John Marquis Converse

Inosculation of vessels of skin graft and host bed: A fortuitous encounter

From the combined procedures of skin stereomicroscopy of in situ grafts in rats, graft removal and supravital intracardiac injection of a contrast medium, the data suggest that the revascularisation of skin grafts is an orderly sequence of events which include: active invasion of the graft dermis by the ingrowing host capillary sprouts; development of anastomoses between the graft and host vasculatures; entry of blood into the graft through the vascular anastomoses by 48 hours after transplantation.

EARLY SKELETAL RELEASE IN THE INFANT WITH CRANIOFACIAL DYSOSTOSIS: The Role of the Sphenozygomatic Suture

We describe our experience with early skeletal release in 10 infants with craniofacial dysostosis. The cranial base is the key to the deformity, and we extend the release toward it as well as resecting strips from the calvarium. Three procedures are described. The early results are encouraging.

Retrospective cephalometric analysis of mandibular bone absorption under silicone rubber chin implants.

A longitudinal study was conducted on 85 patients who received silicone rubber implants to the chin. Over half of these patients were found to have some absorption of the bone beneath the implants, and much other information was obtained. There were no concomitant changes in the soft tissue profile in the patients who demonstrated bone absorption under their implants. It appeared that the bone absorption was less when the implant was placed over the hard bone of the lower part of the mandible, rather than higher or over alveolar bone.

The surgical-orthodontic approach to the treatment of dentofacial deformities☆

Abstract We have reviewed the indications and available techniques for surgical-orthodontic rehabilitation of patients with various types of malformation of the jaws. These malformations include maldevelopment in the anteroposterior dimension, deviations from the midsagittal plane of the face, and open-bite deformities. Many of the techniques described have been developed or improved during the last decade and have made possible successful treatment of difficult problem cases of malocclusion, often with dramatic results in improving facial appearance. Such results are possible only when there is close surgical-orthodontic collaboration.

Report on a series of 50 craniofacial operations.

We present a retrospective study of 50 patients who have undergone craniofacial surgery. The indications, types of osteotomies, complications, and other aspects are reported.

Making uniform photographic records in plastic surgery.

The photographic unit described requires a modest investment in equipment and space, and the photographs can be taken by an office aide after suitable instruction. It provides a means for obtaining clear, comparable photographs--without disrupting office routine. The key to success is consistency in camera settings, lighting, alignment, and positioning. Figures 8 and 9 show representative examples of long-term records.

OBSERVATIONS ON IMMUNOLOGICAL MANIFESTATIONS OF THE HOMOGRAFT REJECTION PHENOMENON IN MAN: THE RECALL FLARE

This investigation of homografts in man was undertaken to study the reactions to repeated skin homografts from the same donor and to evaluate the duration of the resulting sensitivity. Immunological aspects of the rejection of skin homografts have been reported by Medawar (1954)’ and Billingham, Brent, and Medawar (1954).2 These investigators described the active sensitization pattern expressed by the host’s reaction to skin transplants, and also the host’s behavior when again placed in contact with an antigenic challenge from the same source. Secondset skin homografts have exhibited an accelerated form of rejection in the species studied (Medawar, 1944; 1945: 1946;6 Dempster, Lennox, and Boag, 1950;6 Lehrfeld, Taylor, and Converse, 1955;7 Dempster, 1952 ;” Sparrow, 1953;e Gibson and Medawar, 1942;’O Longmire and Smith, 1951;” and Baxter and Entin, 1951’*). Reactions of the host to additional skin grafts from the same source have been described in rabbits, in rats, and in man (Billingham and Boswell, 1953 ;13 Lehrfeld, Taylor, and Converse, 195S7). Data obtained in our laboratories previously (Rogers, Converse, Taylor, and Campbell1*), support the results described in this report. The experimental method outlined below is similar to that used in previous studies. The results obtained in each series were also similar.

A combined biceps and semitendinosus muscle flap in the repair of ischial sores

Abstract In large or recurrent ischial pressure sores with extensive bony involvement, scarring and absence of surrounding soft tissue, radical excision of all involved bone and soft tissue leaves a large space which Conway and Griffith (1956) recommended should be filled by a biceps femoris muscle flap before being covered with a large medially based posterior thigh rotation flap. We have occasionally found the biceps so atrophied in paraplegics that it was inadequate to fill the hole. Additional bulk may be obtained by rotating the semitendinosus together with the biceps.

Antegonial notching of the mandible: an often overlooked mandibular deformity in congenital and acquired disorders.

Mandibular antegonial notching is a concavity of the undersurface of the body just anterior to the angular process (gonion) seen in congenital and acquired disorders. The notch tends to be longer in the congenital than in the acquired state, and the ascending ramus is at a more obtuse angle to the body.

The specificity of skin homograft rejection in man.

In the course of a study of the transfer of delayed hypersensitivity to skin homografts in man with leukocyte extracts,l it was noted that the specificity of homograft responses had not been evaluated as extensively in man2-5 as in animal species.6-10 This report describes an attempt to demonstrate the individual-specific character of skin homograft rejection in man on the basis of the experimental end point provided by the “white-graft” reaction. The application of a skin homograft to a human recipient results in its initial vascularization and proliferation, followed within 8 to 12 days by graft vessel thrombosis, hemorrhage, and escharification.” These changes are associated with development in the host of generalized altered reactivity to subsequent skin homografts from the same donor source. If such a second-set homograft is applied during the first 7 days following first-set rejection, the white-graft reaction is elicited.12 If the latent period after first-set rejection is lengthened to 10 to 15 days, the second-set graft exhibits the accelerated-rejection rea~t ion.’~ Accelerated rejection is associated with initial graft vascularization, followed by rapid vascular thrombosis and breakdown, with gross rejection on postoperative days 4 or 5 . In contrast, the white-graft reaction is characterized by a complete absence of vascularization on stereomicroscopic observation; the graft remains parchment white and opaque. This sharp end point, which denotes a prior specific immunological experience when contrasted with the behavior of control homografts, has been selected for the present study of homograft specificity in man.