Cleft lip repair without suture removal.

The disadvantages of using non-absorbable sutures in cleft lip repair include a need for additional dressings, return to the ward for removal of the sutures under sedation or general anaesthetic and the problem of distressing the child and potentially disrupting the repair. Modern medical adhesives represent an alternative adjunctive technique for skin closure and their use was adopted by this unit in 2005. A few 'key' interrupted sutures of 7/0 Vicryl Rapide followed by layers of a cyanoacrylate adhesive, Dermabond, were used instead of more traditional methods. An audit of the results of cleft lip repairs from this period of change was conducted. Subjective and objective data were collected and are presented to justify the continued use of this technique in the Newcastle Cleft Lip and Palate Unit.

Is pregnancy contraindicated following free TRAM breast reconstruction?

There are reports of patients having normal full term pregnancies following pedicled transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction. These are individual cases and there is only limited published evidence to support the safety of pregnancy following surgery of this nature. Little is known about the effects of pregnancy after free tissue transfer, therefore it has been difficult to advise patients, in this situation, what the recommended course of action should be. A report of pregnancy following free TRAM flap breast reconstruction is presented with a review of relevant literature in an attempt to clarify this issue and improve the consent process. We conclude that TRAM flap breast reconstruction is not an obstacle to normal pregnancy and delivery. Patients need to be guided through the potential risks to their health if they should become pregnant, before reconstruction takes place. Obstetric and Oncological Specialists, as part of the multi-disciplinary setting, need to be involved early in pregnancy to further inform and counsel these patients.

The outcome of varicose vein surgery at 10 years: clinical findings, symptoms and patient satisfaction.

BACKGROUND: Data on long-term outcomes of varicose vein surgery are sparse, and 'success' rates vary substantially depending on the method of assessment. This study used a variety of methods to evaluate patients 10 years after operation. METHODS: A consecutive cohort of 100 patients was identified, of whom 70 (151 operated limbs) were reviewed--50 by clinical and Doppler examination, and all by structured questionnaire. RESULTS: A few months after operation, symptoms were 'cured' or 'much better' in 89% of patients, and remained so at 10 years in 77%. Only 30% patients were completely free of recurrent varicose veins at 10 years (both by self- and clinician-assessment): 44% had 'just a few' varicosities while 26%, had varicose veins 'as badly as before'. Only 24 patients (34%) were not 'generally pleased' at 10 years, because of continuing symptoms (3), recurrent varicosities (13), and other miscellaneous reasons. CONCLUSIONS: Although some recurrence of varicose veins is frequent 10 years after operation, surgery provides long-term relief of symptoms in the great majority of patients.