Routine drainage is not required in reduction mammaplasty.

To date, there have been no randomized trials documenting the efficacy of closed suction drainage when applied to reduction mammaplasty. Despite this, it has become the standard of care. A recent retrospective review suggests that closed suction drainage is not necessary. This study attempts to resolve this issue in a prospective, randomized fashion. The Institutional Review Board of the College of Medicine of The Pennsylvania State University approved the study. Forty-nine consecutive patients who underwent reduction mammaplasty by the inferior pedicled techniques were enrolled. Each patient was randomized to having a drain in either the right or left breast. The other breast was undrained. Patients were followed up for rate of complications and for patient satisfaction. Their ages ranged from 17 to 62 years, with a mean of 33 years. Weight of reduction from the drained breasts ranged from 360 to 1090 g, with a mean reduction of 675 g. Weight of reduction from the undrained group ranged from 380 to 1011 g, with a mean of 620 g. There were a total of 11 complications in the study. In the drained group, there were six complications out of 49 breasts (partial nipple loss in one, minor wound breakdown in two, fat necrosis in two, and hematoma in one). In the undrained group, there were five complications out of 49 breasts (partial nipple loss in none, minor wound breakdown in three, fat necrosis in one, and hematoma in one). Statistical analysis using the McNemar test revealed no significant difference between the two groups. A questionnaire revealed that the patients preferred the increased early postoperative comfort afforded by the absence of a drain. Performing reduction mammaplasty without the use of closed suction drainage is safe and is preferred by the patients.

Dupuytren's disease: physiologic changes in nodule and cord fibroblasts through aging in vitro.

The pathogenesis of the fibrotic disease Dupuytren's contracture remains unclear. The disease process includes two structurally distinct fibrotic elements, the nodule and the cord. It has been proposed that as the disease progresses, nodules develop into cords. To corroborate that hypothesis, the authors took advantage of cultured fibroblast differences found between gap junction intercellular communication and fibroblast-populated collagen lattice contraction. Paired fibroblast cell lines of nodules and cords derived from four patients with Dupuytren's disease were maintained in culture for at least eight passages. The presence of gap junction intercellular communication in nodule- and cord-derived fibroblasts was documented and reported as a coupling index. The contraction of free-floating nodule- or cord-derived collagen lattices was also documented and reported. Early passage (passage 4) cord-derived fibroblasts showed a significant increase in coupling index compared with passage 4 nodule-derived fibroblasts (4.0 +/- 0.4 versus 2.5 +/- 0.3, respectively), where p < or = 0.01. However, late passage (passage 8) nodule- and cord-derived fibroblasts were equivalent in their coupling index (4.1 +/- 0.4 versus 4.4 +/- 0.4, respectively). Early passage nodule-derived fibroblast-populated collagen lattices contracted by 64 percent, whereas late passage nodule-derived lattices showed less contraction, at only 40 percent. Early and late passage cord-derived lattices contracted 46 and 37 percent, respectively. All nodule- and cord-derived cell lines were statistically equivalent at lattice contraction by passage 8. These in vitro studies support the hypothesis that fibroblasts derived from Dupuytren's contracture nodules change their phenotype after undergoing repeated cell passage, acquiring a cord-like fibroblast phenotype. Dupuytren's nodules represent the early, active form of fibrosis in which cells are more proliferative, better at fibroblast-populated collagen lattice contraction, and display less gap junction intercellular communication. The speculation is that alterations in gap junction intercellular communication may be involved in the progression of Dupuytren's nodules to cords as the disease progresses.

Pulp nonfiction: microscopic anatomy of the digital pulp space.

The volar pad of the fingertip provides a very stable yet sensitive surface that gives the hand the ability to pinch and grasp. The focus of this study was to advance understanding of the anatomical features of the digital pulp space. The unusual features of the fingertip pulp space include prominent collagen fiber cords and a branching continuous fine vasculature. Prominent collagen fiber cords radiating out from beneath the epidermal basement membrane are like the cords of a parachute, which directly attach to the periosteum of the distal phalanx. Those collagen fiber cords are responsible for the firm attachment of the fingertip to the distal phalanx. There is a fine patent vasculature within the pulp space. Also contained in the capsule are numerous lobules of fat, which contribute to some elasticity of the fingertip. Principles of treatment for injuries or infections of the digital pulp should attempt to preserve this anatomical construct so that the firmness and vascular supply of the fingertip are maintained and not disrupted.