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Severe genitoperineal trauma with total avulsion of testicles in a 7-year-old boy resulted from a road accident. Soft tissues were reconstructed by local flaps and skin grafts. The only testicle that was found was reimplanted in his biceps muscle in an attempt to restore endocrine function. A human chorionic gonadotropin test showed no response, indicating that the transplanted tissue did not survive.

A newly formulated fast-drying iodophor (FDI) was applied topically to 54 surgical wounds in 41 patients, 80% of whom were over 60 years. The FDI dries completely within 2 min producing a strong non-tacky brownish film from which iodine is slowly released for about 48 h following application. No wound infection was observed in the present series nor was there any impairment of healing. A local rash was observed in one patient, and in four patients there was marked edema and hyperemia. In-vitro antimicrobial analysis indicates that this iodine preparation is significantly superior when compared to 5% chloramphenicol and 1%silver-sulfadiazine creams.

Summary The modern surgical approach of early excision of burns entails the need for immediate adequate coverage of the denuded areas. In severe and extensive burns, and in case of mass burns, there is a shortage of autografts or viable allografts, and the conventional dressings, using topical agents, are prone to allow contamination of the burn surface. A solution for these conditions is provided by the use of porcine xenografts, viable or frozen, or in form of lyophilized porcine skin as a biological dressing. Fifty-nine patients have been treated by early excision and early skin grafting, using lyophilized porcine skin as the primary skin cover prior to final autografting. The results, as shown in this series, demonstrate absence of mortality, low infection rate and short morbidity time.

Concentrations of iodine were assayed in burn patients, who were covered with Iodoplex ointment up to 30% of their body surface. The iodine levels in the serum were found to be in linear proportion to the area treated with an increase of 30 micrograms iodine per 100 ml of serum for 1% of TBSA. The maximal levels were reached within 24 hours of applying the Iodoplex ointment and decreased quickly following its discontinuation. Concentrations of the iodine were much lower than those found after treatment with povidone iodine, a fact which indicates that using Iodoplex in second-degree burns and donor sites entails fewer possible complications due to high levels of iodine in the serum than with povidone iodine.

Twenty-one patients with hemangiomas on the face and lip who were treated with injections of sclerosing agents are discussed. The mode of action of these drugs was also studied experimentally on rats, which were injected through the pampiniform plexus of the spermatic cord. In the clinical study all patients showed satisfactory resolution of the hemangiomas with commensurate improvement in their appearance. The experimental study provides an explanation for the replacement of blood vessels by young connective tissue.

A new type of fasciocutaneous flap, an "island fasciocutaneous flap", is presented. The anatomical basis of this flap and its advantages are discussed.

Presented are various modifications of the McKissock vertical bipedicle dermal flap technique for reduction mammoplasty, to enhance the cosmetic and functional results. Virtual elimination of vascular embarrassment of the nipple-areolar complex and largely unimpaired nipple sensation are features of this technique. Suited to this method are a wide variety of enlarged and ptotic breasts.

A clinicopathological study of 150 patients with primary malignant melanoma of the skin is presented. Information concerning the site, type, depth of invasion and thickness of the tumor is reported. The value of tumor thickness in assessing prognosis is emphasized.

The resurfacing of three severely degloved fingers, by a two stage cross arm flap operation, to maintain length and function is described.

Proximal and distal releasing incisions and skin grafting have been found to be useful as an alternative procedure to the standard transverse incision for dealing with flexion contractures of the popliteal region. In this region important structures underlying the deep fascia may readily be exposed when the deep fascia itself is involved in the scar process and is cut across during the release. Chronic ulcer formation in the centre of hypertrophic scar contracture is a fairly frequent accompanying feature. Proximal and distal release incisions help solve the problem by providing protection for the deep vessels, nerves and tendons, without jeopardising the take of a skin graft.

Following burns of the upper respiratory tract, laryngotracheal stenosis is associated with considerable morbidity. This paper deals with the cumulative effect of various pathologic processes involved in burn trauma of the upper airway. Emphasis is placed on the extended use of endotracheal intubation and the avoidance of tracheostomy whenever possible. When laryngotracheal stenosis develops, it may be safely and successfully treated by prolonged stenting, as has been borne out by our experience with the T-shaped silicone tubes. Limited reconstructive procedures can be performed to facilitate proper placement of the stent. In our opinion, laryngotracheal resection and reconstruction are not the procedures of choice in burn cases. Our experience in following the preceding guidelines is described. Three illustrative cases serve to exemplify the difficulties and problems involved in the various stages of treatment and the results obtained. The patients are symptom-free 18 to 24 months following stenting, and all enjoy an adequate airway and good voice. There were no complications resulting from this treatment and we suggest that it is worthy of trial.

Various modifications have been made in the original McKissock design for breast reduction. These include limited areola elevation, a short inframammary incision, a narrow-based inferior vertical dermal flap, and deep coring out of all the remaining breast parenchyma. Reliance is placed on some sponotaneous skin shrinkage over the upper half of the breast following excision of breast tissue in depth. Consistently satisfactory results have attended routine use of this method-equally so when employed by surgeons in training.

