Letters to the Editor
Polyurethane
foam covered
prostheses
Sir. May I comment on the article by K. W. Dunn rr (I/. (B~Yrislr Jolrrr~~rlo/‘P/tr.stic, .Surgc~r~,. 45. 3 15) in discussing polyurethane foam covcrcd prosthcscs. We have published two papers (I. 2) with a more than twenty year follow-up and the results conform to the shorter follow-up period of Hcstcr’s article (3). Our work. particularly with the MPme prostheses. shows a capsular contraction rate of less than 4 9’0 after a follow-up of at least six years postaugmentation. I tirmly believe from my clinical studies and meticulous follow-up that polyurethane foam prostheses give the best clinical results and patient satisfaction. and that in my series there is no evidence of auto-immune disease or arthritic complications. In a series of over 300 cases the incidence of carcinoma of the breast was less than I ?/o. The claim in the paper by Dunn or trl. that pcri-implant capsular contraction has been largely overcome by rough textured silicone implants is fallacious. as the number of follow-ups is small and the period of follow-up is generally less than four years. Yours faithfully. Benjamin FRACS
C. Cohney
FRCS
IEd],
FRCS
IEng], FACTS,
WC would like to mahc several points about the above paper and in particular relating to our own published work on this subject. Hamilton and Proudman hake dcmonstratcd the appropriatc application of a radial forearm Hap based on ;I proximal pcdicle and incorporating z portion of the Rcxor carpi radialis muscle for the elTccti\e management of ;I difficult elbow wound. They appear to bc unaware. howcvcr. that this prccisc modification of the radial forearm Hap was previously described in this unit (Small and Millar. 19Xx). Furthermore. they rccognise in their paper the patcntial for this nlusculocutaneous flap to bc used as ;L free flap; we have also published a clinical description of this technique (Gordon and Small. 1992). This paper in fact L\;IS submitted elsewhere in I989 but was rejected. and at the time the referee stated : I. That deep fascia is a vxcular as muscle and that therefore a myocutaneous flap holds no advantage o\cr ;I fasciocutancous flap. flaps can easily be made to 2. That free fasciocutaneous conform to irregular surfaces or cavities making the use of muscle unnecessary. Hamilton and Proudman appear to take the opposite stance on both counts and WC uelcomc the fxt that their views, which are similar to our own in thcsc aspects. have been published in the journal. Yours faithfully.
Consultant Plastic Surpcon 27 Outram Street West Perth. 6005 Western Australia
Derek Gordon, FRCSI,
FRCSEd.
Registrar. James Small, FRCSI,
Consultant.
References
Roy Millar.
BSc, FRCSEd,
Consultant. The Ulster. North Down & Ards Hospitals Unit The Ulster Hospital Dundonald Belfast BTl6 ORH 3
Hester, T. K.. Nahai, F., Bostwick, J. and Cukic. J. ( 1’3%).A Iivcyear experience with polyurethane covered mammary prostheses for treatment of capsular contracture. primarq augmentation and breast reconstruction. Cluric.~ irf P/tr.\fic,Swyw,r. IS. MY.
Flexor
carpi radialis
myocutaneous
flap
Sir. Re: R. B. Hamilton & T. W. Proudman (1992). The Radial Forearm Flap ~ Flexor Cat-pi Radialis Myocutaneous Flap:
Polyurethane
foam covered
prostheses
Sir. May I comment on the article by K. W. Dunn rr (I/. (B~Yrislr Jolrrr~~rlo/‘P/tr.stic, .Surgc~r~,. 45. 3 15) in discussing polyurethane foam covcrcd prosthcscs. We have published two papers (I. 2) with a more than twenty year follow-up and the results conform to the shorter follow-up period of Hcstcr’s article (3). Our work. particularly with the MPme prostheses. shows a capsular contraction rate of less than 4 9’0 after a follow-up of at least six years postaugmentation. I tirmly believe from my clinical studies and meticulous follow-up that polyurethane foam prostheses give the best clinical results and patient satisfaction. and that in my series there is no evidence of auto-immune disease or arthritic complications. In a series of over 300 cases the incidence of carcinoma of the breast was less than I ?/o. The claim in the paper by Dunn or trl. that pcri-implant capsular contraction has been largely overcome by rough textured silicone implants is fallacious. as the number of follow-ups is small and the period of follow-up is generally less than four years. Yours faithfully. Benjamin FRACS
C. Cohney
FRCS
IEd],
FRCS
IEng], FACTS,
WC would like to mahc several points about the above paper and in particular relating to our own published work on this subject. Hamilton and Proudman hake dcmonstratcd the appropriatc application of a radial forearm Hap based on ;I proximal pcdicle and incorporating z portion of the Rcxor carpi radialis muscle for the elTccti\e management of ;I difficult elbow wound. They appear to bc unaware. howcvcr. that this prccisc modification of the radial forearm Hap was previously described in this unit (Small and Millar. 19Xx). Furthermore. they rccognise in their paper the patcntial for this nlusculocutaneous flap to bc used as ;L free flap; we have also published a clinical description of this technique (Gordon and Small. 1992). This paper in fact L\;IS submitted elsewhere in I989 but was rejected. and at the time the referee stated : I. That deep fascia is a vxcular as muscle and that therefore a myocutaneous flap holds no advantage o\cr ;I fasciocutancous flap. flaps can easily be made to 2. That free fasciocutaneous conform to irregular surfaces or cavities making the use of muscle unnecessary. Hamilton and Proudman appear to take the opposite stance on both counts and WC uelcomc the fxt that their views, which are similar to our own in thcsc aspects. have been published in the journal. Yours faithfully.
Consultant Plastic Surpcon 27 Outram Street West Perth. 6005 Western Australia
Derek Gordon, FRCSI,
FRCSEd.
Registrar. James Small, FRCSI,
Consultant.
References
Roy Millar.
BSc, FRCSEd,
Consultant. The Ulster. North Down & Ards Hospitals Unit The Ulster Hospital Dundonald Belfast BTl6 ORH 3
Hester, T. K.. Nahai, F., Bostwick, J. and Cukic. J. ( 1’3%).A Iivcyear experience with polyurethane covered mammary prostheses for treatment of capsular contracture. primarq augmentation and breast reconstruction. Cluric.~ irf P/tr.\fic,Swyw,r. IS. MY.
Flexor
carpi radialis
myocutaneous
flap
Sir. Re: R. B. Hamilton & T. W. Proudman (1992). The Radial Forearm Flap ~ Flexor Cat-pi Radialis Myocutaneous Flap:
