Risk factors for complications following breast reduction: results from a randomized control trial.

Reduction mammoplasty has been shown to benefit physical, physiological, and psycho-social health. However, there are some recognized complications. It would be beneficial if one could identify and modify the factors which increase the rate of complications. To determine the effects of resection weight, BMI, age, and smoking on complication rates following reduction mammoplasty. Data were gathered as a part of randomized control trial (RCT) examining psycho-social & QOL benefits of reduction mammoplasty. Sixty-seven consecutive female patients referred to either the Hull Breast Unit or Hull Plastic and Reconstructive Surgery Unit and underwent Inferior pedicle reduction mammoplasty were recruited. Complications were recorded prospectively. Data gathered included resection weight, BMI, age, and smoking status. Smoking status was categorized into current; ex; and never. Prospective records of all complications were noted. SPSS was used for purposes of statistical analysis. Of the 67 patients, 16 (23.9%) had complications. Higher resection weight, increased BMI, and older age are associated with high rate of complications with significance reaching p-values of p < 0.001, p = 0.034, and p = 0.004, respectively. Among the 67 women who had surgery, nine (13.4%) were current smokers, 20 (29.9%) were ex-smokers, and 38 (56.7%) never smoked. The incidence of complications was highest among current smokers and lowest among those who had never smoked. When comparing the current smokers with those who are not currently smoking, there is a 37% difference in the occurrence of complication. The chi-squared test shows that this is a significant difference (p < 0.01) at the 99% confidence interval. Higher resection weight, increased BMI, older age, and smoking are risk factors for complications. Patients should be adequately counseled about losing weight and stopping smoking.

Primary eccrine porocarcinoma of the finger with transit forearm and axillary metastasis.

Sweat gland tumors of the upper extremity are uncommon. Eccrine porocarcinoma is a rare skin malignant lesion representing 0.005% to 0.01% of all cutaneous tumors, which most commonly presents in patients more than 60 years of age. Approximately 250 cases of eccrine porocarcinoma have been reported since this disease was first described in 1963. However, only 2 cases occurring specifically on the finger (including the current case) have been documented in the literature to date. On the basis of the rarity of eccrine porocarcinoma of the finger, we report an eccrine porocarcinoma that presented as an ulcerated lesion of the left ring finger with metastasis to the forearm and axilla in an 80-year-old man. The etiology, diagnosis, treatment, and prognosis of this disease are discussed, with a brief review of the literature.

The impact of dressings on recovery from carpal tunnel decompression.

SUMMARY: This study assesses the impact on outcome of wearing a bulky dressing following carpal tunnel decompression. One hundred patients were randomised for having a bulky dressing removed at either 24h or 2 weeks postoperatively. A Levine score was measured preoperatively and postoperatively at 2 weeks. The surgery and other dressings used were standardised as per the protocol. Comparison was made between the symptom and functional severity scores for each group to assess the impact of duration of wearing the dressing on resolution of symptoms. The results indicate no difference in outcome between the 2 week and 24h groups. We therefore feel that patients should be given the choice as to when to remove their dressing. If they feel restricted, they are free to remove the bulky dressing without an increased risk of a worse outcome. If they feel secure in the dressing, they will not suffer leaving it in place for 2 weeks.

The effect of body mass index and wound irrigation on outcome after bilateral breast reduction.

Thirty patients undergoing bilateral breast reduction by inferior pedicle technique were entered into a prospective, randomized study to determine the effect of unilateral saline wound irrigation and body mass index (BMI) on outcome. Each patient was assessed at 1, 4, and 8 weeks after surgery for wound dehiscence, infection, fat necrosis, and breast comfort by means of a visual analog pain score. The mean patient age was 33 years; mean weight, 67.7 kg; mean BMI, 26.3; and mean weight of breast tissue excised per patient, 1270 g. In 60 breasts there were 13 cases of minor wound breakdown, all of which had healed by 8 weeks postoperatively. Wound irrigation had no significant effect on the rate of T-junction breakdown or on postoperative pain. BMI was associated significantly with wound breakdown (BMI > 26.3, 33% wound breakdown rate; BMI < 26.3, 10% wound breakdown rate; P < 0.05, chi2 test). Patients with a high BMI are more likely to have delayed healing after breast reduction.