Removal from the wild endangers the once widespread long-tailed macaque.

In 2022, long-tailed macaques (Macaca fascicularis), a once ubiquitous primate species, was elevated to Endangered on the International Union for Conservation of Nature (IUCN) Red List of Threatened Species. In 2023, recognizing that the long-tailed macaque is threatened by multiple factors: (1) declining native habitats across Southeast Asia; (2) overutilization for scientific, commercial, and recreational purposes; (3) inadequate regulatory mechanisms; and (4) culling due to human-macaque conflicts, a petition for rulemaking was submitted to the United States Fish and Wildlife Service to add the species to the US Endangered Species Act, the nation's most effective law to protect at risk species. The long-tailed macaque remains unprotected across much of its geographical range despite the documented continual decline of the species and related sub-species and the recent IUCN reassessment. This commentary presents a review of the factors that have contributed to the dramatic decline of this keystone species and makes a case for raising the level of protection they receive.

A model for the noninvasive, habitat-inclusive estimation of upper limit abundance for synanthropes, exemplified by M. fascicularis.

Accurately estimating population sizes for free-ranging animals through noninvasive methods, such as camera trap images, remains particularly limited by small datasets. To overcome this, we developed a flexible model for estimating upper limit populations and exemplified it by studying a group-living synanthrope, the long-tailed macaque (Macaca fascicularis). Habitat preference maps, based on environmental and GPS data, were generated with a maximum entropy model and combined with data obtained from camera traps, line transect distance sampling, and direct sightings to produce an expected number of individuals. The mapping between habitat preference and number of individuals was optimized through a tunable parameter ρ (inquisitiveness) that accounts for repeated observations of individuals. Benchmarking against published data highlights the high accuracy of the model. Overall, this approach combines citizen science with scientific observations and reveals the long-tailed macaque populations to be (up to 80%) smaller than expected. The model's flexibility makes it suitable for many species, providing a scalable, noninvasive tool for wildlife conservation.

Neuroanatomical evidence of reinnervation in primate allografted (transplanted) skin during cyclosporine immunosuppression.

Histological evidence is presented documenting the reinnervation of sensory mechanoreceptors across major histocompatibility barriers in allografted primate (baboon) skin. Meissner and pacinian corpuscles, as well as hair follicles, showed a spectrum of reinnervation by host axons. Our light and electron microscopic evidence to date has suggested that allografted Merkel cells did not survive transplantation. This, and other instances of tissue and receptor destruction resulting from histoincompatibility, indicated marked differences when skin allografts were compared to autografts with respect to the ability of host axons to locate and reinnervate sensory mechanoreceptors.

Management of severe forearm injuries.

A review of principles and an operative guideline for repair of severely mutilating injuries to the forearm have been set forth. These concepts and their application have been illustrated in a series of clinical cases. The following key concepts have developed from these clinical experiences: 1. The surgeon must evaluate each case based upon the potential for return of sensation and function. One cannot justify the statement that a replanted arm is always superior to a prosthesis, even if its only purpose is cosmetic. 2. Care must be taken in the emergency room to evaluate the entire patient, and not to ignore other injuries while concentrating on a mangled extremity. 3. The crush-avulsion nature of injuries seen in a large referral center necessitates aggressive debridement of damaged soft tissue and bone. Wounds that have avulsion of skin, muscle, and nerve throughout the length of the arm do not lend themselves to repair. Destruction of an elbow joint generally precludes repair. 4. A well stabilized skeleton is essential before definitive soft tissue repairs can be performed. 5. Vascular repairs are meticulously performed using magnification. All vessels are reconstructed in an effort to recreate the original anatomy. 6. Wide destruction of muscle and tendon is frequent necessitating ingenuity in connecting proximal motor units to distal tendon. After repair, early active motion of the extremity is emphasized. 7. Perhaps the strongest contraindication to reconstruction of a severely damaged upper limb is avulsion of the nerves throughout the length of the forearm. Sharply divided nerves can be repaired by group fascicular suture. Crushed, divided nerves do well with accurate epineural approximation. Crushed nerves with epineural continuity ar best treated by observation and secondary grafting as required. 8. Primary coverage of areas denuded of skin is by split graft of local transposition flaps. More sophisticated techniques may be used at a later time (myocutaneous flaps or free flaps) if further reconstruction is contemplated. 9. Dressing must be carefully applied without constricting the extremity. A protective plaster is applied beginning from above the elbow and ending in a bonnet over the hand; this allows the recovery room nurse to monitor the vascular status of the repair. 10. The physiotherapist and occupational therapist are integrated into the perioperative care. Active range of motion exercises are begun as soon as the third day after the operation. Lightweight static and dynamic splints help to restore mobility.

Microvascular anastomoses for bone grafts in the treatment of massive defects in bone.

Six patients with large defects in bone are described in whom we performed microvascular anastomoses of grafted fibular vessels (arteries and veins) to vessels in the recipient site. Two other patients, with massive loss of bone and skin, were treated by grafting of osteocutaneous composites also using microvascular anastomoses. All but one defect healed successfully. There is a wide potential for applications of these two techniques in the treatment of large segmental bone defects secondary to trauma or following tumor resection.

