Skin Edges Research Articles

Person-Specific Face Detection in a Scene with Optimum Composite Filtering and Colour-Shape Information

Face detection and recognition have wide applications in robot vision and intelligent surveillance. However, face identification at a distance is very challenging because long-distance images are often degraded by low resolution, blurring and noise. This paper introduces a person-specific face detection method that uses a nonlinear optimum composite filter and subsequent verification stages. The filter's optimum criterion minimizes the sum of the output energy generated by the input noise and the input image. The composite filter is trained with several training images under long-distance modelling. The candidate facial regions are provided by the filter's outputs of the input scene. False alarms are eliminated by subsequent testing stages, which comprise skin colour and edge mask filtering tests. In the experiments, images captured by a webcam and a CCTV camera are processed to show the effectiveness of the person-specific face detection system at a long distance.

The use of octyl cyanoacrylate (superglue) in hypospadias repair including its use as a fixator for urethral stents

BackgroundOctyl cyanoacrylate has been used for many years for simple skin closure, but its use in hypospadias repair and as a urethral stent fixator has not been previously reported. We report our experience. MethodA retrospective study was performed of all children undergoing hypospadias surgery from July 2007 to July 2011. Octyl cyanoacrylate was used for skin closure after placing a few sutures to align the skin edges. No other dressing was used. A urethral stent, if used, was glued to the penis and removed after one week. ResultsSeventy two procedures were performed on 37 patients. Eight distal hypospadias (22%) underwent single stage repair. Seventeen (46%) underwent staged repair for severe hypospadias, and twelve (32%) “hypospadiac cripples” underwent various salvage procedures.One patient (1/72) had partial dehiscence, and one stent dislodged. There were no wound infections. Four (4/25) tabularized urethroplasties developed a fistula (16%). ConclusionOctyl cyanoacrylate is easy to apply on difficult hypospadias contours. It forms a strong, waterproof adhesive bond which separates from epithelial surfaces in 7 to 10days and makes it an effective urethral stent fixator and an ideal dressing for hypospadias surgery.

Mild Electrical Pulse Current Stimulation Upregulates S100A4 and Promotes Cardiogenesis in MSC and Cardiac Myocytes Coculture Monolayer

