Histological examination of the capsules surrounding Trilucent breast implants.

Following a statement by the UK Medical Devices Agency (MDA), soya-oil-filled Trilucent implants for breast augmentation were withdrawn from sale in March 1999. The most recent report on the toxicity of the Trilucent implant suggests that one of the breakdown products of the filler is an aldehyde with an explicit risk of genotoxic and teratogenic effects. Explantation of all these prostheses was advised by the MDA in June 2000. No guidance regarding capsulectomy was put forward by any publication. The operation of capsulectomy confers an increased morbidity compared with simple prosthetic replacement. This study looks at the capsules of 18 consecutive patients who had received Trilucent implants for cosmetic breast augmentation, and who had undergone explantation and capsulectomy. The mean duration of implantation was 3 years (range: 2 years to 4 years 9 months). The capsules were examined histologically. The significant features of all the capsules included a florid foreign-body type reaction, synovial metaplasia, a villous hyperplasia and the presence of refractile material within the substance of the capsule. It is postulated that the refractile material is filler material that has bled through the wall of the intact Trilucent implant, and as such would represent a potential genotoxic hazard. Until such time as this potential hazard has been investigated fully and a conclusion reached, we recommend acceptance of the increased morbidity, and the performance of capsulectomies when explanting Trilucent implants.

The surface anatomy of the germinal matrix of the nail bed in the finger.

Nail spicules result from incomplete excision of the nail matrix of the finger. We report a histological study to delineate the surface anatomy of the nail matrix. Sections were cut longitudinally and transversely in 19 fingertips. The proximal midline extent of the nail matrix was measured and expressed as a ratio of the distance from the nail fold to the distal interphalangeal joint. In the lateral sections, the angle subtended between the midline vertical and the lateral extent of the nail matrix was measured. The mean ratio of the proximal extent was 0.55 in the midline and the lateral angular extent was 66 degrees. The authors recommend that excision of the nail matrix should be rectangular, extending to the midlateral lines and proximally to a point three-quarters of the distance from the nail fold to the distal interphalangeal joint crease.

A prospective randomized comparison of Sutter and Swanson silastic spacers.

This study compares two currently available prostheses for the reconstruction of rheumatoid joints. A single operator performed 72 resection arthroplasties with Swanson or Sutter prostheses being randomly allocated. Assessment of each patient was carried out preoperatively, and at 6 months and 12 months postoperatively by a single investigator. In the Swanson group an improvement of the flexion arc was seen, from 29 degrees to 44 degrees at 6 months but this reduced to 36 degrees at 12 months. In the Sutter group there was no significant difference between flexion arcs pre- and postoperatively. Grip strength improved in the Swanson group, but not in the Sutter group. Extensor lag was improved in both groups. Patient satisfaction measured by linear analogue scales for pain, function and deformity was high in both groups.

A study of the dimensions and taper angles of the medullary canals of the proximal and middle phalanges.

The morphology and dimensions of the medullary canals of the proximal and middle phalanges have been studied with particular interest shown to the angle of taper of these canals. Measurements of 50 cadaveric fingers were taken from computer aided tomographic images using AutoCAD software. Tangents were fitted to the inner cortices in two orthogonal planes and the angles between them were measured. The angles of canal taper in the proximal phalanx were remarkably similar for each digit. This was also true for the middle phalanx of the index, middle and ring fingers but the taper of the middle phalanx of the little finger was found to be different.