Dupuytren's disease in blacks.

Dupuytren's disease in blacks is believed to be rare. Our recent experience with the disease at the John Cochran Veterans Administration Hospital in St Louis is described, including 2 black patients suffering from the condition. The literature is reviewed and some aspects of pathogenesis are discussed. It is our belief that Dupuytren's disease is more common in blacks than previously reported.

Temporoparietal craniopagus. Case report and review of the literature.

A case of craniopagus twins joined in the temporoparietal area is presented, along with a review of the literature on craniopagus. A large area of brain was shared between the neurologically normal infants, with defects in the scalp, skull, and dura. The twins were separated in a three-step procedure. First, areas of shared brain were divided and separated with silicone sheets. The second procedure consisted of the insertion of scalp expanders to allow primary skin closure. In the third procedure complete separation was performed which was complicated by severe hypotension in one infant that was due to dural sinus hemorrhage. Cerebrospinal fluid leak was the most difficult problem encountered in the postoperative period; this was treated with lumboperitoneal and ventriculoperitoneal shunts. After 2 years, one twin is neurologically normal; the other is severely developmentally delayed, possibly related to the severe hypotension experienced during the third procedure. A review of the literature on craniopagus is presented. Analysis of data in the literature suggests that the area involved in the craniopagus as well as the venous connections are closely related to survival following separation of craniopagus twins.

Recurring digital fibroma of childhood.

A recurrent digital fibroma of childhood is reported. This case illustrates difficulties in the management of these recurrent tumors. Despite tumor-free margins on the excised tumors, recurrence occurred at other sites. Recurrences or new primary lesions are reported in 75% of the cases. Because of the rare tendency of these lesions to regress and the high recurrence rate, an individualized approach based on lesion location and behavior is recommended.

The paperclip splint for finger injuries.

A splint for finger injuries is constructed using a paperclip and tape. It is inexpensive, compact, and simple to make. Underlying lacerations are readily accessible, and there is minimal interference with neighboring digits. Furthermore, it provides effective dynamic extension splinting for interphalangeal injuries.

Separation of craniopagus twins utilizing tissue expanders.

An example of craniopagus Siamese twins is presented. The methods used in their separation using skin expanders and scalp flaps to achieve primary closure of the wounds with hair-bearing scalp are outlined. A detailed discussion of the planning and the mathematical considerations of these skin expanders and scalp flaps is included.

Cranioplasty for traumatic deformities of the frontoorbital area.

Cranioplasties of the frontoorbital area pose a major challenge to the surgeon because of the proximity to the globe, the sinuses, and the eyebrows and eyelids. The choice of material for reconstruction includes autogenous and alloplastic materials. A modification of the fixation technique of split rib graft to avoid depression deformities at the periphery of the defect is described. Sixteen patients were reconstructed with different treatment modalities, including the use of alloplastic materials or autogenous bone or a combination of both. The results are reported as are the complications. Limitations encountered with these difficult reconstructions are discussed.

A simplified approach for drilling holes in the inferior orbital rim.

A trochar technique for drilling holes in the inferior orbital rim from any angle is described. It utilizes equipment commonly found in any operating room.

Condyloma acuminatum of the tongue.

Condyloma acuminatum, an autoinoculable infectious growth that usually involves the anogenital regions, occurs very rarely in the oral cavity, including the first histologically proven case, reported by Knapp and Mohara in 1967, a total of 7 cases have been documented in the English literature. This report describes an oral condyloma acuminatum not associated with anogenital lesions.

A simple postoperative blepharoplasty dressing.

Iced saline compresses using cotton gauze eye patches with the center cut out are used by our service following blepharoplasties. This technique enables the patient to see while still enjoying the benefit of the compresses, thus improving postoperative cooperation.

The spread of sensibility into previously anesthetic skin following intercostal flap transfer in a paraplegic.

Sensibility extending into previously anesthetic sacral skin is reported two years following the transfer of a neurovascular intercostal flap in a 13-year-old paraplegic.