Treatment of unilateral giant fibroadenoma by breast reduction skin incision: the inverted "T" technique.

BACKGROUND: Giant fibroadenoma (GFA) has been defined as fibroadenoma greater than 5 cm in it's the widest diameter and/or weighing more than 500 g. A benign lesion, its size also raises the possibility of malignancy requiring differentiation from a malignant breast disease. When unilateral GFA presents with a severe breast asymmetry, due to its size, it is not correctable by simple enucleation alone. Postoperative asymmetry from volume and ptosis disparity results, which needs to be addressed at the primary surgery. The inverted "T" technique, which is effective in volume reduction and ptosis correction in breast hypertrophy, can be applied in the treatment of unilateral GFA. AIM: This is a retrospective review of all GFA treated by inverted "T" method. MATERIALS AND METHODS: A retrospective review was carried out on all patients with GFA treated by inverted "T" skin pattern method over a period of 20 years (January 1988 to December 2007). The procedures were carried out at the University of Nigeria Teaching Hospital and the National Orthopedic Hospital, Enugu. Information, which included patients' demographics, pre-operative assessment, operative findings and outcome of surgery were obtained from the case files of the patients. The degree of ptosis was recorded for each patient. Diagnosis of GFA was made after clinical evaluation and pre-operative tissue biopsy. Immediate results of treatment were based on the patients' satisfaction, visual assessment of symmetry of size of breasts, correction of ptosis and position of nipple areola complex (NAC). RESULTS: A total of 27 patients underwent inverted "T" technique for excision of GFA in their breasts. Their average age was 17.5 years (range 12-25 years) delay in presentation ranged from 2 months to 15 months. In 16 patients (59.2%), the left breast was involved in GFA whilst the tumor occurred on the right breast in 11 (40.7%). The tumor weighed on the average 1500 g (range 655-2200 g). Average diameter of the tumor was 15 cm (range 12-20 cm). All quadrants of the breasts were involved at presentation. The inferior glandular pedicle bearing the NAC was used in all patients. The length of the pedicle ranged from 8 cm to 14 cm whilst the width ranged from 6 cm to 8 cm. Lactation was reported by three patients who went on to successfully breast feed. Complications were minimal. Most were minor wound healing problems and minor breast asymmetry. Epidermolysis in 2, hypertrophic scar in 6,minor breast asymmetry in 3 and delayed healing at the "T" junction in the inframammary fold in 4 were the common complications. All patients were satisfied with the result obtained. CONCLUSION: In GFA with a significant breast asymmetry, excision through inverted "T" technique was successful in achieving postoperative symmetry with the opposite breast in these patients. Complications were minimal.

Burn disaster acute care management in a Nigerian hospital: any change 10 years after?

This study is derived from retrospective data from the management of a fire disaster involving nine students managed in the institution following a fire disaster at the female students' hostel. The average length of stay was 19 days. The total cost was $47.74 per day per patient.

Early results of operative closure of pressure sores in traumatic paraplegics.

The development of pressure sores in the course of management of a paraplegic represents a major setback which will not only delay rehabilitation but prolong hospital stay. Pressure sores may heal under conservative management provided the site is relieved of pressure. This mode of treatment is associated with prolonged immobilisation and is accompanied by a higher incidence of recurrence. Since in our unit pressure sores are mostly closed with flaps, we decided to review our early results. Between 1981 and 1986, 28 patients with 61 pressure sores were surgically closed at the National Orthopaedic Hospital, Enugu, Nigeria. The 29 trochanteric sores were closed with tensor fascia lata (TFL) myocutaneous flap. Sacral sores were closed with bilateral gluteal flaps or a rhomboid flap. Most ischial sores were closed with gracilis myocutaneous flap. Overall 72.1% of our cases healed primarily with no complications. There were 3 major complications requiring reoperation and 14 minor complications which healed on conservative management with daily dressing. We conclude that operative closure of pressure sores in traumatic paraplegics is advocated as this affords the greatest benefit to the patients.