The efficacy of free tissue transfer in the treatment of osteomyelitis.

We evaluated the efficacy of free tissue transfer in the treatment of osteomyelitis in thirty-three patients who were followed for an average of 41.4 months (range, twenty-four to fifty-nine months). The bone lesions were classified in two ways: first, according to whether there had been drainage for less or more than six months and second, according to whether the lesion was Type I, II, or III. The thirty-three patients underwent a total of thirty-seven free tissue transfers, and thirty (79 per cent) of the transfers survived. Major complications were encountered after 41 per cent of the surgical procedures, consisting of failure of the free tissue transfer in seven patients (21 per cent) and recurrent sepsis in six (20 per cent) at follow-up. Four of the seven patients in whom the free tissue transfer failed underwent an amputation. Six of the patients with a failed transfer and nine of the ten with recurrent sepsis had a Type-III lesion. Previously published reports have suggested that free tissue transfer is an extremely successful and reliable procedure for the treatment of osteomyelitis. In our series limited success was achieved in patients with a Type-I or II lesion, but six of the patients with a Type-III lesion had recurrence of infection despite a successful transfer.

Rhinoplasty and the male patient.

A review of male patients undergoing rhinoplasty indicates a surprising diversity of anatomy and especially skin coverage. When compared with rhinoplasty in the female adolescent, the goal must be more of a "balanced rhinoplasty" rather than a reductive rhinoplasty, and the techniques required are more diverse. Careful screening of patients is essential to eliminate a subgroup of men with severe psychologic obsessions.

Rhinoplasty: image and reality.

The rhinoplasty surgeon must convert a mental image into a surgical reality through aesthetics, anatomy, and analysis. This article attempts to provide a reasoned solution to the recurrent difficulty of progressing from image to reality.

Endoscopic forehead lift. Aesthetics and analysis.

The endoscope already has revolutionized aesthetic forehead surgery by reducing the morbidity rate associated with the forehead lift operation. The ability to do the operation through a minimally invasive approach is predicated on the illumination and magnification that the endoscope provides. It is this same illumination and magnification that is being brought to bear on the aesthetics, analysis, goals, and techniques that have guided the classical procedure. Both patients and surgeons will benefit from this renewed focus on aesthetic surgery of the forehead.

Practical microsurgery.

The reconstructive surgeon who wishes to learn microsurgery must realize that its acquisition demands extensive practice in the research laboratory with clinical application occurring after perfection of the fundamental techniques. Their initial usage should be in traumatic extremity injuries followed by replantation of complete and incomplete amputations. Elective reconstructive microsurgery demands consummate clinical skills and should not be attempted except by those who have convincingly demonstrated their microsurgical skills either in replantation surgery or in the research laboratory.

The minus-plus mastopexy.

The minus-plus mastopexy technique is designed for correction of moderate or major breast ptosis where breast volume is adequate but located in the lower quadrants and increased fullness in the upper quadrants is desired. The advantages of this procedure are absence of a medial scar, excellent projection, ensured nipple viability, speed, and flexibility.

Secondary rhinoplasty following open rhinoplasty.

On the basis of 56 cases of secondary rhinoplasty following an initial open rhinoplasty, I conclude that secondary surgery is safe and effective. Either an open or closed approach can be used in most cases with little risk of skin necrosis or poor scar formation. The decision as to which approach to use depends on numerous factors. In general, a closed technique is favored when augmentation is the solution, while an open technique is favored when structural correction is required. Reopening the nose was done consistently without problems but was avoided in two patients because of severe thinning following previous defatting. However, certain "stigmata" were seen following open primary rhinoplasty and should be avoided: (1) a depressed, visible scar, (2) destruction of the soft-tissue facets and nostril apices, (3) columella deformities with associated nostril asymmetry, and (4) excessive tip or supratip defatting.

The nasal tip: anatomy and aesthetics.

New anatomic observations and expanded aesthetics are presented based on an in-depth analysis of 50 patients undergoing primary open rhinoplasty. The alar cartilages can be conceived of as three crura (medial, middle, and lateral), each composed of two segments, plus distinct intervening junction points of aesthetic importance. The classic four-dot tip aesthetics can be expanded and wrapped around the nasal lobule in a three-dimensional fashion. Three nasal tip angles are easily defined (angle of tip rotation, angle of domal definition, and angle of domal divergence) and can be created surgically.

Rhinoplasty: creating an aesthetic tip. A preliminary report.

A new approach for creating an anatomically aesthetic nasal tip is presented. It is based on extensive cadaver dissections which demonstrate that a convex domal segment plus a sharp domal segment-lateral crural drop-off are key determinants of a refined tip. This configuration can be achieved with sutures in a manner similar to creating the anthelical curl in an otoplasty. Two operative variations are presented. One achieves tip refinement with a limited increase in projection, while the other provides maximum projection. Currently, the technique is of value in bilateral cleft lip noses, posttraumatic deformities, certain secondary cases, and very selected primary aesthetic cases where tip refinement and projection are limited.

