Darryl J. Hodgkinson

Cutaneous angiosarcoma of the head and neck

Between 1920 and 1970, 13 patients (7 men and 6 women) with cutaneous angiosarcomas of the head or neck were treated at the Mayo Clinic; the mean age of the patients was 66 years. Three clinical patterns were noted: a superficial spreading type, a nodular type, and an ulcerating type. There were no predisposing benign lesions; however, in one patient, angiosarcoma developed in an area of previously irradiated skin. Three modes of therapy were used: surgery alone, radiation alone, and surgery with postoperative irradiation. Of the 13 patients, 2 survived more than 5 years and 2 were alive within 1 year of therapy. Because cervical lymph node spread is common, lymph node clearance is recommended for patients with lateralized lesion or with palpable lymphadenopathy at presentation.

Aesthetic vaginal labioplasty.

Labia minora that protrude past the labia majora are aesthetically and functionally unsatisfactory to some women. Historically, female circumcision has been practiced in Islamic/Arabic countries for many centuries and is still commonly practiced in these countries. Three case reports present middle-aged women who were dissatisfied with the size and protuberance of the labia minora, and an aesthetic labioplasty was performed in these three women. The technical aspects of this procedure are outlined, and a representative case with 3-month follow-up is presented pictorially.

Keratocysts of the jaw. Clinicopathologic study of 79 patients

A study of 79 patients with keratocysts of the jaws revealed that 72% of the cysts were in the mandible, predominantly in the ramus. The most common symptom was a painful swelling in the jaw. Enucleation was used in 69.2% of the cases. The recurrence rate was 39%. Total removal of the lining of the keratocyst is essential to prevent recurrence.

Scrotal Reconstruction for Giant Inguinal Hernias

Giant inguinal hernias require special consideration for repair of the abdominal wall. The associated greatly thickened, enlarged scrotum should be discarded and a neoscrotum should be reconstructed from the uninvolved perineal-scrotal skin. A cloverleaf design flap is used for this reconstruction.

Chest-wall reconstruction using the external oblique muscle

Abstract Transposed muscle is invaluable material in the repair of chest-wall defects following resection. The strength of the muscle, its size and good blood supply make it suitable for pleural seal, stabilisation and mediastinal protection. The muscle provides an excellent surface for skin grafts and if more stabilisation of the chest wall is needed, a free bone graft can be inserted at the same time. We report the use of the external oblique muscle in the reconstruction of the chest wall after resection of a large radionecrotic ulcer.

Cancer of the oral cavity.

The principles of head and neck surgery have continued to evolve in recent years, but the young head and neck surgeon may struggle in a sea of conflicting viewpoints before finding the support these principles can give. A review of the Mayo Clinic experience over a recent 20-year period and a delineation of those principles leading to our present-day management of intraoral cancer are presented.

Chest wall deformities and their correction in bodybuilders.

Torn pectoialis major muscles are either treated acutely by orthopedic surgeons or, if neglected, result in deformities of the pectoralis muscle. These deformities are visible, with pectoialis muscle asymmetry, especially on muscle contraction. Bodybuilders prone to this injury accentuate the asymmetry by contracting the pectoralis muscles together. Late repair is not usually possible, and cosmetic improvement relies on removing the bulging, unattached muscles or camouflaging the underlying exposed ribs with a customized implant. Similar customized implants are used to repair pectus excavatum. Techniques must take into consideration the desire for accentuation of the pectoralis muscle with minimal visible scarring.The surgeon and the anesthesiologist should be aware of the possibility of anabolic steroid ingestion in the male bodybuilder.

Muscle musculocutaneous and fasciocutaneous flaps in forearm reconstruction.

Four cases of forearm defects requiring reconstruction are presented to demonstrate the usefulness of muscle musculocutaneous and fasciocutaneous flaps in forearm reconstruction. The forearm is divided into four zones--cubitoolecranon, proximal and middle one-third, distal one-third, and wrist--for purposes of discussing the scope of these different flaps. Muscle flaps are useful for defects in all zones except the distal forearm, where fasciocutaneous flaps are available; however, the superficial forearm muscles and tendons should be included to prevent interference with fascial blood supply.

Extensor digitorum turn-down muscle flap.

When the extensor digitorum longus--a multisegmentally vascular-supplied muscle--is rotated distally, its origin can be used for covering defects in the lower one-third of the leg. We have used this technique successfully in four consecutive patients, and it has resulted in osteomyelitic cavity obliteration in three and a stable skin coverage in all four.

The pectoralis major myocutaneous flap for intraoral reconstruction: a word of warning.

The pectoralis major myocutaneous flap is an extremely versatile flap in head and neck reconstruction. However, failure to drain adequately the neck and chest wounds may lead to serious trouble should a fistula develop. A case report is presented as a cautionary tale.