Bevacizumab (Avastin, Genentech, Inc, San Francisco, CA), a humanized monoclonal antibody against vascular endothelial growth factor, was recently approved for the treatment of metastatic breast cancer.A PubMed and OVID search was performed using keywords: bevacizumab, Avastin, wound healing, VEGF, angiogenesis, and colorectal cancer. Our objective was to review the current literature in regard to bevacizumab and its adverse effects on surgical wound healing.Bevacizumab has been associated with multiple complications in regard to wound healing, such as dehiscence, ecchymosis, surgical site bleeding, and wound infection. Current literature suggests patients should wait at least 6 to 8 weeks (>40 days) after cessation to have surgery (half-life = 20 days). In addition, postoperative reinitiation of bevacizumab must wait > or =28 days to prevent an increased risk of wound healing complications, and the surgical incision should be fully healed.The adverse effects of bevacizumab in regard to wound healing must be considered in all surgical patients.

The creation of intestinal stomas for diversion of enteric contents is an important component of the surgical management of several disease processes. However, complications of stoma creation are seen frequently, despite extensive measures aimed at reducing them. Early complications (those seen less than one month postoperatively) are frequently technical in nature. These include, but are not limited to, peristomal skin irritation, improper stoma site selection, acute peristomal herniation and bowel obstruction, and vascular compromise, along with several others. These authors review the early complications associated with stoma creation, discuss means of preventing them, and outline the management strategy for such complications when they do occur.Objectives: On completion of this article, the reader should be familiar with the diagnosis, management, and prevention of early complications arising from intestinal stoma creation.

No abstract

Combined MBP/ABP results in significantly lower rates of SSI, organ space infection, wound dehiscence, and anastomotic leak than no preparation and a lower rate of SSI than ABP alone. Combined bowel preparation significantly reduces the rates of infectious complications in colon and rectal procedures without increased risk of Clostridium difficile infection. For patients undergoing elective colon or rectal resection we recommend bowel preparation with both mechanical agents and oral antibiotics whenever feasible.