Contralateral prophylactic mastectomy.

BACKGROUND: Contralateral prophylactic mastectomy (CPM) is often discussed as a treatment option for women with a diagnosis of unilateral breast cancer. The purpose of this study was to identify the prevalence of pathology within the specimen at the time of CPM and to evaluate potential risk factors. METHODS: Patients with a unilateral breast malignancy who underwent CPM were identified from the database of Scott and White Breast Cancer Clinic. A retrospective cohort study comparing disease status and various exposure parameters was conducted via chart review. RESULTS: Of the 301 patients who met the inclusion criteria, there were 14 cases (4.7%) with malignancy and 45 cases (15.0%) with moderate-to-high risk lesions. Multivariate analysis demonstrated 2 independent factors predictive of malignant or moderate-to-high risk lesions: age >54 years and lobular histology in the original specimen. CONCLUSIONS: The prevalence of malignant and premalignant lesions at the time of CPM was nearly 1 in 5.

Pharmacokinetics of topical and intravenous cefazolin in patients with clean surgical wounds.

BACKGROUND: Surgical-site infection is a common postoperative nosocomial infection. Surgeons frequently treat operative patients with protective antibiotics and often choose cefazolin as the drug. Treatment schemes include both preoperative intravenous dosing and intraoperative dosing by irrigation. This study was designed to measure cefazolin concentrations both in serum and in wound drain fluid after intravenous dosing and after irrigation. METHODS: The authors conducted an institutional review board-approved study involving randomized allocation of breast reduction patients to group 1 (preoperative intravenous dosing) or group 2 (intraoperative dosing by irrigation). Each patient had serum and wound drainage specimens measured over time for cefazolin concentrations. Cefazolin dosing was based on preparations commonly used in the authors' hospital. Results from 24 patients are reported. RESULTS: Patients treated by conventional preoperative intravenous dosing displayed the expected serum degradation curve. These patients also demonstrated wound drainage concentrations (peak, 22.49 microg/ml) for approximately 4 to 5 hours. Measured concentrations were above the minimum therapeutic concentration (8 microg/ml) for Staphylococcus aureus. Patients treated by wound irrigation also demonstrated serum concentrations above minimum therapeutic concentration. In addition, these patients' wound drain fluid demonstrated very high cefazolin concentrations (peak, 4185.93 microg/ml), which remained high for 24 hours. CONCLUSIONS: Protective cefazolin concentrations in the wound can be achieved by both intravenous and irrigation delivery. Wound irrigation produces higher concentrations for longer periods of time.

Through-and-through gunshot wounds to the foot: the "Fearless Fosdick" injury.

Through-and-through gunshot wounds of the foot present the unique problem of needing to fill a defect while at the same time providing coverage of the dorsum and plantar surface of the foot. A series of 5 patients from 2 institutions is presented. These patients all sustained gunshot wounds that penetrated the forefoot, leaving a rim of uninjured soft tissue and bone around the periphery. All patients were reconstructed with free-tissue transfers, but no bone grafting was required to replace missing bone. One patient did have an arthrodesis and wedge osteotomy to help with walking mechanics. Soft-tissue reconstruction only is adequate to restore the foot sufficiently to allow the patient to walk satisfactorily.