The role of tissue expanders in vaginoplasty for congenital malformations of the vagina.

There are many techniques of vaginoplasty in congenital malformations of the vagina, all of which involve the use of labial and perineal skin flaps. The results are not uniformly satisfactory because of delayed stenosis in many patients. To avoid this complication, we have used labial expansion with tissue expanders to obtain an elastic and sufficiently large skin flap. We recommend this technique in patients with the adrenogenital syndrome associated with varying degrees of virilisation and in other intersex anomalies.

Dermofasciectomy and full-thickness grafts in the treatment of Dupuytren's contracture.

We report a 16-year experience with full-thickness grafts to resurface defects created by releasing contractures of Dupuytren's disease. This technique was used in 68 patients with Dupuytren's contracture from 1970 to 1985. Follow-up of 36 hands of 24 patients averaged 3.9 years postoperatively. There was no recurrent disease in the palms and digits that were covered with the full-thickness grafts. The incidence of extension outside the grafts was 8%. The area of full-thickness grafting covered most of the width of the palm, an extension of Gonzalez's technique, which was presented in 1970.

Digital tourniquets: a pressure study with clinical relevance.

This study measured the pressures under the three most commonly used digital tourniquets--the Penrose drain, the rolled rubber glove, and the rubber band. A miniature pressure transducer and a digital strain indicator were used to measure pressures generated by the various tourniquets. The rolled rubber glove technique was highly consistent, irrespective of the clinical experience of the subject, and uniformly generated pressures of less than 500 mm Hg. Pressures generated by Penrose drains and rubber bands were highly variable and were significantly greater than 500 mm Hg. The so-called calibrated Penrose drain generated the highest pressures in the study. The relationship between tourniquet pressures and neurovascular injury in the human digit is not clearly defined.