The fate of preserved autogenous bone graft.

Certain clinical conditions exist in which a section of cranial bone is removed but not immediately replaced at the initial procedure. Preservation of this bone can provide a valuable autogenous donor source for a future reconstructive procedure. The purpose of our study was to compare the volume retention of fresh autogenous bone with that of preserved autogenous bone as inlay and onlay cranial grafts. Two bone grafts were harvested from the skull of 15 adult New Zealand White rabbits. The graft volumes were calculated, and the graft were preserved in a normal saline-antibiotic solution at -20 degrees C. Three months later, during the second procedure, a fresh graft was harvested and then placed in the preexisting occipital defect as an inlay graft. Also at this time, the preserved grafts were placed, one as an inlay graft in the fresh occipital defect and the other as an onlay graft in the frontal region. The animals were sacrificed 3 months later, and the percentage of graft volume retention was determined. The fresh inlay grafts had a mean volume retention of 85.1 percent, while the preserved inlay nad onlay grafts had 61.8 and 75.9 percent mean volume retention, respectively. It is concluded that while fresh cranial autograft remains the "gold standard" for craniofacial reconstruction, preserved autogenous cranial bone is a viable alternative for inlay and onlay grafting of the craniofacial region.

Undetected diabetes and the plastic surgeon.

Plastic surgery candidates are generally healthy. Therefore, major postoperative complications are rare. Should they happen, the surgeon should search for possible causes, one of which is undetected diabetes mellitus. Six patients are presented who, based on the individual or family history or the unusual nature of their complications, were suspected of having diabetic tendencies. This experience necessitated our in-depth search into the role of silent or undetected diabetes. This report emphasizes the importance of positive family history of diabetes and the role of glucose tolerance tests on suspected cases. Even with normal glucose tolerance tests, however, some of these patients with a positive family history of diabetes and history of previous infections suffer from deficiencies in the chemotactic immune system. We recommend full discussion of the increased risk of infection and delayed healing with these patients, conservatism during surgical procedures, and prophylactic use of antibiotics perioperatively.

A severe fibrotic reaction after cosmetic liquid silicone injection. A case report.

A case of a severe, locally aggressive fibroblastic reaction to cosmetic silicone injection involving the orbital cone and anterior cranial base is presented. Included is a brief history and description of silicone injection and its complications. Though many facts remain to be discovered, speculation into the possible pathogenesis, with a review of the literature, shows that while silicone continues to be a useful tool for the plastic surgeon, an awareness of the risks, as well as a search for clues to avoid complications, must continue before further liberal use of this material is encouraged.

Long-term survival following nodal metastases from basal cell carcinoma.

A case of long-term survival with metastatic basal cell carcinoma to regional lymph nodes is presented. The literature has been briefly reviewed. When a metastatic basal cell carcinoma is discovered, the average survival is only 8 to 10 months. The patient in this case report has been followed for 10 years from the initial metastatic discovery and 7 years from the last metastatic surgery by one of the authors. There has been no evidence of recurrent disease. The topic of metastatic basal cell carcinoma is detailed in this report.

A critical comparison of osteoplastic and alloplastic augmentation genioplasty.

This retrospective study was undertaken in order to compare the objective and subjective outcomes of the osteoplastic and alloplastic genioplasties. Of the 76 patients that underwent augmentation or advancement genioplasty, 34 were subjects of osteoplastic genioplasty and 42 received implants. Twenty seven of 34 patients who underwent osteotomy and 32 of 42 patients whose chins were augmented with an implant responded to the questionnaires. The results revealed that both groups were highly satisfied, with a slightly higher satisfaction rate for those who underwent osteotomy. The morbidity was the same for both procedures. However, the soft tissue response was more predictable for the osteoplastic genioplasty. The cervicomental angle improved more with the osteoplastic genioplasty. Based on our experience and conclusions from this study, we recommend the osteoplastic genioplasty for every patient. However, for patients in the older age group, particularly those with a small degree of microgenia, alloplastic genioplastic can be justified.