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Dupuytren's disease is a polyclonal fibroproliferative disorder of the palmar fascia of unclear pathogenesis. It has been described as a disease of northern European men and is reportedly rare in other races. A 10-year retrospective study using the Department of Veterans Affairs computer system was conducted to determine the racial distribution of this disorder among patients treated at all Department of Veterans Affairs medical centers. The study also determined demographic and clinical characteristics of black veterans treated for the condition at department medical centers. There were 9938 patients identified between the fiscal years of 1986 and 1995, of whom 412 were black (estimated prevalence of 130 per 100,000 population), 9071 were white (734 per 100,000), 234 were Hispanic white (237 per 100,000), 11 were Native American (144 per 100,000), 8 were Asian (67 per 100,000), and 202 were of unknown race. The characteristics of the disease in blacks are similar to those in whites. In both groups, the disease has a late onset, affects predominantly the ulnar digits, and is associated with other medical conditions, such as alcoholism, smoking, and diabetes. Unlike Dupuytren's disease in whites, however, the disease is rarely bilateral in blacks. The differential prevalence among racial groups suggests a genetic component to the pathogenesis of the disease.

The objective of this study was to determine whether a split-thickness skin graft can be implanted deep to the skin and whether it can be expanded. We also wanted to find out whether this implanted and expanded split-thickness skin graft can be used as a new source of skin grafts and as a pedicle flap. A tissue expander mounted on a Dacron sheet backing was specially designed for this experiment. Six female Hanford minipigs weighing 20 to 25 kg were operated on in three stages. In stage one, a split-thickness skin graft 0.03 in thick was harvested from the back, placed dermal side out over the expander, and sutured to the Dacron backing. The expander with the overlying split-thickness skin graft was then implanted deep to the panniculus carnosus muscle. Daily expansion was started 2 weeks after implantation to obtain a total volume of 1300 to 2500 cc. In the second stage, performed 4 to 6 weeks after implantation, the skin over the expander was elevated superficial to the panniculus carnosus muscle as a ventrally based flap, and the panniculus carnosus muscle was next elevated as a dorsally based flap lined on its deep surface with the implanted/expanded skin. Full-thickness skin grafts obtained from this implanted/expanded skin and from normal skin were transplanted to two 3 x 3 cm skin defects. The panniculus carnosus muscle implanted/expanded skin flap was then turned 180 degrees and sutured to a dorsally created skin defect. In the third stage, 4 weeks later, we noted the quality, texture, and appearance and obtained punch biopsies from normal skin, normal skin graft, implanted/expanded skin graft, and panniculus carnosus muscle implanted/expanded flap for histopathologic examination. All skin grafts "took" well, survived implantation, and were expanded successfully. The initial surface area of implanted split-thickness skin graft showed a net increase of 8 to 193 percent (mean percentage net increase 90 percent). This implanted/expanded skin also was retransplanted successfully to a skin defect. In all six minipigs, a skin-lined panniculus carnosus muscle implanted/expanded skin flap was constructed and survived transfer to an adjacent skin defect. The smallest flap of panniculus carnosus muscle implanted/expanded skin measured 10 x 12 cm and the largest 12 x 28 cm (mean surface area 228 cm2).

The authors described a case in which the capsule surrounding a breast implant was lined by benign squamous epithelium. A second case, in which a woman was found to have a squamous cell carcinoma in the capsule surrounding a breast implant, was also reported.

External fixation is rarely employed in the treatment of hand fractures, and few reports describing this technique have been published. This is a report on 26 patients with 30 hand fractures (19 metacarpal and 11 phalangeal) treated by closed reduction and external fixation. The fixation consisted of percutaneous and transversely applied Kirschner wires that were fixed externally with methylmethacrylate rods. Active range of motion exercises were started 1 week after reduction with the external fixator in place. Percentage return of total range of motion in phalangeal fractures varied from 66% to 98% (mean, 84%), and in metacarpal fractures it varied from 77% to 100% (mean, 96%).

Trigger finger is a relatively common clinical entity, most frequently caused by stenosing tenosynovitis. Several other conditions not related to tenosynovitis also have been described as a cause of triggering, and these have been reviewed. We present a rare anomaly of the fourth lumbrical muscle insertion as a cause of triggering of the right little finger. This was completely relieved following excision of the anomalous muscle. This rare anatomic variant should be added to the list of potential causes of trigger finger.

Tissue expanders are particularly applicable in the pediatric population. They are extremely well tolerated by children and can withstand the everyday play and trauma unique to children. Over the past 2 years, we have used 26 tissue expanders in 17 pediatric patients. Fifteen of the 17 patients successfully underwent reconstructive surgery with the aid of expanders. The expander became exposed in two patients, necessitating removal. In each of these patients, a more complicated and less satisfactory method of reconstruction was performed.

Many various complications have been reported with tissue expansion since it was popularized by Radovan. As expected with any foreign body implantation, the most frequent complication is infection. Rupture of the expander is relatively rare even in the face of overexpansion or blunt external trauma. Complications from tissue expansion of the scalp are similar to those encountered with the placement of expanders elsewhere in the body. We had a case recently involving rupture of an expander placed in the scalp of an 18-month-old child as a result of erosion of the outer table with bone spur formation. This was a local reaction to the pressure exerted by the expander. We present the following case report to document another potential complication with tissue expansion of the scalp.

When first introduced in 1978, the tensor fasciae latae flap was used both as a free-tissue transfer and as a local rotational flap. Its use as a free flap has diminished as other more appropriate flaps for free-tissue transfer have been described. The tensor fasciae latae flap has remained, however, an instrumental flap in the coverage of anterior and posterior soft-tissue defects around the hip region. The purpose of this paper is to present a new design of the tensor fasciae latae flap in the coverage of trochanteric pressure sores. By essentially creating a VY advancement flap into the trochanteric defect with the tensor fasciae latae, one can cover the trochanteric defect with the best-vascularized portion of the flap and avoid the dog-ear deformity.

Two hundred and forty patients who underwent a corrective rhinoplasty have been presented. Of these, 224 patients (93.3 percent) had a cartilage repositioning procedure in which the alar cartilages were only undermined and repositioned, and 16 patients (6.7 percent) had a cartilage resection procedure. The techniques and indications for both procedures are described and discussed. The results obtained in this series of patients indicate that cartilage repositioning is an effective and reliable procedure to refine and reshape the nasal tip. Cartilage resection is less reliable and should be reserved for a few selected patients with specific indications. Indiscriminate resection of the lower alar cartilage is neither warranted nor wise.

This article is a review of 22 cases of giant hemangiomas of the head and neck treated at the American University of Beirut Medical Center over a 20-year period 1964 to 1984. All these cases were treated by surgical excision. Two maneuvers designed to reduce blood loss during the operation are described: the placement of strangulating silk sutures around the periphery of the hemangioma, and temporary occlusion of the ipsilateral external carotid artery. These cases were studied as to age, sex, site, size of hemangioma, histopathologic characteristics, mode of treatment, and results. A review of the literature and current modes of treatment of hemangiomas of the head and neck is also presented and our results are compared with those in other published reports. The surgical approach as a primary and definitive treatment for these giant hemangiomas is emphasized.