treated with cross pinning and lateral pinning. Materials And Methods : A prospective study with 30 cases of Gartland type 2 and type 3 supracondylar fracture humerus, treated by lateral ( n=16 ) and criss cross ( n=14 ) pinning, was conducted between October 2018 to october 2020. The results were expressed as mean and standard deviation and p&lt;0.05 was considered as statistically significant. Results : In this study, among thirty patients, cross pinning was done in fourteen patients (46.67%), and lateral pinning was done in sixteen patients (53.33%). All patients had satisfactory results according to Flynn's criteria.Conclusion : There was no significant difference in cosmetic outcome, i.e. loss of carrying angle, and in functional outcome i.e.; loss of flexion in degrees between crisscross Kirschner wire fixation and lateral Kirschner wire fixation in supracondylar fractures of the humerus in children.

Viability and Cosmesis of Right Angle and Vertical Paramedian Forehead Flaps Are Equivalent: A Retrospective Quantitative Study.

Paramedian forehead flaps (PMFFs) are commonly used for reconstruction of nasal defects. The classic PMFF is vertically oriented while the modified PMFF is designed with a 90-degree angle. No study has compared outcomes between these PMFF designs. To compare and quantify viability and cosmesis of 90-degree and vertical PMFF. Retrospective chart review of 70 consecutive patients with a vertical or 90-degree PMFF design for nasal repairs after Mohs micrographic surgery (MMS). Cosmetic outcome was assessed on a 10-cm, 100-point, visual analog scale (VAS) by an independent observer using standardized 3-month postoperative photographs. Flap viability was assessed using standardized 3-week postoperative photographs. Descriptive statistics, t -test, and Mann-Whitney test were used for statistical analysis. Forty-eight patients were repaired with a vertical PMFF and 22 using the 90-degree PMFF. The mean defect area of vertical and 90-degree designs was equivalent (7.7 ± 4.0 cm 2 vs 8.1 ± 4.0 cm 2 , p = .70). There was no significant difference in cosmetic outcome (75.9 ± 9.4 vs 72.9 ± 6.8, p = .19) or flap viability (3.8% ± 11.6 vs 2.6% ± 7.9, p = .67) between vertical and 90-degree designs. Vertical and 90-degree PMFF designs for nasal repairs after MMS are equivalent in cosmetic outcome and viability.

Prospective randomized trial of skin closure for pacemaker implantation: absorbable vs. non-absorbable suture : PRO-PACE.

Pacemaker implantations have been performed for > 50years, reaching 1.25million implants worldwide per year. Despite this, only few randomized studies exist regarding technical aspects of the implantation procedure-in particular, wound closure. Accordingly, the authors compared absorbable vs. non-absorbable suture regarding wound healing. Consecutive patients scheduled for de novo pacemaker implantation without defibrillation therapy were prospectively randomized into two groups: non-absorbable (Prolene®, Ethicon Inc.) or absorbable suture (Monocryl®, Ethicon Inc.). The wound was systematically assessed for cosmetic outcome at 1day, 6weeks, and 1year post implantation using the patient and observer scar assessment scale (POSAS). Adverse events noted included bleeding, pocket hematoma, infection, suture insufficiency, and revision surgery. Atotal of 114patients (mean age: 79 ± 10years, n = 60 male) were randomized into the two groups. Of these, 105 completed follow-up (lost to follow-up: 7.9%). Groups were comparable for clinical characteristics or use of oral anticoagulants. There was no difference in cosmetic outcome and incidence of adverse events at any follow-up visit. POSAS scores were: 1day: 1.4 ± 0.4 vs. 1.3 ± 0.4, P = 0.44, 6weeks: 1.4 ± 0.6 vs. 1.4 ± 0.7, P = 0.57; 1year: 1.4 ± 1.4 vs. 2.1 ± 3, P = 0.60. No pocket hematoma or infection occurred in either group. No additional surgery was necessary for local findings. Retrospectively, scar development was straight in the Prolene® group and slightly wavy with Monocryl®. Suture material does not influence wound healing as represented by the cosmetic result and the occurrence of adverse events. The choice of suture material used should be left to the physician's discretion.

