David Y. Johnson

Abdominal Wall Necrosis After Harvest of Both Internal Thoracic and Inferior Epigastric Arteries

BACKGROUND The internal thoracic artery (ITA) and inferior epigastric artery (IEA) may be used as conduits for myocardial revascularization. Harvesting the ITAs and IEAs can lead to clinically significant ischemia of the anterior abdominal wall. METHODS We created a registry with data from 108 patients receiving myocardial revascularization with 1 or greater ITA and (or) 1 or greater IEA. After revascularization, patients were followed to document their outcomes during hospitalization. We sought to identify risk factors for tissue necrosis in these patients. RESULTS All patients had 1 (84%) or 2 (16%) IEAs harvested. Both ITAs were utilized in 81% of patients; 19% had only the left ITA harvested. All patients in whom 2 IEAs were harvested also had 2 ITAs harvested (17 of 108). Of these 17 patients, 2 (12%) developed abdominal wall necrosis. Only patients who had bilateral ITA and bilateral IEA harvest experienced this complication. CONCLUSIONS Bilateral harvest of ITAs and IEAs results in a moderate risk of clinically significant abdominal wall necrosis. The extent of tissue loss may involve skin, muscle, and fascia, but the peritoneum and posterior rectus sheath remained intact in both affected patients in this series. These data may be most valuable to those who contemplate an abdominal operation in a patient who has had one or more of their ITAs or IEAs taken.

Geographic variation in posttreatment surveillance intensity for patients with cutaneous melanoma

BACKGROUND We investigated whether geographic determinants could account for variation in posttreatment melanoma surveillance intensity among plastic surgeons. METHODS A custom-designed questionnaire was mailed to U.S. and non-U.S. members of the American Society of Plastic and Reconstructive Surgeons (ASPRS). Subjects were asked how they use 14 specific follow-up modalities during years 1 to 5 and 10 following primary treatment for patients with cutaneous melanoma. Repeated-measures analysis of variance was used to compare practice patterns by TNM stage, year postsurgery, U.S. census region, metropolitan statistical area (MSA), and managed care organization (MCO) penetration rate. RESULTS Of the 1,142 respondents, 395 were evaluable. Those who did not perform melanoma surgery or follow-up were excluded. Correlation analysis showed that mean follow-up intensity for the modalities surveyed was highly correlated across TNM stages and years postsurgery. Within MSAs, only chest radiograph utilization varied significantly. The pattern of testing varied significantly by geographic region for seven modalities (office visit, computed tomography scan of the brain and chest/abdomen, alpha-fetoprotein level, 5S-cysteinyl dopa level, abdominal ultrasonogram, bone scan); in each of these, utilization by non-U.S. surgeons exceeded utilization in any U.S. census region. The pattern of testing varied significantly by MCO penetration rate for chest radiograph (greater utilization in the lowest MCO penetration rate areas) and 5S-cysteinyl dopa level (greater utilization in the highest MCO penetration rate areas). CONCLUSIONS The intensity of posttreatment surveillance recommended by ASPRS members caring for patients with cutaneous melanoma varies markedly. This analysis provides the first evidence that geographic factors significantly affect the surveillance strategies of clinicians following patients with cutaneous melanoma. Variation by census region was most prominent, although the size of detected differences was small.

Colon and Rectum Carcinoma

The International Agency for Research on Cancer (IARC), a component of the World Health Organization (WHO), estimated that there were 1,023,152 new cases of colorectal cancers worldwide in 2002 [1]. The IARC also estimated that there were 528,978 deaths due to this cause in 2002 [1].

An obturation technique for closure of body wall defects.

Aims: In the vast majority of instances, closure of abdominal wall defects relies on the tensile strength of transposed native tissue and/or prosthetic material. The purpose of this report is to alert clinicians to a different strategy for closure that we have used successfully on several occasions. Presentation of Case: A 72 year old man had a bulky inguinal nodal metastasis from cutaneous squamous cell carcinoma. He had an extended radical groin dissection including full thickness abdominal wall resection, with primary closure, followed by external beam radiotherapy. After 30 months, he developed an abdominal wall hernia and enterocutaneous fistula at the surgical site. Direct closure and local vascularized flaps were not feasible. Obturation of the defect by omentum was employed, taking advantage of its relative incompressibility rather than its minimal tensile strength. The wound was subsequently covered by a skin graft. The patient survived 10 years with an intact hernia repair and died of unrelated causes. Discussion: The technique has yielded good results. Case Study Johnson et al.; BJMMR, 7(12): 1039-1043, 2015; Article no.BJMMR.2015.42

Vaginal and Vulvar Carcinoma

The data for the estimated new cases and deaths worldwide in 2002 for vaginal and vulvar carcinoma were not available through International Agency for Research on Cancer (IARC), a component of the World Health Organization (WHO) [1].

Liver and Biliary Tract Carcinoma

The International Agency for Research on Cancer (IARC), a component of the World Health Organization (WHO), estimated that there were 626,162 new cases of liver carcinoma worldwide in 2002 [1]. The IARC also estimated that there were 598,321 deaths due to this cause in 2002 [1].

Upper Aerodigestive Tract Carcinoma

The International Agency for Research on Cancer (IARC), a component of the World Health Organization (WHO), estimated that there were 484,628 new cases of upper aerodigestive tract carcinoma worldwide in 2002 [1]. The IARC also estimated that there were 261,784 deaths due to this cause in 2002 [1].

Urinary Bladder Carcinoma

The International Agency for Research on Cancer (IARC), a component of the World Health Organization (WHO), estimated that there were 356,557 new cases of bladder carcinoma worldwide in 2002 [1]. The IARC also estimated that there were 145,009 deaths due to this cause in 2002 [1].

Glioma of the Central Nervous System

The International Agency for Research on Cancer (IARC), a component of the World Health Organization (WHO), estimated that there were 189,485 new cases of CNS glioma (specified as cancer of the brain and other nervous system) worldwide in 2002 [1]. The IARC also estimated that there were 141,650 deaths due to this cause in 2002 [1].

Thyroid (Papillary, Follicular, Medullary, Hürthle Cell) Carcinoma

The International Agency for Research on Cancer (IARC), a component of the World Health Organization (WHO), estimated that there were 141,013 new cases of thyroid (papillary, follicular, Hurthle cell) carcinoma worldwide in 2002 [1]. The IARC estimated that there were 35,375 deaths due to this cause in 2002 [1].