John E. Hoopes

Correction of extreme gynaecomastia

Abstract A technique for correction of extreme gynaecomastia utilising crescentic transverse skin incisions and free nipple transplantation is described. Results in 5 cases have been very satisfactory. The technique is reserved for those unusual cases in which excess skin and subcutaneous tissue as well as breast tissue must be removed.

A sex conversion operation for males with transsexualism

Abstract A sex conversion operative technique is described for use in male transsexual patients who are living as females.

Xanthine: Acceptor oxidoreductase activities in ischemic rat skin flaps

Xanthine:acceptor oxidoreductase activities were assayed in free skin flaps following prolonged preservation. In normal rat skin, xanthine dehydrogenase transfers electrons to NAD+ and accounts for 73% of total oxidoreductase activity, and xanthine oxidase transfers electrons to molecular oxygen and accounts for the remaining 27%. Xanthine oxidase activity increased significantly in skin flaps during ischemia: approximately 30 and 100% increases after 6 and 24 hr of ischemia, respectively. Allopurinol inhibited xanthine oxidoreductase activity: free skin flaps obtained from allopurinol-treated animals exhibited a low level of xanthine oxidoreductase activity throughout the period of preservation. Systemic allopurinol significantly improved the survival rate from 32 to 75% of free flaps transferred after 24 hr of preservation at room temperature. These observations suggest that the xanthine oxidase system is a major source of oxygen free radicals following ischemia/reperfusion in skin. The increase in xanthine oxidase is attributable to the conversion of xanthine dehydrogenase to oxidase, a conversion which involves sulfhydryl oxidation in skin flaps.

Enzyme activities in granulation tissue: Energy for collagen synthesis.

Abstract A microchemical technique was used to measure the activities of twelve key enzymes of glucose catabolism in granulation tissue of wounds healing by second intention. The glycolytic enzymes exhibited a prominent increase during the first eight days of wound healing, with phosphofructokinase increasing to twelve times normal. The enzymatic reactions of the pentose phosphate shunt and Krebs cycle were not increased as markedly as those of glycolysis. Glutamate dehydrogenase and β-hydroxybutyryl CoA dehydrogenase also exhibited significant increases during wound healing.

The role of metal ions in ischemia/reperfusion injury in skin flaps

The role of hydroxyl radical generation by the metal-catalyzed Haber-Weiss reaction in producing injury to postischemic skin flaps in rats was evaluated. The venous drainage from groin island flaps was occluded for 7 hr and then reperfused. The flaps were infused with either deferoxamine, CaNa2EDTA, histidine, salicylate, or vehicle (saline) at the time of reperfusion. In another experimental group, the role of hydrogen peroxide was evaluated by the infusion of catalase at the time of reperfusion. Treatment with a single dose of deferoxamine (40 mg/kg), CaNa2EDTA (50 mg/kg), or histidine (50 mg/kg), significantly increased the flap survival rate from 24 to 63, 75, and 63%, respectively. A large dose of salicylate (80 mg/kg) improved the flap survival rate (to 63%): a smaller dose (40 mg/kg) offered no improvement. A large dose of catalase ameliorated the survival rate (to 88%). The results suggest that the presence of metal ions is required for the expression of free radical-induced tissue damage. Hydrogen peroxide appears to be essential for the production of this injury.

Cineradiographic assessment of combined island flap pushback and pharyngeal flap in the surgical management of submucous cleft palate

Summary The application of cineradiographic analysis to the diagnosis, treatment, and prognosis of cleft palate speech is presented. Posterior displacement of the levator veli palatini insertion is essential in the surgical correction of velopharyngeal incompetence.

Enzyme activities in regenerating epithelium during wound healing: I. Acid phosphatase

Abstract Epithelial cell acid phosphatase activity during wound healing was analyzed in various longitudinal segments and vertical strata of marginal and migrating epithelium. Migrating epithelium demonstrated lower enzyme activity than marginal epithelium; the repaired, maturing epithelium exhibited greater enzyme activity than marginal epithelium. Progressively increasing gradients of acid phosphatase activity were demonstrated from: (a) the lower layer to the horny layer of the marginal epithelium; (b) the lower layer to the upper layer of the migrating epithelium; and (c) the advancing epithelial tip of the migrating epithelium to the marginal epithelium. The emigrated cells on day 1 following wounding, the advancing epithelial tips of the migrating epithelium, the lower layer of the migrating epithelium, and the lower layer of the marginal epithelium exhibited similar levels of enzyme activity, with no significant alteration during the 7-day period of observation. The maximum increase of enzyme activity in the upper layer of the marginal epithelium was noted on day 4 following wounding. Enzyme activity in the horny layer of the marginal epithelium increased progressively during the 7-day period of observation. A 2- to 2.5-fold increase in acid phosphatase activity was found in the lower layer of regenerating epithelium, whereas no increase was obtained in the upper layer when the dissected freeze-dried epithelium was homogenized in the presence of Triton X-100.

Improved skin flap survival with nicotinic acid and nicotinamide in rats

The effects of some components of the coenzyme nicotinamide adenine dinucleotide (NAD) on tissue viability were investigated in acute island skin flaps which were constructed to exceed the blood supply provided by a unilateral pedicle of inferior epigastric vessels. Control flaps undergo significant necrosis. Treatment with nicotinamide or nicotinic acid, precursors of NAD, prior to flap elevation significantly improved the area of viability in the random portion of the flap from 44 ± 9% (mean ± SD) to 67 ± 12 and 65 ± 5%, respectively. Similarly, NAD improved viability to 68 ± 10% (P < 0.001). Treatment with other components, adenosine diphosphoribose or quinolinic acid, had no effect on flap survival. The results suggest that nicotinic acid and nicotinamide deserve therapeutic consideration with regard to the treatment of ischemia/reperfusion injury in skin.

Transoral silastic augmentation of the malar region

Abstract Silastic implants have been inserted to augment the malar regions via a transoral approach in 7 patients with satisfactory results. No implants have been removed because of infection. The problem of fluid accumulation about the implants and the use of triamcinolone for its treatment in one case is described. The major advantages of this technique are: ease of exposure; safety for the facial and infraorbital nerves; the ability to place the implant medial to the infraorbital nerve; and avoidance of further external scarring.

Enzyme activities in regenerating epithelium during wound healing

Abstract A microanalytical method was applied to the study of β-glucuronidase activity in 0.5-μg samples from various defined segments of normal and regenerating epithelium. The lower layers of the epidermis exhibited greater enzyme activity than the upper layers. Marginal epithelium exhibited no significant alterations in enzyme activity from normal during 7 days of healing. Regenerating epithelium demonstrated markedly increased enzyme activity. A progressively increasing gradient of β-glucuronidase activity was demonstrated from the wound margin to the advancing tip of the repairing epithelium. The advancing tip of the regenerating epithelium contained extremely high concentrations of β-glucuronidase, and this activity decreased sharply after the epithelium closed the wound site on day 4. It is conceivable that actively migrating epithelial cells are limited entirely to the advancing epithelial tip. β-Glucuronidase may promote epithelial cell migration and may play a role in the contact inhibition of epithelialization.