The horn flap: a curved V-Y advancement flap with lateral pedicle.

The Horn Flap, a curved V-Y advancement flap with a radially based subcutaneous pedicle, has proven to be a versatile, reliable method of reconstruction following excision of small facial lesions, particularly in the medial canthal area. Entry of the pedicle on the radial, or concave, side makes significant advancement possible.

In vivo characterization of the inflammatory properties of poly(tetrafluoroethylene) particulates.

Suburothelial injections of particulate poly(tetrafluoroethylene) (PTFE) is becoming a widely accepted treatment for a number of urological disorders. Because little is known about the long-term histologic morphology of the injection site, this animal study was performed. Three populations, each consisting of two mongrel dogs, five New Zealand White rabbits, and 10 BALB/c mice, were injected with poly(tetrafluoroethylene) particulate in a glycerine carrier (Polytef Paste) and were followed for a period of 1 week, 3 months, 6 months, and 1 year. Mice received one subcutaneous dorsal injection each, rabbits received two subareolar injections each, and dogs received three subareolar injections each in addition to two periurethral injections. Histologic examination of the biopsy sites revealed a persistent chronic inflammatory reaction with progressive growth of the involved tissue volume. In addition to giant cells and macrophages, lymphocytes became apparent at 3 months and constituted up to 40% of the cellular infiltrate by 1 year. Plasma cells were also noted at the 1-year period in the rabbit model. The progressive growth of the inflammatory pseudo-tumors evoked by injected PTFE may compromise the long-term safety of certain urological procedures involving particulate PTFE.

Augmentation of skin flap survival by parenteral pentoxifylline.

One prime factor implicated in flap necrosis is diminished blood flow. A known corollary of morbid ischaemia is an energy-dependent reduction in red blood cell deformability associated with an increase in whole blood viscosity. The newly available drug pentoxifylline is alleged to improve this red cell membrane defect in the low flow state, thereby improving the rheologic characteristics of blood. We studied its effect in a flap model with an ischaemic component and also measured changes in blood viscosity. A caudally-based dorsal flap in a rat model was used. Control (saline-treated) animals exhibited 74.8 +/- 9.8% flap survival. Three groups of animals were treated at different times with pentoxifylline with respect to date of surgery; all groups showed a statistically significant increase in flap survival compared to controls, ranging from 92.3 to 94.3% (p less than .01). Simultaneous viscometric measurements with a cone-plate viscometer were performed. The observed increase in flap survival did not, as suggested by other investigators, correlate dependably with viscosity reduction. Reasons for this are discussed.

Axillary lymphadenopathy: a complication of BCG immunotherapy for melanoma.

We present a patient with a Clark level IV melanoma who received BCG immunotherapy by scarification for 12 months after wide excision. Six months after cessation of treatment, the patient developed regional lymphadenopathy that histology showed to be reactive epithelioid granuloma. Regional immunotherapy thus represents a potentially confusing factor in the post-operative assessment and management of the patient with melanoma.

Lacrimal gland involvement in zygomaticofrontal fracture sites.

Injury to the lacrimal gland following fracture of the zygomatic complex is a rare occurrence. Recently, we have observed three cases of herniation of the lacrimal gland between the diastased frontal and zygomatic bone ends. We present these cases, postulate a mechanism for this phenomenon, and advocate open reduction and internal fixation in the primary management of severe distraction.

Submandibular duct stenosis as a complication of Ludwig's angina.

A case of submandibular duct stenosis subsequent to Ludwig's angina is presented. It illustrates the importance of outpatient follow-up after apparent infections.