The treatment of vaginal atresia.

The many techniques advocated for vaginal reconstruction have been classified and the indications for various useful procedures outlined. The widely used Abbe-McIndoe operation has been described. Other popular techniques have been discussed and attention drawn to their shortcomings.

The surgical anatomy of the scalp.

Cadaveric dissections and surgical observations have led to the description and clarification of the boundaries. blood supply, and nomenclature of the layers of the scalp. Special attention was directed to the layer of "loose connective tissue" that lies beneath the entire galea and above the cranial periosteum centrally, and the temporalis fascia laterally. It has been named the subgaleal fascia (SGF). The subgaleal fascia is a trilaminar structure with unusual potential in reconstructive surgery. Histologic study reveals the subgaleal fascia to be composed of a central dense collagenous layer surrounded by vascularized areolar tissue. It is readily dissected from surrounding galeal and periosteal layers. The subgaleal fascia was probably included in previously described "pericranial flaps," which were often based beyond the periosteum. The blood supply of the subgaleal fascia originates from the proximal portion of the peripheral vessels of the scalp and continues within the areolar lamina. The subgaleal fascia is an exceptionally thin, malleable, and well-vascularized flap useful for facial reconstruction.

Clinical applications of the subgaleal fascia.

The anatomic boundaries and vascular supply of the subgaleal fascia have been described previously. The thin and malleable subgaleal fascia was selected for difficult reconstructive problems in seven patients. This flap has been based on either the supraorbital or the superficial temporal vascular leash. The subgaleal fascia is readily dissected from superficial galea and deep periosteum, leaving behind a well-vascularized scalp and a skin-graftable calvarium. The flap conforms to a cartilage framework for ear reconstruction. It takes a skin graft well. The subgaleal fascia can patch dural defects and fill sinus dead space. It has been used to augment facial contour. Free vascularized transfer of the subgaleal fascia has included the temporoparietal fascia, which was partially split from the subgaleal fascia for bilobed flap resurfacing of the hand. The subgaleal fascial flap should be considered when ultrathin, vascularized coverage is needed.

A standard method for the correction of hypospadias.

A two-stage surgical correction used by one surgeon on 100 consecutive cases of hypospadias is described. The results and complications encountered are discussed and compared with those of the other popular operations.

Clinical experience and complications with fasciocutaneous flaps.

Our experience over the last 5 years with fasciocutaneous flaps in various areas of the body is described. Flap complications and special variations of the fasciocutaneous principle are discussed. Observations on our imperfect knowledge of the blood supply of the skin and deep fascia have been made and relevant experimental work briefly outlined.

Surgical indications for fasciocutaneous flaps.

The development of the fasciocutaneous flap, its relationship to the musculocutaneous flap, and the surgical indications for its use in various areas of the body are discussed. The precise vascular architecture has not yet been described, nor have reliable guidelines been established for the safe use of these flaps, but some clinical observations are made and related to the anatomical findings of other workers.

Secondary correction of the unilateral cleft lip nose deformity.

The reverse U operation of Tajima together with a few small modifications is described. Good results have been achieved in adults and reasons are given for the proposed use of the same technique in children of pre-school age.