Faculty Bibliography

In the 2 cases reported the rectus abdominis muscle was used as a sling to construct the pelvic floor. In patient 1, a large squamous cell carcinoma of the perineum was treated with an abdominal perineal resection. Reconstruction was accomplished internally using a rectus abdominis muscle sling and externally with a gluteus maximus musculocutaneous flap. In the second case, the rectus abdominis muscle was used as a supportive sling to reinforce a perineal hernial repair and prevent recurrence.

A new application of the medial gastrocnemius muscle flap has been described. Lengthening of the sural vascular pedicle was obtained using interposition vein grafts. This allowed coverage of a larger defect than that which could have been obtained with the tethered muscle and without further insult to the already disturbed lower extremity anatomy. The principle of pedicle lengthening can be used to increase the arc of rotation of various other muscle, myocutaneous, skin, or bone flaps and thereby increase their usefulness.

Compartmental syndrome is a condition in which swelling within a closed anatomic space increases the intracompartmental pressure to compromise the circulation and function of tissue within that space. Unless this condition is recognized early and treated by prompt surgical decompression, permanent neuromuscular deficits may result. In those instances in which early clinical evidence of this syndrome is difficult to assess, monitoring of intramuscular pressures may be valuable adjunct in the clinical evaluation of patients at risk for this syndrome. The association of compartmental syndrome with a wide variety of circumstances and the importance of an early diagnosis make it essential that all physicians be familiar with this condition. As physician awareness and recognition of this condition increase, the complications associated with it can be greatly reduced.

As in other areas of reconstruction, microvascular free flaps have earned a definite role in certain breast reconstructions difficult to accomplish with conventional techniques. With improvements in techniques and survival rates, the advantages of such reconstructions have become increasingly more attractive to the patient and the surgeon.

High-frequency (20 mHz) ultra-sonic Doppler in a pulsed mode rather than continuous mode allows blood flow detection in small arteries using a 1-mm crystal embedded in a silastic cuff. The "probe factor" used to determine flow was first established in an in vitro system and found to be reliable. The probe was then tested in five dogs on the saphenous artery and found to be highly responsive to hemodynamic changes in the pedicle. Finally, in 15 long-term studies of island flaps and free flaps, the probes were implanted to obtain daily readings and then removed at 7 days. Except for some dog-related problems and technical errors, the system produced reliable flow data in the percutaneous cable. It is anticipated that such immediate and direct information on the pedicle blood flow would be useful in monitoring flaps.

Few medico-legal issues have generated as much controversy as informed consent--the right of patients to be fully informed about the risks, complications, and alternatives to a medical treatment or surgical procedure before deciding whether or not to submit to it. This paper discusses the complexities inherent in the legal doctrine of informed consent and their implications for dermatologic surgery. Particular emphasis is placed on the legal requirements for informed consent, as well as the problems associated with informing patients and their potential solutions.

A prospective clinical and cephalometric study was conducted on 12 patients under the age of 12 years undergoing Le Fort III advancement with the following findings: 1. There was a remarkable degree of postoperative skeletal stability of the midfacial segment. 2. Disharmony in jaw relationship (anterior crossbite) observed during the period of longitudinal postoperative study could be attributed to expected mandibular development. 3. In some patients, growth and development of the maxilla in a forward and downward direction were documented after Le Fort III advancement. The authors recommend that a Le Fort III advancement can be safely performed at approximately age 4 without a deleterious effect on midfacial development in the patient with craniofacial dysostosis

Orbital abscess following blepharoplasty is surprisingly rare. The diagnosis may not be obvious from the physical signs alone. Ultrasonography is a helpful diagnostic tool in such problems. The abscess cavity can be visualized. A case of orbital abscess is presented