Common Warts

Updated 3/2017-- photos and all links (except to my own posts) removed as many no longer active. and it was easier than checking each one. 

I’m sure I don’t see as many patients with common skin warts as my family practice or dermatology colleagues, but these patients still make it to my office.  Sometimes it’s the primary complaint, sometimes it’s an afterthought.  In reviewing the topic, it occurred to me that most patients don’t need to see any of us for this problem.  They mostly need to accept the fact that the treatment takes TIME.  So if you will persist, then you will often be successful without the expense of seeing a doctor.  (photo credit)

Common warts (Verruca vulgaris) are caused by the human papillomavirus (HPV).  Warts on the hands or feet do not carry the same clinical consequences of HPV infection in the genital area.  It is estimated about 10% of children and adolescents have warts at any given time.  As many as 22% of children will contract warts during childhood.

Common warts can occur anywhere on the body, but 70% occur on the hand.  Often they will disappear on their own within a year.  Even with treatment, warts can take up to a year to go away.

Before heading to the doctor, there are treatments you can try at home:  salicylic acid or duct tape.

When using the 17% salicylic acid gel (one brand name: Compound W), it must be applied every day until the wart is gone.  Only apply to the wart, not the skin around the wart.  This treatment is enhanced by covering the wart with an occlusive water-proof band-aid or duct tape after applying the acid.  It can also be enhanced by gently filing the wart with an emery board daily to remove the dead cells prior to applying the salicylic acid.  Treatment can take weeks to months.  Don’t give up early.

Duct Tape can take weeks or months to be effective.   Apply the duct tape to the wart and  keep it in place for six days.  After removing the tape, soak the wart, and pare it down with a filing (emery) board.  Repeat the above until the wart disappears.  Once again, don’t give up early.

The two  treatments (salicylic acid and duct tape) can be combined.  Apply the salicylic acid liquid to the wart before bedtime.  After letting it air dry for a minute or so,  then apply the duct tape over the wart, completely covering the area. Remove the duct tape the following morning. Each time you remove the tape, you will be debriding some of the wart tissue. Repeat the application each night, until there is no remaining wart tissue.  As with using only one treatment, don’t give up early.

If the above don’t work or you just don’t want to take the time, then you may wish to see your physician for removal.  He can use cryotherapy to destroy the wart.   This method may involve repeated treatment over several weeks.  You can do the following to “get the wart ready for removal” and make the cryotherapy more effective:

1. Every night for 2 weeks, clean the wart with soap and water and put 17% salicylic acid gel (one brand name: Compound W) on it.
2. After putting on the gel, cover the wart with a piece of 40% salicylic acid pad (one brand name: Mediplast). Cut the pad so that it is a little bit bigger than the wart. The pad has a sticky backing that will help it stay on the wart.
3. Leave the pad on the wart for 24 hours. If the area becomes very sore or red, stop using the gel and pad and call your doctor's office.
4. After you take the pad off, clean the area with soap and water, put more gel on the wart and put on another pad. If you are very active during the day and the pad moves off the wart, you can leave the area uncovered during the day and only wear the pad at night.

If none of the above work, then your wart may need to be removed surgically.  Remember the above all take time, so give them time to work.  Even if the wart disappears with any of the above treatments, it may recur later.

Sources

Treatment of Warts; Medscape Article, May 27, 2005: W. Steven Pray, PhD, DPh; Joshua J. Pray, PharmD

What Can Be Done About a Hand Wart That Keeps Reappearing After Removal?; Medscape Article, May 31, 2007; Richard S. Ferri, PhD, ANP, ACRN, FAAN

Duct tape and moleskin equally effective in treating common warts; Medscape Article 2007; Barclay L.

Duct Tape More Effective than Cryotherapy for Warts; AAFP, Feb 1, 2003; Karl E. Miller, M.D.

Shout Outs

Updated 3/2017-- photos and all links (except to my own posts) removed as many no longer active. and it was easier than checking each one. 

Medic 999 is this week's host of Grand Rounds.  Next week I will be the host.  Please, send your posts to rlbatesmd@gmail.com with “Grand Rounds” in the subject line.  Include the title of the post and a correct link.  I will accept post up until noon CST Monday, September 14th.  There is no theme.  Thank you.

