Faculty Bibliography

A series of complex fingertip injuries managed with a reversed digital artery island flap is presented. An island of skin on the side of the proximal phalanx can be elevated on a digital arterial pedicle and rotated to the fingertip to provide abundant skin and subcutaneous coverage for acute or chronic deficits. The flap receives retrograde flow from its ipsilateral digital artery after passage through dorsal and palmar vascular plexuses at the middle and distal phalangeal level. Thirteen flaps were performed on eleven patients with no loss of any portion of the flap. The advantages of this procedure include a reconstruction that necessitates surgery only on the injured digit, allowing for the treatment of single or multiple fingertip injuries that provides functional sensation in the reconstructed fingertip without causing loss of motion

No major breakthroughs have occurred since Kawamoto last discussed this topic in the Clinics in 1976. Advances such as early surgery, cranial bone grafting, modern methods of fixation, and tissue expansion have been applied with success to craniofacial clefts as in the treatment of other craniofacial deformities. Twenty years have passed since Tessier first presented his classification of craniofacial clefts, and that interval has served to reinforce the magnitude of Tessier's contribution to craniofacial surgery

Patients predisposed to postoperative eyelid malposition can be identified by the careful preoperative analysis of the periorbital anatomy in conjunction with a good medical history. When necessary, ancillary procedures are performed at the time of the initial blepharoplasty to avoid undesirable deformities

Excellent patency rates are currently established in the use of autogenous veins as interposition vein grafts in microsurgical practice. Allografts may be a viable alternative source of vein grafts. Recent advances in cryobiology have enabled the controlled freezing of tissues with preservation of vital cellular elements. Although several reports have shown the successful use of cryopreserved large-vessel allografts, few have addressed cryopreservation of microvessels (1 to 2 mm in diameter). In this study, the authors have successfully cryopreserved femoral veins in a rat model and transplanted them as interposition vein grafts into arterial defects across major histocompatibility barriers (ACI to Lewis). Short-term patencies (21 days) were determined, and histologic and scanning electron microscopic analysis were performed. Patency of 100 percent was achieved in both fresh control veins and in cryopreserved veins at 21 days

PURPOSE: To determine the value of breast ultrasonography (US) in the assessment of silicone breast implants for rupture. MATERIALS AND METHODS: Seventy-four women with local or systemic symptoms related to silicone implants underwent breast US. Of these, 28 underwent surgical removal of the implants. RESULTS: Of 57 implants removed, 37 were intact. The most reliable sign of an intact implant was an anechoic interior, although reverberation artifact and radical folds could be seen. Of 20 ruptured implants, 16 were intracapsular and four were extracapsular ruptures. The most reliable US sign of rupture was echogenic, horizontal ('stepladder') lines (14 of 20 ruptures). Two of the four extracapsular ruptures were accurately identified as echogenic nodules outside the implant; two were false-negative findings. Three intracapsular ruptures identified at US were false-positive; six were false-negative. Overall sensitivity for rupture was 70%, specificity was 92%, positive predictive value was 82%, and negative predictive value was 85%. CONCLUSION: Breast US is capable of depicting intracapsular and extracapsular rupture of breast implants

The posteriorly based tongue flap can be very useful to close difficult palatal fistulas, especially because the palatal sling prevents dehiscence of the tongue flap. However, special techniques may need to be employed with very large palatal fistulas or severely scarred palates. This technique has been used successfully in 5 patients. A detailed case report is presented, for which refinements of the tongue flap technique was required

The chemical probes potassium permanganate (KMnO4) and diethylpyrocarbonate (DEPC) have been used to study the conformation of bent kinetoplast DNA from Crithidia fasciculata at different temperatures. Chemical reactivity data shows that the numerous short A-tracts of this bent DNA adopt a similar structure at 43 degrees C. This conformation appears to be very similar to the conformation of A-tracts in DNA exhibiting normal gel mobility. The A-tract structure detected by chemical probing is characterized by a high degree of base stacking on the thymine strand, and by an abrupt conformational change at the 3' end of the adenine strand. In general, no major alteration of this A-tract specific structure was detected between 4-53 degrees C. However, probing with KMnO4 revealed two unusual features of the C. fasciculata sequence that may contribute to the highly aberrant gel mobility of this DNA: 1) the B DNA/A-tract junction 5' dC/A3-6 3'. 5' dT3-6/G 3' is disproportionately represented and is conformationally distinct from other 5' end junctions, and 2) low temperature favors a novel strand-specific conformational distortion over a 20 base pair region of the bent kinetoplast DNA. Presence of the minor groove binding drug distamycin had little detectable effect on the A-tract conformation. However, distamycin did inhibit formation of the novel KMnO4 sensitive low temperature structure and partially eliminated the anomalous gel mobility of the kinetoplast DNA. Finally, we describe a simple and reproducible procedure for the production of an adenine-specific chemical DNA sequence ladder