This case report draws attention to an unusual presentation and subsequent complication following the insertion of a PIP Hydrogel implant for breast augmentation. A cutaneous and capsular foreign body giant cell reaction was identified, and was preceded by the development of a notable increase in breast volume prior to spontaneous discharge. We believe that this was caused by subclinical leakage of the implant contents through a degrading shell. The biodegradability of hydrogel makes it impossible to ascertain the precise nature of the material that leaked out. Given this demonstrable leakage, the adverse clinical effects and the potential for toxicity that is currently unknown, we question whether this product (and other hydrogel breast implants like it) should be formally recalled for the benefit of patient safety.
Member of the Committee for the National Guidelines for Massive Weight Loss (MWL) Body Contouring
Member of the Medical Advisor Committee (MAC) at the Manor Hospital, Oxford, aimed at ensuring safe practice in Cosmetic Plastic Surgery within the hospital.
Faculty member for BAAPS Training days 2014 and 2016. Mr Adams co-chaired and organized the most recent training day on Head and Neck cosmetic surgery at Lady Margaret Hall, Oxford in July 2016.
Directorate Lead for Specialist Surgery Clinical Governance at the Oxford University Hospitals NHS Foundation Trust. 2016- present.
Clinical Lead for Plastic Surgery Governance at the Oxford University Hospitals NHS Foundation Trust 2013-2016.
Barrel explosions (or ‘‘bursts’’) can occur when different gauge cartridges are inadvertently placed into the breech of a shotgun. This article describes two cases in which injuries were sustained to the left hand and forearm as a result of the placement of 12- and 20-gauge cartridges into 12-bore shotguns. Although the incidence of catastrophic barrel failure and the injuries they cause are not known, there is concern that such cases may be increasing as the use of 20-gauge shotguns is becoming more popular.
Sentinel lymph node biopsy (SLNB) is an established investigation used in the management of melanoma, and contributes to disease staging. In the UK, Patent Blue V is injected intra-operatively to help identify the sentinel node. However little is known about the adverse effects associated with Patent Blue V in this technique.
Sentinel lymph node biopsy (SLNB) has become an established investigation for assessing microscopic nodal metastasis in melanoma. The American Joint Committee on Cancer (AJCC) incorporates the sentinel node status in its staging criteria for melanoma. We present our clinical evaluation of performing SLNB in a single UK centre between 1998 and 2008. There were 697 patients with a mean age 53 years (range 13e92). We were able to surgically harvest at least one sentinel node in 694 patients of which 532 (76%) were negative. Of the 162 positive patients, 129 underwent further completion lymphadenectomy with 29 showing further pathologically positive nodes. At median follow up of 46 months, mortality from melanoma for SLN positive and negative patients was 32% and 4%, respectively. Disease recurrence was noted in 10% of the SLN negative group. Survival curves showed significant difference (p < 0.001) in outcomes for patients grouped by Breslow thickness. Postoperative complications were noted in 6% of patients. No life-threatening complications were noted.