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Breast cancer-related lymphedema (BCRL) is a common complication of breast cancer. 1 Indocyanine green (ICG) lymphography 2 can assess lymphatic functionality. However, some patients undergoing taxane-based chemotherapy experience a period of interstitial edema during which no flow is observed on ICG lymphography, because when the dye is injected near the first web space over the dorsum of the hand, it does not flow beyond the wrist. 3 Over time, this resolves and either returns to normal or results in dermal backflow (DBF). The present study aimed to investigate the association between lymphatic functionality and the risk factors for BCRL using ICG lymphography, while particularly focusing on the no-flow pattern.This study retrospectively reviewed 422 breast cancer cases involving axillary lymph node dissection (ALND). BCRL was diagnosed based on ICG lymphography patterns or, for patients with edema unable to undergo ICG lymphography, by comparing volume differences. The patients were divided into two groups based on the presence/absence of BCRL: BCRL( + ) and BCRL( −). The following characteristics were compared between the groups: age, body mass index, laterality, type of surgery (breast-conserving or mastectomy), disease staging, regional lymph node irradiation, hormone therapy, and type of chemotherapy (taxane, nontaxane, or no chemotherapy).Patients exhibiting the no-flow pattern underwent ICG lymphography every 3 months. DBF patterns typically do not change within such a short period, but because the noflow pattern was the result of temporary interstitial edema, changes were observed from one lymphography to the next ( Figure 1 ). Patients with prolonged edema who could not be diagnosed by ICG lymphography alone were assessed by lymphoscintigraphy. 4 Of the 422 patients who underwent ALND, 100 (23.7%) were diagnosed with BCRL. Compared with the BCRL( −) group, the BCRL( + ) group had significantly higher rates of lymph node irradiation (45% vs. 32%; P = 0.020) and taxanebased chemotherapy (94% vs. 63%; P < 0.001). Postsurgical disease staging was significantly more severe in the BCRL( + )

Background Facial pressure ulcers are a rare yet significant complication. National Institute for Health and Care Excellence (NICE) guidelines recommend that patients should be risk-assessed for pressure ulcers and measures instated to prevent such complication. In this study, we report case series of perioral pressure ulcers developed following the use of two devices to secure endotracheal tubes in COVID-19 positive patients managed in the intensive care setting. Methods A retrospective analysis was conducted on sixteen patients identified to have perioral pressure ulcers by using the institutional risk management system. Data parameters included patient demographics (age, gender, comorbidities, smoking history and body mass index (BMI)). Data collection included the indication of admission to ITU, duration of intubation, types of medical devices utilised to secure the endotracheal tube, requirement of vasopressor agents and renal replacement therapy, presence of other associated ulcers, duration of proning and mortality. Results Sixteen patients developed different patterns of perioral pressure ulcers related to the use of two medical devices (Insight, AnchorFast). The mean age was 58.6 years. The average length of intubation was 18.8 days. Fourteen patients required proning, with an average duration of 5.2 days. Conclusions The two devices utilised to secure endotracheal tubes are associated with unique patterns of facial pressure ulcers. Measures should be taken to assess the skin regularly and avoid utilising devices that are associated with a high risk of facial pressure ulcers. Awareness and training should be provided to prevent such significant complication. Level of evidence: Level IV, risk/prognostic study.

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The project also illustrates how different organizations can work effectively together. Key principles identified from this project for effective collaborative working include: communication, common goals, shared expertise, pooled funding and close alignment with Government strategies for Health Reform.

Introduction Perineal defects are commonly encountered in an oncological setting although they may also present as a result of trauma and infection (eg following Fournier’s gangrene). Reconstruction of these poses functional as well as aesthetic challenges. Skin coverage and tissue volume may both be required in addition to anogenital preservation or reconstruction. General prerequisites of an adequate reconstruction of perineal defects include provision of skin cover, well vascularised tissue to fill the dead space (reducing fluid collection and infection), vulvovaginal reconstruction and no faecal or urinary contamination. Methods A literature search was performed using PubMed and MEDLINE®. The search terms included ‘perineal defects’, ‘perineal reconstruction’, ‘perforator flaps for perineum’, ‘vulval flaps’, ‘secondary healing of wound’ and ‘vacuum assisted closure’. Backward chaining of reference lists from retrieved papers was also used to expand the search. Findings Modern developments have led to an increased expectation in improved quality of life as the main goal of reconstruction, therefore necessitating surgery with less morbidity and early return to normal activity. Progress in microsurgical procedures has been the main recent advance in perineal reconstruction and, in future, refinements in perforator flap design and tissue engineering techniques will lead to even better reconstructions.

Modern developments have led to an increased expectation in improved quality of life as the main goal of reconstruction, therefore necessitating surgery with less morbidity and early return to normal activity. Progress in microsurgical procedures has been the main recent advance in perineal reconstruction and, in future, refinements in perforator flap design and tissue engineering techniques will lead to even better reconstructions.

The guidelines for body contouring reconstructive surgery present an evidence-based guide for management of redundant tissue after massive weight loss. A standardised referral pathway to ensure safe and equitable patient care on the National Health Service (NHS) throughout England is recommended. A database of all patients for research purposes is suggested.