Augmented fiberoptic intubation.

Patients who are difficult to intubate are randomly encountered. Patients who are in the postoperative period or who have suffered trauma have a greater chance of being difficult to intubate. The ability to quickly mobilize trained personnel and advanced equipment provides the best chance for a good outcome for these patients. Practice in placement of and intubation with LMAs is an important step toward providing an extensive safety net for patients needing intubation.

Intraductal migration of silicone from intact gel breast prostheses.

This case presents a previously undocumented complication of silicone gel prostheses in which silicone accumulated in the lactiferous ductal system of the breast with the underlying prostheses being intact. It demonstrates the disconcerting potential of silicone to migrate through tissue planes that are not disrupted. It also highlights the fact that a great deal of knowledge about the body's interaction with silicone still needs to be ascertained.

Prevention and treatment of postburn scars and contracture.

The management of postburn reconstruction is complicated by the frequent occurrence of multiple reconstructive needs in a single patient. This article presents a simple, comprehensive approach to burn scar reconstruction. The primary aim of the surgeon is to prevent burn scar deformity by rapid wound closure, correction of tissue deficiencies, and assiduous attention to postoperative splinting and compression therapy. The initial step in managing secondary deformities is to prioritize reconstructive needs. Reconstruction is then carried out in a stepwise fashion aiming to restore active function first, followed by passive function, and finally addressing aesthetic reconstruction. Reconstructive techniques are applied in a hierarchy from simplest to most complex. Primary excision and closure of scars by reorientating the scar to the lines of relaxed skin tension can significantly improve appearance. The use of z-plasty, flap repair, and tissue expansion are also reviewed. Skin expansion, in particular, has become the standard management of postburn alopecia and, although associated with a relatively high rate of complication, has significantly improved the aesthetic appearance of such patients. The management of common problems affecting the face is discussed with particular reference to management of the eyelids, oral commissure, and lips. These areas need to be reconstructed as aesthetic units and each requires individualized management of donor tissue. The reconstruction of the burn patient is often a long process requiring multiple procedures. The approach presented here advocates a stepwise, prioritized approach aiming at both maximum function as well as optimal appearance.

A biomicroscopic method for quantitation of ocular and adnexal toxicity.

A biomicroscopic method for evaluation of ocular and adnexal toxicity in the white rabbit has been developed. When compared to the Draize method, the biomicroscopic method demonstrates a greater spectrum of clinical signs allowing for better dose-response characteristics. This method was found to be both reproducible and easy to execute. The biomicroscopic method, by defining discrete anatomical entities, allows for a high degree of predictability as to severity of ocular and adnexal toxicity as well as the occurrence of permanent ocular injury.

A simple diagnostic sign in the superior mesenteric artery syndrome in a burned patient.

In the superior mesenteric artery syndrome which may complicate extensive burns, a systolic murmur may be heard in the epigastrium when the patient is supine but not when he is prone. This sign combined with straight abdominal x-rays will clinch the diagnosis and thereby avoid an unnecessary barium meal or laparotomy.