A triangular advancement technique to avoid the dog-ear deformity following mastectomy in large breasted women

Abstract

Figure 1 The incision is modified to excise an additional triangle of skin that lies inferior to the area of redundant tissue. DISCuSSION The surgical treatment for a fixed PIPJ deformity by joint fusion is established practice. Other procedures include diaphysectomy, partial proximal phalangectomy and amputation.1 The technique, first described by Taylor in 1940,2 is still used today. One of the key disadvantages of this procedure is that it requires the use of a K-wire, which brings with it risks of infection, wire breakage (up to 18%) and vascular insufficiency.1,3 There is also patient dissatisfaction with the presence of percutaneous wires and their removal. The ‘Oxford’ procedure was developed to remove the need for K-wire fixation and to maintain some mobility at the interphalangeal joint. This operation has been used by the senior author (PHC) for over 15 years with good results. In a study of patients ten years following the Oxford procedure, all were satisfied in terms of pain relief and cosmesis.4 Other surgeons in the UK have also adopted this technique. In a survey of 75 surgeons attending the British Orthopaedic Foot and Ankle Society annual meeting in 2010, 15% reported that they would perform an ‘Oxford’.