Repair of defects of the nasal ala.

BACKGROUND: Alar defects present a reconstructive challenge. OBJECTIVE: To define closure options for alar defects of variable thickness and location. METHODS: The repair options for closure of alar defects are reviewed and discussed with regard to depth of defect and complexity of reconstruction. CONCLUSION: Surgeons repairing defects of the nose should develop a variety of reconstructive approaches for the ala including but not limited to those presented here.

The postauricular (revolving door) island pedicle flap revisited.

BACKGROUND: Few satisfactory closure options exist for large anterior auricular defects. OBJECTIVE: To describe the use of the postauricular (revolving door) island pedicle flap for closure of large defects on the scapha, antihelix, and helix. METHODS: Mohs micrographic surgery for excision of basal cell carcinoma was performed on the anterior auricular surface of two patients. Both defects were closed using a posterior auricular island flap that was advanced through cartilage with excellent cosmetic results. Other closure options are discussed for this region. CONCLUSION: The postauricular (revolving door) island pedicle flap is a good closure option for large anterior auricular defects lacking perichondrium and not easily repaired by other methods.

Treatment of postoperative infection of ascending aorta and transverse aortic arch, including use of viable omentum and muscle flaps.

Postoperative infection of the ascending aorta and aortic arch in 40 patients was treated by antibiotic therapy alone (4 patients) or by operation and lifelong suppressive antibiotic therapy (36 patients). Complications of infection included antibiotic-resistant infection, infected false aneurysm, rupture of suture line, aortocutaneous fistulas, aortic-right ventricular fistulas, arterial embolus, aortic valve insufficiency, aortobronchial fistula, mediastinal abscess, and chest wall problems. These were treated by a variety of operations including composite valve-graft replacement, graft replacement, patch-graft closure of false aneurysm, simple suture of disrupted suture lines and false aneurysm, and debridement of mediastinum and chest wall. The area of reconstruction was covered, and mediastinal dead space was reduced by mobilization of viable tissue, including local tissue and distant structures such as flaps of muscle and omentum. Thirty-three patients (83%) were early survivors, and 28 patients (70%) were alive and well at last follow-up 4 months to 6.5 years after operation.

An occipital dermoid tumor and sinus.

A rare case of an occipital dermoid sinus in a 14-year-old girl is presented. Failure to recognize such a lesion in a timely fashion can have fatal consequences. Extreme caution is advised when a sinus is found penetrating the occipital region because connection with the cranial venous confluence is common, and unanticipated penetration is associated with rapid and fatal exsanguination. Neurosurgical consultation and preparation for posterior fossa exploration and venous sinus repair should be made if full extirpation is anticipated. Clinical presentation, diagnostic evaluation, and treatment of these rare lesions is reviewed.

Rhinophyma.

Rhinophyma, a florid overgrowth of the tip of the nose with hypervascularity and nodularity, is an unusual progression of acne rosacea of unknown cause. In this article, its history, etiology, stages of progression, and current concepts of medical and surgical treatment are reviewed. Successful treatment depends on a clear understanding of the disease and its early medical management as well as corrective surgery of the established tumor with meticulous attention to surgical details.

Ultraviolet light and hyperpigmentation in healing wounds.

The concept of permanent hyperpigmentation in wounds following ultraviolet light exposure during the postoperative period has found a place in plastic surgical literature but has not been documented. This study evaluates the effect of ultraviolet light on healing wounds in paraplegics. It failed to confirm permanent alteration in pigmentation response to ultraviolet exposure and suggests that other factors are of greater importance in the development of hyperpigmentation in the healing wound.

Platelet coagulopathy secondary to topical salicylate use.

The use of topical salicylate-containing creams and ointments is widespread. A case is presented which implicates the use of one such cream (Aspercreme) as a potential cause of platelet coagulopathy after rhytidectomy.

Anatomical findings in median cleft of upper lip.

We present 3 cases of median cleft lip which occurred in 3 patients of differing racial origins. The anatomical findings are presented in the two clefts we repaired.

Treatment of an epithelioma cuniculatum plantare by local excision and a plantar skin flap.

Differentiation between benign and malignant lesions on the plantar surfaces is sometimes clinically impossible and requires biopsy. A case of epithelioma cuniculatum plantare is reported that was futilely treated for years as a plantar wart and then upon proper diagnosis was successfully treated by complete excision and rotation of a flap of plantar skin.

Total glandular mastectomy. Modifications of the subcutaneous mastectomy for use in premalignant disease of the breast.

We describe two modifications of the original subcutaneous mastectomy, in which we remove the nipple en bloc with the breast, and we believe they are as suitable as other mastectomies for the removal of microcarcinomas and premalignant diseases of the breast. We do not advocate them for macroscopic malignancy. We are using the term "total glandular mastectomy" to designate these two modifications.

Abdominoplasty with special attention to construction of the umbilicus: Technique and complications.

We present a simple technique for umbilicoplasty and some guidelines for improving the results in abdominoplasty. These include preoperative erect marking, equal and exacting retraction, formation of a suprapublic fat pad and a central raphe, and prolonged splinting of the abdominal incisions including an umbilical stent.

Bilateral reconstruction of the nipple-areola complex.

We present a method for reconstructing the nipple and areola bilaterally in one stage, one which produces a corrugated, elevated nipple and a glabrous pigmented areola. A satisfactory appearance has been maintained in 4 cases during a follow-up period of up to two years.