Necrotizing fasciitis of the breast: a case managed without mastectomy

To report a rare presentation of necrotizing fasciitis [NF] in the breast and its management. A 61-year-old non-diabetic lady presented with a painful swollen right breast and yellowish discharge associated with fever for the last few days. Based on clinical examination and haematological parameters, a provisional diagnosis of breast abscess was made that later proved to be a case of NF. She was managed conservatively with repeated debridement followed by split-skin grafting with preservation of the breast. This case showed that NF of the breast can present as a simple breast abscess which was managed conservatively

Slippage after adjustable gastric banding according to the pars flaccida and the perigastric approach

To evaluate laparoscopic adjustable gastric banding and the 'pars flaccida' techniques for treating morbidly obese patients. Between May 1999 and July 2002, 64 patients underwent laparoscopic adjustable gastric banding. The 'perigastric' technique was performed in the first 31 patients. From September 2000 the band was positioned according to the 'pars flaccida' technique in the remaining 33 patients. The patients were divided into three groups: group 1 - 'perigastric' technique using Lap-Band size 9.75 and 10 cm [31 patients]; group 2 - 'pars flaccida' technique using Lap-Band size 10 cm [12 patients], and group 3 - 'pars flaccida' technique using the Swedish band [21 patients]. There were 58 females and 6 males with a mean age of 36.6 years [range 17-56]. The preoperative mean body mass index was 46.2 kg/m2. Band slippage occurred in 10/31 patients [32.2%] of group 1, 3/12 patients [25%] of group 2 and none in group 3 patients [p < 0.01]. The 'pars flaccida' technique significantly reduces the incidence of postoperative slippage after gastric banding. This complication is further reduced in the Swedish band group. Furthermore, we do not recommend using the 10-cm Lap-Band in the 'pars flaccida' technique