David W. Robinson

Surgical problems in the excision and repair of radiated tissue

Surgical procedures for tissues damaged by radiation are fraught with the possibility of multiple and serious complications. A knowledge of the altered pathophysiology of such tissues (chiefly diminished blood supply, fibrosis, and direct cellular reparative potential) is necessary for the surgeon to make a proper judgment. Recognition of the pathognomic signs in the skin is important. The possibility of malignant change must be kept in mind. Surgical treatment must include the excision of radiated tissues back to good blood supply, and then proper and adequate coverage by the simplest and best means. If the surrounding local tissues are so altered that they are unsuitable for coverage, structures from a distance must be used. Prior planning of the coverage before the excision pays dividends by preventing disastrous complications.

CERVICAL THYMIC CYST.

Abstract 1. 1. Cervical thymic cyst is a rare lesion resulting from degeneration of ectopic thymic tissue. 2. 2. The embryology, clinical characteristics and pathologic findings have been reviewed. 3. 3. The frequent reports of such cases since 1960 suggest that previously unreported cases have been erroneously diagnosed as branchial cleft cyst.

Acinic Cell Carcinoma: Collective Review, Including Bilateral Cases

Bilateral acinic cell carcinoma of the parotid gland is rare. On the basis of one case and a review of 486 parotid acinic carcinomas, unilateral as well as bilateral, total parotidectomy seems to be the treatment of choice for this low-grade malignant neoplasm that recurs commonly following inadequate excision. If involved by tumor, the facial nerve must be taken. Metastases are more likely to lung and bone than to regional nodes. For this reason, radical neck dissection is not routinely indicated.

Temporalis transfer for lagopthalmos due to seventh nerve palsy.

Abstract Fourteen patients with a loss of function of the seventh nerve have undergone temporalis transfer operations for the resulting lagopthalmos. A detailed description of the operation is given. Ten of the fourteen patients have had good or excellent results. The preservation of all other normally functioning cranial nerves and the dynamic nature of this procedure combined with its low morbidity have led the authors to believe that temporalis transfer is the preferred method of repair of lagopthalmos resulting from seventh nerve palsy.

The treatment of osteoradionecrosis of the mandible

Abstract Osteoradionecrosis of the mandible is a common complication of radiation therapy for intraoral malignancy and results from a combination of radiation, infection and trauma. Radiation injury presents a clinical picture of pain, trismus, ulceration and fetor which is amenable to specific surgical therapy. Treatment depends upon the pathologic condition present. If malignancy exists, therapy is directed toward the ablation of carcinoma, although surgical excision of painful radiation necrosis may be a valuable palliative weapon. Primary osteonecrosis not associated with malignancy, when each case is given carefully individualized attention, can be treated so as to produce dramatic relief of symptoms, with a low mortality rate.

Treatment of carcinoma of the breast

Abstract 1. 1. The clinical estimation of axillary involvement in carcinoma of the breast is in error in approximately one out of three patients. 2. 2. The average duration of symptoms before admission is about the same in those patients with and without axillary metastases. 3. 3. Radical surgery is the main therapeutic weapon to combat carcinoma of the breast. Postoperative irradiation will give a few more five-year survivals in Group II patients. 4. 4. In properly selected patients, considering histology, age, condition and extent of the carcinoma, leaving one or both of the pectoral muscles does not lower the survival rate. 5. 5. Scirrhous and medullary carcinoma are the most malignant, adeno is slightly less malignant and Pagets disease, mucoid and comedo carcinoma are the least malignant. 6. 6. Carcinoma developing in inner quadrants of the breast has a better prognosis than those in the outer quadrants, unless the axillary nodes are involved in which case the reverse is true. 7. 7. With radical surgery and plastic closure the local recurrence rate was 13.3 per cent in Group I, 20 per cent in Group II and 44 per cent in Group III. The average recurrence rate in Groups I and II was 16.0 per cent. 8. 8. Nearly 30 per cent of the five-year survivals later died of carcinoma and nine of twenty-two ten-year survivals had at ten years or later showed a recurrence. 9. 9. It is fully recognized that the study of such a small number of patients is not of great statistical value but presents the trend only in one clinic.

Retrograde flap—A coverage problem

Abstract 1. 1. The problem of the partially detached flap at a wound margin is presented and discussed. 2. 2. The history of the wounding and the appearance of the wound affect closure and care. 3. 3. Devascularized flaps should be detached and the skin, if not damaged, may be used for immediate wound coverage after radical defatting, or free split grafts from other donor sites may be employed. 4. 4. Pedicle tissue is used primarily to protect important structures or to facilitate future reconstruction

Radiation-induced malignancy in a patient with acne vulgaris: Report of four different histologic types

Abstract The hazards of radiation therapy utilized for the treatment of acne vulgaris are emphasized in this case report. The patient was hospitalized for the first time approximately twenty-three years after the radiation therapy and ultimately was found to have four different types of malignant lesions in the area that had been treated. The difficulties encountered in attempting to ablate these multicentric types of malignant lesions and the reconstructive procedures required for rehabilitation are discussed.

SKIN SIGNS OF SYSTEMIC DISEASE

Cancer. Lymphomas and Allied Disorders. Leukemia and Allied Disorders. Histiocytosis X and Related Disorders. Dysproteinemias and Immunodeficiency Disorders. Amyliodosis. Connective Tissue (Rheumatic) Diseases. The Angiitides. Hypersensitivity Syndromes. Sarcoidosis. Blood Vessels. Diseases of the Gastrointestinal Tract. Endocrine and Metabolic Diseases. Connective Tissues. Neutrophilic Dermatoses. Pregnancy and the Menstrual Cycle. Nervous System. Infections.

Plastic Surgery: A Concise Guide to Clinical Practice

The second edition of this complete but concise text of plastic and reconstructive surgery is an improvement on the very successful first edition, published in 1968. The general plan is essentially the same, but the material has been revised and brought up to date by incorporating some new discussion of older subjects and some new chapters on advancements. The organizational grouping of subject matter by anatomical regions and pathological entities is logical and makes it easy to find the desired subjects. The number of references after most chapters has been expanded by nearly 30%, and the index has been enlarged. Especially of value are the new chapters on benign tumors and skin disorders, microvascular techniques and reimplantations, breast augmentations and reductions, lipectomies, and an increased discussion of the treatment of hypospadias. The illustrations are mostly black and white line drawings and are easily understood. For students, residents, and practicing surgeons