Simple Primary Closure Research Articles

Optimizing Morbidity in Unplanned Soft Tissue Sarcoma Excisions: Should We Skip the Reconstructive Ladder?

Soft tissue sarcomas (STSs) are rare and diverse primary malignant tumors that comprise approximately 1% of all malignancies. Misdiagnoses and unplanned excisions of STSs are common due to the tumor's rarity, leading to secondary tumor bed excisions (TBEs). Reconstructive outcomes for TBEs remain poorly understood, prompting this study to address the knowledge gap and inform preoperative discussions. This was a retrospective cohort study of patients who underwent STS excisions at a quaternary cancer center. Patients were categorized into mass excision (ME) and TBE groups. Reconstructive approaches were divided into simple (primary closure, complex repair, skin grafts, local flaps) and advanced (pedicled or free flaps). The groups were compared for postoperative outcomes, including complications, recurrence, and death. When simple reconstructive techniques were used, TBEs exhibited higher rates of overall and major complications, whereas MEs had higher rates of overall and minor complications. Intergroup analysis revealed that with simple reconstruction, rates of overall and major complications were higher in TBEs than in MEs, and rates of minor complications were higher in MEs than in TBEs. Regression analyses revealed that simple reconstruction of TBEs had 90% and 180% higher odds of major complications and reoperation compared to simple reconstruction of MEs (P < 0.05). TBEs, despite their smaller size, exhibited a heightened susceptibility to overall and major complications, challenging the notion that simpler techniques suffice in these cases. Our findings encourage the consideration of advanced reconstructive techniques for TBEs that may seem amenable to simple reconstructive techniques.

THE PATTERN OF CUT THROAT INJURIES, EARLY MANAGEMENT AND OUTCOME-A PROSPECTIVE STUDY IN A TERTIARY CARE HOSPITAL

Objective: To analyze pattern, sex and age ratio, common causes, the most common site and extent of the injury in the patients with cut throat injury at our hospital. To compare the same with previous similar studies conducted at other centers in different parts of the world. Also to note the early management and outcome in our study. Department Setting: of ENT and Head and Neck Surgery, Gauhati Medical college and Hospital, Guwahati, from January 2022 to January 2023. Methods: A total of 60 cases of cut throat injury were included in our study. Proforma was prepared to collect data. Results: 60 cases of cut throat injury patients were included in the study. Out of 60 cases 51 were males and 9 were females. Simple primary wound closure was done in 58 cases and 2 required secondary wound repair. In 20 patients, tracheostomy with primary repair was done. 32 patients needed psychiatric consultation. In our study, Conclusion: majority were males between 20 years to 40 years from lower middle socioeconomic status. Early and improved management will reduce the mortality and morbidity

'Waterproofing layers' for urethrocutaneous fistula repair after hypospadias surgery: evidence synthesis with systematic review and meta-analysis.

To summarize the available evidence and to quantitatively evaluate the global results of different waterproofing layers in substantiating the UCF repair. After defining the study protocol, the review was conducted according to the PRISMA guidelines by a team comprising experts in hypospadiology, systematic reviews and meta-analysis, epidemiology, biostatistics and data science. Studies published from 2000 onwards, reporting on the results of UCF closure after hypospadias repair were searched for on PUBMED, Embase and Google Scholar. Study quality was assessed using Joanna Briggs Checklist (JBI) critical appraisal tool. The results with different techniques were compared with the two samples independent proportions test with the help of Microsoft Excel, MedCalc software and an online calculator. Seventy-three studies were shortlisted for the synthesis; the final analysis included 2886 patients (71 studies) with UCF repair failure in 539. A summary of various dimensions involved with the UCF repair has been generated including time gap after last surgery, stent-vs-no stent, supra-pubic catheterization, suture material, suturing technique, associated anomalies, complications, etc. The success rates associated with different techniques were calculated and compared: simple catheterization (100%), simple primary closure (73.2%), dartos (78.8%), double dartos flaps (81%), scrotal flaps (94.6%), tunica vaginalis (94.3%), PATIO repair (93.5%), biomaterials or dermal substitutes (92%), biocompatible adhesives (56.5%) and skin-based flaps (54.5%). Several techniques were identified as solitary publications and discussed. Tunica vaginalis and scrotal flaps offer the best results after UCF closure in the synthesis. However, it is not possible to label any technique as ideal or perfect. Almost all popular waterproofing layers have depicted absolute (100%) success sometimes. There are a vast number of other factors (patient's local anatomy, surgeon's expertise and technical perspectives) which influence the final outcome.

