Dicran Goulian

The successful one-stage surgical management of a midline cleft of the lower lip, mandible, and tongue.

Developmental growth toward, and fusion at, the midline of the paired first branchial arches results in normal mandibular integrity. Failure of this process is the cause of midline mandibular clefts and associated clefts of the lower lip and anterior tongue. A case is presented with these findings, complicated by the presence of a single ventricle and transposition of the great vessels. A successful one-stage repair of the clefts of the lower lip, tongue, and mandible was performed.

Cleft lip: morbidity and mortality in early repair.

A fifteen-year survey of primary lip repairs done at The New York Hospital revealed that lip closure can be accomplished during the first week of life with no mortality and with major morbidity slightly higher than that in repairs done after one week of age. Modern anesthetic techniques have markedly reduced respiratory complications from lip closure. Adequate postoperative sedation coupled with careful patient monitoring should appreciably reduce the incidence of wound dehiscence.

Screening the Nipple for Involvement in Breast Cancer

On the basis of Independent clinical and pathological screens, mastectomy patients can be effictively classified into high-risk and low-risk groups for neoplastic involvement of the nipple-areolar complex. Clinical criteria included gross nipple signs, cutaneous signs, and tumor location, size, and bilaterality. Pathological criteria comprised subareolar involvement, multicenytricity, and nodal involvement. Fifty consecutive women undergoing masectomy for cancer at the New York Hospital-Cornell University Medical Center underwent classification into high-risk and low-risk groups on the basis of these criteria. Fifty four percent of the patients studied passed the screens and were included in the low-risk group. The incidence of nipple involvement in this group was 0. In the remaining 46%, failing either or both of the screens and constituting the high-risk group, the incidence of neoplastic involvement of the nipple was 35%. All involved nipples fell into this group.

Neurofibromatosis-distribution of lesions and surgical treatment.

Patients seen at the New York Hospital over a ten-year period with a diagnosis of neurofibromatosis or von Recklinghausens disease were studied. Patients were grouped according to presence or absence of cutaneous neurofibromas and further subdivided into those with multiple cutaneous tumors versus those with solitary lesions. The three groups were studied with respect to anatomic distribution of neurofibromas, associated extracutaneous manifestations of von Recklinghausens disease, and surgical procedures performed.

Current status of liquid injectable silicone.

Since the inception of the recently concluded formal study, liquid injectable silicone has been both used and abused by many. Reports in both lay and professional literature reflect this experience in the form of a wide range of opinions and judgments regarding the use of this material in corrective surgery. Those intimately involved in the former study agree that, used properly, liquid injectable silicone appears to have redeeming value in at least a limited group of problem situations. These investigators further agree that its general use could lead to many problems unless its limited scope of usefulness and proper use are known, accepted, and abided by those using it. To satisfy the lingering doubts raised by the many negative reports, further controlled study is also indicated. Until there is a method of control over the general clinical use of liquid silicone and until persistent questions on its safety and efficacy, over a protracted period of time, are answered, the investigators are convinced that the substance should not be made generally available. Designed before the complexity required of a proper study was appreciated, the original research protocol lacked sufficient detail and was broad and vague in scope. The Dow-Corning Company and its investigators therefore recommended the termination of the study and set about planning a new research protocol that would supply more complete information in a much more restricted area of clinical need. This was done with the cooperation of the American Society of Plastic and Reconstructive Surgeons and was submitted for approval by the FDA along with an expanded group of clinical investigators selected with the help of the ASPRS, with consideration given to their even geographic distribution. This new research study was submitted to the FDA and approved. Accordingly, on March 1, 1978, a much more vigorous, detailed, and restrictive study, confined to major tissue defects of the head and neck, was resumed by a larger group of investigators representing the ASPRS supervised by a medical monitor acceptable to all. Hopefully, this study, which will occupy a period of 7 years and a limited number of patients, plus the rigorous efforts to trace and document those involved in the earlier study and the tracking down and full documentation of all known complications, will ultimately bring the true status of liquid injectable silicone into proper and generally acceptable perspective.Since the inception of the recently concluded formal study, liquid injectable silicone has been both used and abused by many. Reports in both lay and professional literature reflect this experience in the form of a wide range of opinions and judgments regarding the use of this material in corrective surgery. Those intimately involved in the former study agree that, used properly, liquid injectable silicone appears to have redeeming value in at least a limited group of problem situations. These investigators further agree that its general use could lead to many problems unless its limited scope of usefulness and proper use are known, accepted, and abided by those using it. To satisfy the lingering doubts raised by the many negative reports, further controlled study is also indicated. Until there is a method of control over the general clinical use of liquid silicone and until persistent questions on its safety and efficacy, over a protracted period of time, are answered, the investigators are convinced that the substance should not be made generally available. Designed before the complexity required of a proper study was appreciated, the original research protocol lacked sufficient detail and was broad and vague in scope. The Dow-Corning Company and its investigators therefore recommended the termination of the study and set about planning a new research protocol that would supply more complete information in a much more restricted area of clinical need. This was done with the cooperation of the American Society of Plastic and Reconstructive Surgeons and was submitted for approval by the FDA along with an expanded group of clinical investigators selected with the help of the ASPRS, with consideration given to their even geographic distribution. This new research study was submitted to the FDA and approved. Accordingly, on March 1, 1978, a much more vigorous, detailed, and restrictive study, confined to major tissue defects of the head and neck, was resumed by a larger group of investigators representing the ASPRS supervised by a medical monitor acceptable to all. Hopefully, this study, which will occupy a period of 7 years and a limited number of patients, plus the rigorous efforts to trace and document those involved in the earlier study and the tracking down and full documentation of all known complications, will ultimately bring the true status of liquid injectable silicone into proper and generally acceptable perspective.

