Tissue expansion of underdeveloped scrotum to accommodate large testicular prosthesis. A technique.

A contracted empty scrotum in a young man will not accept an artificial testis satisfactorily using any of the standard techniques. Previous operative scars, as from a failed orchiopexy, have often added to the difficulties. Greatly enlarging the scrotum by gradual distention of a tissue expander implanted in the contracted side has been successful in overcoming this problem, both cosmetically and functionally.

Electrical stimulation of onlay bone grafts.

An animal model was developed to determine the ability of capacitively coupled electrical fields to enhance onlay bone graft survival in the craniofacial skeleton. Fifteen male New Zealand white rabbits were divided into control and stimulated groups. Blocks of iliac bone were transplanted as onlay grafts to the mandibular rami. In all animals a capacitor apparatus was attached externally over the right mandibular ramus; however, a 5-V peak-to-peak sinusoidal signal was applied only in the stimulated group. The experimental period was 6 weeks, with a total of 30 days of constant stimulation. Graft resorption in the stimulated animals was decreased a total of 24.8 percent (p less than 0.001). There appeared to be a trend toward decreased graft resorption caused by the apparatus alone, although this was not statistically significant. The electric field alone decreased resorption by 11.5 percent (p less than 0.05). No distinguishing features were demonstrated by fluorescent vital stains or routine histology.

Reconstruction of the lids of a child with microblepharon and multiple congenital anomalies.

The initial stages in the rehabilitation of a male child with severe microblepharon, corneal opacities, bilateral facial clefts, bilateral complete cleft lip and palate, and unilateral syndactyly are described. Review of the literature suggests that severe microblepharon is associated with other craniofacial anomalies, and often the child is stillborn or retarded. Surviving children have been abandoned because of their appearance. The child described in this case appears to be unique because his intelligence is normal, and, to our knowledge, this is the first reported case of penetrating keratoplasty after reconstruction of functional eyelids. The principal problems after corneal grafting appear to have been chronic partial exposure due to inadequate lid length and a poor Bell's reflex and the persistence of a rim of vascularized fibrous tissue around the corneal graft. Future reconstructive surgery is outlined.

Some ancillary procedures for correction of depressed adherent tracheostomy scars and associated tracheocutaneous fistulae.

A procedure for the surgical correction of depressed tracheostomy scars and tracheocutaneous fistulae is described which involves reapproximation of the strap muscles and the selective application of a subcutaneous Z-plasty. The results are predictable, satisfactory, and the procedure is quite simply accomplished. Utilization of the Z-plasty improves contour in patients with atrophic tissue and assists the distribution of tension forces in subcutaneous and muscular layers.

Experience with electrothrombosis in the treatment of angiomas.

We report unsatisfactory results of electrothrombosis for the treatment of venous angiomas. After we reviewed a report of successful use of electrothrombosis for treating cirsoid angiomas of the face and scalp and varices of the leg, a clinical trial was begun with 6 patients in whom previous conventional surgery was relatively unsuccessful and in whom further surgery had not been recommended owing to the high risk or probability of unsatisfactory results. Two patients had objective clinical improvement, resulting in no further treatment in 1 patient and allowing secondary surgical correction in the other. Four patients had no significant improvement. We now recommend and will continue further laboratory research with electrothrombosis for the treatment of angiomas before treating additional clinical cases.

Changes in respiratory function following small bowel bypass for obesity.

Spirometry and arterial blood gases were determined before operation and at approximately 6-month postoperative intervals in 11 patients weighing 137 +/- 22 kg (234% +/- 41% of actuarial ideal weight), who underwent a small bowel bypass which left 30 cm of proximal jejunum and 20 cm of distal ileum in end-to-end continuity. The average follow-up period was 20 months, during which time mean weight loss was 31% +/- 8%. Preoperative spirometry was normal, but the patients were significantly hypoxic (PaO2 = 75.3 +/- 8.5 mm Hg) as compared with an age-matched norm (P less than 0.001). PaCO2 and pH were normal. After operation changes in forced vital capacity (FVC) showed a significant linear correlation with the percentage of body weight lost: y = 1.03 x -29 (r = 0.75, P less than 0.001). Because of a significant (P less than 0.001) decrease in FVC, identified in seven patients, during the early period of rapid weight loss, the x intercept occurred at a weight loss of 27.5%. Additional weight reduction was attended by progressive improvement in FVC to values slightly higher, but not significantly different, than preoperative measurements. Forced expiratory volume at 1 second (FEV) varied in accord with FVC. Hypoxia persisted after operation and was unaffected by the amount of weight lost. The results suggest that loss of lean body mass, during the initial phase of rapid weight loss after intestinal bypass, may be detrimental to respiratory function, until a sufficient excess of fat also has been lost to achieve net benefit.

Practical applications of skin biomechanics.

The biomechanical properties of skin have an important influence on plastic surgical decisions. They aid the surgeon in planning elective incisions, excisions, or scar revisions. They provide insight into the most appropriate method of coverage of skin defects as well as the design of an artificial skin substitute. Skin biomechanics can, in part, be characterized in vivo by either a skin extensiometer or by studying the deformation of skin defects. These methods indicate the magnitude and directional orientation of skin tensions which are dependent partly on the mechanical characteristics of the dermal fibers and partly on the pattern in which they are woven. The tensions to which the skin are subjected can be classified as either static or dynamic in origin. Static skin tensions are the natural tensions existing in skin. The magnitude of static tensions varies between individuals, at different sites in the same person, and in different directions in many sites. The dynamic tensions are caused by a combination of forces which are associated with joint movement, mimetic and other voluntary muscle activity, and gravity. Knowledge of these tensions allows the surgeon to align the operative site in the direction of maximal tension and to approximate the wound with the least amount of tension. As a consequence of this, the scar healing between the cut edges of the wound should be narrow and inconspicuous.