Robin sequence and oligodactyly in mother and son.

A combination of the Robin sequence with pre- and postaxial oligodactyly was observed in a mother and her son. This familial association has not been reported before and probably represents a previously unrecognized heritable malformation syndrome.

Postcoital pneumoperitoneum.

A case of postcoital pneumoperitoneum occurring 2 months after abdominal hysterectomy is presented along with a review of the literature. The authors believe this is the first reported case of postcoital pneumoperitoneum after abdominal hysterectomy.

Lower extremity arterial insufficiency after long-term methysergide maleate therapy. Its evaluation with Doppler ultrasonic velocity detector.

Iatrogenic ergotism is the primary source of ergot intoxication. The patient whose case is reviewed had migraine headaches and received methysergide maleate for 13 years. She had, in July 1977, severe claudication of the lower extremities. Measurements of the peripheral arterial circulation were made using the Doppler ultrasonic velocity detector. The extent of disease and subsequent reversal were documented using arteriographic examination. Initial measurements showed the patient was able to walk for one minute and 34 seconds on a treadmill (2 mph, 10% grade) before stopping because of claudication. Symptoms cleared after drug withdrawal and repeated testing produced no claudication. The calculated index (posterior tibial/arm pressure) increased from a mean of 0.22 to 0.74 during the eight-month period following discontinuance of methysergide therapy with no recurrence of migraine headaches. A review of the literature is also presented.

Hashimoto's thyroiditis simulating cancer of the thyroid.

We reviewed a group of 30 patients with Hashimoto's thyroiditis who underwent thyroidectomies for suspicion of cancer. A prominent nodule was present in all of the patients; compression symptoms were present in 13 and pain in the thyroid in six. The nodule was cold on scan in 21 patients. Lack of responsiveness to suppressive therapy or nodule enlargement occurred in 18 patients. In addition to the nodule, operative findings included adherence to surrounding tissues in seven patients, lymphadenopathy in seven, increased vascularity in four, and extension to distant cervical structures in two. Pathologic findings in the nodule were similar to those in the rest of the gland; they consisted of lymphocytic infiltration, fibrosis, and variable follicular size. Examination of lymph nodes demonstrated lymphoid hyperplasia. We emphasize the similarities between chronic thyroiditis and carcinoma of the thyroid; the occasional coexistence of these two conditions stresses the need for newer methods in the differential diagnosis.

Autologen.

This article gives an overview of autologous injectable collagen and reviews the theoretical complications and issues of using an autologous filler material. The benefits of autologous injectable collagen include elimination of local tissue reaction and rejection. The product, however, has not yet been proven to have significant longevity beyond that of its competitors.

Fatal transcutaneous iron intoxication.

Accidental iron intoxication is one of the most serious and potentially fatal intoxications in young children. Occurrence in the adult population is rare and is usually associated with a suicide or homicide attempt. Heretofore, all reported cases have involved oral ingestion of ferrous and ferric salts of iron. In a case of fatal iron intoxication reported by Doolin and Drueck, in addition to swallowing a liquid form of ferrous chloride, the patient aspirated it and absorbed it through chemically burned and denuded areas of skin when he fell into a vat of saturated ferrous chloride at work. It is the purpose of this report to describe the first case of fatal iron intoxication in which the sole route of iron absorption was the burned skin. Clinical course of this patient paralleled that of acute oral iron intoxication with development of refractory acidosis, disseminated intravascular coagulation, respiratory and renal failure, and sepsis.

Treatment of traumatic earlobe clefts.

Torn and split earlobes are common and often due to earring trauma. Repair of split earlobe clefts is one of the most common problems in plastic surgery. However, little has been written recently about this subject. This article compares our technique for repairing cleft earlobes with other described techniques. The technique presented is sound, simple in concept, technically undemanding to perform, and has definite advantages over other methods currently in use. A waiting period before repiercing the ear is suggested to allow the earlobe tissue to soften and assume its final shape. Neither recurrence nor notching of the lobule has been a problem.

Functional applications of suction-assisted lipectomy: a new treatment for old disorders.

Ever since the introduction of suction-assisted lipectomy in the United States in 1981, the technique has been applied to an increasing number of disorders of the subcutaneous tissues. Indeed, suction-assisted lipectomy has evolved into the method of choice in the treatment of certain pathological entities. While the extraction of lipomas is the most common functional application, suction-assisted lipectomy has also been used successfully to treat such conditions as gynecomastia, axillary hyperhidrosis, benign symmetric lipomatosis (Madelung's disease), congenital body asymmetry, congenital or acquired lymphedema, flap defatting, traumatic or postoperative hematomas, and fat necrosis. We have successfully treated patients presenting with the above disorders. No morbidities or mortalities were encountered in our series of 18 patients. The final results were considered favorable by the majority of patients. Acceptance by the patients of this treatment modality was extremely high because of the smaller incisions required, the exactness in contouring, the simple and minimal postoperative care needed, and the ease with which the procedure can be repeated to refine the results. A comprehensive review of the literature is presented along with our own patient management and long-term results.

Reconstruction of penile and scrotal lymphedema.