Octyl 2-cyanoacrylate versus conventional suturing of port site skin closure in laparoscopic appendicectomy: a prospective study

Background: With rapidly developing minimally invasive surgery, the laparoscopic appendectomy has become a preferred method for appendicectomy. Tissue adhesives have become an ideal alternative to conventional sutures and could possibly become the preferred standard of care in many procedures. However, this concept remains unexplored due to scanty data comparing the use of adhesive glues and sutures. The present prospective study was done to compare octyl-2-cyanoacrylate with conventional suturing of port site wound closure in laparoscopic appendicectomy in terms of wound complications, time taken for wound closure and cosmetic outcome.Methods: 60 patients diagnosed to have appendicitis (acute, chronic and recurrent) undergoing laparoscopic appendicectomy were divided into two groups (group A-octyl-2-cyanoacrylate) and (group B- conventional sutures) with 30 in each group. Time taken for wound closure, Wound complications and cosmetic outcome were compared in both groups.Results: Patient demographics were comparable in both the groups. The complications were significantly lower in group A compared to group B. Mean surgical time for wound closure in group A was less compared to group B (p&lt;0.001). Wound closure using octyl-2-cyanoacrylate had lower rate of complications compared to conventional suturing but results obtained were not statistically significant. No significant difference in cosmetic outcome was noted in both groups.Conclusions: Wound closure using octyl-2-cyanoacrylate required significantly less time for skin closure compared to conventional suturing in patients undergoing laparoscopic appendicectomy. However, wound complications and cosmetic outcome using octyl-2-cyanoacrylate did not show statistically significant results compared to conventional suture.

Use of Absorbable Cutaneous Sutures Amid the COVID-19 Pandemic

The use of absorbable epicuticular sutures is highlighted as a measure to decrease the number of patient visits, eliminating the risk of additional exposures for patients and medical staff during the COVID-19 pandemic. We present a case where the use of absorbable epicuticular sutures was preferred over non-absorbable sutures. Studies have shown no significant difference in cosmetic outcomes between non-absorbing suture and absorbable suture. Many patients express anxiety over the thought of suture removal, and often ask if the sutures will “dissolve on their own” during the surgery. Use of absorbable top sutures is one way surgeons can help allay this fear, and studies have shown similar patient satisfaction between absorbable and non-absorbable sutures. Additional stress may be prominent during the current pandemic. Dermatologic surgeons should strongly consider the use of absorbable cutaneous sutures during this pandemic, as this likely improves patient and staff safety, and studies have shown similar cosmetic outcomes and patient satisfaction.

Narrow urethral plate augmentation in anterior and middle hypospadias repair: Onlay flap VS. Inlay graft. A prospective randomized comparative study

