Faculty Bibliography

The anterior mandible defect following cancer excision presents a formidable reconstructive challenge. A trapezius osteomyocutaneous island flap based on the transverse cervical vessels is described which allows immediate reconstruction of the entire defect. The various classes of bone flaps retaining an intact vascular pedicle are discussed. The osseous extension of the trapezius island flap appears to be adequate perfused. The anatomy involved and the orthopedic sequelae of using flap are discussed

Infants afflicted with meningomyelocele are paralyzed as a result of physiologic disconnection of the neural plate from the spinal cord. Intact neural elements within the placode often maintain segmental reflex innervation of paralyzed lower extremity muscles. It was hypothesized that bridging this central peripheral gap with viable intercostal nerves would restore limited voluntary movement to paralyzed muscles. The surgical technique and initial results are the subject of this report

A patient with craniofacial synostosis and vitamin D--resistant rickets who underwent successful Le Fort II advancement is presented. The association of premature cranial synostosis with a variety of metabolic and hematological disorders is discussed

Longitudinal clinical and cephalometric case studies are presented for two groups of patients with craniofacial dysostosis. The first sample includes two infants who underwent an extensive stripping procedure that was extended inferiorly to involve not only the coronal, but also the sphenozygomatic suture. The second sample includes two adolescents with midfacial hypoplasia who underwent a fronto-orbital-maxillary advancement. The extensive cranial stripping procedure had a favourable impact upon growth and development of the craniofacial structures, and longitudinal studies suggest the importance of promoting the growth potential of the bones contiguous to the affected sutures. Craniofacial surgery performed on adolescents results in a dramatic translocation of the skeletal and soft-tissue structures of the face. In contrast to early surgical intervention in infants in whom growth of the effected areas essential to the development of face and cranium was crucial, late surgery appeared to have little, if any, impact upon the development of the craniofacial skeletal structures that had been operated on

Defects of the heel and sole represent difficult reconstructive problems in terms of tissue availability and postoperative morbidity. Although local flaps offer the optimal type of coverage, their application has been restricted to defects of limited size. A study of the plantar skin and fascia, as well as its neurovascular supply, was undertaken in cadavers. Mobility of local flaps is greatest with a narrow pedicle. Dissection deep to the plantar fascia allows the inclusion of the medial or lateral plantar nerve and artery with the flap, thereby allowing considerably mobility while preserving vascularity and sensibility. Several variations of the flap are presented with clinical examples

A case report of successful microvascular replantation of a totally avulsed scalp is presented. The scalp itself, in good condition, was used as a free flap. Following operation, the right temporal artery was patent; the left was not. Repair of the left temporal artery was not attempted but large thrombi were milked from the scalp veins. Excellent perfusion of the scalp was provided through the right side. Hair growth began soon after operation, spotty at first but eventually excellent

1. A total of 758 fibers were isolated from previously transected and repaired ulnar nerves of five baboons. These fibers were compared to fibers from normal and previously crushed nerves studied in an earlier experiment. 2. The conduction velocities of the proximal portion of the injured axons dropped below normal, and this reduction persisted until reinnervation appeared nearly complete. 3. The receptive-field organization and response characteristics of 79 cutaneous afferent fibers serving the glabrous skin were studied in detail and compared to cutaneous afferent fibers of normal and previously crushed nerves studied earlier. 4. Initially, receptive fields were small and irregular, and often one fiber served several distinct skin regions. Ten months later, most of these abnormalities were no longer apparent. 5. Thresholds for single impulses elicited by von Frey hairs remained elevated for up to 4 mo after the receptive field reappeared, but then dropped abruptly to a near-normal range. 6. After reinnervation, rapidly adapting fibers displayed tuning curves characteristic of their submodality, but thresholds were elevated and only began to approach the normal range 6 mo after reinnervation. 7. After reinnervation, slowly adapting fibers displayed stimulus-response curves with elevated thresholds and they tended to saturate at lower stimulus intensities than normal fibers. 8. When compared to the return of function following a crushing injury, axons that had been transected displayed a slower time course for the return to normal values of conduction velocity and threshold. Receptive-field organization also remained abnormal for a longer time period. 9. These data support the hypotheses that a) breaking the continuity of the Schwann cells and extracellular matrix that occurs during transection but not during crush is a major factor leading to errors of axonal regeneration in the distal stump, b) submodality specificity is a property of the regenerating axon, and c) regenerating axons are influenced by an internal or external cue, causing them to form and maintain a single relatively homogeneous receptive field

Reconstruction of the head and neck region following radical parotidectomy with or without mandibulectomy may be a difficult procedure. Facial skin is usually preserved, but the underlying soft-tissue structures and bone are deficient. The challenge is to augment the facial defect while the overlying skin is preserved with a high success rate, minimal time, one operative stage, and reduced secondary deformity to the patient. In certain instances, a microvascular free flap is ideal. We have used a de-epithelialized microvascular free groin flap successfully to reconstruct large parotid-mandibular defects in nine patients. A small bridge of epithelium is left to relieve tension from edema and to monitor the flap postoperatively. The high success rate, minimal complications, and acceptable donor site defect make the microvascular free dermis-fat flap an ideal choice for this type of reconstruction