Mohs' micrographic surgery and prompt reconstruction for basal cell carcinoma: report of 62 cases using the combined method.

Aggressive, recurrent, and difficult to manage skin cancers may require complex solutions. In this review of 62 skin cancers, we demonstrate a novel approach to the management of these tumors. Mohs' micrographic surgery was used to remove the tumor, and was followed by immediate or delayed plastic surgical repair. Using this combined method, the highest attainable cure rate is linked with a coordinated prompt cosmetic repair. In this series of 54 patients with 62 skin cancers, there was one recurrence with a follow-up of one to four years. Most cases (65%) involved reconstruction within ten days of tumor removal. Eighty-one percent had a single-stage reconstruction. In seventeen patients, new tumors developed at other sites during the four-year follow-up period. On the basis of our experience with this combined method, we feel that Mohs' surgery, coordinated with prompt plastic repair, offers distinct advantages in the management of difficult skin cancers.

The osteo-mucoperiosteal flap in repair of cerebrospinal fluid rhinorrhea: a 20-year experience.

Chronic cerebrospinal fluid rhinorrhea (present for 2 months or longer) is a serious condition frequently encountered by the otolaryngologist-head and neck surgeon. The purpose of this report is that it can be successfully repaired transsinally, from below, with a high rate of success. Intracranial repair has been associated with reportedly high morbidity and failure rates. From 1967 to 1987, 16 patients underwent repair of chronic cerebrospinal fluid rhinorrhea in the cribriform plate or fovea ethmoidalis at the University of Iowa with an osteomucoperiosteal flap. Follow-up data from 1.6 to 22 years demonstrated no recurrent leaks in this group of patients. Minimal morbidity and no deaths were associated with the osteomucoperiosteal flap. On the basis of our experience, we recommend this technique, which can be performed by any experienced paranasal sinus surgeon, as superior to craniotomy for the repair of chronic cerebrospinal fluid rhinorrhea from cribriform plate and fovea ethmoidalis defects.

The effects of pentoxifylline on random skin flap survival.

Random skin flaps are an important and frequently used technique in head and neck reconstruction. Pentoxifylline has been shown to improve the deformability of red blood cells by increasing their intracellular adenosine triphosphate content and, therefore, improving their flow properties. This is especially important in ischemia and low blood flow states present in the distal portions of random skin flaps. The rheologic properties of pentoxifylline were studied in the swine model. Swine in group I (eight flaps) served as controls with no pharmacologic manipulations. Swine in group II (16 flaps) received pentoxifylline (20 mg/kg/d) for ten days preoperatively and ten days postoperatively. Necrosis in swine in group I (controls) averaged 32.6%, which substantiated previous reports. Necrosis in swine in group II (pentoxifylline) averaged 2.57%. This study has shown a statistically significant enhancement of random skin flap survival using pentoxifylline in a swine model.

Effects of Oxypherol-ET on random skin-flap survival in the swine model.

Random skin flaps are an important and frequently used technique in head and neck reconstruction. Fluorocarbons (Oxypherol-ET) have a low viscosity and high oxygen solubility that allow them to enhance the microcirculation and reduce skin-flap necrosis. These properties were evaluated using the swine model. Group 1 (four flaps) served as controls, with no hematologic or pharmacologic manipulations. Group 2 (16 flaps) had 20% of their blood volume removed and replaced with an equal amount of lactated Ringer's solution. Group 3 (16 flaps) also had 20% of their blood volume removed and replaced with an equal amount of Oxypherol-ET. Necrosis in group 1 (controls) averaged 32.6%; in group 2 (lactated Ringer's solution), 27.8%; and in group 3 (Oxypherol-ET), 8.34%. This study has shown a statistically significant enhancement of random skin-flap survival in the swine model with Oxypherol-ET.

The use of composite auricular grafts in nasal reconstruction.

Composite auricular grafts are extremely valuable in head and neck reconstruction. They are most commonly used in reconstruction of the ear, eyelid, and nose. Composite grafting provides a relatively simple technique of reconstruction with excellent cosmetic and functional results. The advantage of a one-stage reconstruction is particularly valuable to the patient.