RESUMEN
BACKGROUND: Recent studies suggest that the use of tissue adhesive for closure of both traumatic lacerations and incisional surgical wounds leads to cosmetic outcome comparable to conventional sutures. To date, no studies have investigated tissue adhesive in breast surgery and costs. Our aim was to compare the tissue adhesive 2-octylcyanoacrylate (OCA) with standard suture in breast surgery. METHODS: A prospective randomized study was conducted in which 151 patients were assessed for eligibility, and 133 were randomly allocated to skin closure with OCA adhesive or monofilament suture. Cosmetic outcome with blinded assessment, wound management by the patients, complication rates, and economic outcome were recorded. RESULTS: There was no difference in cosmetic score in the 2 groups, nor in complications at the early, 6-month, and 1-year follow-up. Patient satisfaction with the wound closed with OCA was rated significantly higher when compared with standard suture (P <.0001). The application of the tissue adhesive was significantly faster than that for standard suture (P <.001). In economic terms total costs were less in the tissue adhesive group, mainly due to lower postoperative costs of physician and assistant services (P <.001). CONCLUSIONS: OCA is effective and reliable in skin closure for breast surgery, yielding similar cosmetic results to standard suture. OCA is faster than standard wound closure and offers several practical advantages over suture repair for patients. Cost analysis has found that OCA adhesive can significantly decrease health care costs.
Asunto(s)
Enfermedades de la Mama/cirugía , Cianoacrilatos/uso terapéutico , Mastectomía/métodos , Técnicas de Sutura , Adhesivos Tisulares/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Cianoacrilatos/economía , Femenino , Humanos , Masculino , Mastectomía/economía , Persona de Mediana Edad , Satisfacción del Paciente , Estudios Prospectivos , Técnicas de Sutura/economía , Adhesivos Tisulares/economía , Resultado del Tratamiento , Cicatrización de HeridasRESUMEN
A rare case of gigantic Paget disease is presented. Surgical treatment and reconstructive issues are discussed in detail.
Asunto(s)
Neoplasias de la Mama/cirugía , Carcinoma Ductal de Mama/cirugía , Enfermedad de Paget Mamaria/cirugía , Procedimientos de Cirugía Plástica/métodos , Procedimientos Quirúrgicos Operativos/métodos , Neoplasias Torácicas/cirugía , Anciano , Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/patología , Femenino , Humanos , Enfermedad de Paget Mamaria/patología , Neoplasias Torácicas/secundario , Pared Torácica , Resultado del TratamientoRESUMEN
In August-September 1998 an Italian medical team, composed of a plastic surgeon, an anaesthesiologist, an infectious diseases specialist and a psychologist, assisted by a local non-government organization (Narripokkho), studied a cohort of Bangladeshi women injured by sulphuric acid. The goals of the mission were: (1) recognition of the magnitude of the phenomenon of acid being intentionally thrown at women; (2) evaluation of the type and severity of burns; (3) preparation of a tentative schedule of surgical treatment of the lesions; (4) organization of local facilities; (5) training of doctors and nurses.
Asunto(s)
Quemaduras Químicas/epidemiología , Lesiones Oculares/inducido químicamente , Traumatismos Faciales/inducido químicamente , Ácidos Sulfúricos/efectos adversos , Violencia , Adolescente , Adulto , Bangladesh/epidemiología , Quemaduras Químicas/etiología , Quemaduras Químicas/cirugía , Estudios de Cohortes , Países en Desarrollo , Lesiones Oculares/epidemiología , Traumatismos Faciales/epidemiología , Traumatismos Faciales/cirugía , Femenino , Humanos , Incidencia , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Procedimientos de Cirugía Plástica , Medición de Riesgo , Distribución por Sexo , Factores SocioeconómicosRESUMEN
After our experience with two patients who had persistent posttraumatic defects of the anterior skull base, we recommend using a deepithelialized free radial forearm flap for one-stage reconstruction. The flap provides a thin, water-tight barrier between the cranial cavity and the subcranial spaces for effective prevention of cerebrospinal fluid leakage and ascending infection. It is particularly useful when local flap options are not available.