James E. Bennett

Breast volume and anthropomorphic measurements: normal values.

Fifty-five consecutive female volunteers were evaluated. Linear measurements of the breast and nipple position were determined to fixed points on the chest wall. Volume determination was done by a standard chest-wall casting technique. A highly significant difference was found between left and right breasts in the axilla-to-nipple distance and nipple-to-midline measurements. A significant difference was also found in the distance from the lowest point of the breast (patient upright) to the nipple. Analysis of the volumetric difference between right and left breasts did not achieve statistical significance.

Surgical Treatment of Congenital Breast Asymmetry

Congenital breast asymmetry of sufficient severity to prompt surgical consultation is rare. The present study evaluated 40 patients who were treated for breast asymmetry at the Indiana University Medical Center. Objective measurements have been correlated with a subjective evaluation of symmetry to elucidate the goals of successful treatment. The surgical experience of the entire group is summarized and the patients who returned for follow-up are assessed.

Scleroderma en coup de sabre.

Five cases of scleroderma en coup de sabre are reported, along with a brief review of the literature [3, 10, 11]. Surgical management was tailored to the defects. Involved discolored skin was excised and the resultant wound repaired by direct closure (forehead, lower lip) or with full-thickness skin grafts. Soft tissues were augmented with dermal or dermal-fat grafts. Bony defects were corrected with prefabricated silicone implants (forehead) or autogenous bone (mandible).

Surgical options in the repair of lower-extremity soft-tissue wounds.

Until very recently complex soft-tissue defects of the leg and foot were closed with local tissue, cross-leg flaps, or staged distant flaps. Free vascularized tissue transfer and muscle and musculocutaneous flaps have expanded the surgical options substantially. During the past 5 years, we have been involved in the closure of 60 complex lower-extremity wounds. Methods of repair included local skin flaps, standard cross-leg flaps, free flaps, and muscle and musculocutaneous flaps. Every wound and patient should be considered individually. The ankle region and the sole of the foot remain the most difficult areas to resurface. Based on our experience we list preferred methods of soft-tissue repair for various lower-extremity subregions. Type of operation may also be influenced by patient age and sex.

Excision of giant nevi in children--how should the wound be closed?

The cases of two children with giant nevi of the trunk that were excised and closed in early childhood are presented. Both had cosmetic and functional deformities and were treated by scar excision and skin grafting. The 2 cases demonstrate that excision and closure of giant nevi in young children should be discouraged, as it can result in distortion of surrounding structures.