You can read this week’s edition here (photo credit). It’s the “paramedicine” edition.

Welcome one and all to this weeks edition of Grand Rounds, which comes to you from the world of EMS blogs!

It really is an honour to be hosting. I have only been blogging since the beginning of the year, but have been reading many of your blogs for the last couple of years, and its great to now be part of the medical blogosphere.

Amanda, this crazy miracle called Life, is the host of the latest edition of Change of Shift (Vol 4, No 5) !   You can find the schedule and the COS archives at Emergiblog.  (photo credit)

It's time again for the Nursing Blog Carnival, Change of Shift Version 4, Edition 5 and I can't help but tell you, I'm doing something big folks, annnd I am scared out of my mind.
No, no, no, Kim did not force me to host Change of Shift against my will.  :)  In fact, I like presenting the world with the finest nursing bloggers on the internet.
I'm scared because well, here's the deal... As some of my longtime nurse friends may know, I'm going into my 5th year of college, and I should be graduating in May, but I'm not, thanks to a car wreck and end-stage liver disease.  (If you'd like a refresher, here's a post for you.) ………. 

Wonderful highlight of a low-tech treatment for tennis elbow in the NY Times Phys Ed: An Easy Fix for Tennis Elbow? by Gretchen Reynolds (August 25, 2009)  -- (photo credit)

For those of us with less than thin thighs, the information in this post “Study Shows That Thin Thighs Are Associated With Heart Disease” by Dr Toni Brayer was welcome news.  Well, it doesn’t help with the frustration of clothes fitting, but does help with the “health” issue.  (photo credit)

Finally, a study that many women can like. The British Medical Journal published a study out of Denmark that looked at the association between thigh circumference and the incident of cardiovascular disease and mortality. Why anyone would even think of thigh circumference being of importance is beyond me, but the Danes seem to think it was important. They found people with thin thighs had more risk of developing heart disease or premature death.

More news I love!   MedPage Today article “Enzyme Injections Ease Dupuytren's Contractures” by   Nancy Walsh.  (photo credit)

Injections of the enzyme collagenase into the hands of patients with Dupuytren's disease resulted in significant improvements in joint contractures and range of motion, a phase III study found.

        

This week is Dr Anonymous doesn’t have a guest listed, but come join us anyway.  The show starts at 9 pm EST.

Hypercoagulability as Cause for Flap Failure – an Article Review

Updated 3/2017-- all links (except to my own posts) removed as many no longer active. and it was easier than checking each one. 

Even though I no longer do microvascular surgery, I found this article very interesting.  I can recall a few patients that “fit” the description of their patients.  I wonder if had we recognized the possibility of a hypercoagulability state in the patient and worked them up what would have been found.

Flap failure rates using microvascular free flap techniques have  dropped to under 3 percent in most large series of high-volume centers.  Even with greater experience, improved technology, and development of anastomotic devices, the average failure rate has not dropped below 1 to 3 percent. 

This article discusses the failures due to undiagnosed coagulopathies the patient may bring into the mix.  The authors presented four cases.  Unfortunately sometimes the first presentation of coagulopathy might be microvascular complications of the free flap.

The authors noted that all fours of their cases were similar intraoperatively:

Intraoperative findings that were common to these failed anastomoses were as follows:

1. The arterial anastomosis does not flash when the clamp is removed; it requires manipulation.

2. The arterial anastomosis goes down quickly (within 1 hour), before the rest of the procedure is completed.

3. The vessels, particularly the recipient flap vessels, are flaccid.

4. Topical agents such as papaverine and lidocaine do not appear to resolve the perfusion problem.

5. Heparin may make it worse.

6. Administration of intravascular thrombolytic agents (Activase; Genentech, Inc., South San Francisco, Calif.) provides instant bright red bleeding from every cut surface, but thrombus quickly reaccumulates at the anastomotic site.

The authors note that no routine, inexpensive, specific screening test predicts for the development of hypercoagulopathy-related perioperative complications. You can screen for deep venous thrombosis risk and measure prothrombin time and partial thromboplastin time.  This will identify some patients with possible coagulopathies.

The authors give some nice advice for management once a diagnosis of a hypercoagulable state is established.

