[Fifty years of plastic surgery in the Netherlands. I. Seemingly minor accidents: major hand injuries]. / Vijftig jaar plastische chirurgie in Nederland. I. Ogenschijnlijk kleine ongevallen: grote handletsels.

In patients with hand injury, careful clinical examination is necessary, even in cases of seemingly trivial lesions such as small puncture wounds. Four patients, two women aged 18 and 51 years and two men aged 16 and 28 years, presented with a small volar cut caused by a glass fragment (three patients) and a saw. They suffered from loss of motor function, loss of sensibility or loss of circulation in one finger. They were treated by plastic surgery. Lesions of tendons and peripheral nerves can be diagnosed by relatively simple tests. It is important to recognize them at an early stage because adequate treatment may result in recovery of the sensibility and the motor function. Even a 'dead' finger may be salvaged.

[Fifty years of plastic surgery in the Netherlands. II. Introduction]. / Vijftig jaar plastische chirurgie in Nederland. II. Toelichting.

Plastic surgery is a medical specialism that was born out of was surgery. The first famous Dutch plastic surgeon, Esser, operated in Austria and Hungary during World War I. Koch, trained in England during World War II, and companions founded the Dutch Society for Plastic Surgery on October 7th 1950. During the last 50 years plastic surgery has changed into a very divers specialism, which focuses on craniofacial, esthetic, and reconstructive surgery, micro- and hand surgery, trans-sexuality and surgery of congenital abnormalities, especially of the face and hands. Each plastic operation aims at improvement of form and/or function. There have been many developments in all the fields of interest; these will be highlighted in a short series of articles.

Median cleft of the lower lip and mandible: case reports, a new embryologic hypothesis, and subdivision.

Median clefts of the lower lip and mandible are rare. In the literature so far, about 62 cases have been described. In addition, three more patients are presented here. These cases show a broad variation in the severity of this deformity, ranging from a simple notch in the vermillion to a complete cleft of the lip involving the tongue, the chin, the mandible, the supporting structures of the median of the neck, and the manubrium sterni. Several hypotheses concerning the pathogenesis of median clefts of the lip and mandible have been proposed. Most authors consider it to be a failure of fusion of the first pair of branchial arches or failure of mesodermal penetration into the midline. From our embryologic point of view, however, instead of paired branchial arches, only one first branchial arch develops during the early embryonic period (< or = 17 mm crown-rump length). Within this first branchial arch, two mandibular processes grow out, separated by a groove in the median. These mandibular processes do not fuse but merge during the late embryonic period (> or = 17 mm to < or = 60 mm crown-rump length). In the same developmental period, there is formation of the lip and the alveolar process and the anlage and outgrowth of one membrane bone center in each mandibular process, resulting in the formation of the mandible with its symphysis. As a consequence of the preceding, we propose the following subdivision of the median clefts of the lip and/or mandible: Hypoplasia of the mandibular processes during the early embryonic period will lead to the severest cleft of the mandible extending into the neck. During the late embryonic period, the less severe median clefts will develop. Disturbances of the outgrowth of bone centers of the mandible, resulting in nonformation of its symphysis, cause clefting of the mandible with involvement of all related soft tissues. Defects in the merging process produce just a notch of the vermilion or a higher cleft of the lower lip with or without involvement of the alveolar process of the mandible. In conclusion, the variety of the clefts in the median of the lower lip and/or mandible as well as the low rate of incidence can be explained by the embryologic hypothesis proposed here.

Dermatography: a method for permanent repigmentation of achromic burn scars.

Dermatography, a refined elaborate tattooing technique, has been used successfully in 52 patients suffering from postburn depigmentation. Materials and methods are simple and safe. Over a 5-year follow-up no adverse reactions or complications were noticed. The cosmetic results were very satisfactory both to the surgeons and to the patients. Dermatography is suggested as an alternative for treating localized achromasia, particularly when other medical therapeutic attempts have failed in repigmenting this often disfiguring condition.