A.L.H. Moss

Surgical treatment of painful lichen planus of the hand and foot

Lichen planus of the hands and feet, although uncommon, can be very disabling with painful hypertrophic areas or ulcers, mainly of palmar and plantar surfaces. These lesions may not respond to conventional medical treatment. A case of surgical treatment with excision and split skin grafting of ulcerative lichen planus of the soles, with a fourteen year follow up, is reported. Only three other reported cases with a longer review period could be found. A second patient is described in which excision and grafting of painful, hypertrophic, ulcerative lichen planus of the hands achieved a satisfactory long term outcome. No other examples could be found in the English literature. It is suggested that surgical treatment should be considered more often and sooner in painful lichen planus of the hands and feet.

The development of a dynamic model for microvascular research and practice using human placenta: a preliminary report

Human placenta has been investigated in an attempt to develop a non-animal model for microvascular research and practice, with a dynamic artificial circulation. Initial work has been encouraging and further development is in progress.

Metastatic tumour in the submandibular salivary gland

Abstract Metastatic disease in the salivary glands is rare. The primary neoplasms are usually found in the head and neck region. This is the ninth reported case of metastatic deposit in the submandibular salivary gland from a distant primary tumour outwith the head and neck. A brief review of the literature is appended.

Lengthening of a short traumtic femoral stump

A case is reported in which a severe open injury of the thigh eventually required amputation of the lower limb. Lengthening of the short proximal femoral stump was achieved by turning over a flap comprising bone and soft tissue, with sensation, from the ipsilateral leg.

Lower limb salvage using an extended free radial forearm flap

A case is reported of an unusual double injury, in which a lower limb salvage procedure employed a free radial forearm flap from an amputated upper limb. The use of amputated parts for salvage procedures is well documented but none has previously involved a free forearm flap. This clinical case shows that the entire forearm and hand skin can be adequately perfused on the radial artery along with the superficial palmar arch.

The DIY mini suction drain

Using readily available materials, a versatile mini suction drain system can be quickly constructed.

Metastatic malignant melanoma in muscle.

A case is reported in which metastatic melanoma had extensively infiltrated the sartorius muscle which had been used earlier to cover the femoral vessels at the time of an inguinal node dissection. The patient also had a swelling in the ipsilateral popliteal fossa that was thought to be a metastasis from the primary malignant melanoma of the foot: however, on exploration, this mass was found to be a Bakers cyst.

Inverted papilloma of the nose: an unusual cause of a medial canthal mass

Inverted papillomata usually rise from the mucosa of the nose and/or sinuses and present with signs and symptoms indistinguishable from those produced by ordinary nasal polyps. This benign neoplasm rarely arises from the nasolacrimal system or presents as an external mass. A case is described that demonstrated both these rare features. It is being reported to draw attention to the existence of this type of tumour and to illustrate its characteristic tendency to local recurrence. A brief review of the literature is given together with a recommended surgical approach.

Severe electrical injury from a graphite fishing rod

High tension electrical injuries have a high morbidity and mortality. Carbon fibre and graphite used in the manufacture of fishing rods gives them superconductor qualities. We report a case which teaches an important lesson not only in the management of such severe injuries, but also in their prevention.

The sanctity of the upper lid in lower eyelid reconstruction questioned. A modification of a lid sharing procedure with a long-term follow-up

Sharing techniques using the upper eyelid to reconstruct the lower one have been criticised for causing distortion of the normal upper lid leading to corneal exposure and possible visual disturbance, and for creating second-rate lids. A modification of previously described tarsoconjunctival flap techniques is described which minimises the known complications of earlier methods. A flap of conjunctiva alone is mobilised from the upper eyelid and covered with a full thickness skin graft. A second minor procedure to divide the flap from its donor site is necessary 2 weeks later. Forty-three patients over a 25-year period have undergone total lower eyelid reconstruction with this modified technique and are reviewed with some illustrative cases. Total or subtotal lower eyelid reconstruction is most commonly performed following tumour resection and only occasionally to correct congenital or traumatic defects. The surgical techniques available still cause controversy (Byrd, 1983). An upper lid sharing technique has been criticised for possibly causing a shortened or distorted normal lid (Mustardé, 1981). A modification of this method is described which has been used for over 25 years and has reduced the morbidity of the procedure, leading to acceptable cosmetic and functional long-term results.