First, the operative defect should be temporized using dressing changes until more definitive reconstruction can be safely performed.

Second, immediate perioperative anticoagulation needs to be initiated, as the hypercoagulable state places the patient at high risk for postoperative venous thromboembolism/deep venous thrombosis.

Third, plans for long-term anticoagulation, if any, need to be coordinated with the hematology service. Some hypercoagulable patients (those with lupus or malignancy) might need protracted anticoagulation, whereas other patients simply require counseling on anticoagulation strategies during future scenarios associated with high risk of venous thromboembolism, such as operations, long plane flights, pregnancy, and other conditions that might unmask their predisposition to hypercoagulability.

REFERENCE

Microvascular Free Flap Failure Caused by Unrecognized Hypercoagulability; Plastic & Reconstr Surgery: August 2009, Vol 124 (2), pp 490-495;  Davison, Steven P. D.D.S., M.D.; Kessler, Craig M. M.D.; Al-Attar, Ali M.D., Ph.D. [doi: 10.1097/PRS.0b013e3181adcf35}

SurgeXperiences 305 is Up!

Updated 3/2017-- all links (except to my own posts) removed as many no longer active. and it was easier than checking each one. 

Amanzimtoti is the host of this edition of SurgeXperiences. You can read the “this is Africa” edition here (photo credit).

Welcome to Africa for this 305th edition of SurgeXperiences:
we have some great articles for this edition of the fortnightly surgical blog carnival..

The host of the next edition (306), September 20th, will be Bongi, other things amanzi. The deadline for submissions is midnight on Friday, September 19th. Be sure to submit your post via this form.

SurgeXperiences is a blog carnival about surgical blogs. It is open to all (surgeon, nurse, anesthesia, patient, etc) who have a surgical blog or article to submit.

Here is the catalog of past SurgeXperiences editions for your reading pleasure. If you wish to host a future edition, please contact Jeffrey who runs the show here.

Bud's Quilt Finished

My photos of Bud’s finished quilt are a little dark, but here they are. The quilt uses the block “puss in corner.” I wrote about it here. I paid Anna Lee Hudson to do the machine quilting, then I put the binding on. I have mailed it to Bud after washing it.

In these next two detail shots you can see that the red “bleed” some even with prewashing. I even put a color catcher sheet in the machine just in case.
Notice the “bleed” of the red fabric into the surrounding white/ecru fabric. Thankfully, Bud doesn’t care.

Steve & Lori's Quilt Finished

The quilt uses the block “Alabama.” I wrote about it here. I paid Anna Lee Hudson to do the machine quilting, then I put the binding on. I have mailed it to Steve and Lori who love it.

It measures 56 in X 76 in, machine pieced and quilted.

Teal Toes for Lisette and Yoland

Updated 3/2017-- photos and all links (except to my own posts) removed as many no longer active. and it was easier than checking each one. 

Last year my friend Lisette died of ovarian cancer.  This spring a classmate from medical school,Yoland Condrey-Tinker, died of ovarian cancer.  Last week I stumbled across this campaign “Teal Toes” to increase the awareness of ovarian cancer.  Both would have loved this. (photo credit)

The month of September is Ovarian Cancer Awareness Month and to help bring attention to the fifth leading cause of cancer death in women, an organization called Teal Toes is asking women to wear teal polish on their piggies in September (and anytime, really!) to prompt conversations about ovarian cancer with other people who might see the color and compliment or question it.

I took a trip to Wal-Mart this past weekend and got my teal nail polish.  It is Nicole “Respect the World Nail” Lacquer by OPI.  Here’s the picture of my teal toes:

The Gynecologic Cancer Foundation, the Society of Gynecologic Oncologists and the American Cancer Society, with significant support from the Alliance formed a consensus statement on ovarian cancer. The Ovarian Cancer National Alliance has endorsed the consensus statement, which was announced in June 2007. The statement follows.

Historically ovarian cancer was called the “silent killer” because symptoms were not thought to develop until the chance of cure was poor. However, recent studies have shown this term is untrue and that the following symptoms are much more likely to occur in women with ovarian cancer than women in the general population. These symptoms include:

• Bloating
• Pelvic or abdominal pain
• Difficulty eating or feeling full quickly
• Urinary symptoms (urgency or frequency)

Women with ovarian cancer report that symptoms are persistent and represent a change from normal for their bodies. The frequency and/or number of such symptoms are key factors in the diagnosis of ovarian cancer. Several studies show that even early stage ovarian cancer can produce these symptoms.

