Robert M. Bumsted

Secondary intention healing as an adjunct to the reconstruction of mid‐facial defects

Facial skin cancer has a high incidence during later life. The majority of our patients had been previously treated by a number of different modalities. The recurrence or persistance of their cutaneous neoplasm was often quite extensive and thus required a rather large excision to eradicate the disease. Employment of a number of small operations under local anesthesia in which the patients could return to their home environment provided for a potential reduction in psychological and physical morbidity. The use of delayed healing often allowed reconstruction with a local flap or skin graft that if reconstructed primarily would have necessitated a more extensive operative procedure. Use of local flaps and/or skin grafts avoided excessive blood loss and long periods of immobilization associated with larger regional and distant flaps. Finally the denial of reconstructive surgery because of age should be condemned since fairly small operations in conjunction with delayed wound healing can provide acceptable cosmetic and functional results.

Ultrastructural Observations on Vasomotor Rhinitis

The ultrastructure of the respiratory nasal mucosa of patients suffering from vasomotor rhinitis was studied and compared with the reported ultrastructural findings in cases of chronic perennial allergic rhinitis. The principal ultrastructural differences were the absence of interendothelial gap junctions, the scarcity of eosinophils and plasma cells, and the absence of immunologically stimulated or degranulated mast cells in vasomotor rhinitis. These differences were discussed in the light of the known pathophysiologic facts.

Pneumomediastinum secondary to voice button prosthetic speech.

and Mathes et a1. 17 In retrospect, the likelihood of a wound breakdown might have been anticipated since the overlying skin, like the artery, had sustained considerable radiation damage. Indeed, in this case and others like it, it is recommended that soft tissue coverage be obtained primarily with well-vascularized, nonirradiated tissue. In summary, our case illustrates two important points: (1) Restoration ofarterial flow may be performed safely in selected patients after carotid rupture and may be associated with reduced morbidity and mortality rates, and (2) a myocutaneous flap may be used to cover an exposed vessel in the neck despite moderate bacterial contamination.

Allergy and Fungal Screens in Chronic Sinusitis

Thirty-three patients with chronic sinusitis severe enough to warrant surgery were prospectively screened for atopic disease and fungal sensitivity by history, total IgE levels, an allergen-specific IgE screen panel and fungal IgE levels. Total IgE was elevated in 10 of 31 patients measured. A positive “screen” panel (milk, Candida, house dust, white ash, timothy grass, ragweed) was noted in 57.5%. Fungal sensitivity to one or more of the following molds, Aspergillus, Mucor, Alternaria, Candida, Cladosporium, Penicillin notatum, Helminthosporium, or Curvularia, was noted in 51.5%. Seventeen patients had both positive atopic and fungal screens. All those with positive fungal screens also had positive atopic screens. The predictive value of allergy screens may be useful when the incidence in the population to be tested is 50% or greater. This study suggests that use of allergy screens and/or screens for fungal IgE may have a predictive value of 90% or greater with chronic sinus disease. Measurements of total IgE do not appear to add useful information and have a low predictive value as a test. Preliminary conclusions suggest that the incidence of atopy and elevated fungal IgE is high in patients with chronic sinusitis. Screens for allergies and fungal IgE may be useful to identify patients for further evaluation.