Parietal endoderm-secreted S100A4 promotes early cardiomyogenesis in embryoid bodies [1]. After an acute ischemic event, S100A4 protein appears in cardiac myocytes only in the border zone in rat and human hearts [2]. In wound research, a large outward current of 4 μA/cm(2) was always measured at the wound edges of rat cornea and human skin [3]. We hypothesize that a special electrical circumstance at the border zone may contribute to the phenomenon. An electric stimulation system was designed to give the cells electric pulse current stimulation (EPCS), the feature of the signal is pulse polarity altered one after another, rectangular 2 ms, 2 Hz, 40 μA. This intensity of stimulation is proved to be safe to cardiac myocytes (both in structure and beating behavior compared with the cardiac myocytes which do not receive stimulation) and MSCs (in cell vitality, proliferation, cell cycle, and gap junction generation potential) through our previous work. Canine MSCs are capable of generating voltage-sensitive Ca(2+) channel and Na(+) channels and generating the Ca(2+) handling system during differentiation. We found that CD44 was reduced in the MSCs monolayer treated with EPCS, compared with non-stimulated MSCs; and EPCS MSCs (3 h/day, 6 h/day, 5 days) showed an 14.04 ± 3.44 and 14.55 ± 3.97 % reduction in CD44, compared with the cotemporary MSCs; these reveal that CD44 reduction amplitude is not correlated with time for EPCS disposure and CD29 (integrin β1) expression is not affected by EPCS exposure. EPCS was given to the MSCs and cardiac myocytes coculture monolayer (ratio 3:1) for different time (1, 3, and 6 h/day) for 4 days to see the biological effects. Gap junction protein and troponin T show an increase after EPCS. We found that the gap junction protein Cx43 increased with treating time-in the EPCS group, it exhibited 1.5 and 1.7 fold in the 3 h/day group and 6 h/day group (P < 0.01), and troponin T exhibited to about 3.6 and 4.4 fold in the 3 h/day group (P < 0.01) and 6 h/day group (P < 0.05). Since coculture was used as stimuli, immunofluorescence was used to visualize the changes during EPCS for the purpose of elucidating the impact of EPCS on cardiac myocytes and MSCs. We found that after 5 days exposure, EPCS can enhance the expression of S100A4, which is 2.33 fold in cardiac myocytes (P < 0.01) and 1.99 fold in MSCs (P < 0.01) in gray value. A significant increasing expression of the myocyte enhancer factor (MEF) and GATA4 is detected in neonatal rat cardiac myocytes (P < 0.01) compared with cotemporary coculture monolayer in the control group. Also, EPCS can trigger the assembly of MEF2c in the nuclei. In addition, more cardiac myocytes were found to have two nuclei. But MSCs fail to active MEF2C transcriptional factor like that in cardiac myocytes after EPCS exposure. The elevation of MEF2 in both cytoplasm and nuclei of cardiac myocytes can always make a clear distinction of the cardiac myocytes and MSCs in coculture. Some factors show strong upregulation tendency with EPCS in both cardiac myocytes and MSCs-these include the troponin T (P < 0.01) and Cx43 (P < 0.05) in cardiac myocytes, and troponin T (P < 0.01) and Cx43 (P < 0.01) in MSCs. Collagen I expression is not affected with EPCS. In conclusion, mild EPCS can upregulate the secretion of S100A4 in both cardiac myocytes and MSCs, which is a factor supporting the cardiomyogenesis and angiogenesis; it further triggers the development of neonatal rat cardiac myocytes through upregulation of MEF2C and GATA4, the number of cardiac myocytes with two nuclei increases with EPCS, but this phenomenon does not appear in MSCs. Despite this, Cx43 and troponin T in both cardiac myocytes and MSCs are very sensitive to EPCS. EPCS can act as an effective and multi-targeted physical intervention method in cardiomyogenesis.

A simple suturing technique to close arthroscopy portal wounds

We describe a simple and quick suturing technique that can be used to close arthroscopy portal wounds, resulting in excellent cosmetic appearance. A single suture is seamlessly run in the shape of a ‘figure of eight’ (Fig 1) to give neat apposition of the skin edges. Commonly used, single interrupted sutures result in a ‘dumbbell’ appearance of the wound while the mattress suture may cause rolling of the wound edges. We have found that this technique gives excellent cosmetic results with no wound complications. Figure 1 The figure-of-eight suture

Minimally Invasive Inguinal Lymphadenectomy via Endoscopic Groin Dissection: Comprehensive Assessment of Immediate and Long-Term Complications

Open inguinal lymphadenectomy has been associated with significant postoperative morbidity. Recently, small series have demonstrated the feasibility and efficacy of endoscopic groin lymphadenectomy as an alternative to open surgery. Previously we reported the favorable results of our initial experience. Few reports of novel surgical methods include long-term complications. In this report we present a detailed analysis of immediate and long-term complications associated with the procedure using standardized complications reporting methodology including the Clavien classification. From September 2008 to December 2009, 29 patients underwent endoscopic groin dissection for inguinal lymphadenectomy. The indications for dissection were cutaneous malignancies of the genitourinary area and lower extremities. Endoscopic dissection was performed as previously published. Data were prospectively collected regarding patient demographics and minor/major complications during the perioperative period as well as long-term complications during 1 year. Complications were described using the Clavien classification as well as other complication profiles for open inguinal lymphadenectomy. Minor complications were defined as mild to moderate leg edema, seroma formation not requiring aspiration, minimal skin edge necrosis requiring no therapy and cellulitis managed with antibiotics. Major complications included death, sepsis, venous thromboembolism, re-exploration or other invasive procedures, severe leg edema interfering with ambulation, skin flap necrosis and rehospitalization. A total of 41 endoscopic groin dissections (12 single session bilateral) were performed in 29 patients. Patient characteristics were median body mass index 30 kg/m(2) (range 19 to 53, mean 31.1), median age 61 years (range 16 to 86), median Charlson comorbidity score 4 (range 1 to 11) and median length of stay 1 day (range 1 to 14). Median followup was 604 days (range 177 to 1,172, mean 634). There were no perioperative mortalities. A total of 11 (27%) minor and 6 (14.6%) major complications occurred. Complications from endoscopic minimally invasive lymphadenectomy have low clinical morbidity. Analysis of the immediate and long-term complication profile using standardized Clavien complications reporting reveals that this procedure is safe, even in patients with a high Charlson comorbidity score and body mass index. Major complications were most often infection requiring intravenous antibiotics.

