[Plastic surgical reconstruction in microtia. A follow-up study]. / Plastikkirurgisk rekonstruktion ved mikroti. En efterundersøgelse.

During the period 1967-1987, 26 ear reconstructions were carried out in the Department of Plastic Surgery, Rigshospitalet, Copenhagen. These 26 patients were followed up, partly from the hospital records and partly by means of a questionnaire. Twenty-two patients replied to the questionnaire. The average age was 8.8 years at the commencement of the reconstruction and the average duration of hospitalization was 41 days. The reconstructions employed autologous costal cartilage. Minor complications were observed in approximately half of the patients. One patient developed pneumothorax postoperatively and one lost the grafts on account of repeated infections. 77% of the patients stated that the operation had been worthwhile. 37% found the result disappointing while the remaining 63% considered that the results were better than they had anticipated or as they had anticipated. The operation had no effect on teasing by peers. It is concluded that ear reconstruction should be postponed till an older age and that thorough preoperative information to the patients is important. The operation of surgical ear reconstruction is regarded as a valuable offer to patients with microtia.

Clinical applicability of an amino-terminal radioimmunoassay for determination of parathyroid hormone.

With a radioimmunoassay using hPTH 1-34 for antibody production, for radioiodination and as a standard, hPTH 1-34 was detectable (detection limit 40 pg/ml) preoperatively in peripheral blood in 14 of 29 patients with hyperparathyroidism, but in no controls. In all patients with parathyroid adenoma and detectable hPTH 1-34 preoperatively, the values fell after parathyroid surgery. Contrastingly, three of four patients with diffuse parathyroid hyperplasia and two of three with normal parathyroid glands showed a rise in hPTH 1-34 postoperatively, which was concomitant with very low serum calcium levels. In studies of hPTH 1-34 in central venous blood (3 patients), levels were detectable in all samples, but not in simultaneously drawn peripheral blood. Values for hPTh 1-34 in central blood correlated to PTH determined from a bovine assay, but the peripheral samples showed no correlation. The low levels of circulating N-terminal immunoreactivity in peripheral blood make this assay inapplicable for routine diagnostic purposes. These low levels are due not only to low secretion rates, but also to rapid peripheral metabolization.

Bleeding schwannoma of the small intestine: a diagnostic problem. Case report.

A rare case of intermittently bleeding, solitary benign schwannoma of the small intestine is presented. The tumor was identified by abdominal selective angiography. The importance of this investigation in cases of gastrointestinal bleeding without obvious cause is stressed.

Scrotal reconstruction after Fournier's gangrene.

After primary treatment for Fournier's gangrene, patients are left with skin defects in the genital region. In extensive lesions the whole scrotum may be lost. In these cases various methods for scrotal reconstruction have been recommended. In 3 patients we succeeded in reconstructing the scrotum and covering the penis using split-thickness skin grafts only. We found it a safe and relatively easy method giving the best possible cosmetic results and only minor functional sequelae.

Late patency of clinical microvascular anastomoses to free composite tissue transplants. II. Hemodynamical aspects.

In a series of 37 free composite tissue transplantations performed to the lower extremity in 34 patients, skin islands were included in 35 cases, as a cutaneous island flap (3), as a musculocutaneous island flap (19), and as an osteocutaneous island flap (13). In a follow-up study which included 26 patients with 29 flaps 6-48 months postoperatively an estimate was made of the importance of the blood supply through the vascular pedicle relative to the collateral blood supply through the recipient bed. Using transcutaneous oxygen tension measurements a significant reduction in calculated relative skin blood flow averaging 70% (p much less than 0.01) was seen after digital occlusion of the vascular stalk, suggesting that patent microvascular anastomoses are important for the vascularity of the transplanted tissues, not only for immediate postoperative survival, but also on the longer view.

Fournier's gangrene: 5 patients treated with hyperbaric oxygen.

The classic syndrome of Fournier's gangrene was observed in 5 men with involvement of the external genitals and lower abdominal wall. Mixed flora of anaerobic and aerobic microorganisms were grown, and extensive necrosis of the skin and subcutaneous gas were present in all patients. Soon after hospitalization all 5 patients were treated by excision of all necrotic and undermined tissue, intravenous broad-spectrum antibiotics and hyperbaric oxygen administered at 3 atmospheres of pressure. One patient died of septic shock without any response to the therapy. The infection subsided shortly after the hyperbaric oxygen was instituted in the remaining 4 patients, who were cured. It is proposed that the treatment of Fournier's gangrene should be limited to centers capable of administering hyperbaric oxygen therapy. Our series does not prove that hyperbaric oxygenation is necessary for successful treatment but evidence suggests a beneficial effect of such therapy for nonclostridial gas gangrene.