Daniel J. Hauben

The biologic behavior of basal cell carcinoma: analysis of recurrence in excised basal cell carcinoma: Part II.

On the basis of a study of 188 cases of basal cell carcinoma of the face, the differences between the characteristics of recurrent and incompletely excised lesions are stressed. There was almost no difference in the recurrence rate of completely excised lesions and those in which there was histologic evidence of tumor at one of the margins. On the basis of these findings, a policy of conservative management of incompletely excised basal cell carcinoma is outlined.

On the History of the Free Skin Graft

Skin graft procedures had already been performed prior to Reverdins great discovery. Skin grafting apparently originated with the Hindus 3,000 years ago, but until the beginning of the nineteenth century only a few trials were reported. In the first half of the nineteenth century, skin graft procedures were done by Baronio, Cooper, Bünger, and Dieffenbach. Berts experimental work in 1963 opened the way for the pioneers Reverdin, Ollier, Wolfe, and Thiersch, who contributed the free skin graft.

The biologic behavior of basal cell carcinoma: Part I.

The influence of histopathologic and clinical factors on the biologic behavior of basal cell carcinoma of the face is discussed on the basis of a retrospective study of 188 cases. Fourteen different parameters were studied and correlated with the histologic type and the frequency of incomplete excision of the lesions. The highest frequency of incompletely excised tumors was seen with the adenocystic and morphea types and with Clark level III lesions. The adenocystic type appeared to be the most aggressive form, with the highest frequency of thick lesions and the most marked mitotic activity. The histologic parameters studied provide more information about the behavior of basal cell carcinoma than the conventional subdivision into solid, morphea, and adenocystic types.

Retromammary versus Retropectoral Breast Augmentation??? A Comparative Study

Repeated postaugmentation capsular formation following retromammary silicone implantation led surgeons to seek an alternative procedure. In 1968 Dempsey and Latham first reported the “subpectoral” route for location of the implant. Since then little data has been published comparing retromammary and retropectoral breast augmentation. The aim of this study is to compare the two procedures in terms of various factors affecting the physical and emotional well-being of the breast-augmented patient: breast firmness (according to Bakers classification), patient approval, the surgeons judgment, and the husbands or partners evaluation are all weighed. The study included 40 patients, 20 of whom underwent retromammary augmentation, the remaining 20 retropectoral augmentation. All 40 responded to a questionnaire designed to elicit comparative data. A detailed analysis of the results was made, leading to the following conclusions: first, patient approval was largely the same in the two groups, although slightly higher in the retropectoral group. However, both surgeons and husbands preferred the retropectoral method of prosthesis insertion.

On the history of the treatment of burns

Abstract The diverse methods employed in treating burns throughout the history of mankind, the classification of burns, the complications and the therapeutic armamentarium are discussed, to point out the course of evolution of and difficulties in treating burns. … And there went out fire from the Lord and devoured them and they died before the Lord…

A simple method for the correction of the inverted nipple.

A procedure is described in which a direct approach to the underlying pathology of the inverted nipple is undertaken. The inverted nipple is raised as desired by freeing it from the surrounding tissue by vertical and horizontal undermining and then is stabilized by purse-string suture. It can be performed as an office procedure under local anesthesia. This procedure is simple, reliable, not time-consuming, leaves no visible scars, and requires no special or bulky dressing.

Appropriate location of the nipple-areola complex in males.

Gynecomastia is a common deformity encountered by plastic surgeons. The appropriate location of the nippleareola complex is a major determinant of the aesthetic success of the procedure. To study the natural location of the nipple‐areola complex in the normally built male, 50 nonobese men with no evidence of gynecomastia and an average age of 27.9 years were examined. Three ratios were calculated and found to be relatively constant; they were the ratio between the height of the nipple and the height of the patient, the ratio between the distance between the nipples and chest circumference, and the ratio between the suprasternal notch‐to‐nipple distance and the height of the patient. Using these three parameters, a method of locating the nipple‐areola complex on the male chest wall was devised. The method is advocated as a reliable, simple, and useful technique. (Plast. Reconstr. Surg. 108: 348, 2001.)

Breast-areola-nipple proportion.

Studies of breast volume and size have failed to take into account the aesthetic value of the nipple–areola–breast proportion. These data are important to plastic surgeons in planning breast reduction, augmentation, and reconstruction. In the current study, the anatomic size of the nipple, areola, and breast was measured in 37 women aged 20 to 64 years, and their proportions were calculated. The areola–breast and nipple–areola proportions were 1:3.4 and 1:3, respectively. The natural nipple–areola–breast proportion is approximately 1:3. This study provides a general guideline for plastic surgeons for planning breast surgery with optimal aesthetic results.

Nasopharyngeal profile and velopharyngeal valve mechanism

Proper management of velopharyngeal insufficiency requires an understanding of normal velopharyngeal anatomy and function. The present cephalometric study correlates the nasopharyngeal profile at rest with velopharyngeal function as observed by nasendoscopy and fluorographic and videofluoroscopic studies. Fifty-two normal individuals and 23 patients with insufficient velopharyngeal valves were examined. A correlation was found between nasopharyngeal profiles at rest and the closure patterns of the velopharyngeal valve. It was found that when existent, Passavants ridge is subsequently formed where thick soft tissue corresponding to the superior constrictor muscle is found beneath the mucosa of the posterior pharyngeal wall at rest. Our conclusion is that Passavants ridge is formed by the superior constrictor. The present study represents additional confirmation that differences in velopharyngeal closure patterns are the result of differences in anatomy. A biomechanical model of velopharyngeal valving is presented based on individual spatial muscular orientation and the hierarchical recruitment of the velopharyngeal muscles. This recruitment is progressive and is dependent on the effort required to achieve tighter velopharyngeal sealing. (Plast. Reconstr. Surg. 92: 603, 1993.)

Anterior conchal reconstruction using a posteroauricular pull-through transpositional flap.

A normal complete appearance of the human ear includes a scapha, concha, helix, antihelix, and lobule. The concha is a shallow, almost triangular, cuplike structure with a depth of 1.5 cm. Conchal integrity affects both the aesthetic appearance of the human ear and air conduction to the auditory canal. Trauma, infection, lesions, or surgery may adversely affect conchal appearance. Skin lesions arising in the conchal cavity may involve the perichondrium, and thus adequate excision usually requires the removal of underlying conchal perichondrium or cartilage. Maintaining the structural firmness of the conchal cavity is of the utmost importance to earpiece equipment, air conduction to the external auditory canal, and aesthetic appearance. Reconstruction of the conchal cavity defect by skin graft is subject to centripetal contraction, loose conchal framework, and aesthetic impairment. Using a local flap is therefore safe and leads to better physiologic and aesthetic results. The traditional posteroauricular “revolving door” island flap described by Masson1 is ideal for large conchal defects and usually requires skin graft coverage to the donor site. For smaller lesions, this technique bears more risk for flap necrosis because of a short pedicle.2 The authors present a modified technique previously described by Renard3 suitable for all defect sizes.