British Journal of Plastic Surgery (1991). 44.471472 0 1991 The Trustees of British Association of Plastic Surgeons

Letters to the Editor

Local anaesthetics in dental cartridges

Sir, Many plastic surgeons use the dental cartridge syringe system for injecting local anaesthetics. Most, however, have preferred a weaker concentration than the 2% lignocaine with 1 in 80 000 adrenaline which is the standard dental preparation. 0.5% lignocaine with 1 in 200 000 adrenaline has been used for many years, but production of cartridges containing this concentration ceased recently, and most units’ supplies ran out during 1990.

In the past few years several individuals have gathered information about the demand amongst plastic surgeons for this product, in the hope that the resulting information would stimulate its reinstatement. Most recently we carried out a survey in mid 1990.

Simple questionnaires were sent to 135 consultant Plastic Surgeons in the UK and Ireland; replies were received from 116, an 86% return.

Of these, 70% said that they currently used local anaesthetics in dental cartridges. 84 (72%) said that they would be interested in obtaining furthersuppliesof cartridges containing 0.5% lignocaine with 1 in 200 000 adrenaline; 72 gave estimates of the numbers of cartridges they might need annually-these totalled over 92 000.57 (49%) said that they had tried the alternative prefilled glass syringes containing this concentration, but only four said that they found these satisfactory.

The position currently is that lignocaine with “dilute” adrenaline is not available in dental cartridges. Although the demand demonstrated by this survey is considerable, it is not enough to persuade any manufacturer to produce this item within Britain. It could, however, almost certainly be obtained in batches from manufacturers in Europe or Scandinavia. This would require permission from the Ministry of Health for “special” importation. This is not an uncommon procedure, but the MoH would need to be convinced of the demand by direct representations from senior surgeons or their representatives.

In the meantime, dental cartridges are available contain- ing plain 2% lignocaine, and 2% lignocaine with 1 in 80 000 adrenaline. 0.5% lignocaine with 1 in 200 000 adrenaline is available in 20 ml multidose vials, and in prefilled 5 ml glass and plastic syringes. Although these latter were felt to be unsatisfactory by many of our respondents, they are supplied with a slim flexible needle very similar to that used in the dental cartridge system. Worries were expressed by some respondents about the risk of the glass plunger of this type of syringe breaking and injuring the operator; in response to this the manufacturer is producing a batch with the end covered by a protective plastic cap-which will have the additional advantage of permitting aspiration prior to injection-which has always been a disadvantage of the dental cartridge system.

Yours faithfully, Peter Riley FRCS Anthony H N Roberts FRCS Dept. of Plastic Surgery, Dept. of Plastic Surgery, Whiston Hospital, Stoke Mandeville Hospital, Prescot, Merseyside. Aylesbury.

Removal of unwanted tattoos

Sir, The problem of unwanted tattoos is on the increase. Due to constraints of finances and heavy work load most units have found it necessary to halt all new referrals. Unfortunately the patients’ regrets are never considered.

Fifty six patients who have been on the waiting list for over ten years for removal of tattoos of their hands and forearm were considered for this study. These were all amateur tattoos, inflicted at the age of thirteen to sixteen. All patients were treated under local anaesthesia as out- patients.

All patients regretted their tattoos. Fifty one patients (91%) admitted smoking before the age of sixteen. Twelve patients (21%) tried to remove their own tattoos using oven pads and required hospital treatment. Sixteen patients (28.5%) were refused jobs in checkouts of department stores. Twenty two patients (39%) felt that they were discriminated against in hospitals as they were questioned about past history of hepatitis. Twenty patients (35.7%) had been refused entry to night clubs at least once in the past. Six patients were under care of psychiatrists for depression; this included two patients who had a history of drug overdose. Forty patients said their partners had tattoos.

All our patients regretted their misfortune and admitted that they had been tattooed due to their immature mental state at the time, and all patients were happy to accept a scar immaterial of the quality. Although various methods for removal of tattoos have been described, removal of amateur and professional tattoos can be a time-consuming and costly undertaking. More should be done to educate the young population in order to prevent these regrets in later life.

Yours faithfully, C. Balakrishnan, FRCS, FRCSI, Locum Consultant.

R. Papini, FRCS, Rotating Registrar, Dept. of Plastic Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP.

A modified needleholder for microsurgery-reply

Sir, This is in reply to the points raised by Dr. Vickers in response to my paper ‘A modified needle holder for microsurgery’.

Since papers presented at conferences are not accessible through indexed literature searches, I was unaware of a similar design having been described by Vickers in 1978.

However, Vickers (1988) seems to find no advantage in the paraxial design because ‘lateral displacement of the axis of the jaws will produce a circular motion of the needle

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