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Background Few studies have examined persistent pain after reduction mammaplasty, and sensory changes remain a controversial subject with studies reporting both reduced, improved, and unchanged skin sensitivity following surgery. The aim of the present study was to describe the prevalence, character, and impact of sensory changes and persistent pain following breast reduction surgery and to assess possible causes and predictors of persistent sensory changes and chronic pain. Methods In May 2010, a detailed questionnaire was mailed to all 109 patients who underwent reduction mammaplasty at the Department of Plastic Surgery, Aalborg Hospital from September 2004 to February 2010. Ninety patients (83%) returned the questionnaire; mean age was 48.7 years (SD 14.7); and mean time since surgery was 27.7 months. Results Eight patients reported that they had sensory abnormalities in the breasts before surgery, which normalized or improved in four, remained unchanged in one, and worsened in three patients following surgery. Forty-nine patients (54%) reported sensory changes in the nipple–areola complex or skin as a consequence of surgery. Sixty-nine patients reported having pain before surgery (most often in the neck/back), which was completely relieved in 42% and partially in 43%. Twenty-five patients (28%) reported having pain in the breasts as a consequence of the operation: 20% had chronic pain (defined as constant pain or pain at least once weekly for at least 3 months) and 7% had moderate to severe pain. In more than half of the patients, the pain was compatible with neuropathic pain. Patients with pain tended to be less satisfied with the surgery than those without pain (p = 0.07, Mann–Whitney U test). Young age, time since surgery, complications to surgery and sensory abnormalities before surgery were significantly related to pain. Conclusion Reduction mammaplasty relieved neck and back pain in most patients, but the surgery is associated with a risk of developing new sensory abnormalities and persistent neuropatic pain. Implications The clinical implication of this study is that reduction mammaplasty may sooth preexisting neck- and back pain, but may lead to a new condition in the patient with chronic sensory changes and pain in the breasts.

We present a clinical comparison of short stretch bandage versus a two-layer compression bandage and early mobilization after split skin grafting to lower leg defects. A total of 38 patients were included. The first group were immobilized for four days and given a short stretch support bandage. Group 2 were mobilized one day after the operation with a two-layer compression bandage (Pro-Guide). There was no difference in healing or frequency of complications. The patients treated with Pro-Guide had significantly fewer admission days and out-patient consultations. Larger randomized trials are warranted.

Chronic pain is a well-known complication after surgery, but the prevalence of persistent pain after melanoma surgery is unknown. This study examined the prevalence and predictors of persistent pain after melanoma surgery.Between September 2005 and June 2009, 448 patients underwent surgery for cutaneous melanoma at the Department of Plastic Surgery, Aalborg Hospital. A questionnaire was sent to all 402 survivors, and 350 (87.1%) responded. In addition, all patients with pain and a control group of sex-matched and age-matched patients without pain were invited to a clinical examination.Thirty-four patients (9.7%) reported pain in the scar area within the last month, and 8.6% reported chronic pain. The pain was mostly mild with little impact on daily life, but 1.7% reported moderate to severe pain, and 3.4% reported at least moderate impact of pain on daily life. Sensory changes were reported by 108 patients (31.5%); 25% of these had pain compared with 3% of patients with normal sensation [P0.001, 10.8 (4.5 to 25.8)]. Young age was a predictor for persistent pain. A small group of patients (10 with and 22 without pain in the questionnaire) were clinically examined, suggesting that the areas of sensory disturbances were larger in patients reporting persistent pain or dysesthesia.The results support previous findings that persistent postoperative pain is a complication of almost any surgical intervention. Persistent pain was related to abnormal sensation, and neuropathic pain should be considered in these patients.

Malignant mucosal melanomas are rare and aggressive. The five-year survival rate for malignant oral melanomas is 15%. A case of a 65-year old male with progressive melanosis in the oral mucus and development of four malignant melanomas during a 15-year follow-up period is presented. The patient was treated non-radically. Radical surgical excision of the melanotic area would have included partial mandibulectomy and maxillectomy followed by massive reconstruction and was thus not an option. The patient has been followed closely during the follow-up period and invasive components have been excised followed by local reconstruction. The patient remains without signs of metastatic disease.

Malignant mucosal melanomas are rare and aggressive. The five-year survival rate for malignant oral melanomas is 15%. A case of a 65-year old male with progressive melanosis in the oral mucus and development of four malignant melanomas during a 15-year follow-up period is presented. The patient was treated non-radically. Radical surgical excision of the melanotic area would have included partial mandibulectomy and maxillectomy followed by massive reconstruction and was thus not an option. The patient has been followed closely during the follow-up period and invasive components have been excised followed by local reconstruction. The patient remains without signs of metastatic disease.