A Scalp Scar-Reducing Procedure for the Hair Transplant Donor Area Using a Columnar Trichophytic Suture: A Case Report

One of the main concerns of patients who undergo hair transplantation surgery such as follicular unit strip surgery is scar widening on surgical sites. Until now, trichophytic suture, double-layer suture, tattoos, follicular unit transplantation on scars are suggested as a solution. A 23-year-old man with frontal hair loss underwent follicular unit strip surgery. To reduce hair donor area scarring, we tried a new trichophytic suture method. After surgery, the patient's hair loss degree was corrected with about C1 in the basic and specific (BASP) classification. Also, there was less scar in the columnar trichophytic suture part, compared with almost 7 mm of scar widening in the simple primary closure part. This study highlights that a columnar trichophytic suture may be useful for patients undergoing scalp surgery for cosmetic purposes.

Transposition glabellar flap in post orbital exenteration fistula: case report

&lt;p&gt;Reconstruction of facial orbital region defects, secondary to wound dehiscence following orbital exentration to treat Mucormycosis is an issue confronting the rhinologist. The transposition flaps have a vital role when expected result is unlikely, neither aesthetic nor functional, with a simple primary closure, secondary intention, advancement sliding flap or by free skin grafts. Glabellar transposition flap was used in a patient with a wide defect involving the medial wall of the orbit. Though there is a delicate dissection of pedicel there is likelihood of a trapdoor deformity but the glabellar flap facilitates repair in a single-staged procedure. Moreover, the donor site scars are merged in the margins of the aesthetic units thereby retaining facial cosmesis.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

Semi-occlusive management of fingertip injuries with finger caps: A randomized controlled trial in children and adults.

Background:Human fingertips can regenerate functionally and cosmetically excellent skin and soft tissues. Physiological conditions suppress scar formation and are thus a prerequisite for regenerative healing. Self-adhesive film dressings can provide such favorable conditions. The semi-occlusive treatment is superior to surgery. However, standard dressings leak malodorous wound fluid eventually until the wound is dry. Therefore, we developed and tested a silicone finger cap that forms a mechanically protected, wet chamber around the injury. Its puncturable reservoir allows access to the wound fluid for diagnostic and research purposes and the delivery of pro-regenerative drugs in the future.Methods:Patients >2 years with full-thickness fingertip injuries unsuitable for simple primary closure were randomized to start treatment with either the film dressing or the silicone finger cap. After 2 weeks, we changed to the other treatment. Patients’ choice on the preferred treatment after 4 weeks was the primary outcome parameter. Additionally, we monitored adverse events, unplanned visits, tissue gain, functionality, cosmetic outcome, and quality of life.Results:We randomized 11 patients 2 to 72 years to each group. Eighteen to 20 (90%, intention-to-treat) patients preferred the finger cap. All patients were satisfied with the cosmetic outcome, 88.9% had no disturbing sensibility changes, and 73.7% could report no distortion in the finger’s daily use. Epithelialization took between 5 weeks for Allen II and up to 9 weeks in Allen IV injuries. There were 19 device-related adverse events under film dressing and 13 under the finger cap. There were neither severe adverse device effects nor unexpected severe adverse device effects.Conclusion:Employing the summative or synthetic primary endpoint "patient decision for one or the other procedure," our pseudocross-over-designed RCT succeeded in statistically significantly demonstrating the superiority of the silicone finger cap over conventional film therapy. The finger cap was safe and effective, reaching excellent results on all treated injuries without any need for disinfection, antibiotics, shortening of protruding bones, or treatment of hypergranulations. Distal to the tendon insertions, we did not see any limitations regarding injury mechanism, amputation plane, or patients' age.

Island perforator muscle flaps for chronic osteomyelitis of the lower extremities: a retrospective analysis of 21 consecutive cases

One of the procedures for treating chronic osteomyelitis is the management of dead space resulting from aggressive débridement of the marrow cavity. To fill the void created by débridement, various muscle flaps have been recommended by many surgeons for their convenience and antiinfective properties. The objective of this study was to evaluate the efficacy of island perforator muscle flaps for the reconstruction of chronic osteomyelitis débridement defects of the lower extremities and provide indications for the selection of the muscle flap. A retrospective review of consecutive patients with chronic osteomyelitis of the lower extremities who underwent reconstruction using the island perforator muscle flap procedure from 2015 through 2018 was conducted. Data were collected on characteristics of the patients, wound site, wound size, surgical procedure, muscle choice, and wound healing. For the 21 patients included in the study, all muscle flaps survived. Wounds healed completely within 4 weeks. No infection relapses were identified during the follow-up period of at least 12 months. Simple primary closure, with no additional incision in the donor site, was achieved in five patients. In eight patients, an additional incision was made to harvest a muscle flap, but both the wound and donor site were closed primarily. The results showed that the island perforator muscle flap is less invasive, easy to harvest, and effective, and can be a good choice for the management of dead space resulting from débridement for chronic osteomyelitis in the lower extremity. Therapeutic, IV.

Symptomatic fibroepithelial polyp of the nipple in a pediatric patient

Skin tags are benign growths typically found on intertriginous areas of the body. The most common type of skin tag is the acrochordon, skin-colored papules with short, broad stalks. A rarer type of skin tag is the fibroepithelial polyp (FEP), which tend to be larger, with long, narrow stalks. We evaluated a pediatric patient with a nipple lesion that was intermittently painful and discolored. Simple excision and primary closure was performed with excellent results and relief of symptoms. Pathology revealed benign FEP with a few benign lactiferous ducts at the base of the specimen. While the differential for benign nipple lesions is long, with only 8 documented cases of FEP of the breast and none documented in the pediatric population, this poses a diagnostic challenge. Literature shows that FEPs can grow to a large size over time and become increasingly symptomatic. The benefits of simple excision and primary closure of FEP of the nipple include improved cosmesis, improvement in symptoms, and reassurance for patient and family with benign pathology. Given the rarity of this lesion in both location and patient population, it is important for clinicians to differentiate FEP of the nipple from other benign and malignant growths.

Closure of Challenging Pediatric Scalp Wounds by a Tension-Relief System.

Pediatric scalp defects may be challenging, due to their variant tension level and specific etiologies. Tissue characteristics and pre- and post-management considerations may pose difficulties to reconstruction in the pediatric patient. Primary closure is the preferred surgical technique but is not always possible. Various techniques have been described for facilitating primary wound closure, by reducing tension from the skin wound margins. The authors use a tension-relief system in some challenging scalp wounds when simple primary closure cannot be achieved. This enables primary closure without tension on the surgical margins, and may thus preclude the need for other closure techniques such as tissue-expanders, grafts, and flaps. The authors describe our use of a tension-relief system in 21 pediatric patients treated during 2017-2020, for congenital deformities, vascular malformations and other skin lesions, traumatic wounds, burn scars, and complicated surgical wounds with and without hardware exposure. A tension-relief system is a prompt, simple-to-use, safe, and low-cost surgical solution that offers several advantages over other techniques when tension-free primary intention closure is not possible. These benefits include less extensive surgery, fewer surgeries and associated anesthesia, shorter treatment period and hospitalization, better scarring, lower distress and burden to patients and their families, better pain-control, the absence of donor-site with its comorbidities, and less bleeding and risk of damaging adjacent structures. Based on our experience and the system characteristics detailed, the authors recommend using the described technique, which is convenient, accessible, and reliable, to close challenging scalp wounds in pediatric patients.

