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Cutaneous T-cell lymphomas (CTCLs) are malignancies of T cells that have a special affinity for the skin. We have previously reported that much of the T-cell receptor repertoire is altered in CTCL, and both malignant and nonmalignant clones are numerically expanded, presumably in response to T-cell trophic cytokines. We therefore examined levels of the T-cell trophic cytokines IL-2, IL-4, IL-7, IL-12, IL-13, and IL-15 in plasma in 93 CTCL patients and healthy controls. Only IL-7 levels were elevated in CTCL. We next looked at lesional skin from patients with CTCL and found elevated levels of IL-7 mRNA. Explant cultures of normal and lesional CTCL skin biopsies revealed significantly more IL-7 protein production in CTCL skin. Additionally, cultures of CTCL skin released greater numbers of T cells than normal skin; this was blocked by the addition of an IL-7 neutralizing antibody. Finally, these cultures induced proliferation of normal peripheral skin-homing T cells that were added to the cultures. These observations led us to postulate that IL-7 produced by skin cells contributes to the survival and proliferation of T cells within skin lesions and is likely the source of elevated circulating IL-7 in CTCL.

Oral-antral-nasal fistula (OAN) is a commonly encountered clinical problem. The literature is filled with a plethora of methods described for closing a persistent OAN. Local flaps are available to close minor to moderate defects, however, large fistulae can be a very challenging reconstructive problem. Various areas of the oral cavity have been used for closure of OAN. We describe a technique to reconstruct the oral cavity, in this case an OAN. The anteriorly based buccinator myomuosal island pedicle flap (BMIP) provides an alternative method for reconstructing the oral cavity. An extensive review of the literature as well as the anatomy of the buccinator, its reconstructive capabilities, and two case reports are included.

Previous descriptions of the blood supply of the neck have been contradictory. Neck dissections were performed on 17 adult cadavers after perfusion with radio-opaque microfil silicone rubber compound. In four cadavers cervical incisions were created and flaps elevated prior to perfusion to help demonstrate vascular pathways. In all cadavers myocutaneous perforators were seen passing from the sternocleidomastoid, strap muscles, and trapezius to supply the dermal-subdermal plexus. Also, there were consistently identifiable branches of the superior thyroid, posterior auricular, occipital, facial and transverse cervical arteries, which supply both the platysmal vascular plexus and the overlying dermal-subdermal plexus. The dermal-subdermal plexus is continuous across the midline and this contralateral pathway is supplied chiefly from branches of the superior thyroid artery, facial artery, and myocutaneous perforators of the strap muscles. This information may be useful in the planning of cervical incisions and the design of platysma myocutaneous flaps.