Nicholas B. Hart

Randomized clinical trial examining psychosocial and quality of life benefits of bilateral breast reduction surgery.

The aim was to determine the effects of bilateral reduction mammaplasty on quality of life and psychosocial functioning in women with mammary hypertrophy.

Does reduction mammaplasty improve lung function test in women with macromastia? Results of a randomized controlled trial.

Background: To determine the effects of reduction mammaplasty on lung function in women with mammary hypertrophy (macromastia), a prospective, randomized, controlled trial was conducted at the Academic Surgery and Plastic Surgery Units, Castle Hill Hospital, Cottingham, United Kingdom. Methods: Seventy-three women who were referred for consideration of bilateral breast reduction surgery were randomized into either an early intervention group (surgery within 6 weeks) or a control group (surgery 6 months after recruitment). Each group had two sets of lung function tests: the intervention group had one before and one 3 months after surgery and the control arm had one test initially and a second test 4 months after randomization and before surgery. The main outcome measure was the lung function test. Results: Sixty-five patients completed the study. The mean age was 39 years (SD, 12 years); both groups were equally matched for age, smoking status, social class, and educational status. By independent t test, there was no significant difference in lung function in the two groups. Subgroup analysis of the intervention group demonstrated a positive correlation between specimen weight and forced expiratory volume/vital capacity, forced expiratory volume/forced vital capacity, peak expiratory flow rate, and forced vital capacity. A paired sample t test revealed a significant improvement in the percentage of forced vital capacity performed/forced vital capacity predicted. Conclusion: The improvement in pulmonary function following reduction mammaplasty correlates with specimen weight resected.

Subcutaneous metallic mercury injection of the hand

Poisoning by subcutaneous metallic mercury is rare and usually accidental. Although it does not carry the same risks as mercury-vapour intoxication, it may still cause destructive early and late local reactions. Two deaths resulting from subcutaneous mercury injection have been reported in the literature. We present a case of accidental subcutaneous injection of mercury in the hand and discuss its management with a review of the literature.

Risk Factors for Complications Following Breast Reduction: Results from a Randomized Control Trial

Reduction mammoplasty has been shown to benefit physical, physiological, and psycho‐social health. However, there are some recognized complications. It would be beneficial if one could identify and modify the factors which increase the rate of complications. To determine the effects of resection weight, BMI, age, and smoking on complication rates following reduction mammoplasty. Data were gathered as a part of randomized control trial (RCT) examining psycho‐social & QOL benefits of reduction mammoplasty. Sixty‐seven consecutive female patients referred to either the Hull Breast Unit or Hull Plastic and Reconstructive Surgery Unit and underwent Inferior pedicle reduction mammoplasty were recruited. Complications were recorded prospectively. Data gathered included resection weight, BMI, age, and smoking status. Smoking status was categorized into current; ex; and never. Prospective records of all complications were noted. SPSS was used for purposes of statistical analysis. Of the 67 patients, 16 (23.9%) had complications. Higher resection weight, increased BMI, and older age are associated with high rate of complications with significance reaching p‐values of p < 0.001, p = 0.034, and p = 0.004, respectively. Among the 67 women who had surgery, nine (13.4%) were current smokers, 20 (29.9%) were ex‐smokers, and 38 (56.7%) never smoked. The incidence of complications was highest among current smokers and lowest among those who had never smoked. When comparing the current smokers with those who are not currently smoking, there is a 37% difference in the occurrence of complication. The chi‐squared test shows that this is a significant difference (p < 0.01) at the 99% confidence interval. Higher resection weight, increased BMI, older age, and smoking are risk factors for complications. Patients should be adequately counseled about losing weight and stopping smoking.

Use of lotus petal flap in the treatment of perineal hidradenitis suppurativa

Perineal hidradenitis suppurativa is a complex problem to treat. Various methods of treatment have been tried in the past, but recurrence was common. In this paper, we describe the use of the lotus petal flap in hidradenitis suppurativa of the perineum in three patients. Many local flaps have been used for covering the defect after excision of hidradenitis suppurativa; in our cases, we have used the lotus petal flap. Until now, this flap has been used for vaginal reconstruction after cancer surgery [Yii NW, Niranjan NS (1996) Lotus petal flaps in vulvo vaginal reconstruction. Br J Plast Surg 49(8):547–554, Hashimoto I et al (1999) Vulvo vaginal reconstruction with gluteal fold flaps. J Jpn P R S 19:92–98]. Three patients had five lotus petal flaps after the excision of perineal hidradenitis suppurativa, and there were no recurrences of the lesion in the excised area after follow-up at 2 years.

Achilles tendon graft for static facial sling

Static sling surgery for the paralysed face is a commonly performed procedure for patients who are unwilling or unfit for dynamic reanimation. The sling may be constructed from autogenous tissue or exogenous material such as Goretex suture. Various autogenous tissues have been described in the literature for use in this procedure including fascia lata, temporalis fascia and palmaris longus tendon. A 65-year-old lady had been referred to our department following excision of a parotid mass. She had been treated initially by superficial parotidectomy and preservation of the facial nerve for a presumed pleomorphic adenoma. Histological examination revealed carcinoma ex-pleomorphic adenoma which was incompletely excised at the deep margin. She was planned for completion parotidectomy and sacrifice of the facial nerve. At surgery the facial nerve was sacrificed leaving a small proximal stump and distal temporal, zygomatic and buccal branches. An immediate reconstruction of the nerve was performed with sural nerve grafts from the right leg. In anticipation of the duration and likely degree of recovery of nerve function a static sling had been planned. Dynamic reconstruction had been discussed with the patient preoperatively and ruled out according to the patient’s wishes. Through the incision for the sural nerve harvest a thin (less than 10%) strip of Achilles tendon was harvested by splitting the tendon. The length of the tendon graft was 15 cm. The wounds were closed and the graft used as a Y shape to support upper and lower lips and angle of the mouth. The leg was not splinted and the patient was encouraged to mobilise gently from day one post operatively, at this stage she was discharged. She was seen in clinic for a wound check at one week and review in clinic two months post operatively. She had an excellent result from her facial sling and minimal pain from the donor site. No problems had been encountered with mobilisation. It is our usual practice to use autogenous material for facial sling surgery due to previous problems with extrusion and infection of exogenous materials. Our first choice tissue