Tibialis anterior turnover flap coverage of exposed tibia in a severely burned patient.

A case report of a longitudinally split tibialis anterior turnover flap reconstruction of an exposed tibia in a burn patient is presented here. The patient had sustained deep partial- and full-thickness burns to 70 per cent of his total body surface area (TBSA), resulting in an exposed left patella and upper two-thirds of the left tibia. Although full thickness loss of skin occurred on the left lower leg, no muscle trauma was sustained. Reconstruction was therefore deemed possible using local muscle tissue to provide transposed flap coverage. A gastrocnemius muscle flap was used to cover the exposed patella and superior aspect of the tibia. A portion of the tibialis anterior muscle was split longitudinally and turned over medially to cover the remaining exposed tibia. The advantages offered by this infrequently used flap include technical simplicity, reliability, minimal donor site dysfunction and the allowance of future use of the soleus flap. The tibialis anterior turnover flap may therefore have wide applicability for reconstruction of the severely burned lower extremity.

Reduction mammaplasty for gigantomastia using inferiorly based pedicle and free nipple transplantation.

Patients with gigantomastia have severely distorted anatomical breast structures. Reduction mammaplasty in such cases using the inferiorly based pedicle containing the nipple-areola complex can be technically difficult, yield poor results, and cause postoperative complications such as nipple necrosis and loss. Alternative traditional methods such as amputation mammaplasty with free nipple-areola transplantation usually results in a flattened, nonaesthetic breast with poor projection. This unacceptable result is due to the lack of central breast tissue required for normal anatomical projection. Herein, we describe a method of reduction mammaplasty for gigantomastia combining free nipple transplantation and an inferiorly based pyramidal parenchymal flap for augmentation of breast fullness and nipple projection.

Successful treatment of coccidioidomycosis osteomyelitis in an infant.

A 10-month-old Hispanic male infant with expansile lesions of the third metacarpal and proximal phalanx positively diagnosed as Coccidioides immitis osteomyelitis is presented. Treatment consisted of combined surgical debridement and systemic antifungal therapy and resulted in complete resolution of the lesions. Treatment was guided by clinical response and complement fixation titers. Osteomyelitis is a relatively infrequent manifestation of disseminated coccidioidomycosis. Neonates and infants appear to be more susceptible to the development of dissemination, but less likely to develop toxicity due to systemic therapy. Current therapy consists of concomitant surgical excision of involved lesions and systemic antifungal therapy. Complement fixation titers correlate closely with clinical response to therapy and are useful in detecting subclinical recurrences.

Hemitongue advancement following anterior hemiglossectomy.

A simple technique is described that will restore a full-bodied, mobile anterior tongue following a partial anterior hemiglossectomy. The procedure is applicable following resections of stage I cancers of the anterior tongue. It can also be of value when a large anterior tongue flap has been used for intraoral reconstruction.

Secondary unilateral cleft lip repair: combining rotation-advancement principles with a cross-lip muscle-vermilion flap.

Any lip without a complete philtral complex looks unnatural. This important anatomical entity can be recovered in many lips primarily closed with straight-line or Mirault-Blair-Brown-McDowell procedure. In these patients, combining a rotation-advancement upper lip revision with tubercle reconstruction using a cross-lip vermilion-orbicularis oris muscle flap results in a rotation-advancement scar ideally located in the skin of the upper lip and no scar in the skin of the lower lip. The tubercle is reconstructed as a unit from lower lip vermilion and muscle. The scar in the lower lip is restricted to the vermillion and therefore becomes extremely subtle and difficult to detect. The many scars resulting from a standard Abbe flap are avoided. Even patients with lip deformities considered too mild for a standard Abbe flap no longer need be denied lip revision when the cupid's bow is deficient.

Transconjunctival lower lid blepharoplasty for removal of fat.

Our experience with 7 transconjunctival lower lid blepharoplasties is reported, and the technique is described. It is an excellent operation for patients with prominent lower lid fat who do not need skin resection.

Colon and rectal cancer in the young adult.

801 patients with colon and rectal cancer were studied to assess the behavior of this cancer in the patient under 40 years of age as contrasted to the more commonly seen older patient. The younger patient had a greater frequency of advanced signs, later stages of cancer and mucoid carcinoma. However, when compared by clinical staging, the younger patient did as well or better than his older counterpart. Clinical staging was the most important prognostic factor irrespective of age. No inherent difference was found in the virulence of the cancer in the young, as the five-year survival in the younger patient (31 percent) was essentially the same as in the older patient (32 percent).