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The salvage of an exposed and infected knee prosthesis is reported. The coverage by means of a gastrocnemius myocutaneous flap resulted in good healing and prevented removal of the prosthesis, arthrodesis, and subsequent severe walking disability.

Experience in the estimation of breast implant volume for reconstruction is presented. Three-dimensional computed tomography (CT) was used in a group of 22 patients having this examination as part of another study. The volume of the final implant was estimated by measuring the intact breast volume. The final clinical results showed excellent volume symmetry.

Plagiocephaly in a head-and-neck irradiated rat model or rhomboid-shaped head, occurs in at least 1 in 300 live births. In most cases such asymmetry is not caused by synostosis of the unilateral coronal or lambdoid sutures, but is rather a deformity produced by intrauterine and/or postnatal deformational forces. Categorization and diagnosis of plagiocephaly as synostotic or deformational is reliably made by physical examination and computerized tomography. Its differential diagnosis is extremely important because prompt surgical correction is usually indicated for the synostotic type. In contrast, infants with deformational frontal or occipital plagiocephaly generally respond to helmet treatment. 10 infants with significant deformational plagiocephaly were treated with individual plastic helmets during the past 2 years and 4 other infants with plagiocephaly are currently being treated. In each instance, cranial asymmetry dramatically improved as the brain grew and the head filled out the helmet. There were no significant complications. Awareness of deformational plagiocephaly allows more accurate diagnosis and appropriate treatment, avoiding unnecessary surgical intervention in patients with positional molding.

We developed a mouse recipient model that was used to evaluate and compare four cryopreservation procedures for human cadaveric skin stored for two time periods. Skin specimens were identically processed and preserved by programmed (1 degree C/min), or stepwise freezing, and stored at -180 degrees C or -80 degrees C for periods of 1 month and 6 to 10 months. Samples were grafted on Balb/c mice, and primary take was evaluated after 7 days. The results indicate that although all grafted specimens were initially accepted, as indicated by gross observations, histologic differences were evident and significant. The study groups were analyzed for the effect of method and skin sample variety; the effect of freezing procedure and temperature level; time effect (storage period); and advantage of method 1 (programmed freezing at -180 degrees C) over the other methods. The significance (p value) was determined for separate histologic criteria and average skin score or quality. The overall results indicate that average score of skin preserved by method 1 is highest for both storage periods. This method has an almost significant advantage (p = 0.057) over the others on quality of skin stored for 1 month, and a highly significant advantage (p = 0.007) on graft adherence of skin stored for 6 to 10 months. The effect of method and samples variety on the separate histologic criteria and average score of skin is not always significant. However, an interaction factor (between method and samples) has a highly significant effect (p0.001) on almost all of the histologic criteria and average skin score. The effects of freezing method is significant only on average skin score, for 1 month of storage; whereas temperature effect is seldom significant. Evaluating the effects of time, samples, and the interaction factor (between time and samples) indicated that the interaction factor is highly significant (p0.001). Time and samples effects are rarely significant. Thus the quality of the final product-the cryopreserved skin-is determined by many factors, and quite often they interact. Highly significant is the combined effect, or interaction factor, of sample variability with method of cryopreservation or with storage period.

An 81 year old patient, suffering from Alzheimer's disease sustained a full thickness HCI Acid burn of her abdomen and chest wall due to leakage of gastric content from her gastrostomy feeding tube. The controversial management of such a patient is discussed and early surgical treatment is recommended.

Our craniofacial surgery team includes experts from the following fields: plastic surgery, neurosurgery, ophthalmology, genetics, neurology, orthodontics, pedodontics, facial rehabilitation, psychiatry, social work, anesthesiology and intensive care. Craniofacial surgery became to a large extent pediatric surgery, following evidence that careful, early surgery does not impair growth and that development following surgery is almost normal. The malformations that were repaired included those of the Crouzon and Apert syndromes, requiring frontal remodelling and advancement of the middle third of the facial skeleton; hypertelorism in which orbits were moved to the midline; large craniofacial clefts in which the hemiface from either side was moved to the midline; and different types of craniostenosis in which frontal advancement and remodelling with reconstruction of the vault was performed. The series consisted of 78 patients who presented between 1979-1989. 3 illustrative cases are described.

Home use of nebulizers has increased in recent years, although adequate studies have not been performed to evaluate for possible contamination or transmission of potentially harmful bacteria. This study of 20 asthmatic children demonstrated that transmission of pathogenic bacteria occurs.