Adult onset xanthogranuloma (AOX) is a rare benign xanthogranulomatous disease with unknown aetiology and incidence. AOX presents as yellow-brownish skin tumours of different sizes, mostly as solitary lesions, but also as multiple lesions with predilection areas on the face and collum. We here present the case of a 73-year-old woman, who was treated for third and fourth facial AOX recurrences by surgical excisions at the Department of Plastic Surgery, Aalborg Hospital. Due to the rare occurrence of AOX, a prospective evaluation of its treatment is hardly feasible. Oncological, dermatological and surgical treatment of AOX has been described in the literature.

Persistent postoperative pain is a common complication of surgery, including surgical interventions for cancer. So far, there is limited information about the prevalence and clinical characteristics of pain after lymph node biopsy and dissection in patients with malignant melanoma. In this study, a questionnaire was sent out to all surviving patients (n = 402) after surgery for cutaneous malignant melanoma at the Aalborg Hospital Department of Plastic Surgery, Aalborg, Denmark. Of patients responding, sentinel node biopsy (SNB) and/or lymph node dissection (LND) was performed in 175 patients. All patients with pain and a control group were invited to a clinical examination. Altered sensation and pain were significantly more common after LND (82% and 34%, respectively) than after SNB (32% and 14%, respectively). In patients with LND, 12% reported at least moderate pain and 14% impact of pain on quality of life, while in patients with SNB, 3% reported at least moderate pain and 2% pain impact on quality of life. The most important predictor of pain was sensory abnormalities. At the clinical follow-up, 10 out of 12 patients with pain both met the criteria of the recently proposed grading system for probable neuropathic pain and used descriptors on the DN4 questionnaire suggestive of neuropathic pain. Different patterns of sensory profiles were observed in single patients, suggesting heterogeneous sensory processing within single patients. This study suggested that nerve injury was the main underlying mechanism of persistent pain after lymph node excision.

Background Persistent postsurgical pain has been reported following cosmetic breast augmentation, but little is known about the underlying mechanisms. Aims To describe the prevalence, character, and impact of sensory changes and chronic pain following cosmetic breast augmentation and to assess possible causes of pain. Methods In September 2009, a detailed questionnaire was mailed to all 142 patients who underwent cosmetic breast augmentation at Viborg Private Hospital from 2004 to 2009. Results Ninety-five patients (66.9%) returned the questionnaire; mean age was 34.2 years (SD 9.3). All patients were operated by the same surgeon. Mean time since operation was 31.8 months. Forty-two patients (44.2%) reported having pain as a consequence of the operation, 9.5% had moderate to severe pain, and 6.3% regretted the cosmetic surgery due to pain. Patients with pain were less satisfied with the surgery than those without pain. Seventy-two patients (75.8%) had sensory changes over the breast. There was an increased risk for developing pain in those with hypoesthesia (OR 4.6 (1.7–12.8)) and hyperesthesia (OR 2.6 (1.1–6.2)). Sixty-two percent had touch-evoked pain and 38% used pain descriptors that met the neuropathic pain diagnostic questionnaire (DN4) cut-off criteria for neuropathic pain. Conclusion Sensory changes and persistent pain are common following cosmetic breast augmentation and may have a negative impact on daily activities and satisfaction after surgery. Findings suggest that neuropathic pain should be considered in these patients. Preoperative information about the risk of developing sensory changes and chronic pain after breast augmentation is important.

Metallothionein (MT) belongs to a family of metal-binding cysteine-rich proteins comprising several structurally related proteins implicated in tissue protection and regeneration after injuries and functioning as antiapoptotic antioxidants in neurological disorders. This has been demonstrated in animals receiving MT treatment and in mice with endogenous MT overexpression or null mutation during various experimental models of neuropathology, and also in patients with Alzheimer's disease and amyotrophic lateral sclerosis. Exogenously applied MT increases neurite outgrowth and neuronal survival in rat cerebellar, hippocampal, dopaminergic, and cortical neurons in vitro. In this study, the intraneuronal signaling involved in MT-mediated neuritogenesis was examined. The MT-induced neurite outgrowth in cultures of cerebellar granule neurons was dependent on activation of a heterotrimeric G-protein-coupled pathway but not on protein tyrosine kinases or on receptor tyrosine kinases. Activation of phospholipase C was necessary for MT-induced neurite outgrowth, and furthermore it was shown that inhibition of several intracellular protein kinases, such as protein kinase A, protein kinase C, phosphatidylinositol 3-kinase, Ca2+/calmodulin kinase-II, and mitogen-activated protein kinase kinase, abrogated the MT-mediated neuritogenic response. In addition, exogenously applied MT resulted in a decrease in phosphorylation of intraneuronal kinases implicated in proinflammatory reactions and apoptotic cell death, such as glycogen synthase-serine kinase 3α, Jun, and signal transducer and activator of transcription 3. This paper elucidates the intraneuronal molecular signaling involved in neuroprotective effects of MT. © 2009 Wiley-Liss, Inc.