A study on different modalities of treatment for pilonidal sinus

Background: Excision with lay open method and excision with primary closure (simple closure, z-plasty, limberg flaps are both radical methods for treating pilonidal sinus. The ideal operation should be simple and should not require a prolonged stay, have low recurrence, failure rate and post-operative complication. Aim& Objective: The main objective of the present study to compared different techniques for treatment of sacrococcygeal pilonidal sinus. Methodology: It was a cross sectional study. The materials for this study was taken from the patient admitted to Owaisi hospital from Jan 2013-Dec 2014 (2yr period) Twenty eight patients with pilonidal sinus who were admitted to Owaisi hospital Results: In the present study, 15 out of 28 cases were treated by excision and lay open method. The mortality was nil, but the recurrence was 1 and 2 failures were noticed (totally 22.6% failure) in terms of morbidity. Patients abstained from work till the wound healed i.e. 44-68 days(average 49.5 days).The remaining 13 cases were operated by excision and primary closure (simple closure, z-plasty, limberg flap method) out of which 8 cases were treated with z-plasty and 2 cases with simple primary closure and 3 cases with limberg flap method. The mortality was nil, the recurrence rate and post-operative complications were nil and all patients returned to work early within 7 days. Conclusion: Finally we concluded that all cases where closure is possible should be treated with different closure techniques (simple closure, z-plasty, limberg flap). Deep gluteal cleft is flattened with z-plasty and limberg flap technique. Hence the suction effect is obliterated. All predisposing factors are countered by flap technique hence flap techniques are ideal for treatment for pilonidal sinus.

Reconstruction Options in Oral Cavity Cancer Surgery: A Tertiary Care Centre Experience

Aims &amp; Objectives: To study various reconstructive options in oral cavity cancer surgeries at our centre. Material and Methods: The present prospective study was conducted in the Department of ENT, GMC Jammu from January 2018 to December 2019 on 20 diagnosed cases of head and neck malignancy, who underwent reconstruction options such as local flap, pedicled flap or free flap. Results: Out of 11 lip cancer patients, 1 had local flap repair, rest all underwent primary closure. Out of 7 tongue carcinoma patients, 2 underwent free flap repair while 5 had primary closure. Out of 2 buccal carcinoma patients, one underwent excision with split thickness skin graft repair and 1 had pedicled flap repair. All reconstructions were having successful functional outcome at 6 months after surgery. Conclusion: From our study we can conclude that if performed with utmost care, the functional outcomes of various modes of reconstruction in oral cavity cancer surgeries from simple primary closure to complex ones like pedicled or free flaps, can be satisfactory.

Human Bite Injuries of the Orofacial Region: An Analysis of 26 Cases in Port Harcourt, Nigeria

Study Design: A retrospective study of 26 cases of human bite injuries at the Government Dental and Maxillofacial Hospital (now Maxillofacial unit, Rivers State University Teaching Hospital), Port Harcourt, within September 2011 and August 2016. Objective: To analyze the pattern, presentation, management, and complications of human bite injuries in the orofacial region. Methods: Information was extracted from hospital records of all victims of human bites to the face between the study period. Facial bites resulting from animals were excluded. Data such as age, gender, time lag between the injury and time of presentation in the hospital, nature and the circumstances of the injuries, site of injuries, and treatment outcomes and complications were collected and analyzed. Results: A total of 26 patients within the ages of 18 and 60 years were seen during the period of study. They were all related to fights, which were all resolved out of court. There was a preponderance of females, and the lower lip was the most affected site ( p &lt; .05). In all, 14 patients presented within 24 hours of injury and all but 2 (7.6%) patients presented within 7 days of injury. No wound was overtly infected. Treatments of injuries were varied from simple wedge excision and primary closure to complex multistaged procedures and were uneventful with acceptable surgical outcomes. Conclusion: Human bite wounds reported in this study were all due to social conflicts without legal redress. Although human bite wounds are considered to be dirty or contaminated but with proper wound debridement, antimicrobial cover and primary or immediate surgical closure results in very favorable aesthetic outcomes in all cases.

Excision and tension-free primary closure of pilonidal disease.

