Tattoos: a lasting regret.

occurred shortly after a femur of a 12 year old achondroplastic dwarfwas shortened by 2 cm. Multiple fat emboli were shown at necropsy.3 Certain features peculiar to our case contributed to the outcome. The patient had undergone previous operations to release his hip contractures which had resulted in dense fibrous thickening of the posterior capsule. Thus closed manipulation rather than surgical release was performed. The patient's immobility had made the femurs osteoporotic. This combination of osteoporosis and dense fibrous thickening predisposed the femoral neck to fracture after manipulation. The dense fibrous tissue around the joint capsule would have prevented the escape of the bone marrow, which was thus forced under pressure into the venous system. This hypothesis is supported by the necropsy finding of extruded marrow from the left hip capsule. The treatments that have been suggested for the fat embolism syndrome include heparin, steroids, aprotinin, dextran 40, and alcohol. None would have been likely to have influenced events in this case, in which the problem was obstruction of the pulmonary vascular bed rather than tissue damage from free fatty acids or platelet lysis. Anaesthetists and orthopaedic surgeons should be aware of this rare but potentially fatal complication of closed joint manipulation, particularly in patients with osteoporosis. We thank Mr J F Taylor for permission to report details of his patient. In 1969 it became illegal to tattoo people under 18 years old professionally.' To investigate whether this legislation had been enforced we conducted a survey of tattooed patients attending a plastic surgery outpatient clinic during 1986-9. We also looked at the efficacy of trichloroacetic acid for removing tattoos.2 Patients, methods, and results We interviewed 95 new patients presenting with tattoos at the plastic surgery outpatient clinic. We asked them how they had received their tattoos, how old they had been at the time, and why they wanted them removed. Most were aged 15-34. Twenty nine were men and 66 women, and they had a total of 104 tattoos. Women were more likely to have amateur tattoos than men. The most vulnerable age for obtaining both amateur and professional tattoos was under 18 (table). Forty three women and 14 men had had amateur tattoos done under the age of 18. Seventeen women and 13 men had had professional tattoos done while under 18. The reasons given for wanting the tattoos removed were cosmetic (68 patients), change of job (16), and …