Fetal Foot Length and Femur/ Foot Length Ratio: Significance in Nepalese Context

Aim: 1. To assess relationship between fetal foot length and gestation age and develop a nomogram. 2. To assess relationship between fetal foot length and femur length. Meterials and Method: Cross sectional study. Fetal foot length was taken from the skin edge overlying calcaneus to the distal end of the longest toe on either plantar or the sagittal view in 860 singleton pregnant women between 15 and 40 weeks’ gestation. Normal case was defined as normal sonographic findings during examination and normal infant examination at birth or both. Final study population constituted 779 healthy fetuses. The relationship between gestational age to foot length was analyzed by simple linear regression. Correlation of fetal foot length with gestational age and femur length were also obtained. Results: A nomogram for fetal foot length was obtained. There is linear relationship between foot length and gestational age [foot length (mm)=2.494xGestational age (weeks)-15.46] with significant correlation (r=0.970 and p=0.000) and between foot length and femur length [foot length(mm)=1.049xfemur length (mm)+0.648] with significant correlation (r=0.980 and P=0.000). Femur length/ Foot Length ratio was 0.9 and 1.0 in most of the cases. Conclusion: Nomogram was obtained for fetal foot length at various gestational ages in our population. There is linear relationship and good correlation between foot length and gestational age and foot length and femur length. Fetal foot length can be used as an alternative fetal parameter to assess gestational age. Femur length/ Foot Length ratio is fairly constant throughout gestation. DOI: http://dx.doi.org/10.3126/njr.v1i1.6317 Nepalese Journal of Radiology Vol.1(1): 15-22

Abstract 463: Dietary Nitrite Plays a Role in Wound Healing in Diabetic Mice

Intro: Diabetic wounds heal poorly leading to major morbidity, mortality, and financial cost. Nitric oxide (NO), produced in wounds by NO synthases (NOSs), is essential for normal wound healing and is reduced in diabetic wounds, contributing to poor healing. It is known that NO can also be regenerated from nitrite through xanthine oxidoreductase (XOR). Thus, we hypothesize that dietary nitrite may be an important source of NO in diabetic wound healing. Methods: Diabetic Db/Db mice were fed normal chow, nitrite depleted chow, or nitrite depleted chow with 1.5g/L nitrite supplemented water starting 1 week prior to wounding. Excisional wounds were created on each mouse and wound areas were measured every other day. Skin and wound samples from a separate group of Db/Db mice were obtained prior to and 5 days after wounding. Tissues were used for Western blots and XOR activity assay. Plasma was used for nitrite measurements. Results: Nitrite depletion lowered plasma nitrite by 50-60% vs mice on chow or on nitrite water. XOR was highly expressed in the skin, less so at the wound edge, and minimally in granulation tissue by Western. This was confirmed by XOR enzyme assay showing 5 fold more activity in the skin compared to the wound tissues. Wound healing was delayed in nitrite depleted mice as compared to the chow fed mice (Figure). Nitrite supplementation showed a trend in improved healing rates vs nitrite depleted mice. Conclusion: Diabetic skin and wound edge expresses XOR. Nitrite does contribute to wound healing in Db/Db mice. Dietary nitrite increased plasma nitrite levels and increased the wound healing rate. This suggests a potential therapeutic role for dietary nitrite in diabetic wound care.

