Surgical treatment of familial benign chronic pemphigus.

Familial benign chronic pemphigus (Hailey and Hailey disease) is a rare, recalcitrant, often disabling genodermatosis that may not respond to conservative dermatologic therapy. We describe herein five patients with intertriginous familial benign chronic pemphigus who underwent excision and split-thickness skin grafting. All were men whose duration of disease ranged from one to 38 years. Follow-up evaluations ranging from ten months to nine years revealed no recurrence in graft sites in three patients, mild recurrence in one patient after eight years, and one death from pulmonary embolus in the postoperative period. The occurrence of familial benign chronic pemphigus around graft edges was a universal, but relatively minor, problem. Surgical excision provided definite relief from an otherwise disabling disease in four of our patients and a satisfactory improvement in life-style.

Experience with 100 muscle flaps.

One hundred muscule flap transfers performed at the Mayo Clinic from 1975 to 1978 are reviewed and assessed as to the cause and location of the defects, muscles used, complications, and results. We found the muscle flaps very versatile for covering for a wide variety of difficult soft tissue and bony defects. The complication rate was very low, considering the severity and chronic nature of the problem. Ninety-two percent of patients showed healing after surgery, and 82% remained healed at the time of this follow-up survey.

Bilateral verrucous carcinoma of the feet.

A 51-year-old woman had had bilateral verrucous carcinoma of the feet for ten years. The tumors had been treated many times as extensive verruca vulgaris before a biopsy was performed and the true neoplastic nature of the lesion recognized. This case illustrates the necessity of performing biopsies on atypical or frequently unresponsive verrucous tumors.

Flaps used for nasal reconstruction: a perspective based on 180 cases.

Flap reconstruction of the nose is historically one of the earliest surgical operations. In spite of this long experience, little has been reported on the viability and durability of the various flaps and the time involved in the reconstruction, including the number of operative procedures required for total reconstruction of the nose. One hundred eighty patients were involved in this retrospective study dating from 1940. The midline forehead flap, used for partial nasal reconstruction, was specifically excluded from this study and will be reported separately later. The arm flap (Tagliacozzi), the total forehead flap, the sickle flap, and the acromiopectoral flap are reviewed in terms of the complications encountered, the total number of operations required, and the time involved in the complete reconstruction. The various nasal defects have been classified into five types, and the flaps usually used for reconstruction have been correlated with these defects. Eighty percent of the patients were treated because of a cutaneous malignancy of the nose. However, because these malignancies are currently being treated earlier and more efficiently, there is a significant decrease in present-day experience with this type of surgery.

Management of radiation necrosis and advanced cancer of the chest wall in patients with breast malignancy.

Aggressive resection, with individualized reconstruction by several methods, is of value in many patients with radiation necrosis and/or advanced breast cancer of the chest wall. Although this does not always significantly lengthen survival, it can improve the quality of life markedly in many instances. Remarkably large defects can be reconstructed with single-stage procedures.

Experience with and comparision of methods of reduction mammaplasty.

Experinece with bilateral reduction mammaplasty in 213 patients has been reviewed. Complications, while not infrequent, are rarely of a serious or lasting nature. In the experience of the authors, the McKissock procedure has yielded the most consistently good results, although very good results were occasionally achieved with all of the other techniques employed.

Treatment of chronic radiation injury over the shoulder with a latissimus dorsi myocutaneous flap.

We report our experiences in treating chronic radiation injury about the shoulder, a complication of radiation after mastectomy. Left untreated, these can result in chronic infection and/or amputation. The coverage of a large shoulder area presents certain unique problems, which severely limit the usefulness of traditional procedures. We have found that the remarkable size and versatility of the latissimus dorsi myocutaneous flap enables one to use it with relative simplicity and safety. A further great advantage is that it brings new permanent blood supply into this ischemic area, thus favoring rapid healing and durable coverage.

The banner flap.

Wide experience with the banner flap for closure of postsurgical defects of the nasal dorsum shows not only that it is a predictably safe and versatile procedure but also that its use enables a superior cosmetic result to be obtained. The operative technic is described in detail along with our clinical experience.

A review of 324 rhytidectomies, emphasizing complications and patient dissatisfaction.

The results and complications after 324 rhytidectomies, done between 1962 and the middle of 1973, were reviewed. The major complications were hematoma, skin slough, and facial nerve damage. In addition, respch as numbness of portions of the face, loss of hair, bothersome scarring, and general dissatisfaction with the operation. In general, these latter were of more concern to them than the major complications.

Silicone implants for contour deformities of the trunk.

A follow-up study of 12 patients who had preformed silicone implants inserted for correction of body contour deformities (8 for pectus excavatum and 4 for soft-tissue deformities of the shoulder and pectoral region) has demonstrated the safety of this technique and its lack of significant early or late complications. No implants have been removed, and 10 of the 12 patients regarded the overall results as good or excellent.

Experience with the deltopectoral flap.

The deltopectoral flap is a most versatile source of skin coverage or mucosal lining (or both). There is remarkable safety in the use of this flap in relation to its size, and there is only limited need for delay--because it pedicle is an axial flap. Nonetheless, the terminal part requires the attention to detail which any random flap requires--such as the avoidance of hematoma and infection and the prevention of tension, kinking, and angulation. This not only will ensure the safety of the flap, but also will prevent the rather common and annoying minor complications that delay the patient's convalescence.

Use of muscular, musculocutaneous and omental flaps to reconstruct difficult defects.

These recently popularized flaps make reconstruction of some difficult defects possible in a single operation, with surprisingly good results. They have significant advantage over free flaps (except, perhaps, in the hands ofa few experts) because the chance of failure is considerably less. We do not propose that these flaps be used instead of local tissue (when available), or instead of split-skin grafting (when an appropriate bed exists). Additionally, in some instances, the use of muscle flaps would result in a significant loss of function. However, in suitable cases their use is a rewarding addition to the peviously available methods reconstruction.

Xanthelasma: follow-up on results after surgical excision.

Xanthelasma palpebrarum is the most common xanthoma and is associated with other xanthomas or hyperlipemia syndromes in only 5 percent of the patients--even though one third of the affected patients have an elevated serum cholesterol level. Surgical excision is simple, safe, leaves minimal scarring, and will be definitive in more than half of the patients being treated for the first time. Reexcision may still be worthwhile if the xanthelasma recurs. However, recurrence is to be anticipated if all 4 eyelids are involved, if there is an underlying hyperlipemia syndrome, or if there has been more than one previous recurrence.

Experience with subcutaneous mastectomy.

A review of 67 patients who had undergone subcutaneous mastectomy indicates that the procedure should be used with well defined criteria. Both the patient and the surgeon should understand clearly that the procedure does not afford absolute protection against breast cancer. In proper perspective, used in appropriate circumstance, subcutaneous mastectomy is one more tool in the physician's armamentarium against breast disease-- a tool that may offer relief and satisfaction, with only moderate risk of morbidity.

Breast restoration after mastectomy for cancer.

The clinical problems encountered in the reconstruction of breasts of patients who have undergone mastectomy for cancer are presented. The indications and contraindications for reconstruction of the breast are arbitrarily defined. Various methods are available to reconstruct the breast. We favor implantation of a preformed silicone prosthesis under the skin and subcutaneous tissue overlying either the pectoralis major muscle or the chest wall. The advantages of this procedure outweigh those of other methods. Seven cases are presented to illustrate our experience in this rehabilitative procedure. It is suggested that breast reconstruction should be offered to a much higher proportion of patients undergoing mastectomy for breast cancer.