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It is well reported that patients who have undergone breast augmentation and subsequently develop breast cancer can successfully undergo breast-conserving therapy with preservation of their implants. However, there is a paucity of literature on the radiological investigations and surgical techniques in postmastectomy implant-reconstructed patients who develop recurrences to enable preservation of their implant-based reconstruction whilst effectively treating the local recurrence. The wide adoption of acellular dermal matrix use in prosthetic breast reconstruction in recent years has made radiological evaluation of such patients challenging. Herein presented is a case of a 37-year-old woman where wide local excision of a local recurrence abutting a peri-implant capsule following previous mastectomy and implant-acellular dermal matrix (ADM) reconstruction was performed with successful preservation of reconstruction volume (and shape) using an ADM patch to repair the capsular defect whilst retaining the implant in situ. Radiological investigation facilitated and guided the surgical planning and oncological clearance. [ABSTRACT FROM AUTHOR]

Adequate local anesthetic, in harvesting a split-thickness skin graft (SSG), traditionally involves multiple passes of a needle across the length and width of the marked donor site. We describe a technique using hyaluronidase to uniformly anaesthetize an SSG donor site with one injection, in one pass, of one needle. 1. Preop application of EMLA cream/AMITOP to the donor site 2. Mix 10 mL 1% lidocaine solution with Adrenaline 1:200,000 with 1 vial of Hyaluronidase 1500 units. The mixture is buffered with 1 mL 8.4% sodium bicarbonate to neutralize acidity and minimize pain. 3. Mark out the SSG donor site 4. Using a 27-G long needle (sterican), enter perpendicular to the skin in the middle of the proximal aspect of the donor site. Inject some local anesthetic subdermally, creating a mound. 5. Change the angle of the needle to 180° and continue to inject the remaining anesthetic along one half of the width of the donor site. 6. Using a rolled 4 × 4 swab, apply firm advancing pressure to distribute the mound across the remaining width and length of marked donor site. 7. As the mound advances, the hyluronidase/anesthetic mixture will distribute uniformly across the donor site within the same plane. The skin blanches secondary to the adrenaline during its distribution. The technique described is a fast, reproducible way to improve patient comfort through the elimination of repeated passes of a needle, distributing the anesthetic uniformly across the donor site, and facilitating the acquisition of an SSG of uniform thickness. [ABSTRACT FROM AUTHOR]

We present the case of a successful replantation of a penis, despite an eight-hour cold ischaemic time, after a crushing, blunt trauma with a hammer and amputation with a knife. A 28 year-old male was brought in by ambulance to his local District General Hospital for urology review for amputation of his penis. His medical history reflected a difficult childhood, with a mood disorder and recreational cannabis use. He was transferred to the regional plastic surgery unit at Royal Preston Hospital for replantation, with a cold ischaemic time of approximately eight hours. Intra-operatively, the urethra was repaired over a catheter followed by the tunica to approximate the corpora. Two dorsal arteries were identified with good inflow after a 3 cm proximal resection. These were each anastomosed with a vein graft to the distal stump arteries with 12-0 Ethilon. The dorsal vein was anastomosed with venous couplers. The following day, leech therapy was initiated to proactively treat predictable venous congestion. There was superficial skin loss which was excised and covered with split thickness skin graft, however, the shaft of the penis and the glans were well vascularised. Penile replantation is a rare and challenging problem which historically, has a high risk of failure. From the successful replantation of a crushed, amputated penis, with an extensive zone of injury, we challenge traditional teaching of absolute contra-indications to replantation. As a speciality with the reconstructive expertise to bypass structural injury and restore form, we share our lessons learnt and propose that we rise to the immediate challenge even in such grossly unfavourable circumstances. Level of evidence: Level V, risk/prognosis study. [ABSTRACT FROM AUTHOR]