Firm elevation of the auricle in reconstruction of microtia with a retroauricular fascial flap wrapping an autogenous cartilage wedge.

During conventional reconstruction of the auricle in patients with microtia, simply separating the auricle from the mastoid region with a full-thickness skin graft usually fails to create firm elevation and sufficient projection. To achieve frontal symmetry is difficult, and sometimes the normal auricle needs to be set back. We reconstructed the auricle in patients with microtia in two major stages using a modified Nagata's method. Using a wide W-incision skin flap, the first stage includes implantation of a cartilage framework and transposition of the ear lobule. Our modification lies in the second stage. Instead of using the superficial temporoparietal fascial flap, we elevated a retroauricular fascial flap from the mastoid region, turning it over to wrap an autogenous costal-cartilage wedge, and covered it with a full-thickness skin graft. Between June 1996 and May 1999, eight patients underwent this operation. All the fascial flaps and overlying full-thickness skin grafts survived well. The advantages of our technique include firm elevation, good frontal projection and a natural appearance of the posterior aspect of the ear. Additionally, by using this fast and practical procedure, we avoid creating additional scars on the scalp and preserve the superficial temporoparietal fascia and superficial temporal vessels.

Treatment of axillary bromhidrosis with superficial liposuction.

Axillary bromhidrosis or osmidrosis is a distressing problem that causes a serious personal and social handicap, especially in an Asian society. Surgical excision of the subcutaneous tissue, with or without skin excision in the axillary hair-bearing area, has been the treatment of choice for several decades. However, the complications of partial necrosis of wound edges or hematoma, and the possibility of the obvious unsightly scars, are always problems. We report our method of treatment of modified superficial liposuction with subdermal scraping under local anesthesia with tumescent infiltration. By using two tiny stab wounds, these two steps of liposuction can be done in the two-directional crisscross pattern. From August of 1995 to May of 1997, 20 patients (16 women and 4 men) received this surgery for bilateral axillas on an outpatient basis. The follow-up period ranged from 6 months to 27 months, and the mean follow-up period was 14 months. Eighteen patients (90 percent) had excellent to good results. Complication included only one minor wound infection that was cured easily. Two patients experienced transient subdermal fibrotic bands in one side of the axilla, and one patient experienced axillary skin with marked induration and retraction. All of these symptoms disappeared after 1 month or so. This minimal incision operation has the advantages of a high success rate, low complication rate, tiny to invisible scars, no change of hair distribution pattern, minimal postoperative care with a short term of compressive dressing (less than 2 days), and rapid recovery for daily activity and exercise.

The influence of intra-graft heparin injection on the survival of composite grafts.

BACKGROUND: Intra-replant subcutaneous heparin injection has been reported to be an alternative to venous anastomoses in finger replantations. It has also been recommended for composite graft type replants. In this study, we investigated three different regimens of intra-graft heparin injection in a rabbit ear model. Our aim was to determine whether or not continuous oozing from an incision wound on a composite graft made by an intra-graft heparin injection would increase the survival of a larger composite graft. METHODS: A 25-mm-diameter circular composite graft (including dorsal skin and auricular cartilage) was harvested from the mid-portion of a rabbit ear. This size of graft was selected as the study model due to a significantly lower percent graft survival when compared to smaller-sized grafts (17.0 +/- 5.6%, p < 0.05). Three different regimens of intra-graft heparin injection were performed in the study group and the results of percent graft survival were compared. RESULTS: Intra-graft injection of heparin calcium 250 IU/0.1 ml qd for seven days resulted in a significantly higher percent graft survival than the other two regimens and a control group (64.0 +/- 9.7%, p < 0.05). The "flow-through" phenomenon was observed in this study. CONCLUSIONS: Intra-graft heparin injection resulted in a higher percent graft survival than the control group for the 25-mm-diameter circular composite graft. However, the mechanism of graft survival enhancement could not be clearly explained by this study. It is recommended that the clinical application of intra-graft heparin injection should only be used when subgraft hematoma can be avoided and systemic bleeding tendency is being closely monitored.