This study aimed to estimate simple excision and tension free primary closure and to study its effectiveness in terms of operating and healing time, duration of hospital stay, degree of post operation complications, and rate of recurrence. This is study included 78 patients, of whom 71 were (91%) males and 7 (9%) females, who underwent excision and tension free closure. The procedure was based on bilateral side flaps, which were released and dissected 2-3 cm from the edge of the wound. Patient's age, gender, body mass index, wound healing, operation, drain removal, length of hospital stay, and complications and recurrence were analysed. The study involved 78 patients, 71 (91%) males and 7 (9%) females. Median age of the patients was 28.5 years. Mean operation time was 44.6 minutes . Sixty-one patients (78.2%) had full primary healing without any complication. No one had hematoma or seroma, but five (6.4%) cases had a minor wound infection and three (3.8%) obese patients developed recurrence. Mean length of hospital stay was 2.5 days , most patients went back to their work within 3 weeks. Median follow-up period was in a 26.2 weak range (1-51.4 weak). Five (6.41%) cases had wound infection and three (3.85%) developed recurrence. Excision and tension free primary closure were found to be simple procedures associated with lower rates of wound infection, shorter hospital stay, lower recurrence, early wound recovery and short period of being absent from work. Surgery can be easily performed and preferred for cases of non-recurrent pilonidal sinus and cyst.

The analysis of outcomes of surgical management for colonoscopic perforations: A 16-years experiences at a single institution

Colonoscopy-induced colonic perforation often requires surgical management. The aim of this study was to analyze the outcomes after surgery for colonoscopic perforations (CPs). This was a retrospective chart review study of 48 patients who underwent surgery for CPs between January 2002 and May 2017. The patients were divided into two groups: Group I (n=25) had diagnostic CPs, and Group II (n=23) had therapeutic CPs. The most common perforation sites in Group I were the sigmoid colon (n=19; 76.0%), whereas in Group II were the transverse colon (n=10, 43.5%) and sigmoid colon (n=10, 43.5%; p=0.013). The surgeries performed were primary closure (n=16, [64.0%] Group I; n=11 [47.8%] Group II) and bowel resection (n=9 [36.0%] Group I; n=11 [47.8%] Group II). The rate of temporary stomas was higher in Group II (n=9, 26.1%) than Group I (n=2, 8.0%; p=0.030). The re-perforation rate after surgery was 8.0% (n=2) in Group I and 8.7% (n=2) in Group II (p=0.568). These re-perforation patients all those who had a simple closure without a wedge resection. The conversion rate after laparoscopic surgery was 20.0% (n=2 of 10) in Group I and 33.3% (n=1 of 3) in Group II. Surgical management is one of the important therapies in the treatment of CP. Simple primary closure without a wedge resection should be used cautiously. Therapeutic CPs was associated with more temporary stoma formation. The type of surgery should be carefully selected, depending on the type of CP.

Comparison of Crystallized Phenol Treatment and Simple Primary Closure Methods for Pilonidal Sinus Disease

The objective of the study was to compare the results of the patients treated with crystallized phenol treatment (CPT) or simple primary closure (SPC) for pilonidal sinus disease (PSD). For PSD treatment, both SPC and CPT have the advantages of rapid recovery, minimal pain, and short hospital stay. Even though these two techniques can be used interchangeably in uncomplicated cases, there is not enough evidence about which method is superior. A total of 102 patients who underwent CPT (n = 57) and SPC (n = 45) for uncomplicated PSD were included in the study. In all of the cases, data were recorded and compared between CPT and SPC groups, including age, gender, duration of the symptoms, hospital stay, complications, healing time, and recurrence. The mean age was 25.6 years and the male-to-female ratio was 93:9. The SPC and CPT groups were similar in terms of age, gender, duration of symptoms, complications, and healing time. The CPT group did not require hospitalization or anesthetic procedure in addition to local anesthesia, but the SPC group required a median of 1 day (range, 1–3 days) of hospitalization, and 3 patients (6.7%) needed spinal anesthesia. During a median of 27.5 months' follow-up, the recurrence rate in the CPT group (6 patients; 10.5%) was lower than in the SPC group (13 patients; 28.9%). Both hospital stay and recurrence rates were better in the CPT group. Healing time and complication rates were similar in both methods. Based on these results, we suggest that CPT should be preferred to SPC in uncomplicated cases.

