Donato LaRossa

The role of lymph node dissection for clinical stage I malignant melanoma of intermediate thickness (1.51—3.99 mm)

The survival times of patients who had an elective regional lymph node dissection was compared with that of those who did not undergo the procedure in a database of 72 patients with clinical Stage I melanoma of intermediate thickness (1.51–3.99 mm). All of the patients had been followed for 5 years or longer or until death. No significant differences were found in other reported prognostic factors, suggesting that the two groups were comparable. By multivariate analysis, a low mitotic rate, intermediate patient age, and the presence of an infiltrative lymphocytic response were found to be associated with favorable survival. There did not appear to be any association of elective regional lymph node dissection with survival; and it was concluded that such therapy should not be regarded as “standard” for clinical Stage I melanoma of intermediate thickness.

Experience with the Furlow double-reversing Z-plasty for cleft palate repair.

One-hundred and six cases of soft palate closure using the Furlow double-reversing Z-plasty technique have been reported. Most of these patients have been done in the past 2 years. There seem to be a number of worthwhile advantages to this procedure, with few disadvantages or complications. The operation is adaptable for use in early soft palate closure (3 to 6 months) as well as late closure (12 to 14 months), in submucosal clefts, as well as in secondary palatal repair where lengthening and repositioning of the levator muscle is desired. With this type of palatoplasty, the need for raising or shifting large mucoperiosteal flaps from the hard palate has been completely avoided. The operation can be combined with a primary posterior pharyngeal flap if desired, although this is not advised if early palatal closure (3 to 6 months) is used because of a high incidence of sleep apnea. Preliminary speech results are very encouraging.

EVALUATION OF THE BURN WOUND WITH PERFUSION FLUOROMETRY

Determination of depth of burn injury using vital dyes has been unsatisfactory. The present study evaluated the ability of the fiberoptic perfusion fluorometer to assess the depth of burn in the early postburn period. Sixty-three burns were examined with the fluorometer after intravenous administration of sodium fluorescein. The fluorescein kinetics were monitored for 1 hour within the first 48 hours and again between the third and sixth days postburn. The rate of fluorescein uptake and burn wound fluorescence was determined and compared to that of normal unburned skin. Depth of burn was confirmed by biopsy and healing characteristics. Fluorometric analysis during both study periods consistently distinguished between partial-thickness and full-thickness burns. Partial-thickness burns uniformly exhibited fluorescence within 10 minutes; full-thickness burns showed nil fluorescence. None of the patients experienced a change in skin color or complications from the small dose of fluorescein given.

Periauricular Cysts and Sinuses

Periauricular cysts, sinuses, and fistulas occur commonly in the pediatric population. They arise from developmental defects of the first branchial cleft and first branchial arch. In most instances the diagnosis and management of these conditions are straightforward, but exceptional presentations sometimes occur. Failure to recognize these unusual cases may result in inadequate treatment and subsequent recurrence, and even if the correct diagnosis is made, surgical management of these lesions may be complicated. A series of 15 cases of periauricular congenital lesions is reviewed, of which three cases illustrating a diagnostic or surgical challenge are presented. The embryology, presentation, and management of these anomalies are discussed. This is one of the largest series of first branchial cleft anomalies reported in the literature, and our paper uniquely discusses first branchial cleft anomalies and preauricular sinuses together, with an emphasis on the surgical management of facial nerve, external ear, and middle ear involvement.

Assessment of neovascularization and timing of flap division.

These studies were undertaken to determine if perfusion fluorometry can provide an accurate, reliable means of monitoring neovascularization and predicting optimal time of flap division. An animal model was developed that permitted daily assessment of neovascularization of the flap using fluorescein injections and the fluorometer. An increase in fluorescence of the pedicle-occluded flap of approximately 12 percent the normal skin fluorescence was associated with 100 percent flap survival. This occurred after only 4 days in the rat. Fluorometry proved valuable in the evaluation of clinical flaps. The fluorescence of flaps during pedicle occlusion was observed to increase with each successive fluorometric evaluation performed at 3- to 7-day intervals. It appears that flaps after pedicle occlusion exhibiting at least 25 percent of the fluorescence of normal skin will tolerate pedicle division. Based on the neovascularization studies of the clinical flaps, all pedicles were severed earlier than originally anticipated. Two cross-leg flaps were successfully divided after 11 days. Quantitative assessment of serial fluorescein injections allows reliable evaluation of neovascularization in clinical interpolation flaps and is useful in the timing of flap division.

Cleft palate closure at 3 to 7 months of age: a preliminary report.

The evolution and present criteria for early soft palate closure are reviewed. A definitive group of patients (operated on at 3 to 7 months of age) is reviewed at least 2 years following their surgery. They are compared with our general clinic population (operated on at 12 to 18 months of age) and had significantly fewer secondary operations for velopharyngeal incompetence. The possible advantages and disadvantages of early soft palate closure are discussed.

Paget's disease primarily involving the scrotum

Three cases of Pagets disease primarily involving the scrotum are reported. One case exhibited positive staining for prostate specific antigen (PSA) and was associated with an underlying, invasive poorly differentiated adenocarcinoma of unknown primary. The other cases were not associated with any underlying or visceral malignancy. The literature on Pagets disease primarily involving the scrotum including clinical presentation, differential diagnosis, treatment, prognosis, and possible histogenetic mechanisms of this disease is discussed.

Correction of lower eyelid ptosis in the anophthalmic orbit with an autogenous ear cartilage graft.

: We describe the correction of lower eyelid ptosis in patients with an anophthalmic orbit, using ear cartilage grafts. This procedure has been particularly useful in the scarred or previously reconstructed lower eyelid.

Intravenous nitroglycerin as a means of improving ischemic tissue hemodynamics and survival.

The effects of intravenous nitroglycerin infusion on experimental skin flap survival and fluorescein dye kinetics were studied in animals. Perfusion fluorometry was utilized to examine changes in flap hemodynamics and viability. An improvement in skin flap survival was found in the nitroglycerin-infused animals, whether the nitroglycerin was initiated 30 minutes before or 30 minutes after flap elevation. Dye elimination in the flap appeared to be significantly improved with the drug therapy, indicating an improvement in flap blood flow with nitroglycerin.

Acute monomyelocytic leukemia presenting as a felon. Case report.

We present a case of acute leukemic infiltration in the distal phalanx of the thumb, resulting in a chronic felon with bone involement.