Morphometry of the adult human earlobe: a study of 547 subjects and clinical application.

The purpose of this study was to define the factors that influence earlobe length and to establish a standard for adult earlobe length by sex and age. The study sample consisted of 547 adult subjects older than 20 years of age. A randomized, prospective design was used. Patients with malignancies, previous surgery or trauma to the earlobe, or congenital earlobe anomalies were excluded. The following variables were studied: sex; age; ethnic origin; skin complexion; height, weight, and body mass index; and piercing. Pearson's correlation, analysis of variance, t test, and multiple regression analysis were used for the statistical analysis. There were 383 women (70 percent) and 164 men (30 percent) aged 20 to 80 years. The average length of the left earlobe was 1.97 cm (SD, 0.42 cm), and that of the right earlobe, 2.01 cm (SD, 0.42 cm) (p < 0.0001). A post hoc test revealed a statistically significant difference among the three age groups (20 to 40 years, 40 to 60 years, and >60 years) in both men and women. Pendulous earlobes were significantly longer and less symmetrical than nonpendulous ones by t test. In men, nonpierced left earlobes were longer than pierced lobes; in women, there was no significant difference between pierced and nonpierced ears. Pearson's correlation tests for weight, height, and body mass index showed that only weight had a significant effect on earlobe length, and only in women. Analysis of variance for ethnic origin and skin color revealed a longer left earlobe in Ashkenazi and Sephardic Jews compared with Ethiopian, Asian, and American Jews and Arabs and a short earlobe in blacks compared with dark and fair-skinned people. On multiple regression analysis, sex and age were the only factors that contributed to earlobe length. A table of average earlobe length by age was formulated on the basis of the authors' findings. These data, together with the knowledge that earlobe length changes little in women over 40, that earlobes are not symmetrical, and that right and left nonpendulous earlobes are symmetrical in individual patients and shorter than pendulous earlobes, can assist the plastic surgeon in deciding on the proper time for loboplasty. The preferable technique is creating a nonpendulous earlobe to minimize the chances of further elongation with time.

Use of the SpaceMaker balloon in sternal wound closure: comparison with other techniques.

Sternal wound infection is surgically treated by debridement of the infected sternum and closure of the defect with a muscular flap. These operations tend to be long, stressful, and time-consuming and to involve heavy blood loss. To facilitate wound closure, the SpaceMaker balloon was applied intraoperatively to expand the pectoralis major muscles and enable tensionless closure with musculocutaneous flaps. The aim of the present study was to compare the effectiveness and feasibility of this technique with a variety of others described in the literature. The study population consisted of 40 consecutive patients with sternal wound infection following median sternotomy who were treated with the advancement flap, turnover flap, transposition flap, or SpaceMaker balloon-assisted advancement flap technique (n = 10 each). The balloon-assisted technique was associated with a shorter length of operation and fewer blood transfusions than the other methods. Furthermore, there was no need for reoperation and there were no cases of skin necrosis. In conclusion, closure with the SpaceMaker balloon-assisted bilateral pectoralis major musculocutaneous flap may serve as an adjunctive measure in the treatment of sternal wound infection. This technique seems to have advantages over simple pectoralis major musculocutaneous advancement, particularly for midsternal wounds.

Effect of facial pressure garments for burn injury in adult patients after orthodontic treatment.

Pressure garments are commonly used to prevent and control hypertrophic scar tissue. Complications are unusual, though in children with facial burns, pressure garments may lead to skeletal and dental deformities. Studies in adolescents and adults are sparse. We describe a 24-year-old woman who sustained facial burns. Prior to injury, the patient had undergone premolar extraction in preparation for orthodontic treatment. Her post-burn care consisted of application of a Jobst pressure garment. After 2 months treatment, severe deformation of the dental-alveolar structure was observed. This reports suggests that adults after dental extraction are at a high risk of dental-alveolar deformities from pressure garments and might benefit from the use of occlusal wafers.

The digital pulp as a presenting site of metastatic esophageal carcinoma.

An unusual skin lesion may be a primary skin cancer or a sign of internal malignancy. Metastatic lesions to the hand are rare. The authors describe a patient who presented with a nodule of the digital pulp. Workup, including X-ray films and biopsy, revealed a metastatic squamous cell carcinoma invading the distal phalanx. The primary site of the tumor was the esophagus. To the best of their knowledge, this is the second case described in the literature of a metastatic carcinoma of the esophagus presenting as a lesion of the digital pulp.

The use of serial tissue expansion in pediatric plastic surgery.