Women who have these symptoms almost daily for more than a few weeks should see their doctor, preferably a gynecologist. Prompt medical evaluation may lead to detection at the earliest possible stage of the disease. Early stage diagnosis is associated with an improved prognosis.

Please visit OCNA for more information.

Radiation Therapy and Breast Reconstruction—an Article Review

Updated 3/2017-- all links (except to my own posts) removed as many no longer active. and it was easier than checking each one. 

Postmastectomy radiation therapy is important for many women.  It can improve survival and locoregional control in patients with invasive breast cancer.  When considering the optimal time and technique of breast reconstruction in patients who require postmastectomy radiation therapy, it can often be a difficult decision.  This topic of timing and best technique remain controversial.   There is no general agreement among plastic surgeons.

This article attempted to review the most recent literature on breast reconstruction in patients receiving postmastectomy radiation therapy.  They did a nice job.

To find articles for review, we performed a search of the MEDLINE database for studies of radiation therapy and breast reconstruction. We then read the reference lists of the identified articles to find additional articles for review. Studies were included if most patients were treated after 1985 and the mean follow-up period was more than 1 year. Forty-nine articles were reviewed.

Just from the headings in the article you can get a sense of the complexities of this topic:

• Indications for Postmastectomy Radiation Therapy: Consensus and Controversies
• Design of Postmastectomy Radiation Therapy: Consensus, Controversies, and the Potential for Lower Dose Regimens
• Implant-Based Breast Reconstruction in Patients Receiving Postmastectomy Radiation Therapy
• Outcomes of Implant-Based Reconstruction with Modern Radiation Delivery Techniques
• Impact of Performing the Tissue Expander-Permanent Implant Exchange before Rather than after Radiation Therapy
• Current Role of Reconstruction with a Latissimus Dorsi Flap Plus a Breast Implant in Breast Cancer Patients Who Receive Postmastectomy Radiation Therapy
• Immediate Implant-Based Breast Reconstruction Can Compromise the Design of the Radiation Treatment Fields
• Autologous Tissue Breast Reconstruction in Patients Receiving Postmastectomy Radiation Therapy
• Timing of Flap Transfer in Relation to Postmastectomy Radiation Therapy
• Immediate Autologous Tissue Breast Reconstruction Compromises the Design of the Radiation Treatment Fields
• Delayed-Immediate Breast Reconstruction

Looking at the how “immediate implant-based breast reconstruction can compromise the design of the radiation treatment fields” the authors note the growing evidence that

Not only can postmastectomy radiation therapy adversely affect the aesthetic outcome of immediate implant-based breast reconstruction, there is also increasing evidence that such reconstructions can interfere with the delivery of postmastectomy radiation therapy.

This can be from the slope of  the reconstructed breast vs the flat un-reconstructed chest changing the geometry of the medial and lateral radiation fields.  This can lead to under-dosing of the chest wall, especially centrally underneath the breast prosthesis and near the internal mammary nodes. 

On the good news (for reconstruction) side, studies have found no significant radiation scatter from the metallic port within the tissue expander used for breast reconstruction.

Kronowitz and colleagues highlight a 2005 study from M. D. Anderson Cancer Center which noted that immediate breast reconstructions may limit treatment planning for postmastectomy radiation therapy.  Bold highlighting is mine.

They retrospectively reviewed the records of 152 patients treated with postmastectomy radiation therapy, 17 of whom underwent immediate breast reconstruction and had expanders, flaps, and/or implants in place at the time of postmastectomy radiation therapy. The authors evaluated the impact of various reconstructive techniques on the ability to treat the breadth of the chest wall, treat the internal mammary nodes within the first three interspaces, avoid the lung, and avoid the heart. They found that completely deflated expanders resulted in no compromise; a partially deflated expander prevented treatment of the internal mammary nodes; and fully inflated expanders moderately or severely compromised treatment of the internal mammary nodes and chest wall.

Timing of reconstruction can be difficult as you don’t always know who is going to require postmastectomy radiation therapy.