Use of Biobrane in pediatric scald burns--experience in 106 children.

This report describes 141 scalded children admitted from January 1993 to June 1995. The mean age of patients was 2 yr 11 months. The average burn size was 11.4 percent TBSA. The male to female ratio was 1.6:1 (87:54). One hundred and six of the children were initially diagnosed as suffering from superficial or medium partial-thickness burns. After proper evaluation and resuscitation, all of them received immediate debridement and Biobrane coverage. This biosynthetic dressing was fixed with adhesive tape and compressive dressing. No splints were used. Pain tolerance was good and these children were able to resume their daily activities as early as possible. If vital signs were stable and Biobrane adherence occurred, the patients were discharged. The dressings were easily changed on an out-patient basis; therefore, the hospital stay and ultimate cost of burn care both decreased. This experience confirmed that Biobrane is quite suitable for consideration in treating pediatric scalds. Accurate diagnosis of depth is very important. The best results can be obtained only on superficial partial-thickness burns. A high wound infection rate occurred in the medium partial-thickness burn wounds (7.8 vs. 62.1 percent).

Constituents and cytotoxic principles of Nothapodytes foetida.

A new naturally occurring alkaloid, acetylcamptothecin, together with 17 known compounds, (+)-1-hydroxypinoresinol, omega-hydroxypropioguaiacone, p-hydroxybenzaldehyde, scopoletin, uracil, thymine, sitosterol, sitosteryl-beta-D-glucoside, 3 beta-hydroxy-stigmast-5-en-7-one, stigmast-5-en-3 beta,7 alpha-diol, 6 beta-hydroxystigmast-4-en-3-one, sitost-4-en-3-one, linoleic acid, trigonelline, camptothecin, 9-O-methoxycamptothecin and pumiloside were isolated and characterized from the stem of Nothapodytes foetida. Among them, scopoletin, camptothecin, 9-O-methoxycamptothecin and O-acetylcamptothecin showed significant cytotoxic activity.

Aristolochic acids, aristolactam alkaloids and amides from Aristolochia kankauensis.

Fourteen aristolochic acid derivatives: ariskanins A-E, 3-hydroxy-4-methoxy-10-nitrophenanthrene-1-carboxylic acid methyl ester, aristolochic acid-II methyl ester, aristolochic acid-IV methyl ester, aristolochic acid-C, -I, -II, -III, -IV, -IVa; nine aristolactam alkaloids: aristolactam, aristolactam-AII, -BIII, -AIII, -III, cepharanone-A, 9-methoxy-aristolactam-I, aristolactam-N-beta-D-glucoside and aristolactam-C-N-beta-D-glucoside; a 4,5-dioxoaporphine alkaloid: cepharadione-A, together with 12 other compounds: methyl-p-coumarate, N-trans-feruloyltyramine, N-cis-feruloyltyramine, methyl vanillate, methyl paraben, allantoin, an octadecyl- and eicosyl ferulate mixture, cis- and trans-p-coumaric acid, N-p-coumaroyltyramine, N-p-cis-coumaroyltyramine, methyl ferulate and isorhamnetin-3-O-rutinoside were isolated and characterized from the fresh root and stem of Aristolochia kankauensis. Their structures were elucidated by spectral and chemical methods. Among them, ariskanins-A-E and N-p-cis-coumaroyltyramine are reported for the first time from a natural source. The cytotoxicity and antiplatelet activity of the compounds isolated are also discussed.

Bacteriology of necrotizing fasciitis: a review of 58 cases.

Necrotizing fasciitis is a relatively rare soft tissue infection that is characterized by rapidly widespread necrosis of the fascia and subcutaneous tissue. Fifty-eight cases were reviewed over a 5.5-year period. The majority of wound cultures were polymicrobial and single culture rate was 18.6%. The facultative organisms were most frequently recovered. The most frequently discovered bacteria were E. coli, Proteus mirabilis, Klebsiella pneumoniae, Staphylococcus aureus and group D enterococcus. The overall mortality rate was 48.3%. Early recognition, serial radical surgical debridement and strong and appropriate antibiotics were essential for survival.