Plastic surgery of the trunk--reducing blood loss.

A total of 178 patients has been reviewed who underwent major plastic surgery over a 6-year period. This series compares well with other similar series. No transfusions were required and the average blood loss was estimated at 150 cm3. Dilute epinephrine infiltration and coagulation cautery dissection effectively controls and reduces blood loss in major plastic surgery of the trunk.

Leprechaunism.

Leprechaunism is a rare syndrome of unknown etiology. As only 9 conclusive examples of the syndrome have been reported, it seems useful to add the present case to the literature. This congenital deformity produces a small, grossly hirsute, grotesque infant who usually fails to thrive and survives only a matter of months.

Suture materials in otoplasty.

From my experiences in 101 otoplasties of the Mustardé type, the buried suture materials have shown individual variations, as regards granuloma and slippage complications. As a result, I now prefer 4/0 clear nylon for reconstruction of the anti-helix, 3/0 white Mersilene for concha-mastoidal fixation, and 4/0 chromic or subcuticular Vicryl for skin closure.

Chain-saw facial injuries.

Accidents caused by kickback from chain saws produce facial injuries with consistent features. These features include oblique, destructive, ragged lacerations of the left side of the face. Although eyelid damage may be severe, damage to the globe itself is minimal. An analysis of 10 such accidents revealed this consistent pattern. Of this group, eight injuries were left-sided and six involved mainly the eyelid and adjacent structures. Only one patient was left with permanent damage to the globe and with slightly impaired (20/60) vision. The upper lid was always more severely damaged than the lower. The author discusses the merits and disadvantages of protective devices for both operator and machine.

Importance of donor site selection in skin grafting.

Skin grafting has been done for over 100 years, and the importance of the type of graft--split thickness, full thickness or composite--has been well established. However, the importance of selecting a donor site that is appropriate to the type of graft and to the patient's age and sex has received scant attention, despite the fact that, in many cases, the scar at the donor site may prove to be of greater long-term concern to the patient than the initial injury. Examples of malchosen donor sites are presented and a plea is made for more careful selection by all concerned with skin grafting.

Facial fractures and snowmobile accidents.

Snowmobile accidents are now common in winter; there is a local pattern of facial fractures associated with accidents involving these machines. Facial fractures connected with snowmobile accidents over a period of two successive winters were reviewed; 14 were found to be of special interest because of their severity and localized extent. Compared with motor vehicle accidents most of these fractures were isolated; the patients often had suffered only minimal trauma elsewhere. After reviewing the histories of these patients it was clear that alcohol, night driving, inadequate facial protection and the use of unknown terrain were common precipitating factors. Elimination of these hazards and the use of appropriate protective head-gear would probably reduced the number and severity of such injuries.

Axillary hyperhidrosis.

The literature of axillary hyperhidrosis is reviewed. For treatment, we present a technique of radical glandular clearance, converting the flaps to attached "skin grafts". The extent of the area may be varied, according to the degree of excessive sweating.