…. recommendations regarding postmastectomy radiation therapy are often based on pathologic analysis of the mastectomy specimen, the need for postmastectomy radiation therapy is not always known at the time of mastectomy.

So perhaps “delayed-immediate breast reconstruction” might become the standard of care.  Here are their key points regarding this heading:

Until we can reliably predict the need for postmastectomy radiation therapy, decrease its adverse effects through more targeted therapy, and ensure optimal radiation delivery after immediate breast reconstruction, delayed-immediate reconstruction may be the best option with which to maintain the balance between optimal aesthetic outcomes and effective radiation delivery.

In this approach, a tissue expander is placed at the time of mastectomy to preserve the initial shape and thickness of the breast skin flaps and the dimensions of the breast skin envelope until the final results of pathologic analysis are available. 

In patients found not to require postmastectomy radiation therapy, preservation of the breast skin envelope enables the plastic surgeon to achieve aesthetic outcomes similar to those obtainable with immediate breast reconstruction.

In patients who do require postmastectomy radiation therapy, the tissue expander can be deflated before the start of postmastectomy radiation therapy to create a flat chest wall surface and permit modern, three-beam radiation delivery, and the expander can be reinflated after postmastectomy radiation therapy to permit skin-preserving delayed reconstruction.

Placement of the fully inflated expander allows for more precise positioning of the expander on the chest wall. Placement of an inflated expander also avoids the need for skin expansion and stretching of already thin mastectomy skin flaps, which can adversely affect the safety (expander exposure) and aesthetic outcome (telangiectasia formation) of breast reconstruction.

Expanded breast skin also tends not to tolerate postmastectomy radiation therapy; however, maintenance of the initial thickness of breast flaps after mastectomy, as in delayed-immediate reconstruction, results in better tolerance of the inflammatory effects of postmastectomy radiation therapy because the normal architecture of the dermis is preserved.

MAIN ARTICLE REFERENCE
Radiation Therapy and Breast Reconstruction: A Critical Review of the Literature; Plastic and Reconstructive Surgery. 124(2):395-408, August 2009; Kronowitz, Steven J.; Robb, Geoffrey L. [doi: 10.1097/PRS.0b013e3181aee987]
Articles Reference within Main Article for delayed-immed reconstruction:
Kronowitz SJ, Robb GL. Breast reconstruction with postmastectomy radiation therapy: Current issues. Plast Reconstr Surg. 2004;114:950-960.
Kronowitz SJ. Immediate versus delayed reconstruction. Clin Plast Surg. 2007;96:39-50.
Kronowitz SJ, Kuerer HM. Advances and surgical decision-making for breast reconstruction. Cancer 2006;107:893-907.
Kronowitz SJ, Hunt KK, Kuerer HM, et al. Delayed-immediate breast reconstruction. Plast Reconstr Surg. 2004;113:1617-1628.

Shout Outs

Updated 3/2017-- photos/video and all links (except to my own posts) removed as many no longer active. and it was easier than checking each one. 

Dr. Joseph Kim , Medicine and Technology is this week's host of Grand Rounds. You can read it here (photo credit). It’s the “old school” edition.

Welcome to Grand Rounds Vol. 5 No. 50 @ Medicine & Technology. This week, I've asked medical bloggers to reflect on the theme of "medical safety and technology." We all want to see safer hospitals and avoid medical errors. Advances in technology may allow us to practice safer medicine if we leverage it appropriately. Technology may also improve public health and safety.

From Better Health comes a post by Dr Toni Brayer, High Blood Pressure & Eye Damage. She share this great photo of retinal damage from high blood pressure.

The retina shows blurring of the optic disc (in the middle left) and the white areas are called “cotton wool spots”. The blurry part at the bottom is a partial retinal detachment.

From the Literature, Arts and Medicine Blog comes a very nice post, Is Medical Uncertainty Necessary?. 

I would submit that in daily medical practice, there is a constant measure of low-level uncertainty. …………

One of my favorite poems is David Gewanter’s "My father’s autopsy," because it captures so much of what, in medicine, is science, and what of it is art……..

