Jesus A. Garcia

THE NEMATODE DEGENERIN UNC-105 FORMS ION CHANNELS THAT ARE ACTIVATED BY DEGENERATION-OR HYPERCONTRACTION-CAUSING MUTATIONS

Nematode degenerins have been implicated in touch sensitivity and other forms of mechanosensation. Certain mutations in several degenerin genes cause the swelling, vacuolation, and death of neurons, and other mutations in the muscle degenerin gene unc-105 cause hypercontraction. Here, we confirm that unc-105 encodes an ion channel and show that it is constitutively active when mutated. These mutations disrupt different regions of the channel and have different effects on its gating. The UNC-105 channels are permeable to small monovalent cations but show voltage-dependent block by Ca2+ and Mg2+. Amiloride also produces voltage-dependent block, consistent with a single binding site 65% into the electric field. Mammalian cells expressing the mutant channels accumulate membranous whorls and multicompartment vacuoles, hallmarks of degenerin-induced cell death across species.

Changes in eyebrow position and shape with aging.

Background: Lack of an objective goal for brow-lift surgery may explain why several articles in the plastic surgery literature conclude that brow lifts produce eyebrows with shape and position that are not aesthetically pleasing. By comparing eyebrow shape and position in both young and mature women, this study provides objective data with which to plan forehead rejuvenating procedures. Methods: Two cohorts of women aged 20 to 30 years and 50 to 60 years were photographed to determine eyebrow position. Measurements were made from a horizontal plane between the medial canthi to three points at the upper eyebrow margin. Exclusion criteria included prior surgery, plucked eyebrows, and botulinum toxin. Results: The eyebrow in the 20- to 30-year-old group (n = 36) was 15.7, 19.8, and 21.3 mm above the medial canthus, pupil, and lateral canthus, respectively. Lateral brow position was significantly higher than the mid brow (p < 0.05). In the 50- to 60-year-old group (n = 34), the brow was 19.1, 22.4, and 22.4 mm above the medial canthus, pupil, and lateral canthus, respectively. At all three points, the brow was higher in older compared with younger subjects. This difference was significant at the medial and mid brow (p < 0.05). Conclusions: Unlike other areas of the body where there is descent of soft tissues, there is paradoxical elevation of eyebrows with aging. These findings explain why surgical elevation of the mid and medial brow provides results that are neither youthful nor aesthetically pleasing. Techniques that selectively elevate the lateral brow are more likely to have a rejuvenating effect on the upper third of the female face.

Nailfold reconstruction for correction of burn fingernail deformity.

Background: Fingernail deformities frequently occur after burn injury to the hand. In many cases, the deformity is not the result of injury to the nail bed or germinal matrix but is instead secondary to contracture of soft tissues proximal to the eponychium. The roof of the nailfold peels away from the nail, causing abnormal nail growth and appearance. Alterations in appearance can range from subtle changes in contour and location of the eponychium to complete loss of germinal matrix and absence of nail growth. The majority of patients fall into a midrange category that includes multiple symptoms. The important concept, however, is that in many cases the complex structure of the nailfold is not destroyed by the injury but is only displaced by the proximal contracture. Methods: This deformity is readily treatable with a simple, reliable procedure that releases the proximal contracture with a distally based bipedicled flap and resurfacing with a skin graft. Results: Contracture release allows the displaced and everted roof of the nailfold to slide distally without tension and restores normal nailfold anatomy. The contribution of the dorsal nail matrix to nail growth is restored, improving fingernail appearance and function. Over the past 20 years, this technique has been used in over 100 digits with burn fingernail deformities. There have been no instances of flap loss. Conclusions: This is a simple, straightforward procedure, with few complications, that relieves many symptoms associated with burn fingernail deformity. Thousands of burned digits would benefit from this procedure.

The skin allograft revisited: a potentially permanent wound coverage option in the critically ill patient.

Split-thickness skin grafting is a fundamental surgical technique for coverage of large wounds. Skin is harvested at an appropriate depth of dermis to allow the donor site to heal by reepithelialization. However, these open areas may increase morbidity in elderly or debilitated patients with undue pain and slowness in healing. Our efforts to eliminate or minimize the donor site in such individuals have led to the development of alternative temporary skin substitutes. Allografts of human skin have been used since World War II.1,2 The technique simplifies wound care and allows nutritional optimization and emergence from the critical phase of injury. In nonimmunocompromised patients, the allografts fail once the host’s immune response recognizes the foreign tissue. However, allograft survival may be prolonged from 3 to 10 weeks in the severely ill.3,4 We report in this article the long-term survival of skin allografts applied as a temporary bridge for later skin autografting in three patients too ill to undergo skin autografting. These individuals had either chronic comorbidities in addition to acute critical illness or extensive burn injuries. We believe that our reported cases illustrate that selected patients may benefit from allografting as a potentially final wound closure intervention. CASE REPORTS

Ramón Castroviejo: an ophthalmologist's contributions to plastic surgery.

Every day, in operating rooms around the world, surgeons ask for a fine swaged suture loaded on a “Castro” needle holder. Some senior surgeons call it a “clickety-clack.” The operation might be coronary arterial bypass, free flap transfer, reattachment of a severed part, or closure of a cleft palate. The surgeon grasps an ingeniously designed instrument that has remained largely unchanged since it was patented in 19531 (Fig. 1). However, few surgeons know who designed it or are aware of his many other contributions to the surgical field. Dr. Ramón Castroviejo was an ophthalmologist, teacher, and inventor of the needle holder and several other precision instruments that bear his name. He pioneered successful human corneal transplantation,2 and was instrumental in developing “atraumatic” swaged sutures to facilitate corneal grafting and other delicate ophthalmologic procedures. Castroviejo’s instruments also influenced techniques in other specialties, including plastic surgery.

Mondor's thrombophlebitis 13 years after breast augmentation.

Patient:A 37-year-old woman presented with Mondors thrombophlebitis 13 years after augmentation mammaplasty with subpectoral saline implants. She presented complaining of 1 week of “band-like” cords and pain involving the thoracoepigastric and lateral thoracic vessels. She was evaluated and ruled out for other etiologies of her breast symptoms. Background:Mondors disease is a benign and self-limiting disease characterized by thrombophlebitis of the subcutaneous veins of the chest and abdominal wall. The inflammation causes painful superficial cords manifesting as skin retraction. Mondors disease has been described in aesthetic breast surgery literature, but most cases occur within the first few postoperative weeks. Conclusions:Mondors disease may be idiopathic, iatrogenic, or a manifestation of underlying pathology such as breast cancer. The diagnosis of iatrogenic Mondors disease can be made with high clinical certainty when following aesthetic breast surgery in the early postoperative period. However, in late presentations that are not immediately related to surgery, Mondors disease remains a diagnosis of exclusion, and other underlying pathologic etiologies must be ruled out.

Barbed Suture as a Treatment Approach in Complex Degloving Injuries.

AbstractIn the late19th century, French physician Morel-Lavallée was challenged with a group of patients who sustained similar patterns of degloving injuries, which today carry his eponym. In 1853, he reported a series of cases as well as proposed strategies for the management of these complex degloving injuries. Treatment strategies have not varied significantly over the years, and these lesions continue to plague surgeons today with failure rates in excess of 50%. We present 2 case series using barbed suture in the management of these complex injuries.