Overgrowth of fat autotransplanted for correction of localized steroid-induced atrophy.

A case is presented in which regional subcutaneous atrophy in the lateral thigh after steroid injection was treated with autologous fat grafting. More than 1 year after treatment, an increase in the volume of the transplanted site necessitated a secondary procedure to debulk the area. We believe that this is a case in which the transplanted adipocytes (or preadipocytes) survived and subsequently (for an unclear reason) increased significantly in volume. This case report supports the cell survival theory of fat autotransplantation. Animal studies using radioisotope-labeled lipocytes might provide further understanding of the mechanisms of fat graft "survival."

Pilar leiomyoma: a case report and review of the literature.

Pilar leiomyoma is a benign smooth muscle tumor arising from the arrectores pili muscles associated with the hair follicles of the skin. The multiple biopsies and pathological consultations needed to obtain a diagnosis attest to the rarity of the disease and the difficult histological picture, which often requires an expert pathological consultation. Although a benign soft-tissue tumor, pilar leiomyoma often requires therapeutic intervention to alleviate pain or sensitivity. Medical therapy has been tried with some success to improve the pain and discomfort. The only potentially curative option, however, remains surgical excision. Although complete surgical excision may not be attained, it may achieve substantial symptomatic improvement.

A comparison of pedicled and free TRAM flaps for breast reconstruction in a single institution.

Several reports concluded that free tissue transfer of the transverse rectus abdominis muscle (TRAM) flap for breast reconstruction is superior to pedicled transfer of the flap. In an effort to compare the various parameters of both techniques, the authors took advantage of a unique experience at one hospital where one surgeon (D.L.L.) used only the pedicled method and the other (N.J.Y.) used only free tissue transfer. Additionally, the authors compared the findings of the study with the experiences of other surgeons by surveying active members of the American Association of Plastic Surgeons. The records of 119 patients who underwent TRAM flap reconstruction between January of 1988 and July of 1997 were reviewed. Of these, 33 patients received free TRAM flaps, and 86 received pedicled TRAM flaps. To provide an adequate number of patients for statistical analysis, only those with unilateral, single-muscle reconstructions were considered (immediate or delayed). This provided 61 patients in the pedicled flap group and 26 in the free tissue group. Parameters examined included length of operation and of hospitalization, amount of pain medication used, amount of blood lost and received, and complications. A small subset of the patients had hospital records available to compare hospital charges; the comparison of 17 pedicled and 12 free TRAM flaps showed a mean difference of $15,637 (p < 0.001) in favor of the pedicled flap. On the basis of the findings from this study, it seems that the pedicled TRAM flap has significant economic and clinical advantages over the free TRAM flap. There is less need for blood, a shorter operating time and hospital stay, and a need for less pain medication. However, both methods of transfer have indications and contraindications in certain clinical settings. It will always remain the responsibility of the surgeon to evaluate all issues and select a method that is economically responsible and within the abilities of the surgeon, while producing a satisfactory outcome that best serves the patient. The information provided in this report should aid in accomplishing this goal.

Special report: lengthening the nose: thoughts on correction with a reexamination of some basic principles.

BACKGROUND AND OBJECTIVES: Providing thin, well-vascularized lining flaps is still the most elusive achievement in corrective nasal surgery. The purpose of this article is to reexamine some of the principles of correction. METHODS AND MATERIALS: To demonstrate the importance of releasing or sectioning nasal lining, the authors review the principles of lengthening the nose, illustrated with seven clinical cases from their surgical experience and a detailed 12-drawing presentation of the surgical approach by Tessier--the senior surgeon. RESULTS AND/OR CONCLUSIONS: The nose is the center of the face and a major determinant of facial appearance. The short nose has been one of the more difficult conditions to treat in rhinoplastic surgery. To optimize the result, procedures developed from experience in craniofacial surgery should be combined with the existing methods, developed primarily by rhinoplastic surgery and confined to the nasal tip.

Mucoceles of the maxillary sinus.

The maxillary sinus is an uncommon site for mucoceles within the paranasal sinuses. In this study nine patients with maxillary sinus mucoceles are presented. Six of these patients were treated by open approaches, and three were treated by endoscopic drainage alone. For uncomplicated maxillary sinus mucoceles, endoscopic drainage appears to be a reasonable approach, whereas for more complicated cases extending outside the sinus, open approaches may be required.

Pentoxifylline maintains cochlear microcirculation and attenuates temporary threshold shifts following acoustic overstimulation.

The etiology of noise-induced hearing loss is poorly understood despite years of clinical experience and experimental investigations. One potential mechanism which may contribute to noise-induced temporary threshold shifts (TTS) are vascular pathologies in the microcirculation of the cochlea. Several studies have demonstrated histologic evidence of reduced cochlear blood flow following noise exposure. Recent studies utilizing intravital microscopy (IVM) complement these histologic studies and furthermore demonstrate localized ischemia during noise exposure. The purpose of the current study was to attempt to maintain cochlear blood flow during noise exposure by treating with pentoxifylline, a xanthine derivative which promotes blood flow in capillary beds. The possibility that preserved cochlear microcirculation with pentoxifylline treatment attenuates noise-induced TTS was also examined in this study. The results show treatment with pentoxifylline maintains cochlear microcirculation as assessed by continuous red blood cell movement through capillaries. Pentoxifylline treatment did not prevent vasoconstriction or increased permeability often observed in the cochlear microvasculature during noise. Treatment with this drug reduced noise-induced TTS.