Comprehensive studies comparing tensile properties of sutures are over 25 years old and do not include recent advances in suture materials. Accordingly, the objective of this article is to investigate the tensile properties of commonly used sutures in cutaneous surgery. Thirteen 3-0 sized modern sutures (four nonabsorbable and nine absorbable) were tensile tested in both straight and knotted configurations according to the procedures outlined by the United States Pharmacopeia. Glycomer 631 was found to have the highest failure load (56.1 N) of unknotted absorbable sutures, while polyglyconate (34.2 N) and glycomer 631 (34.3 N) had the highest failure loads of knotted absorbable sutures. Nylon (30.9 N) and polypropylene (18.9 N) had the greatest failure loads of straight and knotted nonabsorbable sutures, respectively. Polydioxane was found to have the most elongation prior to breakage (144%) of absorbable sutures. Silk (8701 MPa) and rapid polyglactin 910 (9320 MPa) had the highest initial modulus of nonabsorbable and absorbable sutures, respectively. The new data presented in the study provide important information for guiding the selection of suture materials for specific surgeries.
Aplasia cutis congenita (ACC) is a relatively rare congenital anomaly that most commonly occurs as a solitary cutaneous defect on the scalp. Depth of involvement varies, and involvement of deeper calvarium and dural structures can be seen in more severe cases. Multiple classification systems have been devised with the Frieden Classification System being the most widely adopted. Using this system, we describe a patient that developed Type V ACC with associated fetal papyraceous. The child healed remarkably well with the application of petrolatum impregnated gauze and topical silver sulfadiazine twice daily for approximately 4 weeks. The child was noted to have no significant contractures or complications at 6-months and 1-year follow-up exams. Herein, we review the current literature on type V ACC including a discussion of treatment options.
: Cutaneous involvement by chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is often observed in patients with a known history of systemic disease. Rarely, CLL/SLL may initially present with skin lesions. There are also rare reports of cutaneous CLL/SLL occurring in herpes scars and as an incidental finding in excision specimens for carcinoma. We present a 76-year-old woman with an inverted conical firm papule on the upper back that was clinically suggestive of a dermatofibroma. Excisional biopsy demonstrated the presence of a dermatofibroma coexisting with CLL/SLL. We describe the rare occurrence of CLL/SLL initially presenting as leukemia cutis. In addition, to the best of our knowledge, this is the first report of dermatofibroma coexisting with CLL/SLL. This finding further expands the types of skin lesions that may coincide with CLL/SLL.
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