Bleeding on the cutting edge: A systematic review of anticoagulant and antiplatelet continuation in minor cutaneous surgery.

BACKGROUND: Anticoagulant and antiplatelet (AC/AP) use is common and practice surrounding AC/AP continuation or cessation peri-operatively for minor cutaneous surgery lacks evidence-based consensus. OBJECTIVE: To determine the risks of haemorrhagic and thromboembolic complications associated with the continuation or cessation of AC/AP therapy in minor cutaneous surgery. METHODS: A systematic literature search was conducted using PubMed, MEDLINE, Embase and CENTRAL, to identify all articles involving the use of AC/AP in patients undergoing minor cutaneous surgery, including skin grafts and local flaps. Eligible studies were randomised control trials, prospective studies and retrospective studies in the English language. Studies investigating free-flap repairs, oculoplastic surgery and hand surgery were excluded. RESULTS: 30 studies included data from over 14,000 patients, of which more than 5000 took regular AC/AP therapy. Thromboembolic events were rare but carry high morbidity and even mortality, and in these studies three events were associated with cessation of AC/AP. There was no increase in haemorrhagic complications in patients taking aspirin monotherapy, but evidence is conflicting regarding warfarin and clopidogrel monotherapy, which shows a small increase in rate of bleeding complications. However, no increase in wound dehiscence, graft failure, wound infection or cosmetic outcome was seen. Too few studies investigated DOAC use to draw reliable conclusions. Data are sparse in comparing multiple versus single AC/AP regimens. Use of skin grafts or local flaps may have a greater complication rate than direct closure in patients on one or more AC/AP, but evidence is limited. CONCLUSION: A case-by-case risk assessment is warranted in all patients but where possible, clinicians should prioritise meticulous haemostasis over cessation of agents.

Multidisciplinary management of head and neck sarcomas.

BACKGROUND: Head and neck sarcomas are extremely rare. This article reviews the management and outcomes in a multidisciplinary clinic. METHODS: The records of 41 male and 19 female patients (mean age, 50 years) were reviewed. Forty percent underwent surgical resection only, 35% underwent surgery and adjuvant therapy, and 25% underwent radiotherapy and/or chemotherapy without surgery. Seventy-one percent had complete histologic clearance. RESULTS: The mean follow-up was 3 years and 10 months, with an overall 5-year survival rate of 60%. Completeness of surgical excision was highly significant in determining 5-year local control (p < .025), and the addition of adjuvant radiotherapy had a major effect on local control, but only if complete surgical clearance had been achieved (p < .025). As expected, patients with more aggressive tumors had a significantly poorer overall prognosis, and achieving local control led to an enhanced 5-year survival (p < .025). CONCLUSION: These tumors are best managed in multidisciplinary clinics, and the mainstay of treatment is wide local excision and planned postoperative adjuvant radiotherapy.

What is the impact of breast augmentation on the Breast Screening Programme?

AIMS: To identify the number of women with breast implants in the Newcastle Breast Screening Programme, it's additional workload and compare the number of screen detected cancers in the implant and non-implant group. METHODS: Retrospective 9 year review of all women with cosmetic breast augmentation who have joined the National Breast Screening Programme in Newcastle. RESULTS: The percentage of total screened attendances involving implants has increased from 61 (0.10%) in 1990-93 to 97 (0.14%) in 1993-96 and 135 (0.23%) in 1996-99. Despite this increasing workload, no additional resources have yet been required in the Breast Screening Unit.1209 cancers (0.57%) were found in the screened population, and there were no screen detected cancers in the implant group, and there was no significant difference between the groups. CONCLUSIONS: As the number of younger women receiving breast implants continues to rise, when they become eligible for the National Health Service Breast Screening Programme (NHSBSP), departments should be aware that additional personnel and finance will be needed.