Faculty Bibliography

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

Infants afflicted with meningomyelocele are paralyzed as a result of the physiological disconnection of the neural plate from the spinal cord. Intact neural elements within the placode often maintain segmental reflex innervation of the paralyzed lower extremity muscles. It was hypothesized that bridging this central-peripheral gap with vaible intercostal nerves would restore limited voluntary movement to the paralyzed muscles. This procedure has been performed on four infants and seems promising

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

Twenty years experience with the tubing technique has proved it to be reliable and adaptable to the usual abnormalities associated with the protruding ear. The technique is especially dependable when all components of the auricle are involved, when the antihelical fold is absent, and there is a large or protruding concha. The recurrence rate of 2.6% is quite acceptable when compared with other techniques.