The measurement of the urethral plate width (as an objective parameter) and its effect of this width on the results of tubularized incised plate urethroplasty (TIPU) have been reported in two series and both authors reported that a urethral plate width<8mm is associated with higher complication rates. The augmentation of the urethral plate either by dorsal inlay graft urethroplasty (DIGU) or Onlay flap has been compared with the original TIPU in different degrees of hypospadias with better surgical results in augmented cases. To evaluate the surgical results of longitudinal Onlay preputial flap (LOF) vs (DIGU) techniques in augmentation of the narrow urethral plate. Primary anterior and middle hypospadias cases with narrow urethral plates were randomly allocated into two groups; group one operated by DIGU and group two operated by (LOF). The Success rate, individual complication rate, and operative times were compared. 39 cases completed the study. No significant differences in patients' characteristics were detected. In the DIGU group, one case (5.3%) complicated with fistula and glandular dehiscence wherein in the LOF group, 7 cases (35%) Complicated with 5 fistulae, 2 glanular dehiscences, one flap loss, one diverticulum (p= .02). No significant differences in the rates of individual complications. Variables affecting the success of hypospadias repairs are many. Urethral plate quality is an important variable among these variables. The definition of urethral plate quality is usually subjective. In the DIGU group, only 1/19 (5.3%) case had two complications, fistula and glandular dehiscence. Mouravas etal., in their comparative study between TIPU and G-TIP without mention of urethral plate width reported a significant reduction of the overall complications and urethral stenosis without significant reduction in fistula rate. In their G-TIP group, only 2 cases out of 24 (8.3%) were complicated with one fistula and one glandular dehiscence where in the TIPU group, 7 cases (30.4%) were complicated with one glandular dehiscence and 6 cases with urethral stenosis. In the LOF group, fistula in 5/20 cases (25%) was the commonest complication followed by glandular dehiscence in 2 cases (10%). Diverticulum and flap loss occurred in one case for each (5%). In the multivariate analysis of 474 patients' cohort by Spinoit etal., there were no significant differences between the risk of re-intervention after TIP and Onlay flap in anterior and middle hypospadias (25.8% vs. 18.8%), and (22.2% vs. 20%) respectively. Our data suggest that augmentation of the narrow urethral plate with DIGU has a better surgical outcome than with LOF. No significant difference in cosmetic outcomes detected.

Single incision multiport versus conventional laparoscopic inguinal hernia repair: A matched comparison

Background:The popularity of single-incision procedures is on the rise as wound cosmesis is increasingly being seen as an important body image-related outcome. In this study, we assess the potential benefits of single-incision multiport laparoscopic totally extra-peritoneal (S-TEP) without using specialised ports or instruments and compare the same with the conventional laparoscopic TEP (C-TEP) surgery in terms of operative time, post-operative pain, complications, cost and cosmesis.Materials and Methods:This is a prospective case-matched study of the patients undergoing S-TEP versus C-TEP from June 2014 to December 2015.Results:Each group had 36 patients. The two groups were comparable in the clinical characteristics. The mean duration of surgery for a unilateral hernia in C-TEP and S-TEP was 45.13 ± 10.58 min and 72.63 ± 15.23 min, respectively. The mean visual analogue scale (VAS) score for pain was significantly higher in S-TEP group at post-operative day (POD) 0 and 1. However, at POD 7, there was no significant difference between the groups. At 1st and 6-week post-surgery, the cosmetic results were significantly better in S-TEP group as compared to C-TEP, however, at 6 months, the scar was highly acceptable in both treatment groups.Conclusion:S-TEP, using conventional laparoscopic instruments, is safe and feasible even in resource challenged setting. However, there is a need to review the indications and advantages of single-incision laparoscopic surgery, as no difference in cosmetic outcome by VAS score in S-TEP versus conventional laparoscopic arm seen by the end of 1 month.

Comparison of the Outcome of Diathermy Versus Scalpel Skin Incision in Surgical Cases

The objective of this study was to compare the outcome of cutting diathermy incisions versus surgical scalpel incisions in three different sites of elective surgery. This study was a prospective observational study conducted at a tertiary care teaching hospital in Pune, India, over a period of 2 years from June 2014 to June 2016 including a 1-year follow-up period. Inclusion criteria were patients of both sexes who were admitted for elective surgeries of the thyroid, breast, and abdomen. Data including demographic details, infection rate, and cosmetic appearance were recorded in both groups to compare the final surgical outcome. A total of 135 patients were finally analyzed in the study. A total of 68 patients (group A) underwent operation via diathermy skin incision and 67 patients (group B) underwent operation via scalpel skin incision. In diathermy (group A), a total 18% (n = 12) patients developed complications and in scalpel (group B), a total 21% (n = 14) patients developed complications (chi-square = 2.386, p value = 0.801). In diathermy (group A), 56 cases (82%) had excellent scar, 12 cases (17%) had fair scar, and 1 case (1.5%) had poor scar. In scalpel group (group B), 53 cases (79%) had excellent scar, 12 cases (18%) had fair scar, and 2 cases (3%) developed poor scar (f = 2.56, p = 0.112). No significant difference was noted in wound healing and the rate of wound complication in skin incision made by cutting diathermy as compared to the conventional scalpel skin incision in our present study. We also conclude that there is no difference in cosmetic outcome in both groups after 1 year of follow-up.

