No abstract

Surgical resection of nonmelanoma skin cancer (NMSC) may be performed via Mohs micrographic surgery (MMS) or standard surgical excision with complete margin analysis. Whereas MMS may necessitate delayed reconstruction surgery, intraoperative frozen section analysis (IFSA) may be used to ensure clear surgical margins before proceeding with reconstruction. To achieve curative resection while optimizing aesthetic outcomes, surgeons may use surgical excision guided by IFSA to forego extensive or delayed reconstruction. Patients undergoing wide local excision for NMSC using IFSA from October 2008 to November 2016 were evaluated. Analysis included IFSA versus permanent section outcomes, the number of required excisions, and the recurrence rate. Our analysis contained 145 patients involving 162 lesions. IFSA demonstrated that 73.4 per cent of margins were negative after one excision and 26.5 per cent were re-excised until achieving negative margins. Analysis revealed one false-positive case (0.62%) and four false-negative cases (2.47%). Nine patients had local recurrence (5.56%). Frozen section sensitivity was 88.99 per cent and specificity 99.20 per cent. The positive predictive value was 96.97 per cent, and negative predictive value was 96.90 per cent. Mean follow-up time was 39 months. Both resection and recurrence data of excised NMSC lesions at our institution suggest that surgical excision using IFSA is a safe and effective alternative to MMS.

Introduction Previous literature demonstrated the importanceof stacking at least three reversing half-hitches on alternating posts(RHAPs) following arthroscopic knot placement. However, RHAPsconstruction involves looping the suture in either an “overhand” or an“underhand” manner as it relates to the post, which may affect knotsecurity. This study investigated the presently unidentified influenceof different stacking combinations of three RHAPs and suture materialon arthroscopic knot security. Methods Four different RHAPs stacking combinations were tiedwith three different suture materials. Ten knots of each configurationwere tied using each suture material, resulting in 120 evaluated knots.A single load-to-failure test was performed. The mode of failure andmean ultimate clinical failure load were recorded. Results Different overhand/underhand stacking combinations ofthree RHAPs had a statistically significant effect on arthroscopicknot strength and security; however, all combinations surpassed theminimum ultimate clinical failure threshold. Knots constructed witheither Force Fiber® or braided fishing line had mean ultimate clinicalfailure loads of greater than 200 N and most commonly failed due tosuture material breakage (100%, 60 - 80% respectively). Conversely,FiberWire® demonstrated lower mean ultimate clinical failure loadsand had a higher incidence of elongated but intact failure (60 - 90%). Conclusion Different overhand/underhand stacking combinationsof three RHAPs yielded an arthroscopic knot capable of secure tissuefixation. A significant effect was observed for suture materials on theknot strength. This study increases our understanding of suitableRHAPs construction following arthroscopic knot placement that canlead to improving the ultimate clinical failure loads of constructedarthroscopic knots observed between orthopedic surgeons.