Fasciocutaneous flap coverage for periolecranon defects.

Soft tissue defects in the periolecranon region are difficult to manage by standard techniques such as closure by approximation, split-thickness skin grafting, or healing by secondary intention. We employed cadaver injections and dissections to study the vascular anatomy of the periolecranon region in search of a suitable local flap for coverage of periolecranon defects. This report details our experience in 31 patients with a one-stage technique for elbow coverage employing a proximally based forearm fasciocutaneous flap. Surgical techniques and clinical applications are discussed; a satisfactory long-term outcome is documented in 30 of 31 patients. The advantages of using this model fasciocutaneous flap include enhanced vascularity, sensibility, and ease of elevation.

An attempt to explain the differences between the upper and lower halves of the striate cortical map of the cat's field of view.

Cowey and Rolls have shown that the magnification factor with which the retina is imaged onto the striate cortex is proportional to visual acuity. Schwartz has used this to derive how visual peripheral acuity in the human varies with distance from the fovea, in good agreement with experiment. The same reasoning applied to the map of the lower half of the field of view as imaged onto the striate cortex of the cat indicates that the cat fixating a point up to about 100 cm in front of him sees the foreground portion of the horizontal surface on which he is standing approximately uniformly blurred.

Superselective embolization and surgery of noninvoluting hemangiomas and A-V malformations.

Eight patients with severe arteriovenous malformations of the head and neck region have been treated by superselective embolization utilizing Ivalon and surgery. Six of those patients underwent surgical resection of the malformation following embolization with apparent lack of recurrence of the vascular tumor. The approach of superselective embolization is different because it is an attempt to occlude the malformation from the inside out, that is, occluding the smallest vessels first, and utilizes the increased vascular demand of the tumor. The increased blood flow to the malformation is seen to change, since new vessels dilate instantly following occlusion of major feeders. The malformations fill from the ipsilateral side first, but frequently from the contralateral vessels as well. The futility of surgical ligation of large incoming filling vessels is pointed out. Complications other than what may occur with any transfemoral arteriogram included skin slough, particularly when the "glue" was utilized to an excess of extracranial sites.

Orientation in endoscopy.

This paper is intended to help the beginner endoscopist learn to interpret the orientation of the object seen through the endoscope. This is applicable only to an endoscope with a reflecting (side view) prism at its distal end, such as a cystoscope. A proposed counterrotation device for turning the image upright is described.

A reading aid for patients with macular blindness.

A new reading aid (called "kraspegig") for patients with macular blindness is described. It is based on the principle that, in peripheral vision, our attention is strongly drawn to moving objects. Accordingly, it sets the reading matter moving with respect to the patient's retina. Its essential part is a patterned mask into which is cut a window through which a few words of text can be seen. As the mask is slid along, the patient follows it with his eyes, so that the text lags behind. A magnifier is part of the device.

Buccal lipectomy.

An operation to correct "chubby" cheeks is described. The technique is simple and safe and gives predictable results. The buccal lipectomy may be performed by itself or as an adjunct to other facial cosmetic surgery. No permanent complications were experienced in 9 patients over a three and a half-year period.

Low-velocity gunshot wounds to the maxillofacial complex.

A review of the past literature of gunshot wounds indicates that the clinical material deals mainly with high-velocity missile injuries from military experience. A series of 66 cases of low-velocity gunshot wounds to the maxillofacial complex at San Francisco General Hospital between 1971 and 1978 indicates a clinical difference between injuries caused by low-velocity as compared to previously reported high-velocity missiles. Damage to vital structures resulting from missile injury to the maxillofacial complex are classified in three anatomic areas: 1) supra-orbital (28 cases of which 20 involved neurological damage); 2) mid-face (24 cases of which 8 involved the orbits and/or globe); 3) lower face (14 cases, of which 3 involved laceration of the carotid and 2 involved airway obstruction necessitating tracheostomy). The management of gunshot wounds to the maxillofacial area is outlined, emphasizing: 1) Debridement and prompt closure of intraoral wounds with antibiotic coverage: 2) Early stabilization of mandible fractures: 3) Indications for tracheostomy; 4) Arteriographic studies. In our series there were only four infections, which were treated easily with incision and drainage and appropriate antibiotic selection.

Clinical experiences with Proplast as an implant.

We report our experiences with 38 Proplast implants to the face, with 33 results which we classified as good. The material seems to be biocompatible, and because it is porous there is rapid tissue ingrowth into it.

On the interaction of otolithic and cupular sensations.

A differential equation is proposed for describing how the brain compromises between a sensation of rotation about a particular axis (derived from the semicircular canals) and a sensation of gravity perpendicular to this axis (derived from the otolith organs). It is shown that this differential equation, with suitably chosen and reasonable values of the parameters and initial conditions, will satisfactorily explain the experimental results of Lansberg, Guedry, and Graybiel (7).

Metastatic renal adenocarcinoma presenting as periapical pathosis in the maxilla.

A case is reported because of the infrequency with which tumors metastasize from the kidney to the maxilla. It is of special interest because it presented as a periapical pathosis associated with a nonvital tooth and emphasizes the value of routine histopathologic examination of tissue.