Study on the relationship between the color of the lip-around skin and facial edge skin with the spleen-stomach symptoms

Objective To study the diagnostic significance of the gray degree of lip-around and facial edge skin on the spleen-stomach symptoms.Methods With the International ColorCheck,160 cases of facial digital images were got from physical examination groups.The gray degree of the upper and lower lip-around and facial edge skin were judged.Questionnaires of spleen-stomach symptoms were also collected from the people.Results Logistic results showed that the dark upper lip-around skin were closely related with dry mouth,stomach pain,etc; the dark lower lip-around skin were closely related with hiccups,etc; the dark facial edge skin were closely related with bloating- afternoon,bad-breath,vomiting,cool-stomach,the thick white fur and so on.Conclusion The gray degree of lip-around and facial edge skin implied the status of the spleen and stomach function,which could be used as diagnostic indicators for spleen and stomach symptoms. Key words: Complexion inspection; Symptoms of spleen and stomach; Color of the lip-around skin

Prone Accelerated Partial Breast Irradiation After Breast-Conserving Surgery: Compliance to the Dosimetry Requirements of RTOG-0413

The dosimetric results from our institution's trials of prone accelerated partial breast irradiation are compared with the dosimetric requirements of RTOG-0413. Trial 1 and Trial 2 are 2 consecutive trials of prone-accelerated partial breast irradiation. Eligible for both trials were stage I breast cancer patients with negative margins after breast-conserving surgery. The planning target tumor volume (PTV) was created by extending the surgical cavity 2.0 cm for Trial 1 and 1.5 cm for Trial 2, respectively. Contralateral breast, heart, lungs, and thyroid were contoured. Thirty Gray was delivered in five daily fractions of 6 Gy by a three-dimensional conformal radiation therapy technique in Trial 1 and were by image-guided radiation therapy/intensity-modulated radiation therapy in Trial 2. Dosimetric results from the trials are reported and compared with RTOG 0413 requirements. One hundred forty-six consecutive plans were analyzed: 67 left and 79 right breast cancers. The plans from the trials complied with the required>90% of prescribed dose covering 90% of PTV_EVAL (=generated from the PTV by cropping 0.5 cm from the skin edge and excluding the chest wall): V90% was 98.1±3.0% (with V100% and V95%, 89.4±12.8%, 96.4±5.1%, respectively). No significant difference between laterality was found (Student's t test). The dose constraints criteria of the RTOG-0413 protocol for ipsilateral and contralateral lung (V30<15% and Dmax<3%), heart (V5<40%), and thyroid (Dmax<3%) were satisfied because the plans showed an average V5% of 0.6% (range, 0-13.4) for heart, an average V30% of 0.6% (range, 0-9.1%) for ipsilateral lung, and <2% maximum dose to the thyroid. However, our partial breast irradiation plans demonstrated a higher dose to contralateral breast than that defined by RTOG constraints, with a median value of maximum doses of 4.1% (1.2 Gy), possibly as a result of contouring differences. Our technique for prone accelerated partial breast irradiation generally satisfied RTOG-0413 requirements.

Clinical case-study describing the use of skin-perichondrium-cartilage graft from the auricular concha to cover large defects of the nose

BackgroundThe composite graft from the conchal cartilage is a graft that is often used, especially in surgery on the nose, due to its capacity to resolve problems of cover and tissue deficit, arising from the removal of neoplasms or as the result of trauma, burns or following over-aggressive rhinoplasty. We have started to use skin-perichondrium-cartilage graft from the ear to cover large areas of the nose with very satisfying results as well as we describe in the reported clinical case.MethodsThe operation consisted of reconstruction of the cartilaginous nasal septum, which had previously been removed, using two vestibular labial mucosa flaps to reconstruct the mucosa, and cartilage from the ear conch for the cartilaginous septum. After this, the skin edges of the fistula were turned to recreate the inner lining of the nose and form a vascular base of wide area to accept the composite graft. The case concerns a female 74-year old patient who had undergone several oncological surgery for a relapsing basal cell carcinoma on the dorsum of the nose. The operation consisted of reconstruction of the cartilaginous nasal septum using two vestibular labial mucosa flaps to reconstruct the mucosa, and cartilage from the ear conch for the cartilaginous septum.ResultsThe perichondrial cutaneous graft has shown in this surgical case very favorable peculiarities that make it usable even in facial plastic surgery.ConclusionsWe believe that the positive experience that we achieved in the use of composite grafts for the reconstruction of large areas of the nose could be interesting for others surgeons.

