Cigarette smoking, plastic surgery, and microsurgery.

Although tobacco smoking is known to result in coronary heart disease, chronic obstructive pulmonary disease, peripheral vascular disease, cerebrovascular disease, lung cancer, and other smoking cancers, many surgeons believe that smoking also results in impaired wound healing and poor surgical results. Large clinical experiences in several areas of plastic surgery reinforce this suspicion. Procedures that have been noted to be adversely affected by cigarette smoking include rhytidectomy, abdominoplasty, breast reconstruction, free-tissue transfer, and digital replantation. This article reviews the available data, introduces new clinical data, and hypothesizes about the ways in which some procedures are more affected than others.

Elbow defect coverage with a one-staged, tunneled latissimus dorsi transposition flap.

Upper extremity reconstruction is very challenging due to the unavailability of expendable local muscles. A review of the literature reveals that the latissimus dorsi muscle has been used for functional restoration of elbow extension and flexion as well as soft-tissue coverage of upper arm and shoulder defects. In addition, the latissimus dorsi muscle has been used for forearm reconstruction. Although we have been unable to find any reports of the use of the latissimus dorsi muscle for pure coverage of complex elbow wounds, we have successfully used the latissimus dorsi transposition flap to cover complex elbow defects in a one-staged procedure for patients. In 3 of 4 patients, the latissimus dorsi transposition flap was the first choice. In the other patient, the latissimus dorsi flap was successfully used as an alternative choice for coverage of an open, comminuted elbow fracture after a failed rectus abdominis free tissue transfer. A technique is described for coverage of complex elbow defects by transferring a latissimus dorsi muscle on its vascular pedicle with or without an overlying skin island. This procedure is safe, one-staged, and results in minimal donor morbidity. The latissimus dorsi transposition flap provides reliable coverage of complex elbow defects and should be considered the flap of choice for coverage of the elbow.

Monoclonal antibodies specific for human IgE and their clinical applications.

By applying the hybridoma technique, two mouse anti-human Immunoglobulin E (IgE) monoclonal antibodies, designated as E17-58 and E20-62, were generated and characterized. E17-58 was a murine IgG2b with an affinity constant of 4 x 10(8)l/mole. E20-62 was a murine IgG1 with an affinity constant of 1 x 10(8) l/mole. These two antibodies recognized different antigenic determinants specific to the IgE molecule. They were used in combination to quantify the total serum IgE level of forty-nine persons. Data obtained correlated highly with that obtained by using the Pharmacia PRIST Kit (r = 0.91). E17-58 was also used to detect the anti-Aspergillus specific IgE of twenty-one atopic patients by a radioimmunosorbent test. The positive rate detected correlated very well with the skin test (p less than 0.05). In addition, in the Western blot system, these monoclonal antibodies were capable of identifying IgE binding components of crude allergen extracts. Extracts from pollens of Bermuda grass were evaluated, and a new major allergenic component with a molecular weight of 40 kd was identified.

[Autologous mixed lymphocyte reaction in systemic lupus erythematosus].

The autologous mixed lymphocyte reaction in patients with systemic lupus erythematosus was lower than that of normal individuals (p less than 0.05). The impairment was not due to the dysfunction of various regulatory lymphocytes, but there was a negative correlation with the B cell function. The low autologous mixed lymphocyte reaction was found in patients with high B cell function.