Subungual pilonidal sinus of the hand in a dog groomer.

Interdigital pilonidal sinus of the hand is an occupational hazard in barbers, sheep shearers and cow milkers. We present a case of a subungual pilonidal sinus of the thumb of a dog groomer, complicated by the development of osteomyelitis in the distal phalanx.

Extraordinary case of matrotrophy in the African skink Eumecia anchietae.

The viviparous African skink, Eumecia anchietae, exhibits a matrotrophic fetal nutritional pattern. Until well after the limb bud stage, extravitelline nutritional provision is in the form of holocrine secretion originating from the stratified uterine epithelium of the uterine incubation chambers. Uterine secretions are absorbed by a specialized yolk sac ectoderm and chorioallantois through histotrophy. The yolk sac is not in close contact with the uterine lining from the limb bud stage onwards. The yolk sac ectoderm forms invaginations filled with uterine secretion and consists of a single layer of vacuolated hypertrophied cells bearing microvilli. The chorioallantois at the limb bud stage is extensive, well-vascularized, and not intimately associated with the uterine epithelium. Where the uterus is folded, the chorioallantois may interdigitate loosely. Chorionic cells are low to high columnar, clearly vacuolated, and bear microvilli. The allantoic layer consists primarily of squamous cells exhibiting villous projections. By the time embryos have well-defined digits, the specialized yolk sac ectoderm has regressed and the yolk sac lumen has been invaded by vitelline cells. The chorioallantois is very extensive and in areas greatly folded. Where it contacts the uterine epithelium, a proper chorioallantoic placenta is formed. Cell layers of the chorioallantois and uterine epithelium are thin and cuboidal to squamous in appearance. The chorioallantoic placenta is simple in structure, occurs throughout the incubation chamber, and is epitheliochorial in arrangement. It is unknown whether the placentome observed in other highly matrotrophic scincids is formed in late stage embryos of this species.

The rupture rate of acute flexor tendon repairs mobilized by the controlled active motion regimen.

A series of 233 patients with complete divisions of flexor tendons in zones 1 and 2 underwent operation following emergency admission over a period of 3.5 years. These included 203 patients with 317 divided tendons in 224 fingers injuries in zones 1 and 2 and 30 patients with 30 complete divisions of the flexor pollicis longus tendon in zones 1 and 2. All of these patients were mobilized post-operatively in a controlled active motion regimen. 13 (5.8%) fingers and five (16.6%) thumbs suffered tendon rupture during the post-operative period. Patients treated during the last year of the study were followed prospectively for a minimum period of 3 months; ten of the 16 (62.5%) fingers with zone 1 repairs, 50 of the 63 (79.4%) fingers with zone 2 repairs, all three (100%) FPL divisions in zone 1 and three of four (75%) FPL divisions in zone 2 had good and excellent results on assessment by the original Strickland criteria (Strickland and Glogovac, 1980). These results confirm the safety of this regimen as an alternative to other regimens of post-operative flexor tendon repair mobilization in zone 1 and 2 finger injuries. However, in the unmodified form used in this series, this regimen has too high a rupture rate for FPL mobilization.

Cross-arm dermis flaps for repair of dorsal finger defects.

Two cross-arm dermis flaps were successfully used to cover distal defects on the finger where tendon reconstruction was needed. Division after five days allowed early mobilisation.

Mandibular reconstruction using vascularised fibula.

The osteocutaneous fibula flap has been used to reconstruct large segments of mandible in cases following ablation for cancer or radionecrosis. The bone can be cut to the appropriate shape and the fasciocutaneous flap may be used simultaneously to provide oral cavity lining or skin cover. The technique is described and its successful use in seven patients is reported with details of the complications encountered.

Comparison of laser-assisted and conventionally sutured microvascular anastomoses by bursting pressure: a reanalysis and further studies.

Methods of testing the strength of microvascular anastomoses are reviewed historically, in the light of recent applications to laser-assisted microvascular anastomosis techniques. The results of two experiments using hydrostatic distension to bursting point to determine the strengths of laser-assisted and conventionally sutured anastomoses of rat arteries and veins are presented. Considerable variation of the bursting pressures was found at any given time after anastomosis, and by the third postoperative day, the sutured vessels showed a significant fall in strength to their weakest level, with not as great a fall in the laser group. The sutured vessels were stronger than were the laser-anastomosed vessels, except at 3 days and after 6 weeks, when there were no significant differences between the two types of anastomosis. Aneurysmal vessels did not always burst at lower pressures than did nonaneurysmal vessels of comparable age.

Laser assisted microvascular anastomosis of arteries and veins: laser tissue welding.

Using a milliwatt CO2 laser, a series of 160 arteries and 105 veins have been anastomosed in Wistar rats. Three stay sutures and a laser tissue welding technique were used. These were compared with a series of conventionally sutured vessels in terms of patency, speed and ease of procedure, and aneurysm formation. Patency rates of successful first time anastomoses are comparable with conventional suturing methods but the aneurysm rate is higher. Laser assisted anastomosis is faster to learn and perform than conventional suturing, but microsurgical skills are still needed. Despite the large number of variables the laser assisted technique has a high success rate, and work to minimise variables and optimise the laser parameters may improve these results.

Tracheostomal reconstruction using a fenestrated deltopectoral skin flap.

Tracheostomal stenosis following laryngectomy can prevent satisfactory rehabilitation of a patient, and may be difficult to correct. A reconstructive technique using a flap within a deltopectoral flap to treat this condition is described.

Malignant melanoma in childhood.

Only two cases of malignant melanoma in childhood have previously been reported in this Journal (Olbourne and Harrison, 1974; Keall et al., 1981). The report describing 31 cases in the Manchester area (Pratt et al., 1981) indicates that this condition may be more common in this country than previously supposed. A case of malignant melanoma arising in a mole in a 23 month male child is reported. A review of the literature shows that there are no survival figures for cases without metastasis but at present there is no reason to suspect that the disease is any less aggressive than in adults. It cannot be stressed too often that any mole with rapid growth, ulceration, bleeding with minimal trauma and change in colour should be biopsied urgently irrespective of the age of the patient.

The adaptation of the "crane principle" to vascularise a free lipo-dermal graft.

This paper describes the use of the "crane principle" to vascularise a free lipo-dermal graft in the correction of a complicated post-burn contour defect of the forehead.

Treatment of endobronchial amyloidosis by intermittent bronchoscopic resection.

In a patient with widespread endobronchial amyloidosis, the amyloid deposits resulted in severe disability over a ten-year period from obstruction of large airways and from recurrent chest infections and atelectasis. Repeated excision of small quantities of amyloid material during rigid bronchoscopy under general anaesthetic have resulted in symptomatic relief and measurable improvement of aiways obstruction.