Abstract P2-12-21: The “penny farthing” incision for mastectomy: A novel technique to reduce “dog ear” deformity and improve access to the axilla

Introduction:

Medial and lateral “dog ear” deformities are a common problem with mastectomy incisions. The challenges include different skin tensions superiorly and inferiorly and variable BMI. Also, the standard mastectomy incision is also not in the optimal place for sentinel node biopsy access.

No published technique is universally applicable and some advanced techniques require excess dissection and operative time.

Aims:

1) To perform a literature search for all published techniques

2) To pilot test a new, simple incision

Methods:

A literature search using PubMed was performed that revealed eight previous techniques (1).

A new, simple technique was developed to incorporate most of the historical principles. Circles of different sizes are marked out medially (small) and laterally (large). The lateral circle incorporates the optimal position for access to the axilla for sentinel node biopsy or axillary clearance. These circles are joined by asymmetrical superior and inferior lines to encourage rotation during closure. Tumour size and position are taken into consideration. Wound closure begins from the centre which allows the wound to "choose" its own corners and tuck them inwards therefore minimising "dog ear" formation.

Results:

Seventy- five consecutive patients had the procedure by a single surgeon over an 18 month period.

At the conclusion of each procedure there was no residual "dog ear" deformity at either wound end.

Of the 36 patients seen for 12 month follow up only one (BMI 42) has required revision of the wound.

Conclusion:

The "Penny Farthing" incision is a novel, simple and promising technique to deal with "dog ear" deformity in mastectomy.

Reference:

1. Thomas R, Mouat C, King B. Mastectomy flap design: the ‘waisted teardrop’ and a method to reduce the lateral fold. ANZ Journal of Surgery. 2012; 82: 329-333.

Citation Format: Poole G, Sheikh L. The “penny farthing” incision for mastectomy: A novel technique to reduce “dog ear” deformity and improve access to the axilla. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-12-21.

Impact of antibiotic usage on resistance in microorganisms; urinary tract infections with E-coli as a case in point

OBJECTIVES

In this study, we sought to establish a correlation between consumption of flouoroquinolones in our hospital and the emergence of ofloxacin resistant strains of E. coli in the urinary specimens. Data of all urinary samples, received at Aga Khan University Hospital between January 1995 and December 2002, was retrieved and analyzed. Specimens yielding E-coli as an isolate were included in this study.

METHODS

E. coli Isolates showing >103 colonies were identified using standard microbiological techniques. Antibiotic susceptibility of E. coli was tested using Kirby Bauer disc diffusion method. Antimicrobial usage data, obtained through hospital Pharmacy as unit utilized per year for Quinolones in different medical and surgical units was available only for the period of 1997- 2002.

RESULTS

Among 32,722 urinary specimens E. coli (53%) was the most frequent isolate. Steady increase in the number of ofloxacin resistant E. coli was noted, 24% in 1995 to 55% in 2002. Maximum quinolone resistant E. coli have been observed in Medical units, 41% in 1997 increasing to 70% in 2002, followed by Surgery units (35% to 54%) and Pediatrics (12 to 38%). Sharp increase in ofloxacin consumption in our hospital, 1997 (28613 units) to 2002 (96880 units) has been observed. Trends in quinolone resistance correlate significantly with utilization in the same period as shown by linear regression.

CONCLUSION

E. coli resistance against most antibiotics has been on a rise particularly for quinolones. The utilization of quinolones correlates with increasing resistance in our hospitalized patients.

Parent Preparation for the NICU-to-Home Transition: Staff and Parent Perceptions

Thirty-four nurses who were employed more than 20 hr per week in a neonatal intensive care unit (NICU) at a midwestern teaching hospital participated in a survey on discharge teaching. The survey consisted of 43 topics on which parents may or may not receive instruction prior to their baby's discharge from the NICU. For each topic, nurses were asked how important the topic is for parents to learn about prior to discharge, whether parents in the NICU are currently receiving instruction on the topic, and who among the NICU staff is responsible for instruction on the topic. Data obtained from this survey were compared to data obtained from a similar survey conducted 18 months previously with parents in the same NICU. Nurses rated the majority of topics in the survey as being very important for parents to learn about prior to their baby's discharge. For many of the items, a significant discrepancy existed between the percentage of nurses reporting the topics that were routinely taught and the percentage of parents who actually recalled learning about the topics. Suggestions on ways to improve the effectiveness of discharge teaching are provided.