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INTRODUCTION
The
commonest malignancy in females across the world is breast cancer.1
For reasons of lack of screening programmes, ignorance, poverty, superstition,
inimical cultural practices and stigma, late presentation of this disease is
rampant in several parts of the developing world.2,3,4
Tumour
ulceration and fungation may ultimately compel the otherwise reluctant patient
to seek medical attention as last resort. Surgical treatment in the form of
toilet mastectomy offers the best form of palliation for these offensive,
infected, putrid, unsightly and sometimes bleeding lesions.5
The
manual aspect of handling these fungating growths intraoperatively is
challenging to the surgeon as the lesion could bleed excessively and/or
fragment with an escalated risk for surgical site infection. Therefore it is
expedient to devise a reliable barrier which would securely isolate and conceal
the ulcerated tumour surface intraoperatively so as to mitigate the peculiar
challenges encountered by the surgeon as well as optimize the outcome of a
palliative resection.
METHODOLOGY
A retrospective
study of 7 consecutive histologically confirmed cases of fungating breast
cancer who underwent palliative mastectomy at a mission hospital
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over a three-year
period (August 2015 – July 2018).
Relevant
information obtained included biodata, duration of symptoms prior to
presentation, reason for late presentation, side affected and the clinical
stage of the disease. The laboratory and radiological investigations of
interest were the tumour histology, full blood count, blood grouping and
cross-matching, retroviral screen, wound swab culture and sensitivity, fasting
blood sugar, plain chest X-ray and abdominal ultrasound scan.
The
anaemic patients were transfused to a PCV of ≥ 30% before surgery. Further two units of blood were
provided and reserved for each patient to cover for the operation. Preoperative
antibiotics were commenced in all patients according to the culture sensitivity
report.
Intraoperatively,
routine skin preparation and draping were performed under general anaesthesia.
Thereafter, the fungating tumour was enclosed within a stretched sterile
elbow-length (gynaecological) latex glove to create what we termed
“glove-shield” which completely concealed and contained the ulcerated surface
(Figs. 1, 2, 3, 4).
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