Absorbable mesh and topical negative pressure therapy for closure of abdominal dehiscence with exposed bowel.

Permacol mesh is a porcine dermis-derived biomaterial used for the repair of abdominal incisional and inguinal hernia. It has been found to be a safe and effective alternative to non-absorbable mesh for application over exposed bowel. This mesh has also been successfully applied over contaminated abdominal wound beds and around stomas. Topical negative pressure therapy has been used for the management of wound complications after surgical implantation of Permacol mesh. We describe our experience with the combined use of Permacol mesh and simultaneous application of topical negative pressure therapy to aid wound contraction and granulation in a patient with abdominal dehiscence and exposed bowel.

Home management of upper airway obstruction in Pierre Robin sequence using a nasopharyngeal airway.

OBJECTIVE: This unit has reported management of infants with Pierre Robin Sequence (PRS) and upper airway obstruction using nasopharyngeal airways and nutritional support until enough growth takes place for the infant to thrive. There was a mean hospital stay of 60 days. This long in-patient stay prompted review of our management protocols and consideration of treatment at home. This paper reports our experience of managing infants with PRS at home using a nasopharyngeal airway and nasogastric feeding tube and reviews whether such management reduces in-patient stay while remaining safe and effective. DESIGN: Retrospective review of cases referred over a 3.5-year period. Comparison is made with the unit's previously published results. PATIENTS: Thirteen PRS infants were referred to the West Midlands Regional Cleft service and required transfer to Birmingham Children's Hospital for specialist assessment and airway control. INTERVENTIONS: The parents of 12 infants underwent training to manage the airway and feeding tube. Treatment then continued at home. OUTCOME MEASURES: In-patient episode, rate of weight gain, and complication rate were used. RESULTS: The median hospital stay was 19.5 days compared to 54 days previously. The median rate of weight gain was 34 g/d. There were no complications or readmissions. CONCLUSION: This series demonstrates the revised management protocol followed has reduced in-patient stays and remained effective, with infants continuing to thrive after discharge home, and has a low complication rate.

The bacteriology of children before primary cleft lip and palate surgery.

OBJECTIVE: Bacterial infections can complicate any surgery. Knowledge of potentially pathogenic bacterial flora in children with cleft lip and palate allows appropriate risk management, including the need for prophylactic antibiotics. This project reviewed the bacteriology of children before primary cleft lip and palate surgery. DESIGN: A retrospective study of the results of nose, throat, and ear microbiological swabs taken from children, aged 1 to 26 months, before repair of primary cleft lip, cleft palate, or both was carried out. Swabs with Staphylococcus aureus and beta-hemolytic streptococcus were considered positive. RESULTS: From October 1987 to May 2002, 321 primary cleft lip or palate operations were performed in 250 patients. Results from 326 sets of preoperative swabs were available, including five repeat sets from patients whose operations were postponed. There were 235 (72.1%) negative sets and 91 (27.9%) positive sets. Of the positive swabs, 86 sets grew S. aureus, and 10 sets grew beta-hemolytic streptococcus. CONCLUSIONS: Children with unrepaired cleft lip and palate have a significant risk of carrying S. aureus and a small risk of carrying beta-hemolytic streptococci. These risks need to be considered when deciding on protocols for preoperative bacteriology tests and prophylactic antibiotics.

Core biopsy vs fine needle aspiration cytology in a symptomatic breast clinic.

AIM: The adequacy of physical examination, mammography and fine needle aspiration cytology (FNAC) (conventional triple assessment) in the diagnosis of breast cancer has been questioned. We have performed a prospective study directly comparing FNAC and core biopsy in our symptomatic breast clinic. METHOD: Between 15/5/00 and 17/1/01, 330 consecutive patients with breast lumps were assessed by physical examination, ultrasound, and mammography if over 35 years, and FNAC and core biopsy with or without ultrasound guidance. RESULTS: Three hundred and forty four specimens yielded the following FNAC and core biopsy results: C1-109, C2-144, C3-6, C4-17, C5-68; B1-97, B2-150, B3-7, B4-3, B5-87. The FNAC results corresponding to the 87 B5 samples were as follows: C1-5, C2-2, C3-0, C4-12, C5-68. All C5 samples were associated with a corresponding B5 result. All except one cancer in this series was diagnosed at a single clinic visit. CONCLUSION: In this series, core biopsy diagnosed symptomatic breast cancer more accurately than FNAC.

Experience of explantation of Trilucent breast implants.

On 6 June 2000, the Medical Devices Agency (MDA) recommended that all Trilucent (soya-bean-oil filled) breast implants should be removed. This accelerated a trend that had already begun in our unit. This study follows our previous report on a 3 year series of women with Trilucent breast implants. The aim was to present our operative findings at explantation, and to correlate them with the preoperative signs and symptoms, the postoperative complications and the details of the hospital stay. In total, 44 patients (82 implants) underwent explantation, of whom 34 were cosmetic cases and 10 were reconstructive. Five patients had their implants removed before the MDA announcement. Implant rippling was the most common problem reported (25%), followed by pain (18%), implant deflation (9.1%) and capsular contracture (4.5%). Free oil was seen around the implant in 15 cases; four of these presented with clinical deflation, and three with rippling. The remaining eight patients were asymptomatic. We conclude that these implants tend to bleed, as evidenced by the presence of free oil around the implant in 34% of patients. The absence of free oil in 73% of the patients who presented with rippling suggests that the leaking oil is often metabolised and absorbed. The findings of this study are significant for women in whom free oil was found around the implant during explantation, and for those who still have Trilucent implants in place, for whatever reason, in spite of the MDA recommendation.

An unusual case of metastatic post-irradiation breast sarcoma.

A 71-year-old lady developed a left breast angiosarcoma 10 years after a wide local excision and external beam radiotherapy for invasive breast cancer. Three years after a left simple mastectomy for the angiosarcoma, she presented with metastatic angiosarcoma in the contralateral axilla. There were no local or distant metastases. This is the first reported case of isolated contralateral axillary metastases from post-irradiation angiosarcoma of the breast. A previous study has reported ipsilateral axillary metastases in relation to secondary breast angiosarcoma. Contralateral axillary metastases have always been associated with extensive distant metastases. We present a review of the available literature on radiation-associated breast angiosarcomas.