Comparative study of hybrid laparoendoscopic single-site (LESS) partial nephrectomy and conventional multiport laparoscopy

ObjectiveTo investigate the surgical and oncological outcomes of hybrid laparoendoscopic single-site (LESS) in partial nephrectomy with reusable components compared with multiport laparoscopy. Material and methodHybrid LESS technique with auxiliary 3.5mm trocar (n=20) was compared with conventional multiport laparoscopy (n=26) by a prospective, paired, nonrandomized, and comparative study in partially nephrectomized patients. ResultsFollow-up average was 31±18.6 months. In one case, LESS was converted to laparoscopy. No differences were found regarding age, sex, body mass index, laterality, localization, tumor size or use of double J stent. Dominance of Loop-I (P=0.09) and benign histology (P=0.05) were observed in the LESS group. Neither there were differences regarding operating time, ischemia time, use of hemostatic materials, estimated blood loss, postoperative hemoglobin levels, transfusion or other complications. In any case, to extend the skin incision for specimen extraction was not necessary. Drainage time (P=0.006) and hospital stay (P=0.003) were better in LESS patients. Concerning complications, no significant differences were observed according Clavien-Dindo scale. In laparoscopic group one patient died of pulmonary embolism after hospital discharge. No positive margins were observed in any case. During follow-up neither tumor recurrence nor disease progression were observed. ConclusionsRegarding surgical outcomes, partial nephrectomy by LESS technique does not imply improvements, excepting shorter hospital stay, probably due to accurate surgical hemostasis and/or selection of cases. No surgical and oncological risks are involved, as well as no improvement in ischemia time, blood loss or transfusion rate. We find no significant difference in cosmetic outcomes.

Análisis comparativo entre nefrectomía parcial LESS híbrida y laparoscópica convencional multipuerto

ObjectiveTo investigate the surgical and oncological outcomes of hybrid laparoendoscopic single-site (LESS) in partial nephrectomy with reusable components compared with multiport laparoscopy. Material and methodHybrid LESS technique with auxiliary 3.5mm trocar (n=20) was compared with conventional multiport laparoscopy (n=26) by a prospective, paired, nonrandomized, and comparative study in partially nephrectomized patients. ResultsFollow-up average was 31±18.6 months. In one case, LESS was converted to laparoscopy. No differences were found regarding age, sex, body mass index, laterality, localization, tumor size or use of double J stent. Dominance of Loop-I (P=0.09) and benign histology (P=0.05) were observed in the LESS group. Neither there were differences regarding operating time, ischemia time, use of hemostatic materials, estimated blood loss, postoperative hemoglobin levels, transfusion or other complications. In any case, to extend the skin incision for specimen extraction was not necessary. Drainage time (P=0.006) and hospital stay (P=0.003) were better in LESS patients. Concerning complications, no significant differences were observed according Clavien-Dindo scale. In laparoscopic group one patient died of pulmonary embolism after hospital discharge. No positive margins were observed in any case. During follow-up neither tumor recurrence nor disease progression were observed. ConclusionsRegarding surgical outcomes, partial nephrectomy by LESS technique does not imply improvements, excepting shorter hospital stay, probably due to accurate surgical hemostasis and/or selection of cases. No surgical and oncological risks are involved, as well as no improvement in ischemia time, blood loss or transfusion rate. We find no significant difference in cosmetic outcomes.

Comparison of transumbilical laparoscopic-assisted appendectomy versus single incision laparoscopic appendectomy in children: which is the better surgical option?