A set for wetting burned limbs with bactericidal solutions, using an occlusive dressing, is described. The set is made of polyethylene porous tubing, wound spirally around the burned area, and is connected to a reservoir by a standard infusion set. The spreading of the solution on the burned area is very uniform and therefore controls infection efficiently. The set requires the minimum of attention from the medical staff. It has been used on burned patients with satisfactory results and is now a standard procedure. This paper deals specifically with the technological and physical aspects of the system, and presents a mathematical model for the flow through porous tubing.

Fifty-eight patients with keloid scars were subjected to combined cryosurgery and intralesional corticosteroid therapy. Complete regression of the scars occurred in 41 patients. In 8 patients the scars improved, and there was no improvement in 9 patients. Keloid scars of the earlobes were the most responsive to treatment. The possibility of differing biological activity of cryosurgery and corticosteroids complementing each other is postulated, and a combination of their respective actions may offer promise in treatment.

An aggressive enteral nutritional approach has been employed to support our severely burned patients. The diet is based on a daily intake of 5 eggs/10 kg of body weight, incorporated into milkshakes. Twelve patients with severe burns (age, 24 +/- 4 years; burns, 54 +/- 12 per cent of total body surface area (TBSA] were studied. Enteral feeding was initiated on the day of injury and gradually reached the full formula within 3-7 days. Feeding was carried out either orally or through a nasogastric drip or a combination of both, depending on the patient's condition. Each bottle of milkshake contained 2318 kJ, 29 g protein, 51 g carbohydrate and 28.6 g fat in 250 ml. Each millilitre of the diet contained 9.32 kJ. The protein provided 21 per cent of the total calorie intake, while the fat and carbohydrate provided 42 per cent and 37 per cent respectively. The mean daily intake consisted of protein (5 +/- 1.5 g/kg), carbohydrate (8 +/- 0.75 g/kg) and fat (5 +/- 1 g/kg), providing a daily administration of 378-420 kJ/kg. Plasma lipids remained within normal limits during the 40 days of the diet, while serum protein levels rose to normal levels within the first 3 weeks.

In this modern era, compound fractures of the middle third of the tibia are relatively common. With the advent of external fixation, these fractures can be more rapidly and effectively dealt with, and attention can be directed to immediate coverage of the exposed bone. External longitudinal splitting of the anterior tibialis muscle offers a convenient and safe method for converting the open fracture to a closed one. The uniqueness of the tibialis anterior muscle is twofold. It is circumpennate, and it has an internal axial tendon corresponding to almost its total length. Both these features impart to it considerable strength, and the muscle splitting herewith described does not appear to impair its function. Five treated limbs, each with loss of soft tissues overlying compound mid-third tibial fractures, are presented. Rapid healing and virtual absence of bone infection was observed in all cases.

The use of bilateral superomedial thigh flaps for primary reconstruction of scrotum and vulva is presented. These flaps have proved to be reliable, ensuring good healing and providing almost normal sensation. Further indirect evidence that these are arterial flaps is given.

A new technique for closure of rounded defects is described. The biwinged procedure consists of excising two equal triangles on either side of the defect, one above and one below the dissecting line. Closure is in the form of a step. It can be made to parallel in part a wrinkle or contour line, such as a nasolabial fold, a temporal region above and beside the eyebrow, an area over the lower border of the mandible, or on the dorsum of the hand. A mathematical comparison of the amount of healthy tissue in the biwinged excision and in six other procedures is presented.

The efficacy of prophylactic therapy with cimetidine or antacids combined with early enteral feeding to prevent gastrointestinal bleeding in patients with severe burns was evaluated. Fifty patients with burns exceeding 30 per cent of the total body surface area (TBSA) were divided into two groups, each of them treated by one of these agents in combination with early feeding. Bleeding was not encountered in either group. It is assumed that the combination of either agent with enteral feeding early in the post-burn course equally protected against gastrointestinal bleeding. Because of the ease and lack of side-effects of cimetidine in this series, its use was preferable.

Summary Irradiation of basal cell carcinoma of the mid-face is complicated in certain cases by uncontrolled spread of the tumour. Four such cases are presented of widespread local infiltration by the tumour. A slow painful death, resultant directly from the effects of local invasion, occurred in three of the patients with the fourth patient tragically moving to the same inevitable conclusion. The anatomical features of the mid-face may account for this type of spread. There may also be an alteration of tumour-host relationship following radiotherapy. Surgery, rather than irradiation, is the treatment of choice for basal cell carcinoma of the mid-face.

The silicone loop was used to ensure patency of the distal urethra reconstructed by a tubularized full-thickness skin graft in patients with proximal or penoscrotal hypospadias. By this method we avoid repeated dilations of the urethra and the attendant anesthesia and discomfort to the patient.

An unusual case of lethal salt poisoning of a burned child is presented. Excessive hypernatraemia and hyperosmolality resulted in an irreversible cascade of events which lead to death despite vigorous attempts to rescue the victim.

In 16 women who underwent face lift operations, we performed intraoperative stretching of the undermined facial and neck skin using either a silicone bag for expansion or skin traction sutures. The object of this endeavor was to attempt to harness the viscoelastic properties of the skin to maximize the amount of skin excision and so improve the overall long-term operative results. We believe we were successful with both techniques. It is not clear at this juncture whether the long-term results of this one-stage procedure will approximate those of the two-stage procedure, which were consistently satisfactory.