Acquired genital chronic lymphedema and elephantiasis are not common problems in the United States. Most noncongenital cases are due to lymph node dissection, injury, or irradiation. Genital lymphedema is a functionally disabling and emotionally incapacitating entity, especially in the elderly population. Methods of reconstruction reported in the literature involve either lymphangioplasty or direct excision of the involved tissue with local tissue reconstruction. We report a case of acquired genital elephantiasis in an elderly man following radical cystectomy and pelvic irradiation for transitional cell bladder cancer. Our technique of reconstruction consisted of (1) excision of all involved lymphedematous skin of the penis and scrotum, and (2) use of posterior scrotal flaps, superiorly based flap of the pubic area for testicular coverage, and split-skin graft to the penis. Genital lymphedema presents a formidable challenge for reconstructive surgeons. The low morbidity and successful outcome observed in this case, however, indicate that the procedure described herein can and should be offered to elderly patients to improve function and quality of life.

Cleft palate and congenital lateral alveolar synechia syndrome: case presentation and literature review.

Cleft palate and congenital lateral alveolar synechia syndrome remains a rare occurrence. Our patient represents only the fourth case of bilateral alveolar synechia with isolated cleft palate in the world literature and, as such, is only the second patient from the United States. More commonly, additional anomalies are associated. Just more than 50 cases involving intraoral synechiae have been reported. This group of cases has implications on fetal facial growth and cleft palate development because there are no documented cases of lateral interalveolar synechiae without cleft palate. Earlier reports can be grouped as variants along the spectrum. Theories of etiology are discussed.

The expanded forehead flap for nasal reconstruction.

A 3-year experience using forehead tissue expansion for nasal reconstruction is presented. The series includes 7 expansions in 6 patients with different degrees of nasal loss due to either cancer, trauma, or avascular necrosis. Balloon tissue expansion minimizes the well-known limitations and drawbacks found in using forehead flaps for nasal reconstruction. Technique, timing, and sequencing of procedures are discussed and compared with those of other authors. The complications of tissue expansion are few, but obtaining a satisfactory nasal reconstruction requires multiple operations over a period of time. A learning curve is necessary due to inadequate previous experience and new developments in tissue expanders. The results obtained were possible due to the excellent tissue provided by forehead expansion.

Median cleft of the lip: its significance and surgical repair.

Median cleft lip is a midline vertical cleft through the upper lip in the absence of a prolabial remnant. This may occur as a sporadic event or be part of an inherited sequence of anomalies. A failure of formation or fusion of the medial nasal prominences derived from the frontonasal prominence is ultimately responsible for this aberration. Two categories of dysplasia are associated: (1) frontonasal deformity associated with hypotelorism and (2) median facial cleft syndrome associated with hypertelorism. A patient presents with median cleft lip, mild bifid nose, and hypertelorism. Following surgical reconstruction, a good result is achieved. The embryology, implications for associated abnormalities, and surgical technique for treating these cases are discussed.

Treatment of asymptomatic preauricular sinuses: challenging conventional wisdom.

Congenital preauricular sinuses must not be considered trivial lesions. They can and should be differentiated from branchial cleft cysts. Cure is achieved only through complete excision of the sinus tract and its associated cysts. Total extirpation of the sinus tract is difficult in the presence of infection. The embryoanatomy and treatment of congenital preauricular sinus tracts as well as our experience with 6 patients are reported. We recommend excision of asymptomatic congenital preauricular sinus tracts.

The use of leeches for treatment of venous congestion of the nipple following breast surgery.

The medicinal leech, Hirudo medicinalis, played a central role in the evolution of medieval and folk medicine. Today, for the first time in history, the leech actually has a real and valuable purpose in medicine as a useful adjunct for the plastic surgeon: It provides relief of venous congestion. For over 2000 years, leeches were needlessly applied for a multitude of maladies as an adjunct to blood-letting. Their use in Europe peaked between 1830 and 1850, however, shortages led to a subsequent decline in leech application. Today there is a real clinical use for leeches which had led to a resurgence in their use in plastic surgery. Plastic surgeons use leeches in microsurgery to salvage congested flaps, whose viability is uncertain due to venous congestion. We present our experience with two patients where leeches were used to treat isolated venous engorgement of the nipple following breast surgery. Leech therapy is painless, well tolerated, and does not result in significant scarring. Prompt initiation of treatment is mandatory and produces dramatic resolution of venous congestion.

Silicone granuloma following closed capsulotomy of mammary prosthesis.

Rupture of the silicone prosthesis can occur following external closed compression capsulotomy for fibrous capsules that develop after augmentation mammaplasty. The forces needed to rupture the fibrous capsule can cause silicone gel from the prosthesis to be pressure injected into the breast tissue and surrounding musculature. Film-screen mammography can be utilized to diagnose prosthetic rupture.

Computed tomography in the management of orbital cellulitis from an imbedded eye prosthesis.

Computed tomography (CT) is far superior to plain radiography or xeroradiography in the detection of orbital foreign bodies and in defining altered anatomic relationships in this region. We present a case in which CT was instrumental in the management of orbital cellulitis in a patient who had forgotten that an eye prosthesis had been inserted in the past. We stress the importance of CT in our case and discuss its usefulness in other reported clinical situations involving the orbit.