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u r t s p v u p r Over the past 20 years, microvascular free tissue transfer has become the primary choice for reconstruction of acquired or developmental defects of the head and neck. Multiple free flaps have been described and used for reconstruction of the inherently challenging defects of this region, effectively meeting the demands of reestablishing form and function. The radial forearm free flap is particularly popular because of ease of harvest, versatility, minimal morbidity, and predictable successful outcomes. Although the radial forearm free flap is highly reliable, there remains the problem of closing the distal forearm donor site defect. Primary closure is not feasible in most of these defects because of the paucity of soft tissues in the area, as well as the potential of placing the distal upper extremity in danger of ischemia. Although the iterature is replete with a variety of techniques for losure of these defects, currently there remains no dopted standard procedure. Multiple sites have been discussed for harvest of ull-thickness skin graft (FTSG), particularly the skin f the abdomen and groin. At our center, we favor the

Patients undergoing standard highly-active antiretroviral therapy for the treatment of human immunodeficiency virus may suffer from severe facial lipotrophy, also known as facial wasting. Facial wasting can impose a devastating psychosocial burden to the affected patients. Injectable filler materials are currently used worldwide for soft-tissue augmentation in various parts of the body. Injectable filler materials can be absorbable, semipermanent, or permanent. Permanent injectable filler materials have been used to augment facial soft-tissue defects, to treat rhytids, or to treat patients affected by facial lipoatrophy secondary to human immunodeficiency virus–associated antiretroviral therapy.

Rosai and Dorfman first described sinus histiocytosis with massive lymphadenopathy (SHML) in 1969 with an article detailing 4 cases in which they differentiated this disease entity from the grouping of diseases categorized as histiocytosis X, where it was previously classified. Also known as Rosai-Dorfman disease (RDD), it is clinically characterized as massive, painless, bilateral, symmetric cervical lymphadenopathy, with fever and leukocytosis. An 11-year-old African American boy was referred to our clinic for extraction of a severely decayed tooth #30 and evaluation of a large right-sided neck mass. Initially, the patient had been seen by his general dentist who had diagnosed the mass as an odontogenic abscess. After 2 courses of different antibiotics, no changes in the mass were noted. Subsequently, the patient was sent to the emergency department where CT revealed multiple right-sided neck masses with the largest measuring 4 × 2 cm. The patient underwent an incisional biopsy by otolaryngology and a diagnosis of necrotic lymph tissue was made. Upon our examination, the carious tooth #30 was felt to be an incidental finding and fine-needle aspiration cytology of the largest mass was performed in 2 places. This also provided a diagnosis of necrotic lymph tissue. In concert with the patient and his mother, the decision was made to excise the mass because of psychosocial concerns. A massive right-sided lymph node attached to the submandibular gland was found and excised without complication. Histologic examination with S-100 stain confirmed a diagnosis of RDD. The patient healed well following surgery and has experienced no further lymphadenopathy. This case presentation and review of the literature is unique, as the patient presented with unilateral cervical lymphadenopathy only. Open biopsy and 2 fine-needle aspirations all returned as necrotic lymph tissue. Obtaining the correct diagnosis was additionally hampered by coincidental dental pathology on the affected side and final diagnosis was made only by excisional biopsy, which is not necessarily indicated in cases of RDD.

Telemedicine is defined as the use of medical information exchanged from one site to another via electronic communications to improve delivery of care. This improvement in delivery of care is evident by more-efficient consults, triaging, and real-time communication between patient and surgeon. Internet-capable smartphones are capable of transferring radiographs and other images. Aziz and Ziccardi in 2009 demonstrated using smartphones for downloading images from the hospital archiving system to the resident's phone and then e-mailing or texting them to the attending for immediate review. Here we build on the work of Aziz and Ziccardi as we describe a novel use of smartphones for virtual rounding between residents and faculty based on improvements in technology, specifically video capability and increased accessibility of compatible devices.