Reed O. Dingman

The Versatility of Pericranial Flaps

The pericranium is the source of multiple, dependable, well-vascularized flaps which are of use to the plastic and reconstructive surgeon for multiple defects of the face and skull. Based anteriorly, the flap can cover the entire central third of the face or be transposed intracranially to correct abnormalities of the cribriform plate and dura. Based laterally on the temporalis muscle, the flap can be turned to multiple arcs for reconstruction of the face, ear, and intracranial defects. Donor-site morbidity and complications have been minimal.

COSTAL CARTILAGE HOMOGRAFTS PRESERVED BY IRRADIATION

Use of preserved cartilage homografts in restoring contour to defects of the supporting structures of the face is described and illustrated. Adequate sterilization of contaminated cartilage is effected by Co/sup 60/ gamma irradiation for 15 hr using 3,000,000 rep. The cartilage is then stored in saline at room temperature. No pathologic organisms were cultured from a series of 70 cases in which Co/sup 60/sterilized cartilage was used. Experiments in dogs, with direct measurement and inspection of 38 grafts implanted in the rectus sheath and on the pericranium, 2-12 months after transplantation, revealed that canine costal cartilage sterilized in merthiosaline gave 33.3% complete and 33.3% partial absorption, while irradiated cartilage stored in saline gave 27.8% complete and 5.5% partial absorption. Clinical evaluation of 30 patients examined from 7 months to 31/2 yr postoperatively revealed evidence of absorption only in two grafts. Techniques of preparing, sterilizing by irradiation, and storing of human costal cartilage are described. (TCO)

Reconstruction of the Chest Wall

Reconstruction of the chest wall can now be accomplished reliably and expeditiously. Past experience with local flaps and split-thickness skin grafts recommends their continued use when appropriate. Recent studies in blood flow have demonstrated that very large muscles with or without the overlying skin can be moved primarily and reliably. The four most reliable myocutaneous flaps for chest wall reconstruction are described. Microsurgery allows movement of large segments of skin and muscle from expendable areas of the body to the chest wall.

Total reconstruction of aplasia cutis congenita involving scalp, skull, and dura.

A case of total reconstruction of skull and scalp in a patient with a large defect from aplasia cutis congenita is reported. Tissue expansion was successfully employed on two occasions: first to construct a well-vascularized space to sustain multiple rib grafts for cranial reconstruction and then to develop adequate quantities of scalp and forehead for total coverage.

Surgical correction of mandibular prognathism, an improved method

Abstract The details of a surgical technique are described for the correction of mandibular prognathism by means of sectioning a portion of bone from the body of the mandible, without interference with the inferior alveolar nerve and without compounding the wound intraorally.

Ankylosis of the temporomandibular joint

Abstract Chronic ankylosis of the temporomandibular joint is discussed from the standpoint of incidence, etiology, pathology, diagnosis, and treatment. Complete excision of the condyle head under local anesthesia, whenever possible, is the preferable method of treatment. An auricular incision provides adequate access to the joint and gives the best cosmetic results. Bilateral cases should be done in two operative procedures with an interval of at least one month between operations.

A solitary bone cyst of the mandibular condyle

A review of the literature concerning solitary bone cysts of the jaws is presented. Our patient is typical except for the location of the cyst. No previous case of a solitary bone cyst confirmed to the mandibular condyle has been reported. No precise etiology for solitary bone cyst is known. The use of routine panoramic radiography has made detection of such cysts more common. Surgical exploration is indicated for diagnosis and treatment.

The superficial inferior epigastric artery flap for coverage of hand and forearm defects

Large wounds of the hand and upper extremity require secure closure for protection of the underlying structures. The skin of the lower abdomen can be raised in a lenticular fashion, supported by the superficial inferior epigastric artery and vein, and applied as a flap to wounds of the distal upper extremity. The flap demonstrates versatility in positioning, and the donor site can be closed in a linear fashion. Viability of this superficial inferior epigastric artery flap is demonstrated by the case reports.

THE NEW AUTOMOBILE WINDSHIELD AND ITS EFFECTIVENESS IN REDUCING FACIAL LACERATIONS

FACIAL LACERATIONS FROM HEAD IMPACT TO THE NEW AUTOMOBILE WINDSHIELD ARE MARKEDLY REDUCED IN NUMBER, EXTENT, AND SEVERITY. PREVIOUSLY, WHEN THE PRE-1966 THINNER LAMINATE WINDSHIELD WAS IMPACTED BY THE HEAD, SLICING LACERATIONS WERE TYPICALLY FOUND. HEAD IMPACT TO THE NEW WINDSHIELD WILL TYPICALLY PRODUCE ABRASIONS AND SMALL LACERATIONS OF THE FOREHEAD AND NOSE THAT OFTEN DO NOT REQUIRE SURGICAL CLOSURE. ONLY RARELY IS THE LAMINATE OF THE NEW WINDSHIELD TORN. WHEN THIS DOES OCCUR, THE HEAD-TO-GLASS IMPACT SPEED IS MORE THAN DOUBLE THAT REQUIRED TO PERFORATE THE OLD THIN LAMINATE WINDSHIELD. IN THOSE FEW CASES WHERE THE THICKER LAMINATE IS TORN BY THE HEAD, SLICING LACERATIONS ARE SUSTAINED; BUT THESE TEND TO BE LESS EXTENSIVE AND LESS SEVERE THAN THOSE PREVIOUSLY NOTED ON THE OLD TYPE OF WINDSHIELD. THERE IS NO EVIDENCE THAT THE INCIDENCE OF INTRACRANIAL OR NECK INJURY IS INCREASED BY STRIKING THE NEW WINDSHIELD. /SRIS/

Correction of webbed neck defects.

The posterior approach for correction of the webbed neck defect involves wide anterolateral skin undermining and skin resections from the nape of the neck. The redundant tissue and the underlying defect are corrected and the resultant scar is hidden in the scalp rather than being exposed on the lateral aspect of the neck or shoulder as would be the case with a Z-plasty procedure. In addition, the hairline remains smooth and in a relatively natural position. The surgical dissection is not difficult, and few anatomical structures are involved. The procedure has been employed in 4 patients and has proved to be effective and safe, with long-lasting improvement and acceptable aesthetic results.