Dog Bites in Children: A Descriptive Analysis.

To describe characteristics of dog bites and their treatment in a pediatric population including infection, medical specialties involved, rates of admission, and need for surgery. Patients presenting with a dog bite to the emergency department of a tertiary care pediatric hospital between January 1, 2015, and June 30, 2017, were included. Details related to demographics, complications, consultations, and treatment were extracted from the patients' records. Descriptive statistics were performed and binary logistic regression was used to assess potential predictors of infection. One hundred fifty-eight dog bite patients were identified. Most patients were male (53.8%) and less than 5 years of age (50%). Bites occurred most frequently in June (13.3%) and July (16.5%). The face was most commonly involved (42.9%), followed by the hands (12.6%) and the scalp (26.6%). Pit bulls (11.4%), Labrador retrievers (7.0%), and German shepherds (4.4%) were the most common offending breeds. Most bites were superficial (91.1%). Half were treated conservatively with dressings and petrolatum-based ointment, with 41.1% requiring simple primary closure. Ten (6.3%) cases necessitated primary repair in the main operating room under general anesthesia. More than half of patients were treated with prophylactic systemic antibiotics (55.1%). Plastic surgery was the most common service involved (24.7%). Seven (4.4%) patients developed an infection and there were no mortalities or long-term complications. Rates of infection did not differ between patients who did or did not receive prophylactic systemic antibiotics (P = .88). Regression analysis revealed no significant predictors of infection. Most dog bites are superficial and involve the head and hands. Infection rate is low, with no significant difference in infection rates between patients treated with or without prophylactic antibiotics.

A study of surgical approach to typhoid ileal perforation at a tertiary care hospital of South Gujarat, India

Background: Even with variety of procedures, typhoid (enteric) perforation still has a high rate of morbidity and mortality. The aim of the present study is to study clinical presentations, to evaluate management pattern of typhoid ileal perforation, to determine mortality and morbidity of perforation and to study the re-exploration rate and causes of re-exploration and its effect on mortality and morbidityMethods: This prospective observational study was conducted in the Departments of Surgery at Surat Municipal Institute of Medical Education and Research, Surat during June 2008 till October 2010. A total 45 patients with typhoid ileal perforation were included in the study. Among them, 32 cases (71%) undergone the simple primary closure of the perforation and peritoneal lavage after refreshing the edge, 7 cases (16%) undergone exploratory laparotomy with proximal loop ileostomy with primary closure and 6 (13%) were operated by exploratory laparotomy with resection anastomosis.Results: Mean duration of the stay for patient undergone PC+PL was 10.20 days and for ileostomy it was 18.4 days and for RA + PL it was 18.6 days. Total 37 incidence of complications were found in 45 cases. Among them wound infection was presented in 16 (43%) and burst abdomen presented in 2 (5%) cases. Fecal fistulae, post-operative collection and pneumonitis were present in 4 (11%) cases each.Conclusion: The overall mortality was found nearly 4 percent in our study. The typhoid ileal perforation should be always treated surgically. There are many operative techniques to deal with, but no one is full proof.

Efficacy of Plastic Reconstruction (Limberg Rhomboid Flap) in Management of Sacrococcygeal Pilonidal Sinus