Transplantation of the cryopreserved nipple-areolar complex.

The full nipple-areolar complex of dogs has been successfully removed, cryopreserved using a controlled-rate freeze protocol, and reimplanted without loss of viability. The technique for reimplantation calls for the use of a new fixed double bolus technique that prevented dislodging or contamination in all but 2 cases. The feasibility of performing this procedure in humans is discussed.

A Study of the Functional Capacities of Spleen Cells After Maintenance in vitro

Summary Spleen cells were cultured for varying lengths of time in vitro. The cells were then injected into lethally irradiated mice to ascertain their ability to protect the animals against irradiation death. Complete loss of ability to protect irradiated animals was found to occur after 9 days in vitro despite the injection of adequate numbers of viable spleen cells. The significance of these results is discussed.

Further refinements on the triangular flap closure of the cleft lip.

Refinements in the triangular flap closure of the unilateral cleft lip are presented. Randalls mathematical interpretation of the Tennison repair has been extended by using a series of arcs to determine the crucial points which form the triangular flap. Using this easily taught method, an isosceles triangular flap can be plotted which will interdigitate into the noncleft side of the lip. Two symmetrical vertical distances on either side of the cleft are thus formed. This allows for a standardized repair which may be more readily taught than the rotation-advancement technique. In addition, flaps are created which are turned medically toward the cleft and are used to accentuate the philtral pout, close the nostril floor, and reinforce the lip repair, allowing closure of even extremely wide clefts in one stage. These refinements in using the triangular flap closure for the repair of the unilateral cleft lip are diagrammatically presented. We believe that these refinements enhance the results of this closure.

Xanthoma disseminatum: an unusual cause of facial and limb deformity.

A rare case of xanthoma disseminatum producing deformity of the head, neck, and extremities is reported. This pathologically benign disease, considered to represent one of the histiocyte proliferative disorders, is manifested by numerous cutaneous xanthomas primarily in flexion areas. Progressive enlargement of these lesions accompanied by marked fibrosis has produced the severe cosmetic and functional deformities described in this patient. Treatment in this case involved excision of xanthomatous contraction bands with split-thickness skin grafting, followed by intensive physical therapy.

Congenital band of the abdomen and the amniotic etiology of bands

Abstract A case of congenital constricting abdominal band is presented and the general entity discussed in relation to cause and relation to other congenital disorders and rupture of the amniotic membrane.