Closure of skin lacerations under tension

We read the technical tip by Nawaz et al with interest. The approximation of skin in thin-skinned individuals is often difficult due to the natural contracture of thin skin coupled with local soft tissue swelling and the potential for suture ‘cut-out’. We have used a technique of applying wide Steri-Strip™ (3M, St Paul, MN, US) skin closures perpendicular to the wound edges to approximate the skin edge and subse-quently suturing through the Steri-Strip™.1 This technique has been particularly helpful for tibial lacerations with skin flaps and for the dorsum of the hand in patients with thin or poor quality skin. The use of Steri-Strip™ skin closures across and perpendicular to the wound reduces shear forces on the epidermis. The wounds can then be monitored in a ‘soft tissue/dressings’ clinic, with sutures removed after a period of time as outlined by the operating surgeon.

Pediatric sutureless circumcision without using skin closure adhesives: a new technique for poor setting.

INTRODUCTION ircumcision is one of the most common procedures performed worldwide. Neonatal circumcision is mostly done due to social, cultural, personal, and religious reasons.(1) cised.(2,3) World Health Organization has introduced medical male circumcision as a human (4) Nevertheless, inadequate funding and concerns about the safety of the surgical procedure, as well as diverse tance to circumcision. Many various methods can be used for circumcision, but the two commonly used are the sleeve technique and use of the Plastibell® device. With the sleeve technique, the skin edges are approximated by interrupted stitches using non-absorbable suture materials. The main disadvantage of this method is unsatisfactory cosmesis.(5,6) On the other hand, proximal migration of the Plastibell® ring, due to use of an inappropriate size, may occur causing serious penile injury.(7) For the skin closure in sleeve technique, the long chain derivatives of cyanoacr-

Use of a Silicone Penrose Drain to Protect Incised Skin Edges During Thyroid Surgery

Acceptable wound cosmesis is an important issue in thyroidectomy. We introduce a simple, economical and effective method of preventing traction and thermal damage to the incised skin edges during thyroidectomy.

Parietal Peritonectomy

Parietal peritonectomy is an initial part of cytoreductive surgery in patients with peritoneal surface malignancy. After this dissection, the necessary visceral resections, other peritonectomy procedures, and perioperative hyperthermic chemotherapy are administered. The parietal peritoneum is an immobile portion of the abdominal and pelvic surface area that is often involved by cancer implants in patients with carcinomatosis or peritoneal mesothelioma. The dependent peritoneal surfaces, such as the right retrohepatic space, paracolic sulcus, and pelvis, are involved as a result of gravitational forces. The undersurfaces of the diaphragm and omentums are involved because of major peritoneal fluid resorption at these anatomic sites. Before the parietal peritonectomy is initiated, a peritoneal window is created to digitally and visually inspect the undersurface of the anterior abdominal wall, small bowel, and small bowel mesentery. This inspection is frequently repeated so that parietal peritoneum is removed only where there is visible evidence of cancer implants. Electrosurgery is used as a dissection tool. The dissection proceeds in a centripetal fashion starting at the edges of the large midline abdominal incision and proceeding to the attachments of the peritoneum to the viscera. Initially, exposure is maintained with traction sutures from the skin edge to the fixed retractor. As the dissection deepens, a self-retaining retractor is positioned. Generally, the parietal peritonectomy takes approximately 2½h and does not require blood replacement. After the parietal peritonectomy, additional cytoreductive surgical procedures and then perioperative chemotherapy are performed.

