Surgery of male genital lymphedema.

Incapacitating male genital lymphedema most commonly results from filariasis, which is endemic in the tropical and subtropical countries. However, with the advent of extensive ablative surgical and radiotherapeutic measures against abdominopelvic malignancies, more cases of iatrogenic lymphedema of the genitalia can be expected in other parts of the world as well. Surgical treatment of male genital lymphedema is essentially divided into 1) excision of subcutaneous lymphedematous tissues with genital reconstruction using the remaining skin and 2) complete excision of lymphedema followed by split thickness skin grafting of the denuded phallus. The rationale behind our preference for the latter procedure is discussed with illustrative case profiles and important salient surgical steps are outlined.

The surgical treatment of congenital webbing (pterygium) of the popliteal area.

We describe a case of congenital popliteal pterygium in conjunction with other specific congenital malformations. This syndrome has been called the quadruple syndrome. The literature is reviewed. A rationale for more aggressive treatment of this deformity is discussed. One child who has undergone major multiple nerve grafts as a part of the primary corrective surgery is reported. Her result has been pleasing to the patient, the parents, and the surgeons.

Development of a plastic surgical teaching service in a women's correctional institution.

A plastic surgical teaching service has been organized at a women's correctional institution to provide a previously unrecognized medical need and to serve a valuable educational function for our residents in training. A total of 177 surgical candidates demonstrating a wide range of reconstructive problems including tattoos, scars, keloids, neoplasms of the skin and hands, deformities of the face and breasts, and numerous disabilities of the hands were identified among 241 inmates requesting examination. Thus far, 116 operative procedures have been performed on 101 patients. Patient acceptance has been high, and the support of prison authorities has been enthusiastic. Persistent efforts to convince legislators of the wisdom of supporting this program financially have only been partially successful and will require further accumulation of sociologic data bearing on the rehabilitative potential of the detained patient with a correctable deformity. Meanwhile, residents in training gain maturity as they provide a very "private" type of service for what has traditionally been considered a very "public" population of patients.

Surgical treatment of Moebius syndrome by platsma and temporalis muscle transfers.

The essential features of Moebius syndrome are described. The etiology of the condition remains in doubt. The role of heredity and the possible familial incidence are noted. We present two cases of Moebius syndrome in which the facial paralysis was surgically corrected by means of dynamic muscle transfers. The use of an innervated platysma muscle flap in the first patient is believed to be the first surgical description of such a procedure.