Emergency department repair of hand lacerations using absorbable vicryl sutures.

The use of absorbable suture material has a number of potential advantages when compared to nonabsorbable suture. We conducted a 5-year retrospective study of 102 patients with hand lacerations and compared the quality of scar formation and healing in these patients. Those patients who did not have tendon, nerve, or bone injury were included in the study. Lacerations were repaired with either 5-0 Vicryl or nylon. There were no reported complications or infections in any study group patient. The quality of scar, when compared visually and by palpation, was the same at the end of 6 months. In addition, there was no difference in the incidence of scar retraction. We conclude that the use of absorbable suture material is an acceptable alternative in the repair of hand lacerations.

Free tongue composite graft for correction of a vermilion defect.

A case report of hemangioma of the vermilion border treated with excision and free composite tongue graft is presented. A technique of lip reconstruction utilizing a composite tongue graft in one step has been described. It constitutes an improvement over the tongue pedicle flap technique, which has been hitherto used and requires two stages. The indications and limitations of the technique have been discussed.

Management of squamous cell carcinoma in a patient with dominant-type epidermolysis bullosa dystrophica: a surgical challenge.

Epidermolysis bullosa dystrophica is a rare congenital skin disease inherited either as a recessive or dominant form, the latter form being less common and much less severe. Squamous cell carcinoma is a rare complication in the dominant form of the disease, only three such cases being reported before, making this case the fourth known case. Although the squamous cell carcinoma is well-differentiated by histopathology, it has a poor prognosis owing to its invasiveness, distant metastases, and multicentricity. Its management also poses a great challenge to the surgeon and personnel involved in patient care. A complete outline of the total management of such a case is described with some interesting observations not mentioned previously in the literature. All the previous three patients are deceased, and this is the only known surviving patient.

Cervicofacial rhytidoplasty in Ehlers-Danlos syndrome: hazards on healing.

Ehlers-Danlos syndrome is an uncommon autosomal-dominantly inherited connective tissue disorder marked by excessive skin and joint laxity and easy bruising and ecchymotic tendency that poses a formidable threat to achieving face lift surgery in its normal perspective. Since this surgery is often sought by these patients as a result of premature excessive skin wrinkling of the face, one has to be aware of its possibility during the preoperative examination of the patient. All the possible complications and their management are described to the patient with a case history actually presenting these complications.

Reversed reconstruction in subcutaneous mastectomy: insertion of the prosthesis in advance.

A new approach to reconstruction in subcutaneous mastectomy has been presented. It involves insertion of the prosthesis in advance as the first stage. After a review of 22 consecutive cases of subcutaneous mastectomy, we are convinced that it is the method of choice. In our opinion, most of the complications following subcutaneous mastectomy with augmentation can be diminished by using this technique. Another outstanding advantage is that the patient has less psychological trauma.

The seagull incision in posterior cervical lift: indications, limitations, and surgical technique.

A seagull incision in the posterior scalp as used by us for the past 15 years for the correction of flaccidity in the posterior and anterior lower neck regions through a posterior cervical lift has been described in detail with its advantages, indications, and limitations. In our experience, the posterior cervical lift has little or no effect in correcting flaccidity in the upper anterior neck region, and therefore, this procedure should not be routinely performed in all cases of rhytidoplasty. One has to be highly selective in performing this procedure.

Umbilical reconstruction with secondary abdominoplasty.

Umbilical loss is not an uncommon problem following primary abdominoplasty done by an improperly trained surgeon who either sacrificed the umbilicus or lost it through postoperative complications. Deep psychological trauma with mental depression is often the result of such an amputation and is also the main concern of the patient seeking help. There are usually other secondary sequelae, such as residual cutaneous and musculoaponeurotic flaccidity, asymmetrical scarring with dog-ears at either extremity, and fatty bulges that may not bother the patient. In the past, umbilical reconstruction has been handled as an isolated procedure. We have tried to alleviate this condition along with the other residual deformities by doing complete secondary abdominoplasty. Along with the technical details of umbilical reconstruction, 2 such case reports with preoperative and postoperative results are presented.

Some problems and solutions in abdominoplasty.

A review of 428 abdominoplasties performed for the correction of abdominal flaccidity emphasizes the need for a wide repertory of surgical techniques to achieve an aesthetically natural appearance of the abdomen. Six details of surgical technique have considerably improved the results of abdominoplasty performed at our institute during the past 14 years. These six technical details are easy to accomplish without prolonging the total operating time.