Component Separations

Component separation is a technique used to provide adequate coverage for midline abdominal wall defects such as a large ventral hernia. This surgical technique is based on subcutaneous lateral dissection, fasciotomy lateral to the rectus abdominis muscle, and dissection on the plane between external and internal oblique muscles with medial advancement of the block that includes the rectus muscle and its fascia. This release allows for medial advancement of the fascia and closure of up to 20-cm wide defects in the midline area. Since its original description, components separation technique underwent multiple modifications with the ultimate goal to decrease the morbidity associated with the traditional procedure. The extensive subcutaneous lateral dissection had been associated with ischemia of the midline skin edges, wound dehiscence, infection, and seroma. Although the current trend is to proceed with minimally invasive component separation and to reinforce the fascia with mesh, the basic principles of the techniques as described by Ramirez et al in 1990 have not changed over the years. Surgeons who deal with the management of abdominal wall defects are highly encouraged to include this technique in their collection of treatment options.

The use of a silicon sheet for gradual wound closure after fasciotomy

We present a silicon sheet for temporary wound covering and gradual wound closure after open fasciotomy. Fasciotomy was performed in a total of 70 limbs with compartment syndrome (CS). The main etiology of CS was predominantly vascular. All patients were treated with a silicon sheet to cover the soft tissue defect and gradually reapproximate the skin margins. In 53% of the patients, a delayed final wound closure was achieved after a mean of 11.9 days. This method allows final closure of fasciotomy wounds without scar contractures, marginal necrosis, infection, or significant pain.

Autonomous Robot Control Using Facial Expressions

In this paper, a novel real time robot control system using human facial expressions is presented. The proposed system mainly consists of three modules: face detection, facial expression recognition and robot control. The first module aims to find the user's face from the image captured from a live video through a series of steps including skin color classification, edge detection and mathematical morphology, while the second module analyses the detected face to recognize the facial expressions like happiness, sadness, surprise, anger and neutral using Principal Component Analysis (PCA) and Euclidian distance calculation. Finally, the detected facial expressions are used as controlling commands for the robot. Experiments were conducted for respective modules. 150 images under different lightening conditions and complex background were employed. In the experiment on detecting the facial region, the rate of detection was 99.3% and on recognizing the facial expression, the recognition rate was 97.3%. The robot was then controlled autonomously with an accuracy of 100%. Combining the above three rates, the overall rate of success of our system was 97.3%.

A Study of Pinna Injuries and their Management

Background: Ear trauma is complex, as different harmful agents can affect different parts of the ear. The causative agents for ear trauma include mechanical and thermal factors, chemical injuries, and pressure changes. Since physicians who are not specially trained in otology often provide the initial care of ear injuries, proper recognition and treatment are critical to avoid possible complications, and to improve treatment outcomes. Objective: This study was conducted to examine the various types of pinna injuries that occurred as a result of mechanical trauma, their management and treatment outcome. Materials and Methods: In this prospective case series, Sixty consecutive cases of otological trauma were studied for a period of one year at Karnataka Institute of Medical Sciences, Hubli, Karnataka, India. Injuries to the pinna constituted 40% of these cases. All cases were managed under local anaesthesia by thorough irrigation, debridement and suturing of skin edges. Contour of pinna was maintained where necessary by applying stay sutures to cartilage or pressure dressing. Prophylactic antibiotics were given to prevent infection. Results: Complete healing without any deformity or occurrence of chondritis following appropriate surgical management took place in 66.7% of these cases. In 12.5% of cases, healing took place without deformity after occurrence of chondritis, while the same percentage of cases developed minor deformity following chondritis. Amputation of part or whole of pinna was seen in 8.33% of cases. Conclusion: Road traffic accidents were the commonest cause of otological injuries, followed by injuries due at assault and brawls. Auricle was the most often injured part of the ear. Meticulous and timely surgical management with efforts to maintain contour of pinna and prevention of infection helped minimise disfigurement.

P2-16-07: A Randomised Controlled Trial To Evaluate the Role of Tisseel, a Fibrin Sealant on Seroma Formation in Latissimus dorsi Breast Reconstruction.