Rhinoplasty and rib grafts: evolving a flexible operative technique.

A flexible operative technique for utilizing rib grafts in difficult rhinoplasty and nasal reconstruction cases requiring support is presented. An osseocartilaginous rib segment is used for dorsal contour or support, while a rigid cartilaginous strut provides for both tip projection and columellar contour. The bone is contoured extensively, while the cartilage is altered minimally. An open approach is employed. A bony fixation platform is established by radix reduction followed by bony fixation with ultramicroscrews. Distally, the grafts are united when nasal lengthening or total support is required; otherwise, the grafts are juxtaposed to allow lateral movement. The operative technique and technical difficulties are described in detail based on experience in 14 patients.

Rhinoplasty: a simplified, three-stitch, open tip suture technique. Part I: primary rhinoplasty.

Tip suture techniques offer a reliable and dramatic method of tip modification without needing to interrupt the alar rim strip or add tip grafts. The present simplified three-stitch technique consists of the following: (1) a strut suture to fix the columella strut between the crura, (2) bilateral domal creation sutures to create tip definition, and (3) a domal equalization suture to narrow and align the domes. If required, columella septal sutures can be added; either a dorsal rotational suture or a transfixion projection suture can be used. This simplified method represents a refinement based on more than 13 years of experience with tip suture techniques. It does not require a complex operative sequence or specialized sutures. Primary indications are moderate tip deformities of inadequate definition and excessive width and certain specific tip deformities, including the parenthesis tip and nostril/tip disproportion. The primary contraindications are for patients with minor tip deformities that are best done through a closed approach and those with severe tip deformities requiring an open structure graft. The technique is simple, efficacious, and easily learned.

Rhinoplasty: a simplified, three-stitch, open tip suture technique. Part II: secondary rhinoplasty.

Tip suture techniques have proven effective in managing many secondary tip deformities. The open approach is used in most cases because it allows analysis and utilization of the alar remnants. If the alar rim strip is intact and not deformed, then a three-stitch technique (strut, domal creation, and domal equalization) is used. If the domes were previously transected, they are repaired and an attempt is made to shape them with sutures. If sutures are ineffective or the domes are deformed, judicious excisions and tip-shaping sutures are employed to achieve an aesthetic "tip shape," as expressed through the overlying skin. Removal of sutures from previously sutured tips has proven effective in the columella and infralobular area, ineffective in the supratip midline, and unpredictable over the domal segment. Overall, tip suture techniques should be considered in secondary tip deformities whenever the alar cartilage remnants permit.

Rhinoplasty: large nostril/small tip disproportion.

Surgeons must recognize large nostril/small tip disproportion as a distinct challenge in rhinoplasty surgery. The critical first step is to correctly analyze the intrinsic and extrinsic factors that contribute to the deformity. The nostril axis is drawn between the nostril apices and extended in both directions. It is then subdivided into a nostril and intrinsic tip component. The ratio of nostril to tip should be 55:45; a ratio of 60:40 is acceptable. The surgical solution requires both an increase in intrinsic tip projection by lengthening the infralobular segment and a nostril reduction. The anatomical deformity consists of three components: (1) the alar cartilages are highly divergent, (2) the infralobular segment is quite short, and (3) the domal segment is flat and ill defined. The operative technique advocated by the author combines a three-stitch tip procedure, including an interdomal suture over a straight strut, plus nostril sill/alar wedge resections.

Rhinoplasty: the retractable roof.

A new operative technique is described in which the natural curved nasal dorsum is retained in a modified fashion. Specifically, the nasal dorsum is elevated, the nasal height is reduced, and then the newly designed roof is lowered. Based on a minimum 1-year follow-up of 14 patients and a total experience of 28 patients, the procedure has the following advantages: (1) near normal anatomic structure is retained, (2) common secondary dorsal deformities are avoided, (3) the retained roof can function as a spreader graft, (4) the skin attachment with its attendant blood supply is preserved, and (5) the graft can be removed primarily or easily modified secondarily. Disadvantages appear to be the need for greater finesse and a limited follow-up of 2 years.

Rhinoplasty: a CT-scan analysis.

In order to assess the postoperative consequences of various rhinoplasty techniques, CT scans were done in 35 patients having a rhinoplasty operation. This series can be subdivided into those having preoperative and postoperative scans at both 2 days and 6 months (15 patients), a postoperative scan only at 48 hours (10), or a long-term postoperative scan at a mean of 12 months (10). Preoperative analysis indicates that a wide variation exists in lateral nasal wall anatomy and angulation. Surgically, the lateral nasal walls undergo limited medial movement, with tilt a significant component. Postoperatively, extensive remodeling can occur, and virtually all osteotomies are healed by osseous union at 6 months. Future application of CT scans in severely deviated noses may be justified.