Fish-tail plasty: a safe technique to improve cosmesis at the lateral end of mastectomy scars.

BACKGROUND AND AIMS: Redundant skin at the lateral end of a mastectomy scar can be unsightly and uncomfortable, especially in elderly obese patients. The aim of this study is to evaluate a technique of mastectomy wound closure designed to maximise cosmesis at the lateral end. PATIENTS AND METHODS: Thirty lateral skin flap advancements were performed in 28 patients. The procedure was performed primarily in 27 cases. In three cases a delayed scar revision was performed. Following anterior advancement of the skin overlying the latissimus dorsi muscle, two areas of redundant skin were excised and the wound closed in the shape of Y-plasty. RESULTS: The patients' mean age was 70.6 years (range 51-93) and the mean body mass index (BMI) 30.4 kg/m2 (range 21-35). The mean weight of the excised breast tissue was 1015 g (range 356-2003). The mean lengths of the two limbs of the Y-plasty were 5.3c m (range 3-10). The mean length of the base of the flap was 8.3 cm (range 4-14). One patient developed a small area of skin necrosis at the apex of the Y-plasty. Two further patients developed superficial wound infections. CONCLUSION: Fish-tail plasty is a safe and easy technique and may be recommended following mastectomy in obese patients to improve cosmesis and avoid discomfort caused by redundant skin.

Randomized clinical trial of the effect of needle gauge and local anaesthetic on the pain of breast fine-needle aspiration cytology.

BACKGROUND: Breast fine-needle aspiration cytology (FNAC) is an invasive investigation which can be uncomfortable or distressing. This randomized study investigated the discomfort of breast FNAC and the effect of different techniques. METHODS: Some 116 FNAC samples were taken from 98 women with a palpable breast mass. Each patient was randomized to one of four study groups; aspiration was performed using a green-hub (21 G) or blue-hub (23 G) needle, either with or without local anaesthetic. Each patient scored the pain of the whole procedure using a visual analogue scale. RESULTS: A green-hub needle caused significantly more discomfort (mean(s.e.m.) pain score 5.1(0. 4) cm) than a blue-hub needle (2.9(0.4) cm), or either a blue- or green-hub needle with local anaesthetic (3.0(0.4) and 2.1(0.4) cm respectively) (F = 10.28, 3112 d.f., P < 0.01, analysis of variance). CONCLUSION: The discomfort of breast FNAC is dependent upon the gauge of the needle and the use of local anaesthetic. A blue-hub needle without local anaesthetic should be first choice for breast FNAC.

The effect of needle gauge and local anaesthetic on the diagnostic accuracy of breast fine-needle aspiration cytology.

AIMS: The value of breast fine needle aspiration cytology (FNAC) is well established. This prospective study evaluates the effects of local anaesthetic (LA) and different gauge needles on the diagnostic accuracy of breast FNAC. METHODS: Aspirates were obtained from 59 consecutive excised breast tumours (51 malignant, eight benign) using green (21-G) and blue-hub (23-G) needles, both before and after infiltration of LA at the aspiration site. RESULTS: There was good agreement for the cytological diagnosis of each tumour when compared by needle size (kappa = 0.85) and the presence of LA (kappa = 0.77). Diagnostic sensitivity ranged from 88 to 92%. None of the differences were statistically significant. In addition LA appeared to have no effect upon the cytological grading of breast carcinomas (chi2 = 1.98, (df 3, P = 0.58). DISCUSSION: The use of the smaller gauge blue-hub needle or LA does not appear to affect adversely the diagnostic accuracy of breast FNAC. Whether using LA or the blue needle routinely in the breast clinic will have an effect upon the discomfort experienced during FNAC remains to be proven.

Cystic lymphangioma of the pancreas.

Cystic lymphangioma of the pancreas is a rare condition. A 14-year-old girl presented with a cystic abdominal mass and abdominal pain. She was initially treated by biopsy and cyst drainage, and subsequently with partial excision of the cystic mass. The mass, which was a cystic lymphangioma involving the pancreas, recurred after each operation. Persisting symptoms led to a pylorus-preserving pancreatectomy and hepaticojejunostomy. Total excision is the only effective method of treating this benign tumour. The patient remains symptom free 2 1/2 years after pancreatectomy.