Abstract Introduction: Donor site seromas are common complications following Latissimus dorsi breast reconstructions (LDBR), as shown in the UK National Mastectomy and Breast Reconstruction audit. Level I clinical evidence following the performance of an RCT supports ‘fixation’ of the back skin flaps by quilting sutures1. Fibrin sealants (Tisseel) have been postulated to reduce seromas after simple mastectomy and axillary dissections2, but their role in reducing donor site seromas after breast reconstruction has yet to be performed in a ‘robust’ clinical trial. The aim of this RCT was to compare Tisseel against Control (no Tisseel) on the incidence of seromas after LDBR. Methods: In an ethics approved single centre, single-blinded study comprising 2 surgeons from 2005–2010; 106 women were randomised to either Control (52) or Tisseel (54) interventions after immediate or delayed breast reconstructions. Sixteen patient's were excluded as follows due to incomplete data at 3 months or re-operations of the donor site for complications. The types of breast reconstructions comprised implant-assisted LD (LDI) in 45 women, 23 extended LD flaps (ELD) and 23 ELD with implant (ELDI). Immediate breast reconstructions (n=87) comprised the majority compared to only 4 delayed procedures. Intraoperative drains were placed to the breast, axilla and donor site (x two) as per standard practice. A 0.5% fibrinogen concentration was used in a hydraulic hand-held Tisseel spray application to the donor site chest wall over 60 seconds. Two stay sutures were pre-placed 2 cm adjacent to the donor wound skin edges above and below prior to the Tisseel application. In the control group, 2 drains only were placed. The primary outcome measure was the total seroma volumes from all the sites over 3 months. This was used for the power calculation of the sample size and showed a requirement for a minimum of 95 women. Secondary outcomes included the volumes of the donor site seromas, and the frequency of post-drain removal donor site aspirations of all symptomatic seromas by patient self-report. Results: The effect of Tisseel glue was to reduce the mean total drain (breast, axilla and back) volume from 2170ml to 1919ml (P=0.05, Mann-Whitney) within 7–10 days. The donor site seroma volumes were similar between the 2 groups over 3 months. The mean donor site total drain volumes (LD donor site drain volume and symptomatic donor site aspirations) were 5412ml in the Control group (840-6252), compared to the Tisseel group producing 4646ml (5384-738). There were no statistical differences between the frequencies or volumes of patient reported seromas aspirated post-drain removal between the two groups. This comprised a mean of 4 aspirations (range 0–13) in the Control group compared to a mean of 9 aspirations (range 0–11) after the use of Tisseel (P=0.548). Conclusion: Tisseel glue may reduce the ‘early’ effect of seroma development, but has not shown any significant role in minimising the potential ‘shearing’ of the donor site skin flaps causing later seroma formation. Current evidence recommends quilting sutures as the gold-standard in reducing this complication. 1. Daltrey I et. al. BJS 2006; 93(7):825–830. 2. Jain PK et. al. BJS 2004; 91:54–60. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-16-07.

Ultraviolet-Fluorescent Tattoo Location of Cutaneous Biopsy Site

Cutaneous biopsies often heal with little or no scarring. Prior studies have shown an alarming percentage of patients who incorrectly identify biopsy sites at the time of surgery. To investigate the safety and utility of an ultraviolet (UV)-fluorescent tattoo for biopsy site identification. A preclinical proof of concept was established with skin culture. An UV-fluorescent tattoo was applied to discarded neonatal foreskin in culture medium. The stability of the tattooed skin was examined clinically and histologically. One patient with a recurrent basal cell carcinoma in a difficult-to-identify location underwent tattoo application at the time of biopsy to demarcate the site. The patient was monitored for tattoo reaction and referred for surgical excision. The cultured tissue exhibited stable UV fluorescence with daily washing. Tissue histology demonstrated tattoo particles lining the skin edge under fluorescent microscopy. The patient was reluctant to undergo another surgical procedure and instead returned to our clinic at 3 months and 17 months after the biopsy for management of other tumors. The patient had no symptoms of allergic reaction to the tattoo dye. The fluorescent tattoo remains invisible under visible light and visible only under Wood's light. The present study documents the utility of an UV-fluorescent tattoo to locate a biopsy site.