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Closing Cutaneous Surgical Wounds
JAMA Dermatology
Published online April 15, 2015
What’s the optimal way to close a cutaneous surgical wound? Custis et al. evaluated the use of adhesive strips along with dermal suturing and found that the strips neither improved cosmetic outcomes nor reduced scar width.
The researchers enrolled 48 patients who were scheduled for dermatology procedures, the majority of which involved Mohs surgery for skin lesions. All wounds were at least 3 cm and closed using subcuticular buried vertical mattress sutures. Adhesive strips were applied to a randomized half-section of each wound.
At the 3-month mark, 45 patients were available for evaluation. No significant differences were observed between wound half-sections in terms of scar appearance and width as well as vascularity, pigmentation, thickness, relief, pliability, and surface area. One case of wound dehiscence was noted at a site where adhesive strips were used, while 2 cases occurred at sites that did not receive the strips.
The researchers concluded that, given the low cost of adhesive strips and the small amount of time needed to employ them, further studies should be undertaken.
Preventing Corneal Graft Failure
American Journal of Transplantation
Published online April 14, 2015
Why do corneal allografts—especially second or third grafts—fail? Paunicka et al. investigated this question in an animal model of penetrating keratoplasty (PK). They found that the answer lies in the transplantation procedure itself, which nullifies immune privilege when corneal nerves are severed in the graft bed. Moreover, they noted that when PK is performed in one eye, immune privilege is eliminated in the fellow eye.
Using mice, the researchers found that 50% of the initial corneal transplants survived, while 100% of the subsequent grafts in the fellow eyes underwent rejection. They determined that when corneal nerves are severed during surgery, substance P (a neuropeptide) is secreted in both eyes, thus disabling the regulatory T cells that are required for graft survival. However, the researchers were able to restore immune privilege and promote graft survival by administering a substance P antagonist.
In an accompanying editorial, Blanco and Saban noted that the cornea is an intriguing model site for exploring how the nervous and immune systems interface, as it is arguably the most densely innervated site in mammals. As to why the unilateral severing of corneal nerves triggers a bilateral burst in substance P, they hypothesized that the burst has a pathogenic effect on the long-lived macrophages that reside proximal to nerves.
Severe Dry Eye and Neuropathic Pain
British Journal of Ophthalmology
2015;99(5):665-668
Galor et al. set out to determine whether dry eye could be linked to self-reported symptoms of neuropathic ocular pain (NOP). They found that NOP features are common in patients with dry eye and that these features correlate with the severity and persistence of dry eye symptoms.
For this cohort study, the researchers evaluated 102 men seen at a Veterans Affairs eye clinic. The patients underwent a baseline exam consisting of a dry eye questionnaire and an ocular surface evaluation. They were reevaluated 2 years later. NOP was considered present if a patient reported 1) eye pain that was “hot burning,” 2) symptoms of allodynia to light and/or change in temperature, and/or 3) symptoms of hyperalgesia to wind.
In all, 70 patients reported at least mild symptoms of dry eye during both evaluations, and 53 of these reported 1 or more symptoms of NOP—with 21 describing 1 NOP feature, 20 describing 2 features, 8 describing 3 features, and 4 describing all 4 features. The presence of any NOP feature was associated with significantly higher dry eye symptom scores at either examination.
The researchers acknowledged that self-reported assessments of pain are not as precise as direct assays of nerve conduction. Nonetheless, they noted that patients who have dry eye symptoms and report NOP may be candidates for multimodal therapy that focuses on protecting the ocular surface.
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Roundup of Other Journals is written by Jean Shaw and edited by Deepak P. Edward, MD.
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