Sacrococcygeal pilonidal sinus disease is a common condition usually seen in young adult males. The definitive treatment of sacrococcygeal pilonidal sinus is a surgical excision of all sinus tracts. The surgical procedures range from simple excision with or without primary closure to complex flap reconstruction. However, no single operative intervention is superior to another based upon overall rate of healing, time away from work, and risk of recurrence. Between January 2014 and march 2017, a total of 30 patients (28 male and 2 female) aged between 17 and 40 years old complaining from sacrococcygeal pilonidal sinus, 10 cases are recurrent after previous operation (6 recurrent cases after excision and simple primary closure and the another 4 recurrent cases after excision and lay open the wound to heal with secondary intension). Another 12 cases diagnosed several months after drainage of previous surgical drainage of pilonidal abscess with persistent non healed sinus and the remaining 8 cases are chronic pilonidal sinus with no history of previous abscess or operations. All cases after proper investigation managed with Limberg rhomboid flap for wound closure after surgical excision of the sacrococcygeal pilonidal sinus. The mean operative time was ranged from 50 to 70 minutes (average 60 minutes). Most cases (25 patients) received spinal anesthesia and the remaining (5 patient) received general anesthesia according to their desire. All patients discharged home 24 h to 48 after the operation and only one recurrent case need admission again for reoperation within 6 months. No recorded cases of wound infection, or flap necrosis were observed. All patients returned to work from 2 to 4 weeks after the operation with minimal postoperative pain with no wound tension or irritability and all were satisfied. The present investigation was concluded that the sacrococcygeal pilonidal sinus is chronic disease and surgeons have been treating it by different modalities range from lay open technique to wound closure either simple or based on plastic flap reconstruction. Limberg rhomboid flap reconstruction after excision of sacrococcygeal pilonidal sinus is meticulous, safe, easy to be done, low operative time, low post-operative pain, low hospital stays, early return of the patient to work, suitable to primary and recurrent cases with low local recurrent and meet acceptance from the patient preoperative during discussion with the patient for writing the surgical consent and postoperative due to the previous benefits.

Safety and efficacy of the keystone and rhomboid flaps for immediate reconstruction after wide local excision of non-head and neck melanomas.

BackgroundAfter wide local excision of cutaneous melanoma, large defects not amenable to simple primary closure are often covered with skin grafts. We report our experience using the rhomboid and keystone flaps to immediately close large axial and extremity wounds after potentially curative surgery for non-head and neck melanomas.MethodsBetween January 2011 and September 2016, demographic, operative, pathologic, and outcome data were prospectively collected on 60 patients who underwent wide local excision of melanoma followed by immediate flap reconstruction. Flaps were of either rhomboid or keystone type. Chi-square analysis was used to compare relationships between factors.ResultsAll procedures were done by the senior author and as outpatient surgery. No patient required a surgical drain unless they were undergoing concomitant radical regional node dissection. Flap separation (arbitrarily defined as a >5-mm dehiscence of the suture line) occurred in 16/61 patients (26 %). No patient had flap loss. The risk of flap morbidity was significantly higher if the primary tumor was on the distal extremity—10 of 24 patients (42 %), all with keystone flaps—than if it was on the trunk or the proximal extremity (6/37 patients, 16 %), p = 0.04. There were no margins positive for either invasive or in situ melanoma in the entire cohort.ConclusionsSimple transposition flaps can successfully cover large defects after melanoma excision without the need for skin grafting. Keystone flaps in the distal extremity are more prone to separation, but this is minor and does not result in flap loss. There is minimal risk of a positive margin requiring flap takedown and a second re-excision.

V-Y fasciocutaneous flap closure technique is a safe and efficacious alternative to primary closure of the perineal wound following abdominoperineal resection

BackgroundThe aim of this study was to compare wound complications from V-Y flap vs primary closure in the setting of abdominoperineal resection. MethodsThis was a single institution retrospective review (1999–2014). The main outcome measures were any wound complication, hospital length of stay, and unplanned readmissions. ResultsAmong 80 patients included, 21 (26%) received reconstruction with V-Y flap. Compared with those who received primary closure, patients who underwent V-Y flap reconstruction had lower rates of overall wound complications (14.3% vs 64%, P = .002), superficial surgical site infection (6% vs 32%, P = .05), and wound dehiscence (4.5% vs 14%, P = .251 statistical significance not met). ConclusionsReconstruction of perineal defect following abdominoperineal resection using a V-Y fasciocutaneous flap is a safe and efficacious alternative to traditional simple primary closure and is associated with reduced postoperative morbidity. Further comparative effectiveness studies should be undertaken to evaluate long-term and quality-of-life outcomes.