Arthur G. Ship

The role of lateral pharyngeal wall movement in pharyngeal flap surgery.

A total of 202 patients with pharyngeal flaps were assessed with nasopharyngoscopy and multiview fluoroscopy to determine the role of lateral pharyngeal wall movement postoperatively. Variations in the construction of flaps resulted in three categories: namely, a long narrow flap with a high insertion, a short broad flap with a low insertion, and an intermediate-size flap that is inserted in a position somewhere between the first two. It was found that in all cases where there was no evidence of velopharyngeal insufficiency, the sole determiner of velopharyngeal closure was the medical excursion of the lateral pharyngeal walls to the sides of the flap. In flap failures, the causes for velopharyngeal insufficiency were inappropriate degree, level, and symmetry of the lateral pharyngeal wall motion. The success of pharyngeal flap surgery depends largely on the preoperative assessment of the velopharyngeal mechanism and the choice of a type of pharyngeal flap that will best assist closure of the velopharyngeal port during speech.

Dorsal Skin and Fingernails on the Volar Aspect of the Hand: An Unusual Anatomic Deformity

A very unusual hand malformation is reported in which dorsal skin and nails exist on the volar aspect of the hands. This patient also exhibits mental retardation and microcephaly as well as a partial deletion of chromosome 6. Fifty percent of a small series of patients previously reviewed who presented with chromosome 6 abnormalities demonstrated abnormalities of the hands. Unusual deformities of the hands associated with mental retardation and microcephaly may be related to an abnormality of chromosome 6.

Sternal keloids : successful treatment employing surgery and adjunctive radiation

Traditional treatment of keloids by surgery or surgery combined with other techniques has met with limited success. Successful treatment of sternal keloids by surgical excision and skin grafting, followed by radiation therapy is reported. Eleven patients, ranging in age from 14 to 66 years, were so treated. The groin was used as a donor site in all patients. Postoperative radiotherapy was administered to suture lines only, using three doses of 500 cGy each, such that 1,500 cGy was delivered within 7 to 14 days of surgery. The protocol was followed without variation in all patients. Follow-up ranged from 1 to 24 years. Only 1 patient demonstrated recurrence. Six patients received postoperative, episodic steroid injections for localized itching or nodule formation. None of these patients demonstrated recurrence of their keloids.

Pigmentation after dermabrasion: an avoidable complication.

A 20-year retrospective study of patients undergoing dermabrasion is reported. All patients included in this study met the strict criteria of a minimum of a 6-month follow-up examination, abstention from exposure to sun, and photographic documentation. Fifty-nine percent were seen at 1 year or more, and 41 percent were seen at 5 years or more. Unfavorable pigmentation as a result of dermabrasion was encountered in only eight patients. In seven, this receded with the passage of time. The eighth was lost to follow-up. Hypopigmentation was noted in three patients: two blacks and one Caucasian. Persistent redness occurred in three Caucasian patients. Recurring pigmentation with exposure to sun, continuing years after the procedure, was reported in two black patients and two Caucasian patients. Hispanic patients appear to be more aware of subtle pigmentary and textural changes. Adverse pigmentation does not appear to be an inevitable consequence of dermabrasion in patients who abstain from exposure to sun in the initial postoperative period. Dermabrasion is viewed as a valuable surgical procedure for improvement of acne and other scar deformities.

Restoration of breast contour with autologous tissue after removal of implants.

There is increasing demand for removal of silicone-gel and saline implants. We report our experience with reconstruction using autologous tissue after explantation. We used the dual-pedicle dermoparenchymal mastopexy, previously reported, and the deepithelialized transverse rectus abdominis muscle pedicle, both of which have produced satisfactory results. There have been no significant complications, and patients have expressed satisfaction with the lasting results of both techniques.

Diazepam and fentanyl as adjuncts to local anesthesia

A method is presented for supplementing local anesthesia with intravenous diazepam and fentanyl. Ease of administration and high patient acceptance in over 1500 cases is discussed.

Von Willebrand's disease--a potential bleeding problem in plastic surgery.

Von Willebrands disease, a common hereditary bleeding disorder, may be responsible for undue or unanticipated intraoperative or postoperative hemorrhage. The diagnosis may be difficult to establish, although it may be suspected clinically and can usually be confirmed by adequate laboratory investigation. Patients with Von Willebrands disease appear to be especially susceptible to developing significant prolongation of their bleeding time after the ingestion of aspirin.

Lip commissuro-plasty alter electrical burns

SummaryA procedure has been presented for the reconstruction of full thickness destruction of the oral commissure resulting from electrical burns. Major features are the translocation of orbicularis oris muscle remnants to restore muscle continuity, and the use of local skin and mucosa to provide the elements of a normal commissure.