The versatility of double-Z rhomboid plasty.

The versatility of the double-Z rhomboid plasty is demonstrated in the closure of excisional wounds in the face and extremities following resection of skin tumors. The degree of distortion resulting from the double-Z rhomboid, simple rhomboid, and direct closure are compared in foam rubber models. The original design as described by Cuono is compared with modifications suggested by Katoh. The indications for the double-Z rhomboid repair are reviewed and the technical aspects to maximize the results are described.

Cytogenetic findings in two basal cell carcinomas.

We describe the cytogenetic study of two basal cell carcinomas. Only single chromosomally abnormal clones could be detected in both. In addition, many nonclonal changes were seen in the samples, which may represent small neoplastic clones or the result of a basic molecular defect induced by carcinogens.

Translocation (4;14) and concomitant inv(14) in a basal cell carcinoma.

Chromosome analysis of short-term cultures from a basal cell carcinoma was performed. The analyzed karyotypes showed a pseudodiploid clone characterized by a der(4)t(4;14) (p14;p11) and a concomitant inversion of the same chromosome 4 involved in the t(4;14) with the breakpoints at p14 and q25.

Multiple cytogenetic clones in a basal cell carcinoma.

Chromosome analysis of short-term culture of a basal cell carcinoma showed five clonal chromosome abnormalities, t(9;14)(q12 or q13;p11), del(1)(q23 or q25), trisomy 5, trisomy 7, and monosomy X. In addition, several nonclonal structural and numerical changes were seen in the tumor cells.

Breast reduction with short L scar.

I didactically compared the breast as a glandular cone with an envelope of skin and subcutaneous tissue. The aesthetic alterations of the breast are classified in four groups related to form, to volume, to grams, and to ptosis in centimeters. An imaginary plane that passes by the mammary sulcus (plane A) will determine the area of the breast that is ptotic. The projection of this plane in the anterior part of the breast is called point A. The distance between point A and the nipple will give in centimeters the amount of ptosis. I use this distance to draw geometrically in the breast the amount of excess of skin to be removed to correct the ptosis. In group I, the volume is normal and part of the mammary gland is under plane A. In this type of breast, the skin is resected, and since there is no excess of breast tissue, the breast that is under plane A is used as an inferior pedicle flap to give a better volume to the new breast. In group II, the base of the breast is large, the height is normal, and the volume is increased by the enlargement of the base. In this type of breast, the excess of breast under plane A and a wedge under the nipple are resected to reach the normal volume at the end of the surgery. In group III, the base is normal and the volume of the breast is increased by the height. For treatment, I resect the excess of breast under plane A as well as a segment at the base to reduce its height. In group IV, the volume of the breast is increased by the size of the base and the height of the cone, and I treat by resection of the excess of tissue under the ptotic area, a wedge under the areola, and a transversal segment in the base to reduce all the dimensions. In the final result of this technique in the majority of patients I will obtain a short scar. This technique was used in 1083 patients from January of 1979 to May of 1988.

The buccinator musculomucosal flap: anatomic study and clinical application.

Since 1984, we have used the buccinator muscle mucosal flap for the treatment of mucosal defects after tumor resection, osteomyelitis of the mandible, closure of cleft palate fistulas, primary closure of very wide cleft palates, and lengthening of the soft palate. A study was made in the facial regions of 14 cadavers, and a comparison was made to descriptions found in the anatomic literature. It was confirmed in our dissections that the buccal artery, which reaches the posterior half of the muscle, is the major arterial pedicle of the buccinator and that it runs very close to the buccal nerve. Several veins originating from the lateral aspect of the muscle make the venous drainage of the buccinator even richer than its arterial supply. The abundant vascular supply from multiple interconnected pedicles supports the blood supply of the buccal mucosa. The motor innervation of the buccinator muscle comes from the facial nerve. The buccinator is considered to be a part of the sphincteric muscular system involving the functions of sucking, whistling, propelling food during mastication, and voiding the buccal cavity. The flap was utilized clinically in 38 patients: 24 to close primary cleft palates that required palate lengthening, 12 to close palatal fistulas, 1 to treat a mandibular osteitis, and 1 to repair the palate after tumor resection. We had three small fistulas as complications in our series owing to technical mistakes.

Abdominoplasty: a new concept and classification for treatment.

From a study of the deformities of each layer of the abdominal wall, we have categorized five types of abdominoplasties. For each type, we used a different surgical technique, aiming to sculpture the abdomen and treat each layer according to the deformity present in each patient. Two hundred thirty-eight patients were treated with this method, and the results were judged good to excellent by the surgeons and patients because of the more natural appearance of the final results.