Thumb subungual melanoma: is amputation necessary?

Subungual melanoma is uncommon. Traditional teaching advocates amputation of the affected digit. Recent studies have shown that more distal levels of amputations do not compromise survival or recurrence rates. When the thumb is involved, functional and aesthetic loss can be substantial. We present a new conservative, digit-sparing approach in the treatment of subungual melanoma of the thumb. Four informed patients were recruited to undergo the new treatment. Local excision with 1cm margins down to and including the periosteum was carried out. Reconstruction was with a local flap. There has been one recurrence and no deaths with a minimum of 6 years follow up. In selected cases, conservative management of subungual melanoma allows preservation of length and minimises disability.

Soft fluted silicone drains: a prospective, randomized, patient-controlled study.

BACKGROUND: For some patients, removal of surgical drains can be the most painful part of surgery. The authors present a prospective, randomized, patient-controlled study comparing soft fluted silicone (Blake) drains with conventional rigid (Portavac) drains. METHODS: After ethical committee approval, 43 patients undergoing bilateral breast reduction surgery were recruited into the study. A Blake drain was inserted on one side and a Portavac drain was inserted on the contralateral side; the patients therefore acted as their own controls. Pain scores were measured on a descriptive scale 10 minutes before, during, and 10 minutes after drain removal. Statistical analysis was carried out using the Wilcoxon signed ranks matched pairs test. RESULTS: The results show that Blake drains are less painful before (p = 0.05), during (p = 0.01), and after removal (p = 0.009). Of those patients who expressed a preference, 27 preferred the Blake drain and 10 preferred the Portavac drain. CONCLUSION: The authors advocate the use of a silicone fluted (Blake) drain for any wound requiring drainage, especially if large-caliber drains are indicated.

Intraoperative findings of cancer in delayed breast reconstruction: a dilemma?

Recurrence of breast cancer discovered at the time of reconstruction is rare. However, with increasing numbers of delayed postmastectomy reconstructions being performed, this scenario may become more common. There are no guidelines on how to manage this dilemma. There are two main issues: the effect on the patient and the effect on the reconstruction itself. The authors present two cases and discuss the factors involved in this difficult decision, along with their recommendations.

Management of infants with Pierre Robin sequence.

OBJECTIVE: Several methods of treating babies with Pierre Robin sequence have been described since the condition itself was first documented in 1923. The main aim of treatment has been to relieve upper airway obstruction. Treatment methods used range from positioning of the baby to invasive surgery. The aim of this article was to describe the assessment, treatment, and monitoring methods used for babies referred with Pierre Robin sequence (PRS). SETTING/PATIENTS: From December 1995 to May 2000, 22 consecutive patients were admitted to Birmingham Children's Hospital with PRS. Their airway and nutritional status were assessed and continuously monitored. INTERVENTIONS: Treatment concentrated on the relief of airway obstruction with a nasopharyngeal airway (NPA) and nutritional support of the babies until they grew out of their respiratory and feeding difficulties. MAIN OUTCOME MEASURES: Outcome measures were oxygen saturation, growth of the babies, and the need for surgery. RESULTS: All babies were managed successfully with an NPA and nutritional support. No baby required surgery, and the majority showed good weight gain. CONCLUSION: Relieving airway obstruction by NPA is an effective and safe treatment for babies with PRS until they have grown out of their respiratory and feeding difficulties. It avoids the need for surgery and can be used on neonatal wards using the monitoring described.