Human bite injury in North East England--the impact of alcohol intake on a mode of violent assault.

Ninety-two retrospective cases of human bite injury referred to a Plastic Surgery department are presented. Particular emphasis is placed on the relationship of alcohol intake to these injuries, their distribution and subsequent management. A review of the literature is conducted. The human bite is a leisure time injury of the young single male in the North East. It has been shown that there is a clear link to alcohol and in particular weekend drinking. Prompt operative intervention and wounds located at the head and neck have been shown to be associated with a decreased risk of subsequent infection, which reflects findings in the earlier literature. Fifteen cases were infected. One was the result of a postoperative complication. The remainder were infected on admission. The majority of infected cases were upper limb bites and were associated with a delayed presentation.

Is pregnancy contraindicated following free TRAM breast reconstruction?

There are reports of patients having normal full term pregnancies following pedicled transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction. These are individual cases and there is only limited published evidence to support the safety of pregnancy following surgery of this nature. Little is known about the effects of pregnancy after free tissue transfer, therefore it has been difficult to advise patients, in this situation, what the recommended course of action should be. A report of pregnancy following free TRAM flap breast reconstruction is presented with a review of relevant literature in an attempt to clarify this issue and improve the consent process. We conclude that TRAM flap breast reconstruction is not an obstacle to normal pregnancy and delivery. Patients need to be guided through the potential risks to their health if they should become pregnant, before reconstruction takes place. Obstetric and Oncological Specialists, as part of the multi-disciplinary setting, need to be involved early in pregnancy to further inform and counsel these patients.

Amniotic band syndrome: the association between rare facial clefts and limb ring constrictions.

The pathologic cause of both rare craniofacial clefts and congenital limb ring constrictions is the subject of some debate. Uncommon though these two conditions are, they have often been anecdotally reported in association. This study sought to determine the frequency of congenital limb anomalies in general and limb ring constrictions in particular amongst a population of patients with rare craniofacial clefts. Eighty-five cases of nonsyndromal, rare, craniofacial cleft were identified from a population of 280 patients assessed at the Women's and Children's Hospital, North Adelaide, with a diagnosis of rare craniofacial cleft classifiable by the Tessier system. Twenty-two patients (25.9 percent) displayed congenital limb anomalies. Eleven of these (12.9 percent) showed evidence of limb ring constrictions, a frequency much greater than in the general population. The group with limb ring constrictions demonstrated a significantly greater complexity of involvement with craniofacial clefting than the non-limb ring constriction group (4.27 clefts/patient versus 2.3 clefts/patient, p < 0.01). The distribution of craniofacial cleft locations in patients with evidence of limb ring constrictions was found to differ significantly from those with other or no limb anomalies (p < 0.01). The clefts in cases in which limb ring constrictions coexist are largely restricted to the paramedian 2-12, 3-11, 412 axes. This study confirms an association between rare craniofacial clefts and limb ring constrictions. The two conditions may therefore possess common etiology.

Fungal growth within a silicone tissue expander: case report.

Fungal contamination of tissue expanders has not previously been reported. There are, however, reports of fungi in association with inflatable breast prostheses. Colonisation of a tissue expander with Aspergillus niger resulting in mechanical obstruction of the device is described. The possible modes of inoculation and survival of the organism within the expander envelope were studied including an investigation of the permeability to gases of the silicone expander envelope. Recommendations are made about prevention of this complication.

Cutaneous malignant peripheral nerve sheath tumour (MPNST) of the hand: a review of current literature.

Malignant peripheral nerve sheath tumours (MPNST) are spindle cell sarcomas normally situated in the deep soft tissues. Cutaneous MPNST is an uncommon variant, usually occurring in the head and neck. When it arises in the upper limb this tumour may pose a considerable diagnostic and therapeutic problem. We present a case of cutaneous MPNST arising in the hand. Tumour extension was exclusively perineural along three major nerve trunks from an interdigital origin. Current knowledge of the clinical behaviour of cutaneous MPNST is reviewed.

Provision and acceptability of day case breast biopsy: an audit of current practice.

The introduction of a national breast cancer screening programme and wider public awareness of breast disease have contributed to an increasing workload for breast surgeons. One method of dealing with this problem efficiently is to encourage day case surgery for breast biopsy patients. We studied our own day case breast biopsy workload, asked other surgeons what proportion of breast biopsies they performed in this way and assessed its acceptability to patients. Of surgeons working in units with facilities available, 40.3% perform 25% or less of breast biopsies as a day case. Of 235 patients undergoing breast biopsy in our unit during an 11-month period, 195 (83%) were performed as day cases. Of these, 192 were under general anesthesia. In all, 97.2% of patients were satisfied with their treatment as a day case, and only 4.5% would have preferred admission postoperatively. Carcinoma was present in 22 (11%) lesions biopsied, 11 (50%) of which occurred in patients under 50 years of age. Surgical complications were encountered in 32 (16.4%) cases; significant bruising 26 (13.3%), wound infections 4 (2.05%), dehiscence 1 (0.51%), and retained suture 1 (0.51%). Breast biopsy is an appropriate and acceptable procedure to undertake as a day case.