Peripheral in-continuity tissue examination.

When treating skin cancers, it is essential to remove the entire neoplasm if possible. Immediate reconstruction is most helpful in returning the patient to a useful and satisfactory life. The Mohs histologic technique can be time-consuming and cumbersome. Reconstruction can be delayed. A modification of Mohs technique, peripheral in-continuity tissue examination (PITE), is described in which the surgeon and the pathologist combine their talents to remove the tumor. All margins are evaluated, and the surgical defect is closed primarily. Larger and more complex tumors can be removed and defects immediately reconstructed using this efficient technique, obviating the inconvenience, pain, and expense of multiple, separate procedures.

Levator muscle reconstruction: resulting velopharyngeal competence--a preliminary report.

The purpose of this study was to evaluate a levator muscle reconstruction procedure on the basis of resulting velopharyngeal competence. Ages of the patients at time of surgery ranged from 5 months to 7 years. The patients were reevaluated postoperatively. If the patients were judged to have normal nasality and no nasal emission, the procedure was considered to have yielded a satisfactory result. If hypernasality and nasal emission resulted, the patients were examined utilizing nasoendoscopy and/or videofluoroscopy. If velopharyngeal incompetence was confirmed, the operative procedure was judged to be successful. Results showed that 60 percent success was achieved. The age range which yielded the best results (73 percent satisfactory) was 37 to 60 months. The data also revealed that the more severe the cleft, the less likely this operative procedure is to produce satisfactory results. The authors recommend continued evaluation of this procedure, preferably utilizing prospective studies.

The role of the dentist on cleft palate teams.

A dentist may be called on by cleft palate teams for expertise in the area of dentistry or for other expertise that he or she has accumulated over the years. There can be no disagreement with the statement that cleft palate teams need dentists, especially those who are imaginative and industrious. The CCPC has been fortunate in this regard.

Reduction mammaplasty: central cone technique for maximal preservation of vascular and nerve supply.

Many types of breast reduction procedures have been described and are now being used. Before 1984, we used variations of the Wise technique, with free grafting of the nipple-areola complex; because of problems with inadequate nipple projection, squareness of the breasts, and decreased nipple sensation, however, we have subsequently used the central cone technique, as advocated by Hester et al. We present 44 cases with follow-up periods extending up to three years.

Midfacial skeletal profile in early and late closure of the hard palate.

The midfacial profile (anterior projection of the maxilla) was studied in 57 white children with cleft lip and palate and Veau type III clefts operated upon by one surgeon. These patients were divided into three groups delineated by the time of repair of the hard palate. One group had hard palate repair at 2 years of age, the second group at 3 or 4 years of age, and the third after eruption of the first permanent molar teeth, at about 6 years of age. Lateral cephalograms were obtained and SNA measured. In this study it was the timing of hard palate closure, not the presence or absence of the prosthesis, that was evaluated. There was a statistically significant difference in the midfacial profile (which is dependent on the anterior projection of the maxilla) in those whose hard palate was repaired before and after eruption of the first permanent molar teeth.

Subcutaneous mastectomy with delayed subpectoral augmentation.

National survival statistics for breast cancer victims are basically the same today as they have been for the last 50 years. Less than 60% survive five years after diagnosis, and they frequently must accept mutilating results of treatment. To improve this bleak picture, our efforts should be directed toward prevention. One aspect of prevention would be to identify the breasts most likely to develop malignancies and remove the breast tissue with planned restoration of contour. Subcutaneous mastectomy and immediate insertion of Silastic gel prostheses has not met with the desired results either medically or esthetically. The complications with this procedure are numerous, and there is an unnatural "cystic" appearance on the chest wall with a thin skin covering through which the prostheses can be palpated. We advocate subcutaneous mastectomy with appropriate fixation of the nipples and areolae on the pectoral muscle and fascia, followed several months later by subpectoral augmentation. This two-staged procedure has proved to be a reliable one with few serious complications. It is hoped it will play a significant role not only in reducing the mortality associated with breast cancer but also in lessening the undesirable psychologic impact of the loss of breasts.

Reconstruction of full-thickness lip defects.

We describe the reconstruction of lip defects using a bipedicled musculocutaneous flap for the preservation of form and function.

The hamstring myocutaneous flap in repair of ischial decubiti.

A hamstring myocutaneous flap is described. This flap delivers a well-vascularized soft tissue mass to the debrided ischial site in one stage, without need of split grafting. A case is presented using this method bilaterally.