Quantitative evaluation of mast cells in cellularly dynamic and adynamic vascular malformations.

Mast cells were counted in 78 histologic specimens from 70 patients with various vascular malformations showing cellularly dynamic and cellularly adynamic lesions. In growing stages of strawberry hemangiomas, there was an increased number of mast cells (mean 11.0 cells per high-power field in stage III and 23.7 in stage IV), as well as a high number of mast cells in the initial involution of strawberry hemangiomas (stage V, mean 21.0 cells per high-power field). In later involuting stages (stages VI and VII), the number of mast cells decreased (mean 9.3 in stage VI; mean 4.7 in stage VII). In cellularly adynamic lesions, i.e., port wine stains, the mean number of mast cells was 4.8, and in congenital arteriovenous malformations, it was 3.6. In normal skin, the mean number of mast cells was 3.2. In cellular hemangiomas that showed active growth (stages III to IV), the number of mast cells was strikingly low (mean 1.3). It seems that the mast cells are not responsible for the proliferation of the endothelium or for growth of the hemangioma. The markedly increased number of mast cells in the growing stages and initial involuting stage of strawberry hemangiomas parallels the gradual growth of fibrous connective tissue inside the tumor. Mast cells may thus be a precursor of the beginning of the involution of a strawberry hemangioma.

Selective use of serial expansion in breast reconstruction.

The advent of serial expansion adds a new dimension to the armamentarium of the plastic surgeon. While latissimus dorsi and rectus abdominis flaps remain invaluable in patients with severe tissue deficiency, they are unnecessary in most patients. The judicious use of the Radovan prosthesis has enabled us to place adequate-sized prostheses entirely beneath the chest-wall musculature. It has also allowed us to better control reconstruction in other developmental and traumatic deformities of the breast.

The use of tissue expansion in head and neck reconstruction.

The use of expanding prostheses to augment local tissues in reconstruction of the head and neck has been successfully accomplished in 13 patients over the past three years. Excellent results and reliability have been demonstrated.

Ultrastructure of mast cells in growing and involuting stages of hemangiomas.

Mast cells from 11 patients with growing strawberry (capillary) hemangiomas and cellular hemangiomas and from ten patients with involuting stages of strawberry hemangiomas were investigated electron microscopically. Two types of mast cells were evident: numerous elongated, fibroblastic cells and a few round, classic cells. The mast cells in growing hemangiomas contained many small, simple-type granules in various stages of development. It is possible that, owing to the immaturity of these granules, mast cells have different, probably weaker, functional activities. Mast cells in involuting stages of hemangiomas were filled primarily with compound-type granules, showing typical parallel, concentric lamellae or crystalloid structures, which were similar to the mature mast cells in normal skin.

Crystalloid inclusions in endothelial cells of cellular and capillary hemangiomas. A possible sign of cellular immaturity.

The fine structure of crystalloid inclusions were found in the endothelial cells of capillary (strawberry) hemangiomas and cellular hemangiomas in nine infants. The inclusions measured from 0.5 to 2.0 microns in diameter and showed parallel lamellar bands with a regular periodicity of about 180 to 300 A. The presence of crystalloid inclusions and the absence of typical rod-shaped tubulated Weibel-Palade bodies suggest the immaturity and embryonic character of the endothelium present in the blood vessels of these kinds of hemangiomas.

Cellular haemangioma. Light and electron microscopic studies of two cases.

Light and electron microscopic studies were conducted on the immature vascular tumors of two infants, containing various stages of differentiation of the blood vessels and both benign haemangioendotheliomas and haemangiopericytomas. We were able to confirm the existence of two kinds of hyperplastic, immature cells i.e. endothelial cells and pericytes in the same tumor. Presence of crystalloid inclusions in the endothelial cells and absence of the Weibel-Palade bodies, as well as a deficiency in factor VIII-related antigen and no tissue fibrinolytic activity, suggested that the endothelial cells in these lesions were immature. Electron microscopic studies appear more decisive in the diagnosis of heterogenous cellular vascular tumors than light microscopy and if available should be used to aid in the final diagnosis. The authors propose that the term cellular haemangioma would be more appropriate in describing this vascular entity.

The lateral calcaneal artery skin flap (the lateral calcaneal artery, lesser saphenous vein, and sural nerve skin flap).

The lateral calcaneal artery skin flap is an axial-pattern flap that can provide skin flap coverage over the exposed calcaneal tendon or os calcis on the posterior or plantar heel. The flap can be designed as a short (8.0 X 4.5 cm in the adult) vertical flap or a long (14.0 X 4.5 cm) flap that curves forward to the base of the fifth metatarsal. Anatomic dissection and Doppler flow studies have been done on healthy volunteers and in patients with severe peripheral vascular disease. There was blood flow in the lateral calcaneal artery in 100 percent of the healthy patients and in 92 percent of those with peripheral vascular disease. Caution must be observed when planning the long version of the flap to be certain that there is adequate arterial flow. We recommend directional Doppler studies in all patients in whom the long version of the flap is planned. When there has been significant lower extremity trauma, an angiogram should be obtained before proceeding with either the short or long version of the flap. When the long lateral calcaneal artery flap is to be used, parallel sides of the flap should be incised and undermined and a vascular clamp should be placed on the distal end of the flap. The intravenous fluorescein test is then performed before determining whether to divide the third side of the flap or to delay it.

Peripheral nerve regeneration in primates during D-penicillamine-induced lathyrism.

We have attempted to alter collagen metabolism in young squirrel monkeys by inducing lathyrism with D-penicillamine to weaken scar tissue. We then tested the effectiveness of this drug in improving regeneration of transected peripheral nerves at the wrists using a dose of 200 mg/kg/day. We did find a significant increase (doubling) in the soluble collagen in Ivalon sponge samples that had been implanted 3 weeks after the onset of drug treatment. We also compared the control and treated groups in terms of :(1) the rate of appearance of evoked muscle action potentials, (2) the amplitude of evoked muscle action potentials, and (3) the nerve conduction velocities. Using these tests we were not able to demonstrate any improvement in the quality or rate of nerve regeneration. The possible explanations for these observations are discussed.

Increasing the incidence and the size of successful experimental composite ear grafts by advance preparation of the recipient bed.

Composite grafts were transferred from one ear to the other in adult macaque monkeys. Evidence was found that preparation of the recipient bed (cutting a wedge-shaped hole from the rim inward, 10 or 11 days ahead of transfer) would increase the incidence of complete takes and would also increase the size of grafts that could be transferred successfully.

Results from tattooing port-wine hemangiomas. A long-term follow-up.

Nineteen patients who had completed their course of dermatattoo treatment for the camouflage of port-wine hemangioma were evaluated at an average of 3.1 years following completion of treatment. A panel of 7 people evaluated preoperative and postoperative photographs and judged that none of the patients were more than "50 percent improved" in the camouflaging of their hemangioma, and that most of them (15 out of 19) were either "not improved" or "25 percent improved," as compared to their original photographs. We cannot rule out the possibility that this treatment may be effective in adults, as all of our patients at the time of their first treatment were between the ages of 4 and 20 years; and most of them were between 6 and 10 years old. On the basis of this evaluation, we no longer recommend the technique of dermatattoo for camouflage of port-wine hemangioma in patients in the younger age group.

Teratomatous choristoma and its associated syndromes. Case report.

The literature on oral teratomata is reviewed, and a theory for the embryological basis for these malformations is presented. We present an unusual case of Class III (Schwalbe) teratoma, in association with a complete cleft of the hard palate. Corrective surgery was required in the neonatal period.