It was noted clinically that patients under long-term steroid treatment were susceptible to avulsion injuries following minor trauma. Laboratory experiment in mice revealed significant reduction in the breaking strength following steroids therapy

Central sections, ranging in width from 3 to 6 mm and in length from 9 to 15 mm were removed from the cartilaginous nasal septum in 21-day-old rabbits. Within six weeks postoperatively a lack of forward growth of the upper face and malocclusion of the incisors were noted. The postoperative survival was 16 weeks. Postmortem gross findings revealed that in the experimental animals the snout was shorter and smaller with a relative mandibular prognathism. The nasal and premaxillary bones were shorter and the nasal cavity and piriform aperture were smaller than in the control animals. After the central continuity of the septal cartilage had been interrupted, there was a dissipation of the interstitial growth force expressed in part in the overlapping of the margins and in the lessened dorsal and forward growth of the snout. A relationship exists between the site and amount of cartilaginous nasal septum resected and the location and extent of the ensuing growth arrest of the snout.

Two cases of gangrene of the scrotal and penile skin are reported which developed as a complication of large ischiorectal abscesses and required plastic reconstruction. This is a rather rare complication and the literature is reviewed with special reference to Fournier's gangrene.

Two sibs with a syndrome including cleft lip and palate, sparse scalp hair, malformed protruding ears, and partial syndactyly of the fingers and toes are reported. The older child also has mental retardation and pili torti. This syndrome is most probably inherited as an autosomal recessive disorder.

Reimplantation was attempted in 24 of 30 amputated fingers in 16 patients; 17 attempts were successful. The indications for surgery, the operative technique postoperative complications and results are discussed. It should be stressed that revival of the amputated digits does not necessarily mean functional success, and a careful evaluation of the results is needed. Organization of the reimplantation service is very important for achieving better results in this branch of surgery.

Skin of C57BL mice was preserved in skin-graft fluid at 4 C for six weeks. The mean survival time of such skin grafted to BALB/c mice was 17.1 +/- 0.29 (SD) days. Control grafts transplanted immediately after removal from animals had a mean survival time of 11.5 +/- 0.32 days, whereas in a second control group, transplanted with C57BL skin preserved up to two weeks in serum-free medium, rejection occurred after 10.9 +/- 0.16 days. Some hypotheses on the mechanism of such graft prolongation are discussed.

Eikenella corrodens, a gram-negative, slow-growing rod, belongs to the normal flora of mucous membranes. Infections of the hand including this pathogen, are described in human bite and clenched fist injuries. Our case demonstrates another possibility of wound contamination with normal oral flora causing Eikenella corrodens infection. The consequences due to the delay of appropriate therapy are discussed.

Twenty-two patients with congenital and acquired defects, rehabilitated with silicone ectoprostheses, were followed up for 6 mo to 4 yr. The simplicity of the procedure, its good results and the early physical and social rehabilitation attained, favor its use when adequately indicated.

A patient who presented with posttraumatic ptosis of the right upper eyelid proved to be a case of unilateral blepharospasm with facial palsy of the forehead. He was successfully treated with selective facial neurectomy.

We report a case of pilar tumor of the nose and review the literature. No such tumor in a similar location has been reported previously.

Dermoid cysts of the floor of the mouth in the infant are rarely encountered although the aetiology is mainly embryological. Meyer proposes the classification of the cysts based on the histological differentiation of the elements of the cyst wall. A case is reported which shows differences in the epithelial lining of the cysts found followed by the differential diagnosis and treatment.

A 6-year-old girl with an avulsion injury of the dorsum of both feet had multiple fractures of the ankles and the tarsal and metatarsal joints. She was treated by wet dressings followed by simultaneous coverage of both feet with bilateral cross-thigh flaps.

A simple method for achieving satisfactory regional anaesthesia for a wide range of hand surgery is presented. It entails separate attention to the two aims of regional anaesthesia, namely analgesia of the tourniquet and of the operative site. This study of 149 patients indicated that (a) subcutaneous ring anaesthesia produced excellent tourniquet analgesia, both in the forearm as well as the upper arm; (b) a tourniquet applied to the forearm provided excellent regional ischaemia in 98% of our cases, contrary to what has been previously accepted. The advantages of this method are its safety and simplicity even for the relatively untrained surgeon. It also obviates the need for brachial plexus blocks, intravenous regional or general anaesthesia with all their drawbacks.