Tropical Medicine & Surgery

Abstract

The Use of a Wound Protector as a Self Retaining Skin Retractor for Skin Sparing Mastectomy and Immediate Reconstruction

Chaturvedi S and Ramsay G

 Introduction: The skin sparing mastectomy allows appropriate skin closure for immediate reconstruction without threatening the oncological intent of the operation. Obtaining access to the peripheral aspects of the breast through a circum-areolar or a small incision can be difficult. Conventional retraction with metallic retractors leads to extensive point pressure on the skin flaps leading potentially to skin necrosis. Flexible Ring wound protectors are now commonplace in abdominal procedures. Here, we describe the use of the Alexis® wound retractor (Applied Medical, USA) in skin sparing mastectomies. Methodology and technique: The incision is a limited elliptical incision including the nipple-areolar complex. Skin flaps are raised circumferentially to approximately 3 cm all round and the internal ring of the medium sized Alexis® wound retractor (2.5 to 6 cm) is placed within the wound. The external component of the device is rolled inward until sufficient retraction is obtained. The dissection plane is easily visualised through the circumferential retraction obtained from the wound retractor with little additional conventional retraction and the skin sparing mastectomy is undertaken. We have also found this product helpful in axillary dissection placing small (2.5 cm) retractor with in the medium one. Discussion: We have used Alexis® retractor (Figure 1) in 30 skin sparing mastectomies and 16 axillary dissections. We have found this to be particularly useful as a retractor as the dissection plane is easily visualised. The device also provides wound protection from potential infective processes in an environment where prosthetic material is likely to be placed. The circumferential retraction allows appropriate exposure in both the breast and axilla without compromising blood supply of skin flap.