Prominent ears and their correction: a forty-year experience.

The technique described in this article correcting the protruding ear deformity has evolved over 40 years. The original procedures and our subsequent modifications are described, including 20-year followup results. The possible pitfalls in carrying out this procedure and how to avoid them are also described.

The use of particulate hydroxyapatite and plaster of Paris in aesthetic and reconstructive surgery.

The authors describe their early investigative results of using a mixture of hydroxyapatite (HA) and plaster of Paris (PP) in skull and frontal sinus defects in a large series of cats. Histologically, bone was found to form and infiltrate the HA-PP implant over a period of months, with gradual resorption of the plaster in 6-8 weeks. Clinically, the HA-PP combination has been used in 24 patients over the past seven years for various skull, zygomatic, and mandibular defects.

The effect of povidone-iodine solutions used as surgical preparations on the bacterial flora of the skin.

One hundred fifty hospitalized patients undergoing elective surgery were enrolled in an open study designed to assess the bactericidal and clinical efficacy of a preoperative skin preparation procedure--application of 7.5% povidone-iodine surgical scrub followed by 10% povidone-iodine antiseptic solution. Of 99 patients with bacterial colonization of the skin prior to surgery, 84 patients (85%) had no detectable levels of bacteria at completion of surgery; bacterial flora persisted after surgery in the remaining 15 patients (15%).

The inferior dermal-pyramidal type breast reduction: long-term evaluation.

The evolution of the technique of breast reduction using an inferior dermal pyramidal flap is discussed, including the changes we have found to enhance this procedure. The recommended use of a wide-based pyramidal breast parenchyma with a dermal pedicle nipple-areola flap is based on our 12-year study of 1,001 breast reductions in 519 patients ranging in age from 13 to 73 years; 37 of the patients underwent a unilateral breast reduction. The weight of tissue excised ranged from 207 g to 3,350 g from each breast.

Preoperative positioning of the protruding premaxilla in the bilateral cleft lip patient.

The rationale and technique for preoperative retraction of a protrusive premaxilla in the bilateral complete cleft lip and palate patient are presented. Two types of pinned intraoral appliances are presented that can expand the palatal shelves while retracting the premaxillary segment. Findings from lateral cephalometric x-ray studies of eight appliance patients and six control patients with bilateral clefts but no appliance treatment are presented at age 15.

Evaluation in cats of a new material for cranioplasty: a composite of plaster of Paris and hydroxylapatite.

The materials ordinarily used to reconstruct bone defects in the calvaria and facial bones either are difficult to shape, are partially resorbed by the body, or are likely to become infected if used near a contaminated area such as the frontal sinus. Calcium sulfate hemihydrate (plaster of Paris) has been known for years to have excellent reparative qualities in bone defects, but ordinarily it is quickly resorbed. Consequently, a new material, a composite of a dense form of plaster of Paris and hydroxylapatite, was devised to provide nonabsorbable hydroxylapatite particles for bone to form around and within during the phase of plaster absorption.

Mammary implants, diving, and altitude exposure.

Mammary implants were exposed to various simulated dive profiles followed by altitude exposures to stimulate aircraft travel and then were observed for bubble formation and volume changes. Minimal volume changes occurred after each dive. Numerous bubbles formed, however, reaching their maximum size in 3 hours.

The orticochea pharyngoplasty and primary palatoplasty: an evaluation.

A primary Orticochea pharyngoplasty with a primary palatoplasty was studied in 15 children with cleft palates. Although all children demonstrated velopharyngeal competence, radiographic, endoscopic, and oral examinations suggested that 54% of the children studied would not have needed a pharyngoplasty. In addition, 27% of the children demonstrated aberrant speech patterns associated with velopharyngeal incompetence.

An aesthetic approach for nasal tumors.

An elongated columella flap has been found to give excellent exposure to the nasal dorsum, allowing satisfactory removal of soft tissue nasal masses such as dermoid cysts or hemangiomas. This approach provides a more acceptable scar than the standard vertical dorsal nasal incision.

Long-term clinical outcome of immediate reconstruction after mastectomy.

Immediate reconstruction of a breast removed for treatment of carcinoma can be accomplished without altering the cancer-ablative surgical procedure. The theoretical possibility that reconstruction might compromise the cure rate has tempered enthusiasm for this approach. To test this issue, the relapse-free survival of 101 patients who underwent breast reconstruction in the immediate postmastectomy period was compared with that of 377 patients with breast cancer who underwent mastectomy without immediate reconstruction.

Efficacy of povidone-iodine in pre-operative skin preparation.

Cultures were obtained of the microbial flora from the skin of the operation site pre-operatively and following preparation of the surgical field with povidone-iodine (PVP-I). Preliminary results indicate that PVP-I is a reasonable and effective antibacterial agent when used to prepare skin for surgical operations.

To share or not to share.

We describe our extensive experience in nipple reconstruction on breasts formed by subpectoral implants, latissimus dorsi musculocutaneous flaps, or rectus abdominis musculocutaneous flaps.

Cherubism.

Cherubism is a rare, hereditary fibroosseous lesion of the jaws that is thought to undergo spontaneous involution after puberty. Treatment is unnecessary unless functional or emotional disturbances develop. This article describes the 21-year follow-up of a patient with cherubism and briefly reviews the pertinent literature.

A flap for moderate-sized oral defects.

The use of a cervical musculocutaneous flap is described which is easily transferable to the oral cavity to cover an osseous and soft tissue operative defect, eliminating the need for a more distant and extensive musculocutaneous flap.

The meaning of concepts related to breast reconstruction.

Information is presented from a psychometric study using a semantic differential to measure the meaning of concepts related to breast reconstruction. One hundred five women participated. All were experiencing breast reconstruction subsequent to mastectomy.

A rationale for modifying the site of insertion of the orticochea pharyngoplasty.

A modification of the insertion level of Orticochea flaps is proposed. The purpose of the modification is to place the pharyngoplasty at a higher site, in the area of attempted velopharyngeal contact. The site of velopharyngeal contact can be identified using lateral radiographic techniques.

Masseter muscle hypertrophy.

Benign hypertrophy of the masseter muscle is an uncommon entity important in the differential diagnosis of head and neck masses, particularly a unilateral mass located in the cheek. Ten cases of benign masseteric hypertrophy are reviewed, current surgical treatment is described, and the pertinent literature is summarized.

Rhinophyma: a thirty-five-year experience.

We have treated rhinophyma by a variety of methods during the past 35 years. We describe our current management, which has given the most satisfactory results and fewest problems.

Microsurgical composite tissue transplantation: indications and technical considerations in breast reconstruction following mastectomy.

Twenty-six patients are presented who underwent reconstruction of the breast and thorax following mastectomy. A successful result ensued in 96 percent of the patients. Indications for the use of microsurgical composite tissue transplantation in breast reconstruction following mastectomy include.