A story, "The Save," recently published in Pulse, Voices from the Heart of Medicine tells this story. The surgeons devote themselves to reattaching a limb that the patient has deliberately sawed off. They ignore the psychiatric disorder that led to this self-mutilation and then are shocked when the patient tears off the repaired limb after surgery………….

How do you handle the issue of cell phones in the exam or waiting room? Here’s Dr Gwen’s on the issue: Please Note: “No Cell Phones” signs are for everyone…even you!

I have a new pet peeve. It’s called the “willful violation of posted no cell phone zone” callers. It drives me completely bonkers!

I thought about it the other day when I was waiting in a big down town Boston physician’s office waiting room. All the waiting rooms in this facility are very nicely appointed with comfortable chairs, magazines, and water bubblers. They have quiet, all-ages music piped in overhead at a reasonable level. On the walls are the following signs:….

• “No-cell phone zone”…depicted in words and with this symbol (photo credit)………

If you don’t know about this wonderful Corpus Clock, Chronophage, check out this video:

Happened to catch this episode of Here and Now (NPR) about modern-day slavery.

Anti-slavery advocate Kevin Bales is co-author of the new book “The Slave Next Door: Human Trafficking and Slavery in America Today,” which argues that slaves are all around us, hidden in plain sight in the U.S.  Bales is also president and co-founder of the advocacy group, “Free the Slaves.” We also speak with Given Kachepa, a 23-year-old Zambian who was brought to this country by a missionary who enslaved him and other young boys in a choir in Texas.

This week is Dr Anonymous’ guest is Brandice Schnabel author of Columbus Groove. Come joint us. The show starts at 9:30 pm EST.

Suture Allergy vs Suture Reactivity

Updated 3/2017-- photos and all links (except to my own posts) removed as many no longer active. and it was easier than checking each one. 

This past week I was once again asked about suture allergy.  It has prompted me to revisit the issue which I have posted about twice now. (photo credit).

Sutures by the vary nature of being foreign material will cause a reaction in the tissue.  This tissue reactivity is NOT necessarily a suture allergy.

Many factors may contribute to suture reactivity.

• The length of time the sutures remain.  The longer the sutures are in, the more reactivity occurs.
• The size of the sutures used.  The larger the caliber of the suture, the more reactivity.  The increase of one suture size results in a 2- to 3-fold increase in tissue reactivity.
• The type of suture material used.  Synthetic or wire sutures are much less reactive than natural sutures (eg, silk, cotton, catgut).  Monofilament suture is less reactive than a braided suture.
• The region of the body the suture is used affects tissue reactivity.  The chest, back, extremities, and sebaceous areas of the face are more reactive.

In general, accepted time intervals for superficial suture removal vary by body site, 5-7 days for the face and the neck, 7-10 days for the scalp, 7-14 days for the trunk, and 14 days for the extremities and the buttocks.  The deeper placed sutures will never be removed.

Sutures meant to dissolve (ie vicryl sutures) placed too high in the dermis (which happens often when the dermis is thin) can “spit” several weeks to several months after surgery. This is a reactive process, NOT a suture allergy.  It usually presents as a noninflammatory papule (looks very much like a pimple) and progresses with extrusion of the suture through the skin. The suture material may be trimmed or removed if loose, and it is not needed for maintaining wound strength.  Rarely does this affect the scar outcome.

The remaining portion is a “repost” about suture allergies:

Allergic reactions to suture materials are rare and have been specifically associated with chromic gut. However, Johnson and Johnson mention known triclosan allergy as a contraindication for use of certain sutures (see below). Contact allergy to triclosan is uncommon.

Surgical gut suture (Plain and Chromic) is contraindicated in patients with known sensitivities or allergies to collagen or chromium, as gut is a collagen based material, and chromic gut is treated with chromic salt solutions.

MONOCRYL Plus Antibacterial suture should not be used in patients with known allergic reactions to Irgacare MP(triclosan).

PDS Plus Antibacterial suture should not be used in patients with known allergic reactions to Irgacare MP (triclosan).

VICRYL*suture should not be used in patients with known allergic reactions to Irgacare MP (triclosan).  [In rechecking facts, I found that only Vicryl Plus has the triclosan, so simple vicryl or coated vicryl should be okay.]

