Equal cosmetic outcomes with 5-0 poliglecaprone-25 versus 6-0 polypropylene for superficial closures.

BACKGROUND: Cutaneous sutures should provide an aesthetically pleasing result. After placing subcutaneous sutures, enough absorbable suture often remains for the superficial closure. Mohs surgeons often use a nonabsorbable suture to close the superficial layer to obtain cosmetically elegant results, but using this additional suture is less cost effective than using the remaining absorbable suture. OBJECTIVES: To compare the cosmetic results of simple running sutures using an absorbable suture material (5-0 poliglecaprone-25) with those of a nonabsorbable suture (6-0 polypropylene) in primary closures of suitable facial Mohs defects. MATERIALS AND METHODS: Fifty-two patients with 57 facial Mohs surgery defects appropriate for multilayer primary repair had the defects prospectively randomized into a side-by-side comparison. After closure of the deep layers with 5-0 poliglecaprone-25 sutures, half of the wound was closed with a 5-0 poliglecaprone-25 simple running suture, and the other half of the wound was closed with a 6-0 polypropylene simple running suture. The investigators blindly determined the cosmetically superior side of the closure at 1 week and 4 months after suture removal. RESULTS: Forty-four patients (48 total defects) completed the study. At the 4-month follow-up, 85% (41/48) did not show any difference between poliglecaprone-25 and polypropylene, 4% (2/48) had better outcomes with poliglecaprone-25, and 10% (5/48) had better outcomes with polypropylene. There was no statistically significant cosmetic difference between the two closure types. Wound complications such as infection, hematoma, and dehiscence did not occur in any of the patients. CONCLUSION: In primary closures of facial defects, using 5-0 poliglecaprone-25 or 6-0 polypropylene for the superficial closure did not affect the cosmetic result. Therefore, 5-0 poliglecaprone-25 provides a comparable and cost-effective alternative to nonabsorbable sutures for epidermal approximation in layered closures.

Hidradenitis suppurativa complicated by squamous cell carcinoma and paraneoplastic neuropathy.

Squamous cell carcinoma is a rare complication of chronic, severe, hidradenitis suppurativa. We describe a patient with a 20-year history of extensive perineal hidradenitis suppurativa who presented with subacute muscle weakness and sensory symptoms. He was subsequently diagnosed with squamous cell carcinoma arising in the area of hidradenitis. The neurologic symptoms and signs resolved after complete excision of the tumor. This presentation is consistent with a paraneoplastic neuropathy, which has not been reported previously in patients with squamous cell carcinoma arising in patients with hidradenitis suppurativa.

Impact of midtrimester dilation and evacuation on subsequent pregnancy outcome.

OBJECTIVE: This study was undertaken to evaluate the impact of second-trimester dilation and evacuation (D&E) on subsequent pregnancy outcome. STUDY DESIGN: Medical record review of 600 patients undergoing midtrimester (14-24 weeks) D&E from 1996 to 2000 and evaluation of subsequent pregnancy outcome. Mann Whitney U, Spearman rho, and chi(2) tests were used in statistical analysis with a P value <.05 considered significant. RESULTS: Ninety-six subsequent pregnancies were identified, including 12 first-trimester spontaneous abortions, 1 second-trimester fetal death, 1 ectopic pregnancy, and 5 elective terminations. Seventy-seven pregnancies resulted in the delivery of a live-born infant at a median gestational age of 39.0 weeks. Five pregnancies (6.5%) were complicated by spontaneous preterm birth. Patients delivered preterm had an earlier gestational age at D&E (18.0 vs 20.0 weeks, P =.02) and a trend toward less preoperative cervical dilation (2.0 vs 3.0 cm, P =.09) than patients delivered at term. CONCLUSION: Second-trimester D&E is not a risk factor for midtrimester pregnancy loss or spontaneous preterm birth. Preterm delivery in future gestations appears less likely when greater preoperative cervical dilation is achieved with laminaria, possibly because of a decrease in cervical trauma.