BackgroundTransumbilical laparoscopic-assisted appendectomy (TULA) is a single incision technique that exteriorizes the appendix through the umbilicus. The aim of this study was to compare the surgical outcomes of TULA with SILA in pediatric appendicitis. MethodsA retrospective review of medical records between April 2011 and April 2015 identified 250 pediatric patients who underwent single incision laparoscopic appendectomy. Of these, 137 patients underwent TULA and 113 patients underwent SILA. Measured outcomes included patients' demographics, clinical characteristics, operative time, length of stay, pain, and postoperative complications. ResultsTULA group had a shorter operative time than SILA group (28.93 vs. 49.19min, p<0.001). The use of rescue analgesics was more frequent in the SILA group (six cases (6.5%) vs. 19 cases (23.4%), p<0.001). There was no significant difference in cosmetic outcome between the two groups. However, TULA was associated with a lower complication rate (2/137, 1.5%) than SILA (11/113, 9.8%) (p=0.0035). In multiple logistic regression analysis, TULA was significantly associated with a lower complication rate (p=0.049). ConclusionsTULA is preferable to SILA for treating pediatric acute appendicitis because it is technically easier, results in better surgical outcomes, and provides the same excellent cosmetic results.

Clinical comparison of brachytherapy versus hypofractionated external beam radiation versus standard fractionation external beam radiation for non-melanomatous skin cancers.

PurposeNon-melanomatous skin cancer (NMSC) is the single most common cancer in the US. Radiation therapy is an excellent treatment alternative to surgery. High-dose-rate (HDR) brachytherapy and external beam radiotherapy (EBRT) are commonly used radiation treatment modalities but little data is published comparing these modalities. We present our institution's experience and outcomes with these therapeutic options.Material and methodsFrom June 2005 to March 2013, 61 patients were treated with HDR brachytherapy (n = 9), hypofractionated EBRT (n = 30), or standard fractionation EBRT (n = 22) for NMSC. The primary outcome measure was local control at most remote follow-up and secondary outcome measures were overall survival, cosmetic outcome, and toxicity. Univariate analysis was performed to compare outcomes between treatment modalities. Kaplan-Meier analysis and log-rank test were used to compare overall survival.ResultsMedian follow-up was 30 months. The most common histologies were BCC (47%) and SCC (44%); mean patient age was 83.3 years. Local control was 81% and 2-year actuarial overall survival was 89%. There was no statistical difference in local control or overall survival between treatment modalities. There was no statistical difference in cosmetic outcome or toxicity between treatment modalities, although five of six “poor” cosmetic outcomes and the only grade 3 toxic events were found in the standard fractionation EBRT group.ConclusionsAll modalities investigated represent effective treatments for NMSC and have good cosmetic outcomes and acceptable toxicity profiles. The finding of higher grade toxicity and a greater portion of patients experiencing toxicity among standard fractionation therapy is counter to expectations. There was no statistical significance to the finding and it is not likely to be meaningful.

Concurrent or Sequential Hormonal and Radiation Therapy in Breast Cancer: A Literature Review.

Background and objectives: Adjuvant hormonal therapy is frequently used in the treatment of women with estrogen receptor (ER)/progesterone receptor (PR) positive breast cancer. When radiotherapy is given, hormone therapy may be delivered in a concurrent or sequential manner. Hormonal blockade with tamoxifen or aromatase inhibitors is thought to arrest hormonally dependent cancer cells in the early G1 phase of the cell cycle. This has been theorized to reduce the efficacy of radiation, which is known to be more effective in cells that are actively dividing. Therefore, there has been a reluctance by many to treat with concurrent hormonal and radiation therapy.Methods: We performed a search of the Medline database that led to the identification of 39 studies. and full-text review of these studies led to the identification of seven English non-review studies in peer-reviewed literature between 1995 and 2015 that addressed the question of timing of radiation and hormonal therapy. Outcome measures were captured from each of the studies.Results: No difference in survival or local-regional recurrence was identified between concurrent versus sequential treatment. Furthermore, no difference in cosmetic outcome or adverse effects was noted for either approach. However, when comparing radiation alone or radiation and hormonal therapy, there was an increased risk of breast and lung fibrosis with combined treatment.Conclusions: Hormone therapy, concurrent or sequential, with radiation results in comparable disease-related outcomes, including survival and recurrence. However, given the theoretical reduction in efficacy and increased rates of fibrosis with concurrent use, it is reasonable to support the use of sequential therapy.