Surgical Stainless Steel Suture may elicit an allergic response in patients with known sensitivities to 316L stainless steel, or constituent metals such as chromium and nickel. Skin staples are surgical steel so should be used with the same precautions.

Dermabond -- Tissue glues should not be used in patients with a known hypersensitivity to cyanoacrylate or formaldehyde.

SO WHAT IS LEFT TO USE

So what is left to use in a patient who may have or has a proven allergy to suture or closure material?

Silk, Dexon, Nylon(monofilament or braided), Prolene, INSORB (absorbable staples), and any of the above listed (in the allergy section) to which the patient in question doesn't react negatively.

The choice of a particular suture material will have to based further on the wound, tissue characteristics, and anatomic location. Understanding the various characteristics of available suture materials will be even more important to make an educated selection.

The amount of suture placed in a wound, particularly with respect to the knot volume, affects inflammation. The suture size contributes more to knot volume than the number of throws. The volume of square knots is less than that of sliding knots, and knots of monofilament sutures are smaller than those of multifilament sutures.

REFERENCES

Allergic Suture Material Contact Dermatitis Induced by Ethylene Oxide: G. Dagregorio, G. Guillet; Allergy Net Article

Johnson and Johnson Product Information

Current Issues in the Prevention and Management of Surgical Site Infection - Part 2; MedScape Article

MECHANICS OF BIOMATERIALS: SUTURES AFTER THE SURGERY; Raúl De Persia, Alberto Guzmán, Lisandra Rivera and Jessika Vazquez

Materials for Wound Closure by Margaret Terhune, MD; eMedicine Article

Product Allergy Watch: Triclosan; MedScape Article by Lauren Campbell; Matthew J. Zirwas

New References

• Surgical Complications; eMedicine Article, May 29, 2009; Natalie L Semchyshyn, MD, Roberta D Sengelmann, MD
• Engler RJ, Weber CB, Turnicky R. Hypersensitivity to chromated catgut sutures: a case report and review of the literature. Ann Allergy. Apr 1986;56(4):317-20. [Medline].
• Fisher AA. Nylon allergy: nylon suture test. Cutis. Jan 1994;53(1):17-8. [Medline].

Related Posts

Allergies from Suture Material (September 7, 2007)

Suture Allergies Revisited  (April 30, 2008)

Suture (June 7, 2007)

Basic Suture Techniques (June 8, 2007)

SurgeXperiences 305 – Call for Submissions

 Updated 3/2017-- all links (except to my own posts) removed as many no longer active. and it was easier than checking each one.

SurgeXperiences 304 (August 23rd)  will be hosted by Amanzimtoti.   The deadline for submissions is midnight on Friday, September 6th.  Be sure to submit your post via this form. 

Amanzimtoti blogs out of Mpumalanga, South Africa.  She has this to say about herself:

I'm a doctor and a mother. When I'm not practicing medicine, I'm taking care of the kids: a little boy, a little girl and their slightly less mature father.

Check out her recent post, Don't judge a book by its cover.

………….I saw this patient a while back. He didn't speak English to me so I used an interpreter to take his history. He had a miriad of complaints, none of which I can remember now because none of them were very serious. When I examined him, I noticed he had a rash which looked suspiciously like a drug induced rash. I asked the interpreter to ask how long he'd had it and whether he'd been taking any medication before it started. He answered her in Swazi. I said out loud "This looks like a drug rash". He looked at me and said "It was a Stevens-Johnson syndrome that was caused by TB treatment. I was in hospital for about a week and then it got better."

SurgeXperiences is a blog carnival about surgical blogs. It is open to all (surgeon, nurse, anesthesia, patient, etc) who have a surgical blog or article to submit.   If you would like to be the host  in the future, please contact Jeffrey who runs the show here.

Here is the catalog of past SurgeXperiences editions for your reading pleasure

Coins Quilt

This summer I have been trying to use up some of my fabric scraps as they seem to be taking over my sewing room.  This is one of the quilts made from those scraps.  It is machine pieced and  quilted.  It is 42 in X 52 in.  I have given it to a nephew and his wife.

Here is a detail photo of some of the fabrics.  I love the flying pig.


Here is another detail photo which shows some carolers, a zebra, some boots, and lots of colors.


In this photo you’ll find flowers, dots, dogs, and trees.