Christopher M. Ward

The search for volumetric symmetry in reconstruction of the breast after mastectomy.

The difficulty in achieving volumetric symmetry in the course of reconstruction of the breast after mastectomy is emphasised. The published methods of estimating breast volume are outlined before describing a new apparatus relying on the displacement of air within a large calibrated cylinder and which, by objective and clinical evaluation, has proved to be gratifyingly accurate. The method of achieving symmetry is illustrated in a patient originally referred with an inadequate breast mound reconstruction.

An Abnormality of Nail Growth Associated with Median Nerve Damage

It has been recognised for a long time that damage to the median or ulnar nerves is usually followed by slowing of growth of the fingernails. In the past, this has always been ascribed to immobilization of the appropriate digits, rather than to a neurotrophic factor. No other nail changes appear to have been described in association with nerve damage. We present two patients with marked nail changes following median nerve injury, in which immobilization does not appear to be responsible.

The use of thick split thickness grafts from the instep in paediatric hand surgery

In skin grafting the hand restoration of function must always be the priority, but an acceptable appearance is also important and care should be taken in selecting a skin graft that matches the recipient site. The disadvantages of some traditional donor sites are outlined. A clinical study of thick, split-thickness grafts from the instep is described from which it is concluded that a good aesthetic result can be achieved without compromising hand function--but only in children and adolescents among whom there was no donor site morbidity.