Camouflaging hairless areas on the male face by artistic tattoo.

Marked improvement in the aesthetic appearance of scars and skin grafts of the hair-bearing facial areas of male patients can be achieved by camouflage with punctate tattooing. The technique is easy and simple to learn. The procedure is performed under local anesthesia and on an outpatient basis.

Single artery replantation of totally avulsed scalp.

The treatment of choice for the avulsed scalp is microvascular replantation. After replantation there are numerous arterial anastomoses, with venous congestion. Usually an effort to establish inflow through two arterial anastomoses is made. We elected to anastomose one artery and multiple veins in each of our patients. We present three consecutive successful replantations of total scalp avulsion, using only one arterial anastomosis, and multiple veins. Surprisingly, two of the patients regained their ability to elevate their eyebrows actively.

[Transaxillary mammary augmentation with texture silicone implants].

45 texture silicone prostheses (Siltex, Mentor Co.) were used for augmentation of ptotic and hypoplastic breasts in 23 women, 17-45 years old. The dissection was submammary in all cases and the results were very good. In only 1 of 45 breasts is there Baker grade III contracture, and in 1 case the placement of the prosthesis was too high. There were no other complications. The axillary approach is recommended to reduce the rate of complications and to conceal the scar.

[Lateral arm free flap transfer to cover traumatic hand injuries].

The advantages of free flaps over distant pedicled flaps in hand reconstruction are well documented. They often require only a single operation, do not depend on local conditions of the wound and permit early physiotherapy. The lateral arm free flap is essentially suitable for reconstruction of the hand. It is thin, potentially sensate, and gives nearly perfect skin color and texture match. An additional technical advantage is the possibility of elevating the lateral arm free flap with tourniquet control at the same surgical field as the recipient site. We describe 3 cases of traumatic damage to skin and soft tissue of the hand, in which reconstruction was by both elective and emergency lateral arm, free flap transfer. They demonstrate the merits of this method of reconstruction.

Successful microvascular replantation of an amputated penis.

Total amputation of the penis is a disfiguring, and functionally and psychologically disabling injury. We report a case of successful microvascular replantation following self-emasculation by a psychotic patient. The need for a multidisciplinary approach combining the expertise of such diverse disciplines as surgery, intensive care and psychiatry is emphasized.

A quick stapler tie-over fixation for skin grafts.

A simple method to ensure split-thickness skin graft immobilization is presented. The method uses foam rubber and a staple gun. The method is safe and reliable and saves operating room time.

Tensor fascia lata musculocutaneous flap for abdominal wall reconstruction.

We report a case of abdominal wall reconstruction following excision of irradiated skin and a ventral hernia. A very large tensor fascia lata musculocutaneous flap was used with good results. The anatomical features of this flap make it an excellent method of abdominal wall reconstruction.

Very deep high temperature burns associated with blunt abdomino-thoracic trauma.

A 14-year-old boy with deep burns, blunt abdominal trauma and extensive muscle damage is described. The patient was operated on for a ruptured liver, developed acute tubular necrosis, had 3220 gr of necrotic tissue removed in serial tangential excisions, had an above elbow amputation of the left hand, removal of necrotic ribs and excisions of necrotic spinal processes, developed sepsis twice, empyema of right pleura, had open infected knee joints and was successfully treated until complete healing over a period of four months. The successful outcome seems to be due to early and aggressive surgical treatment, hemodialysis, total parenteral nutrition for over two months, antibiotic therapy, cryoprecipitate and devoted nursing, occupational and physiotherapy.

Microsilicone anastomoses.

Silicone tubes used for lacrimal system reconstruction have already been tested as temporary microvascular shunts. As a model of the small vessel, the silicone tube is used for initial training in microvascular surgery. It is useful for both teaching and practicing.

Surgical correction of ectropion of the anal mucosa.

A method to correct an ectropion of the anal mucosa, using the triangular flap technique, has been described. The operation is simple and physiologically sound, with special attention being paid to skin tension lines. The results are excellent, and the patient is relieved of discomfort, bleeding tenesmus and pruritus which accompany ectropion of the anal mucosa.

Envenoming by Cerastes viper - a report of two cases.

Two cases of envenoming by Cerastes vipera are described Both were in snake collectors who were accidentally bitten on the finger while handling the snake. In both cases, local signs included a haemorrhagic bulla with fang marks, swelling and tenderness. These signs were mild in one case and moderately severe in the other, necessitating fasciotomy. No systemic signs were observed. Some coagulation abnormalities were found in both cases. In one, prolonged bleeding from the wound and a shortened euglobulin lysis time may suggest activation of the fibrinolytic mechanism. In the other, prolongation of prothrombin time occurred with no haemorrhagic diathesis. Treatment included fasciotomy in one case and elevation of the affected part and antibiotics in the other. It appears that the clinical course of this snakebite is relatively benign.

Spontaneous midesophageal rupture.

Spontaneous rupture of the esophagus is rare. To date, 17 such cases, including our patient, have been reported in the literature. We present a case of true spontaneous rupture that occurred during sleep. Because the correct diagnosis was made 36 h after the rupture, treatment consisted of surgical drainage only. The drainage was extrapleural, though a posterior mediastinal approach, thereby avoiding the complication of empyema. The paraesophageal abscess was repeatedly irrigated with povidone-iodine solution. The patient recovered after a long period--56 days--of hospitalization. The report includes a review of the signs and symptoms of esophageal perforation, the current mode of therapy, and some speculation on the pathogenesis of true spontaneous perforation.