Laparoscopic omentoplasty and split skin graft for deep sternal wound infection and dehiscence patient

Treatment of sternotomy dehiscence secondary to infection is complex. We describe a case where following debridement and negative pressure therapy the greater omentum was harvested laparoscopically, pedicled on the right gastroepiploic artery and transposed through a subxiphoid window and laid into the chest wound. The omentum was covered with a split skin graft. The omental transposition provided a healthy vascular bed for the skin graft to be laid on top of. This technique allows for larger defects to be closed when due to the amount of bone loss the sternum cannot be brought together. Such procedures are normally performed when all other measures have failed and myocutaneous flaps cover the omentoplasty. Our case is novel in that the laparoscopic harvest and the use of direct skin grafting make this an option to be considered earlier as a single definitive procedure.peer-reviewe

Adenolipomas : a case series of 16 patients over 5 years

Introduction: An adenolipoma is a benign, rare variant of a lipoma and is histologically very similar to a lipoma but contains eccrine glands amongst the mature adipose tissue. According to our knowledge, this case series of adenolipomas, is the largest one in the literature. The aim is to increase awareness about this variant of lipoma.Method: The data was collected retrospectively from the histopathology department and patients’ notes.Results: We had a total of 16 cases of adenolipomas between 2013 and 2017 in our hospital. 75% of the patients were being managed by General Surgeons. 88% of them occurred in female patients and the patients’ age varied between 15 and 64 years. The most common location of adenolipomas was the thighs and the largest diameter of the histology specimen varied between 15 and 100mm. 31% were encapsulated, 25% had apocrine glands present and 6% had myxoid changes. None of them had mast cells present. No recurrences were documented.Conclusion: It is a benign lesion and awareness amongst pathologists is imperative so that it can be identified histologically.peer-reviewe

Bilateral breast reduction surgery at Mater Dei Hospital : analysis of physical and psychological symptoms using the BREAST-Q

Introduction: The literature describes the high patient satisfaction rate after breast reduction. In this retrospective study, we use the BREAST-Q to analyse satisfaction with breast appearance and physical, psychosocial and sexual well-being of patients who underwent bilateral breast reduction (BBR) at Mater Dei Hospital (MDH). We also looked into whether age, co-morbidities and weight of breast tissue removed makes a difference to the overall satisfaction rate. Method: Permission to use the BREAST-Q questionnaire and translate it into Maltese was obtained from Mapi Reasearch Trust. The questionnaire was offered either in Maltese or in English, after an official translation was produced following a linguistic validation process. All patients who underwent BBR at MDH under the care of both consultant Plastic Surgeons were invited to complete the BREAST-Q questionnaire via a telephone call and asked to come to MDH to fill it in. Other patient specific information was obtained from their hospital notes. Results: We hope to demonstrate a better quality of life following surgery and aim to compare the results of this study to others carried out worldwide. In this way we can better understand the local situation and see where there is the room for improvement. Conclusion: In this world of evidence-based medicine, the BREAST-Q is ideal for a holistic approach in analysing patient satisfaction after BBR. Having local data at hand makes it easier for patients who are interested in undergoing the surgery to associate themselves with other local individuals.peer-reviewe