Cautery versus scalpel for abdominal skin incisions: a double blind, randomized crossover trial of scar cosmesis

The purpose of this study was to determine whether there is any difference in cosmetic outcome between using cutting diathermy and using a scalpel to make abdominal skin incisions. This was a prospective, randomized, double-blind crossover study. The primary end point was wound cosmesis as judged by the patient. In each case, one-half of the skin incision was made using diathermy, and one-half using a scalpel blade. Patients were contacted at 6 months post-operatively, and were asked which half of the wound looked better to them. A panel of 18 surgeons was also shown photographs of the wounds taken after 6 months, and were asked the same question. Of the 31 patients with complete follow-up, 11 (35%) reported no difference between the two halves of the wound. Nine (29%) preferred the half incised with diathermy, and 11 (35%) preferred the half incised with the scalpel (P = 0.82, chi-squared test). Twenty-four patients consented to having their wound photographed. There was no difference in the surgeons' preference between the diathermy and scalpel halves of the incision (P = 0.35, signed-rank test). We found the use of cutting diathermy to make abdominal skin incisions to be cosmetically equivalent to cutting with the scalpel. As previous studies have not shown adverse wound outcomes using this technique, and considering the safety concerns for theatre staff when the scalpel is used, the routine use of cutting diathermy for skin incisions in abdominal surgery is justified.

Randomized controlled trial: comparison of two surgical techniques for closing the wound following ileostomy closure: purse string vs direct suture

Surgical site infection (SSI) is a common complication following ileostomy closure with a frequency of up to 40%. This prospective randomized controlled trial was initiated to compare two surgical techniques - direct suture (DS) and purse-string suture (PSS) - used to close the wound following ileostomy closure. The primary end-point was the SSI rate. Secondary end-points were cosmetic outcome [using two validated scales: the Patient and Observer Scar Assessment Scale (POSAS) and the Body Image Questionnaire (BIQ)] and the influence of other factors on the SSI rate. Of a total of 99 patients screened, 84 were included in this study. Forty-three patients were randomized into the PSS group and 41 were randomized into the DS group. Follow up was performed within 3 days after surgery, at discharge, and 30 days and 6 months after the operation. In the PSS group there were no cases of SSI compared with 10 (24%) cases in the DS group (P = 0.0004). There were no statistically significant differences in cosmetic outcome between the two groups. No other statistically significant factors influencing the incidence of SSI could be identified. The rate of SSI is significantly lower following PSS than following DS, and both techniques have a similar cosmetic outcome. PSS closure should be considered as standard of care for wound closure after ileostomy reversal.

Would Fewer Port Numbers in Laparoscopy Produce Better Cosmesis? Prospective Study

Study ObjectiveTo determine whether fewer ports in laparoscopic adnexal surgery would lead to better cosmesis. DesignProspective comparative study (Canadian Task Force classification II-2). SettingUniversity hospital. PatientsOne hundred thirty consecutive patients with adnexal tumors. InterventionsPatients underwent laparoscopy using a single port (n = 75), 2 ports (n = 22), or 4 ports (n = 33). Cosmetic satisfaction was assessed using a validated Body Image Questionnaire at 1, 4, and 12 weeks after surgery. Measurements and Main ResultsPatient characteristics (age, parity, and sociodemographic data), details of the procedures performed, and histologic findings were similar between the 3 surgical groups. There was also no difference in number of conversions to other surgical approaches, operative time, estimated blood loss, postoperative pain, and perioperative complications. Compared with the 2- and 4-port groups, the single-port group reported substantially greater cosmetic satisfaction at 1, 4, and 12 weeks after surgery. However, there was no important difference in cosmetic outcome throughout follow-up in the 2-t and 4-port groups. ConclusionUnlike 2- or 4-port laparoscopy, single-port laparoscopy has a definite benefit in cosmetic satisfaction.