There are clinical situations in which even despite the use of simultaneous multiple tissue expanders, complete coverage of a defect cannot be achieved. In this situation, serial, repeated tissue expansion may be indicated. There are few studies that have reported repeated tissue expansion in pediatric plastic surgery. Twelve children (6 girls, 6 boys) with a mean age of 7 years underwent serial tissue expansion for giant hairy nevus (N = 3) or burn reconstruction (N = 9). A total of 63 tissue expanders were used. Serial expansion of the expanded flap was performed a second time in 12 children, a third time in 6 children, and a fourth time in 2 children. The major complication rate was 4% for the first expansion, and 20%, 18%, and 0% for the second, third, and fourth expansions respectively. Clinically, at the time of expander reinsertion, there was no evidence of capsule from the previous expander in any patient. This was confirmed on histological examination of 12 biopsy specimens. Repeated tissue expansion is a safe and effective procedure for use in pediatric plastic surgery.

Congenital Volkmann-Lesser ischemic contracture of the upper limb.

Neonatal vascular compromise to limbs has been associated traditionally with perinatal injury of the brachial plexus, fracture of the clavicle or humerus, or iatrogenic causes. Congenital Volkmann's ischemic contracture is an exceptional etiology of ischemic limb in the newborn. Fewer than 10 cases had been described in the literature. The authors report a newborn presenting at birth with partial bluish discoloration of the right forearm. The clinical picture and laboratory studies lead to the diagnosis of congenital Volkmann-Lesser ischemic contracture.

Staged TRAM breast reconstruction: combining the advantages of tissue expansion with surgical delay.

The TRAM flap has become the gold standard in breast reconstruction but suffers from the disadvantages of poor color match, different texture, and impaired sensation compared to the normal breast. This study reports on a two-stage procedure to address these problems. The first stage consists of insertion of a tissue expander and surgical delay of the TRAM flap. The second stage consists of removal of the tissue expander and transposition of a deepithelized TRAM flap into the tissue expanded cavity. (The capsule is excised.) Four cases of breast reconstruction are reported. The advantage of this procedure is that it offers the benefits of tissue expansion, viz., normal color match, texture, and sensation, and in addition, reconstruction is achieved with autologous tissue by a pedicled TRAM flap. The vascularity of the TRAM is enhanced by a surgical delay procedure.

Mirror foot.

Mirror image polydactyly is a rare congenital abnormality that may occur in isolation, or in association with multiple congenital anomalies. A case of unilateral mirror foot with an ipsilateral short, broad tibia is described. The clinical, radiologic, and operative findings are presented, and current theories of embryo-pathogenesis are reviewed.

Profile of the pediatric burn patient at the Schneider Children's Medical Center of Israel.

BACKGROUND: Burn trauma occurs mostly in young children. Burn injury in the pediatric age group has multiple-aspect sequelae. OBJECTIVES: To characterize the profile of the injured pediatric burn patient, thus targeting the most vulnerable pediatric group. METHODS: Between 1 January and 31 December 1996, a total of 9,235 pediatric patients were admitted for various traumatic injuries (burns, lacerations, fractures, etc.) to the Emergency Medicine Department of Schneider Children's Medical Center. We conducted a retrospective study of the patients' charts, including demographic data, which were stored in a computerized database, for statistical evaluation. The characteristics of pediatric burn patients were examined and compared with other pediatric trauma patients. RESULTS: Of the total patient population, 282 (3.1%) suffered from burns (37% females, 63% males). The most frequent burn injury was scald burn (58%). The pediatric group that was most exposed to burns was 13-18 month old males. CONCLUSIONS: Having identified the high risk group among the pediatric burn patients, we suggest that prevention programs be directed towards this group in order to reduce further risk of burn injury.

Tissue expansion for frontal hairline restoration in severe alopecia in a child.

Burn alopecia has serious sequelae, both aesthetic and psychological, particularly in children. A case of 70% scalp alopecia due to a flame burn, and the modality of treatment is described. This consisted of an expanded temporo-parietal flap, which was transposed to create a frontal hairline. A relatively simple surgical procedure had both substantial aesthetic, and psychological benefits.

"Apron" flap and re-creation of the inframammary fold following TRAM flap breast reconstruction.

To the best of our knowledge, the recreation of an inframammary fold after TRAM flap breast reconstruction has not yet been described. This article offers a technique for the creation of an inframammary fold as a secondary procedure. The technique has been performed thus far in two patients with good aesthetic outcomes and no postoperative complications. It may also be suitable for adding bulk to the TRAM flap, especially in bilateral breast reconstruction, and for other minor chest deformities.

Penile lengthening for traumatic penile amputation due to ritual circumcision: a case report.

Some tribes in South Africa still practice ritual circumcision in adolescent boys. A traditional healer performs the procedure and, not uncommonly, amputation occurs. The authors present a case of a 20-year-old man who sustained a midshaft penile amputation as a result of a ritual circumcision. Treatment was with a modified penile-lengthening technique that incorporates gracilis muscle transposition to fill the dead space created after detaching the penile suspensory ligament. This may help prevent retraction. Almost 3 cm of lengthening was obtained. This is a useful method of treatment for penile amputation.